With technological development of multi sensors, UAV  can identify and locate key targets in essential monitoring areas or geological disaster-prone areas by taking video sequence images, and precise positioning of the video sequence images is constantly a matter of great concern. In recent years, precise positioning of aerial images has been widely studied. But it is still a challenge to simultaneously realize precise, robust and dynamic positioning of UAV’s patrolling video sequence images in real time. In order to solve this problem, a visual positioning model for patrolling video sequence images based on DOM rectification is proposed, including a robust block-matching algorithm and a precise polynomial-rectifying algorithm. First, the robust block-matching algorithm is used to obtain the best matching area for UAV’s video sequence image on DOM , a pre-acquired digital orthophoto map covering the whole UAV’s patrolling region. Second, the precise polynomial-rectifying algorithm is used to calculate accurate rectification parameters of mapping UAV’s video sequence image to the best matching area obtained above, and then real time positioning of UAV’s patrolling video sequence images can be realized. Finally, the above two algorithms are analyzed and verified by three practical experiments, and results indicate that even if spatial resolution, surface specific features, illumination condition and topographic relief are significantly different between DOM and UAV’s patrolling video sequence images, proposed algorithms can still steadily realize positioning of each UAV’s patrolling video sequence image with about 2.5 m level accuracy in 1 s. To some extent, this study has improved precise positioning effects of UAV’s patrolling video sequence images in real time, and the proposed mathematical model can be directly incorporated into UAV’s patrolling system without any hardware overhead. Patrol inspection is an important work in many industries, and UAV  has gradually become a new tool for field patrol inspection due to its low cost and high efficiency. Shooting video to discover what has happened at sometime and somewhere in real-time is a common way of field patrol inspection by UAV, which is usually equipped with an image sensor and a POS (position and orientation system) unit. Accessing precise location of interest points in UAV’s real time patrolling video sequence images is of great value for discovery and elimination of hidden safety hazards. At present, there are four different kinds of methods that can be used for positioning of UAV’s patrolling video sequence images: photogrammetry method, binocular vision method, image feature matching method, and optical flow method.3 can calculate out geodetic coordinates of homologous image points with assistance of POS data in real time. But the poor results cannot meet accuracy requirements of UAV’s patrolling video sequence images positioning. Block adjustment algorithm6 can precisely calculate out geodetic coordinates of homologous image points by using large overlapped sequence images under certain geometric conditions, but it is a post-processing algorithm which cannot meet the real-time requirements of UAV’s patrolling video sequence images positioning.Photogrammetry method includes forward intersection algorithm and block adjustment algorithm that can be both used for positioning of UAV’s patrolling video sequence images. Forward intersection algorithm13, which cannot meet the dynamic requirement of UAV’s patrolling video sequence images positioning.Binocular vision method uses binocular cameras with precise 3D coordinates and 3D orientations to shoot two images of the same scene simultaneously, and then geodetic coordinates of homologous image points can be calculated out according to vertical parallax of the two images. Binocular vision method has high accuracy and efficiency, and mainly focus on precise calibration of the fixed binocular cameras at present15, which is widely employed in image registration17 and image mosaic19. Ke proposed PCA-SIFT algorithm20 by using PCA  method to reduce dimension of regional gradient distributions, which improved efficiency of feature matching to a certain extent. Following the idea of scale-invariant in SIFT, Morel proposed a so-called ASIFT algorithm of affine-invariant by simulating image geometric distortions caused by variations of camera optical axis21. Bay constructed multi-scale spaces by using box filters and integral images, constructed key-points and corresponding descriptors by using non-maximum suppression method22 and Haar wavelet transform, and then proposed SURF (Speed Up Robust Features) algorithm24. SURF is one order magnitude faster than SIFT25. A more faster algorithm ORB (Oriented FAST and Rotated BRIEF)25, further proposed by Bblee, used oriented FAST (Features from Accelerated Segment Test) algorithm26 to detect key-points and used rotated BRIEF (Binary Robust Independent Elementary Features) algorithm27 to construct descriptors. Other feature matching methods also exert certain influence on image matching, including BRISK  algorithm29, KAZE algorithm30, hardware acceleration algorithm31, and etc. Literature33 compare and analyze accuracy, efficiency, advantages and disadvantages of existing feature matching methods in details, and we will not go into much here. Feature matching method can be used for precise real-time image matching, while matching results only have relative positioning information, which cannot meet the absolute