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BACKGROUND Pain is one of the most common, yet challenging problems leading to emergency department (ED) presentation, despite the availability of a wide range of pharmacological therapies. Virtual reality (VR) simulations are well studied in a wide variety of clinical settings, including acute and chronic pain management, as well as anxiety disorders. However, studies in the busy environment of an adult ED are scarce. The aim of this study is to explore the feasibility and effectiveness of a VR simulation for pain and anxiety control in a convenience sample of adult ED patients presenting with traumatic and non-traumatic pain triaged 2-5 (i.e., urgent to non-urgent) with a pain rating of ≥ 3 on a numeric rating scale (NRS 0-10). METHODS Prospective within-subject, repeated measures interventional feasibility pilot study at a Swiss University ED. The intervention consisted of a virtual reality simulation in addition to usual care. Pain and anxiety levels were measured using a verbally administered numeric rating scale (NRS) before and after the intervention. Information on patient experience was collected using established rating scales. RESULTS Fifty-two patients were enrolled. The most common pain localisations were extremities (n = 15, 28.8%) and abdomen (n = 12, 23.1%). About one third of patients presented with trauma-associated pain (n = 16, 30.8%). Duration of pain was mainly acute ( 24 h) (n = 32, 61.5%). The majority of patients were triage category 3, i.e. semi-urgent (n = 48, 92.3%). Significant reduction in pain (NRS median pre-VR simulation 4.5 (IQR 3-7) vs. median post-VR simulation 3 (IQR 2-5), p

Introduction: Worldwide health systems are being faced with unprecedented COVID-19-related challenges, ranging from the problems of a novel condition and a shortage of personal protective equipment to frequently changing medical guidelines. Many institutions were forced to innovate and many hospitals, as well as telehealth providers, set up online forward triage tools (OFTTs). Using an OFTT before visiting the emergency department or a doctor's practice became common practice. A policy can be defined as what an institution or government chooses to do or not to do. An OFTT, in this case, has become both a policy and a practice. Methods: The study was part of a broader multiphase sequential explanatory design. First, an online survey was carried out using a questionnaire to n = 176 patients who consented during OFTT usage. Descriptive analysis was carried out to identify who used the tool, for what purpose, and if the participant followed the recommendations. The quantitative results shaped the interview guide's development. Second, in-depth interviews were held with a purposeful sample of n = 19, selected from the OFTT users who had consented to a further qualitative study. The qualitative findings were meant to explain the quantitative results. Third, in-depth interviews were held with healthcare providers and authorities (n = 5) that were privy to the tool. Framework analysis was adopted using the five-factor framework as a lens with which to analyze the qualitative data only. Results: The five-factor framework proved useful in identifying gaps that affected the utility of the COVID-19 OFTT. The identified gaps could fit and be represented by five factors: primary, secondary, tertiary, and extraneous factors, along with a lack of systems thinking. Conclusion: A theory or framework provides a road map to systematically identify those factors affecting policy implementation. Knowing how and why policy practice gaps come about in a COVID-19 OFFT context facilitates better future OFTTs. The framework in this study, although developed in a universal health coverage (UHC) context in South Africa, proved useful in a telehealth context in Switzerland, in Europe. The importance of systems thinking in developing digital tools cannot be overemphasized. © 2022 by the authors.

Additional file 1: Supplement table 1. Technical details of the VR simulation. Supplement table 2. Vital parameters before and after the VR simulation. Supplement table 3 Analgesics administered before, during or after the simulation, according to gender. Supplement figure 1. Beach simulation. Supplement figure 2. Forest simulation.

To get a better overview of atmosphere-driven mass changes at the 79N Glacier (Nioghalvfjerdsfjorden Glacier), the largest outlet glacier of the northeast Greenland ice stream, the surface mass balance (SMB) is modeled by linking the COupled Snowpack and Ice surface energy and mass-balance model in PYthon (COSIPY) with the output of a regional atmospheric model (Polar WRF) for the years 2014–2018. After a manual model optimization, the model produces reliable results when compared to observations in the region and to values from the literature. High spatial resolution (1 km) simulations reveal strong interannual variability of the SMB. Stronger surface melting increased the ablation and runoff in years with high mass loss (2016 and 2017) whereas in other years (2015 and 2018) melting and refreezing inside the snowpack dominated the mass balance (MB). A cooler regional climate with higher snowfall-driven accumulation, higher albedo and reduced surface melt in the ablation period of 2018 resulted in a positive SMB in 2018, however, the annual total MB remained negative. The results suggest a promising new dataset for gaining more insights into mass-balance processes and their contribution to the acceleration of glacier retreat in northeast Greenland.