positioning requirements of UAV’s patrolling video sequence images.Feature matching method realizes image matching by verifying consistency of descriptors that are obtained from surrounding pixels of corresponding key-points in two images. The famous SIFT  algorithm realizes feature matching of scale-invariant, rotation-invariant and illumination-invariant by constructing Gaussian pyramid images and regional gradient distributions34 and HS optical flow35. LK optical flow is constructed on three basic assumptions, namely, brightness constancy (projection of the same point looks the same in every frame), small motion (points do not move very fast) and spatial coherence (points move like their neighbors)34. LK optical flow can calculate out motion displacement of pixels between two adjacent sequence images accurately, but performs poor stability sometimes. Based on above mentioned three basic assumptions, HS optical flow adds a regularization term in the self-constructed differential-difference equations. By minimizing the self-constructed differential-difference equations with regularization term, HS optical flow obtains the optimal motion displacement between two adjacent sequence images’ homologous points, which achieves a more stable performance. However, “brightness constancy” and “small motion” are two strong assumptions in LK optical flow and HS optical flow, which are difficult to be satisfied in practical applications. For this reason, lots of improved algorithms have been proposed. In Literature36, gradient conservation is used to replace the assumption of brightness constancy, which improves robustness of optical flow algorithm against illumination variation. Literature37 proposes multi-scale searching strategies, which has improved optical flow algorithm’s tracking efficiency of objects with large motion and shortened calculating time. A coarse-to-fine process has been mentioned in literature38, which further improves optical flow algorithm’s tracking ability of objects with large motion. Literature39 proposes an optical flow algorithm based on interpolation of correspondences, which has achieved good results in tracking objects with large displacement and significant occlusions. In literature41, polynomials fitted by intensity of regional pixels are used for tracking objects with large motion, illumination variation and noise interference, and good results have also been achieved. With the development of artificial intelligence, optical flow algorithm based on neural network42 has also emerged, but their robustness on unknown data sets remains to be verified. At present, optical flow algorithm has been widely used in medical image registration45, remote sensing image registration46, visual navigation47 and many other industries. Optical flow method can be used for precise matching of sequence images, while the relative positioning results cannot meet the absolute positioning requirements of UAV’s patrolling video sequence images.Optical flow method can obtain motion displacement of pixels between two adjacent sequence images through energy differential-difference equations which are constructed by certain assumptions and solved by certain optimization criteria. If all the image pixels are involved in this method, we call it dense optical flow, and if only part of the image pixels are involved in this method, we call it sparse optical flow. Two of the most classical optical flow algorithms are LK optical flowTo sum up, there is no method that can solve absolute positioning of UAV’s patrolling video sequence images accurately and robustly in real time. For this reason, a series of visual positioning algorithms for UAV’s patrolling video sequence images based on DOM rectification are proposed following the coarse-to-fine principle in this paper. All the proposed algorithms are analyzed and verified by three practical experiments, and results show that these algorithms are fast, effective and feasible.As shown in Fig. As shown in Fig. First, extract datum-DOM (number 4) from region-DOM (number 3) according to the POS data of video frame (number 2), and replace region-DOM (number 3) by datum-DOM (number 4) as a new matching area for video frame (number 2), so as to reduce matching area of video frame (number 2) on region-DOM (number 3) and increase matching speed.Second, extract block-matched-DOM (number 5) from datum-DOM (number 4) by using the proposed robust block-matching algorithm. It should be noted that, video frame (number 2) and block-matched-DOM (number 5) have the same size in pixels, but the matching accuracy between these two images is still poor due to numerous negative factors. Therefore, a further optimization step is needed.Third, figure out accurate rectification parameters for mapping video frame (number 2) to block-matched-DOM (number 5) by using the proposed precise polynomial-rectifying algorithm.Finally, obtain geodetic coordinates of each pixel in video frame (number 2) by using the accurate rectification parameters calculated above, so as to realize the real time positioning of video frame (number 2).The algorithm flow of this study is shown in Fig. Following the basic idea of this paper, datum-DOM should be extracted from region-DOM at the beginning, so as to reduce matching area of video frame on region-DOM and increase matching speed. As shown in Fig. Finally, datum-DOM can be extracted from region-DOM according to the already known parameters mentclass2pt{minimFollow the basic idea of this paper, the best matching area for video frame on datum-DOM should be extracted. However, existing image feature matching methods are all difficult to match video frame and datum-DOM automatically, since illumination conditions, surface specific features, projection modes and spatial resolution of these two kinds images are greatly different. Therefore, a robust block-matching algorithm is constructed for the purpose of finding out the best matching area for video frame on datum-DOM.It is necessary to unify spatial resolutions of datum-DOM and video frame, so as to facilitate the subsequent matching work. To ensure the spatial resolution of datum-DOM is the same as video frame, datum-DOM is scaled as:At this step, the best matching area for video frame on datum-DOM can be found out based on the similarity of these two images in RGB color space. As shown in Fig. At this step, the best matching area for video frame on datum-DOM can be found out based on the similarity of these two images in gradient magnitude space. As shown in Fig. In practice, it has been found that the above proposed RGB based block-matching method exhibits better performance in video frame with large color difference and complicate texture, while the above proposed gradient magnitude based block-matching method exhibits better performance in video frame with small color difference and simple texture.Therefore, it is necessary to further construct a robustly block-matching method by considering both color difference and texture complexity of video frame.In the robustly block-matching method, symbol d in Eq. , and theAs shown in Fig.  by Eqs.  and 4)  \documen to Eqs.  and (4).According to parameters d in Eq. , Block-mIt should be noted that, video frame and its corresponding block-matched-DOM have the same size in pixels, and geodetic coordinates of each pixel on video frame can be obtained directly from the geodetic coordinates of pixels at the same position on block-matched-DOM. That is to say, positioning of UAV’s patrolling video frame can be realized by directly assigning geodetic coordinates of each pixel in block-matched-DOM to pixels at the same position in UAV’s patrolling video frame.Unfortunately, there is a high probability that pixels in video frame are not homologous with pixels in block-matched-DOM at the same position, due to numerous negative factors, such as illumination variation, inconsistent spatial resolution, diverse surface specific features, topographic relief, camera distortion, different projection modes and etc. That is to say, the positioning accuracy of video frame is still poor, if we assign geodetic coordinates of each pixel in block-matched-DOM directly to pixels at the same position in video frame. In order to realize accurate positioning of UAV’s patrolling video sequence images, a precise polynomial-rectifying algorithm is further constructed.The basic idea of the proposed precise polynomial-rectifying algorithm is to find out homologous regions in block-matched-DOM for regions in video frame, so as to figure out accurate rectification parameters for mapping video frame to block-matched-DOM. And finally, accurate positioning of video frame can be realized by using accurate rectification parameters to calculate geodetic coordinates of each pixel in video frame. It should be noted that, we are committed to find out homologous regions between video frame and block-matched-DOM, instead of finding out the homologous points. Because homologous regions are more stable and reliable than homologous points under numerous negative influences. Where, homologous regions refer to the most similar local areas between two images.Through in-depth study of common characteristics between block-matched-DOM and video frame, the precise polynomial-rectifying algorithm is constructed based on three assumptions: (1) video frame and block-matched-DOM can be regarded as two adjacent sequence images. (2) Overall surface features are similar between video frame and block-matched-DOM. (3) Pixels in a local area of the video frame share a same deformation law.In order to reduce negative influence of illumination variation, gradient magnitude images of video frame and that of block-matched-DOM are used for image matching. In order to further reduce negative influence of diverse surface specific features, gradient magnitude images of video frame and that of block-matched-DOM are represented by second-order polynomials respectively, and the second-order polynomials of these two images are used for image matching ultimately.As shown in Fig. Block-matched-DOM is the best matching area for video frame on datum-DOM. However, there are still irregular motion displacements between homologous regions of these two images due to numerous negative factors. Therefore, finding out homologous regions of these two images is important for precise positioning of video frame.Based on the assumption that video frame and block-matched-DOM can be regarded as two adjacent sequence images, the second-order polynomials of video frame and that of block-matched-DOM can also be regarded as two adjacent sequence images. And then, differential-difference polynomials can be constructed based on Eq. , and furAs shown in Fig. d in Eq. .Figure 5In Eq. , let \doFurther, we can obtain equations of According to Eqs.  and 10)10), precWhere, As shown in Eq. , the tasm of Eq. , as therAccording to the presumption that the minimum energy difference should exist between video frame and block-matched-DOM in homologous regions, the optimization criteria for the m of Eq.  can be pr to Eq. .In order to obtain the optimal estimation of ① Down-sample images and construct k-layer image pyramids for video frame and block-matched-DOM.