The growing network density and unprecedented increase in network traffic, caused by the massively expanding number of connected devices and online services, require intelligent network operations. Machine Learning (ML) has been applied in this regard in different types of networks and networking technologies to meet the requirements of future communicating devices and services. In this article, we provide a detailed account of current research on the application of ML in communication networks and shed light on future research challenges. Research on the application of ML in communication networks is described in: i) the three layers, i.e., physical, access, and network layers; and ii) novel computing and networking concepts such as Multi-access Edge Computing (MEC), Software Defined Networking (SDN), Network Functions Virtualization (NFV), and a brief overview of ML-based network security. Important future research challenges are identified and presented to help stir further research in key areas in this direction.

Background: Working in ad hoc teams in a health care environment is frequent but a challenging and complex undertaking. One way for teams to refine their teamwork could be through post-resuscitation reflection and debriefing. However, this would require that teams have insight into the quality of their teamwork. This study investigates (1) the accuracy of the self-monitoring of ad hoc resuscitation teams and their leaders relative to external observations of their teamwork and (2) the relationship of team self-monitoring and external observations to objective performance measures. Methods: We conducted a quantitative observational study of real-world ad hoc interprofessional teams responding to a simulated cardiac arrest in an emergency room. Teams consisting of residents, consultants, and nurses were confronted with an unexpected, simulated, standardized cardiac arrest situation. Their teamwork was videotaped to allow for subsequent external evaluation on the team emergency assessment measure (TEAM) checklist. In addition, objective performance measures such as time to defibrillation were collected. All participants completed a demographic questionnaire prior to the simulation and a questionnaire tapping their perceptions of teamwork directly after it. Results: 22 teams consisting of 115 health care professionals showed highly variable performance. All performance measures intercorrelated significantly, with the exception of team leaders’ evaluations of teamwork, which were not related to any other measures. Neither team size nor cumulative experience were correlated with any measures, but teams led by younger leaders performed better than those led by older ones. Conclusion: Team members seem to have better insight into their team’s teamwork than team leaders. As a practical consequence, the decision to debrief and the debriefing itself after a resuscitation should be informed by team members, not just leaders. Keywords: Debriefing, Self-monitoring, Ad hoc teams, Resuscitation, Emergency medicine, Postgraduate education, Interprofessional education

Information is the key element in modern factory automation and process control systems, and one of the most difficult tasks is to provide, distribute, and properly process it. Information transfer and processing in this scenario depend to a large extent on appropriate communication systems, usually referred to as 'industrial networks.' Significance, content, and properties of information may, of course, vary within a given application context. For instance, a distributed control system typically handles sensor and actuator information with stringent real-time requirements, whereas production planning needs to cope with huge amounts of data, such as those concerned with customer orders or bills of material, with more relaxed timing. The industrial networks deployed at the various hierarchical levels of automation systems thus have to meet different requirements, to ensure that timely and reliable data flows are maintained among the different components they connect, such as field devices, controllers, human-machine interface (HMI) systems, cloud computers, manufacturing execution systems (MES), and so on [1], [2]. According to the specific needs of the numerous application fields such as manufacturing, electrical power distribution, motion control, environmental monitoring, and chemical processes, to mention but a few [3], [4], industrial networks may have diverse architectures, traffic types, and performance.

Poly(ether imide) (PEI), which can be chemically functionalized with biologically active ligands, has emerged as a potential biomaterial for medical implants. Electrospun PEI scaffolds have shown advantageous properties, such as enhanced endothelial cell adherence, proliferation and low platelet adhesion in in vitro experiments. In this study, the in vivo behaviour of electrospun PEI scaffolds and PEI films was examined in a murine subcutaneous implantation model. Electrospun PEI scaffolds and films were surgically implanted subcutaneously in the dorsae of mice. The surrounding subcutaneous tissue response was examined via histopathological examination at 7 and 28 days after implantation. No serious adverse events were observed for both types of PEI implants. The presence of macrophages or foreign body giant cells in the vicinity of the implants and the formation of a fibrous capsule indicated a normal foreign body reaction towards PEI films and scaffolds. Capsule thickness and inflammatory infiltration cells significantly decreased for PEI scaffolds during days 7–28 while remaining unchanged for PEI films. The infiltration of cells into the implant was observed for PEI scaffolds 7 days after implantation and remained stable until 28 days of implantation. Additionally some, but not all, PEI scaffold implants induced the formation of functional blood vessels in the vicinity of the implants. Conclusively, this study demonstrates the in vivo biocompatibility of PEI implants, with favourable properties of electrospun PEI scaffolds regarding tissue integration and wound healing.