② Set ③ Construct matrix ④ Calculate correction vector for ⑤ Calculate vector of residual errors as: ⑥ Redefine weight matrix as: ⑦ Set ⑧ Repeat steps ④–⑦ ⑨ Set By using the optimal estimates of Finally, according to Eq. , preciseThree practical experiments are designed in this study, which includes 3 videos and 2 region-DOMs. Among them, 3 videos are shot by 3 sorties fly of UAV in different areas, including town area, river area and high relief amplitude area. 2 region-DOMs have different spatial resolutions, one of the 2 region-DOMs has a lower spatial resolution, and the other one has a higher spatial resolution.As shown in Fig. According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in section "Figure Figure mentclass2pt{minimBy timekeeping in our program, it takes about 0.206 s to complete extracting of the block-matched-DOM, it takes about 0.330 s to complete calculating of the optimal estimation As shown in Fig. According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in Section "Figure Figure entclass1pt{minimaBy timekeeping in our program, it takes about 0.119 s to complete extracting of the block-matched-DOM, it takes about 0.118 s to complete calculating of the optimal estimation As shown in Fig. According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in section "According to the theory proposed in Section "Figure Figure By timekeeping in our program, it takes about 0.118 s to complete extracting of the block-matched-DOM, it takes about 0.122 s to complete calculating of the optimal estimation In the first experiment, spatial resolution of region-DOM is far less than that of video frame, region-DOM’s surface universal features are similar with video frame’s, and region-DOM’s surface specific features and illumination condition are great different from video frame’s. From the experimental results, we can see that average positioning deviation of all interest points in Fig. In the second experiment, spatial resolution of region-DOM is still far less than that of video frame, region-DOM’s surface universal features are similar with video frame’s, region-DOM’s surface specific features and illumination condition are greatly different from video frame’s, and surface features on the left side of video frame is significantly less than those on the right side. From the experimental results, we can see that average positioning deviation of all interest points in Fig. In the third experiment, spatial resolution of region-DOM is similar with that of video frame, region-DOM’s surface universal features are similar with video frame’s, region-DOM’s surface specific features and illumination condition are a little different from video frame’s, while there are extensive mountain body shadows on region-DOM. From the experimental results, we can see that average positioning deviation of all interest points in Fig. Geometrical shape of video frame deformed obviously after accurate positioning, as shown in Figs. The average positioning deviations of video frame by using the proposed robust bock-matching algorithm is 5.653 m, and the average positioning deviations of video frame by using the proposed precise polynomial-rectifying algorithm is 2.681 m. That is to say, positioning accuracy of video frame can be significantly increased by using the proposed precise polynomial-rectifying algorithm.The red homologous points located on roads and low-rise buildings have a higher positioning accuracy, while the red homologous points located on mountains and high-rise buildings have a lower positioning accuracy.Using region-DOM of high spatial resolution can significantly improve positioning accuracy of video frame, while extensive shadows that are similar to video frame’s surface universal features will significantly decrease positioning accuracy of video frame.The proposed model can be applied in various areas, such as, town area, river area, high relief amplitude area and etc. And experiment results show that, the average positioning accuracy in town area and river area is gentle higher than that in high relief amplitude area, as high terrain relief will impose a negative influence on the distortion of imaging.By timekeeping in our program, the average time of extracting the block-matched-DOM is about 0.148 s, the average time of calculating the optimal estimation The proposed methods can be also applied in the field of medical image registration, remote sensing image registration, visual navigation of other industries and etc. Subsequently, the current mathematical model can be optimized significantly by fusing with multi-source data, such as airborne LiDAR point cloud, and then can achieve a higher positioning accuracy and a broader application.By analyzing the above three experiments, following conclusions can be achieved.In order to realize real-time positioning of UAV’s patrolling video sequence images, a visual positioning model is recommended, including a robust block-matching algorithm and a precise polynomial-rectifying algorithm.First, the robust block-matching algorithm is constructed to realize roughly positioning of UAV’s video patrolling video sequence images. The robust block-matching algorithm is divided into 5 steps, including scaling datum-DOM, block-matching roughly based on RGB, Block-matching roughly based on gradient magnitude, block-matching robustly, and extracting block-matched-DOM. Through the above 5 steps, the so-called block-matched-DOM can be obtained, and rough positioning of UAV’s patrolling video sequence images can be realized by assigning geodetic coordinates of each pixel in block-matched-DOM to pixels at the same position in UAV’s patrolling video sequence images.Second, the precise polynomial-rectifying algorithm is constructed to realize accurate positioning of UAV’s patrolling video sequence images. The precise polynomial-rectifying algorithm is divided into 5 steps, including constructing polynomials of video frame and that of block-matched-DOM, constructing differential-difference polynomials, constructing precise rectifying equations, constructing optimal estimation model, and calculating geodetic coordinates of interest points in video frame. Through the above 5 steps, the so-called accurate rectification parameters can be obtained, and accurate positioning of UAV’s patrolling video sequence images can be realized by using accurate rectification parameters to calculate geodetic coordinates of each pixel in UAV’s patrolling video sequence images.Finally, all the proposed algorithms are verified by three practical experiments, and results indicate that the proposed robust block-matching algorithm can realize positioning of UAV’s patrolling video sequence images with an average accuracy of 5 m, even if spatial resolution, surface specific features, illumination and topographic relief of region-DOM are greatly different from that of UAV’s patrolling video sequence images. The proposed precise polynomial-rectifying algorithm can further improve positioning accuracy of UAV’s patrolling video sequence images with an average accuracy of about 2.5 m. And calculation time of positioning a single UAV’s patrolling video sequence image is less than 1 s.


The following stages were conducted: pre-production, production, post-production and evaluation of the video by the target population.five female nurses evaluated the video storyboard and indicated understanding of the subject matter, the topics addressed and the language used as adequate and pertinent to the theme. Another five female nurses considered the following as present and desirable elements: quality of the audiovisual technique employed, simulated environment, characterization of the characters, and development of the nurse-patient communication strategies The final version of the video was evaluated by nine Nursing students that presented a level of item understanding of at least 96%. The video presents the following strategies: General communication strategies, Intercultural Communication, NURSE, Tell me more, Ask-Tell-Ask, Therapeutic Communication and Communicating Bad News.this study portrays the creation of a video, its validation by experts and its evaluation by the target population, which indicated it as a relevant educational resource for the teaching-learning process regarding communication strategies. Both the evaluators and the target population considered that the video is a valid instrument to teach content about the nurse-patient communication strategies. It is through communication that nurses establish rapport with the multiprofessional team, with the family members and with the patients.In the Nursing context, communication is considered as a basic component for care, as it allows expressing emotions, needs, fears and opinions. Thus, it is considered an important indicator of the quality of the assistance provided, characterizing itself as a key component to implement patient safety,8.With regard to nurse-patient communication, the professionals are the active agents in the communicative process, as they use communicative skills to obtain and provide diverse information about clinical conditions, inform procedures, identify the patient’s needs, promote listening to demands and establish a team-patient-family bond,9-10.However, for communication to be efficient, it is necessary to overcome certain barriers. They can be related to the interlocutors, to the environment, to the situation, and to the professionals’ skills or expertise. When the barriers are related to the interlocutors, they can present themselves as physical conditions that involve difficulties expressing, receiving or understanding messages, level of hierarchy, forms of approaches or social treatments, use of technical language and cultural differences. Those related to the environment emerge as interferences related to the noise of equipment alarms, precarious lighting, parallel conversation in the environment and privacy; whereas those related to the situation have to do with the relevance given to the subject matter, in terms of communication. In addition, the barriers related to the professionals’ skills and expertise and to empathy are related to the rules and sequences inherent to a conversation. In addition to that, the professionals’ and patients’ safety can also be affected, as failures in communication are pointed out as one of the main causes of adverse events in the Nursing area.These interferences can lead to lack of information sharing among team professionals, inconsistencies in medical records, losses in the identification and monitoring of the patient’s clinical signs, and compromise in achieving good results. However, some studies point out that communication is insufficiently addressed during undergraduate Nursing studies and that, when it takes place, it is not always able to develop skills that allow the students to deal with the patients’ emotions-16.The National Curriculum Guidelines for the Nursing course determine the content to be taught and emphasize that communicative skills are competences to be acquired during Nursing trainingThus, given the need to propose forms of innovative strategies and effective methodologies in the teaching of communication, the development, for the time being, of an educational video on communicative strategies in Nursing is justified. It is estimated that using the video in a later study may be able to measure its impact on knowledge acquisition in the area.For such purpose, the objective of this study was to create, validate and evaluate an educational video on nurse-patient communication strategies for undergraduate Nursing students.. It was conducted at a public Higher Education Institution in the city of Rio de Janeiro . The process to create the video, validate it with experts and evaluate it with the target population lasted 24 months, encompassing the period from January 2020 to December 2021.This is a methodological study with a longitudinal design and quantitative analysis-19. A minimum of five evaluators was selected in this paper.According to the literature, there is still no consensus on the number of evaluators required for content evaluation. Some authors indicate that a minimum of five and a maximum of 10 evaluators should participate in the validation process; whereas others suggest from six to 20 participants, with a minimum of three in each group of professionals selectedIn order to select the participants for validation of the storyboard, the inclusion criteria were the following: experience in the area of nurse-patient communication. In turn, to select the evaluators for video validation, the professionals selected were those with experience in educational and audiovisual resources. The exclusion criterion corresponded to professionals that were not nurses. The following individuals participated in this study: ten nurses, five with experience in the area of communication in Nursing and five with experience in educational resources in health; as well as nine students attending the Nursing course (target population), regularly enrolled in the educational institution where the study took place.The participants were invited by means of a letter sent to the professionals’ email addresses. All the participants invited accepted to take part in the research.In relation to the invitation for the target population, the following inclusion criteria were considered: students enrolled in an undergraduate Nursing course from the fourth period onwards and aged more than 18 years old. A total of 25 participants were invited, although only 9 accepted to take part in the research.Data collection, as well as the instruments used, varied depending on the process to create, validate and evaluate the educational video..Creation and validation of an educational video comprises three phases: pre-production , production , and post-production . In order to write the script, a scoping review on the nurse-patient communication strategies was conducted, with its protocol registered in the Open Science Framework (OSF) under DOI: 10.17605/OSF.IO/26QMX, based on the methodology proposed by the Joanna Briggs Institute (JBI).During pre-production, the video script and storyboard were prepared; and presents its protocol based on the PCC strategy . In this research, the Population consisted in the nurse and the patient; the Concept corresponded to the communication strategies; and the Context/Scenario was Nursing.Scoping reviews seek to map fundamental concepts of a given area, indicating the main available evidence. It consists of the following stages: identification of the research question, identification of relevant studies, selection of studies and mapping of the findingsLiteratura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Once non- existence of reviews on nurse-patient communication strategies was verified, a detailed search was conducted based on the following strategies: MEDLINE ); CINAHL (MH communication AND MH nursing care); and LILACS (“comunicação em saúde” [Descritor de assunto] AND “enfermagem” OR “cuidados de enfermagem” [Descritor de assunto]). Consequently, during the first half of 2020, two independent female researchers sought to answer the guiding question: “Which is the available scientific evidence on the nurse-patient communication strategies?”. The following were considered as eligibility criteria: studies that had nurses and/or patients as participants; that addressed the nurse- patient communication strategies; carried out in the Nursing context/scenario; and with qualitative, quantitative, reflective, descriptive, observational, methodological and review methodologies. Duplicate studies were excluded.A primary search was initially conducted in the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Thus, after extracting the information and based on the experience of the researchers involved, the findings were compiled and categorized to write the script..The video storyboard was prepared with the purpose of guiding and clarifying the process to create the following stages. It was developed as a chart, with a description of each audiovisual resource to be used, such as the following: scenes, animations, voiceover and background sounds, which presented the stages of creation and validation of an educational video on communication in the context of communication in intravenous therapy installation. Thus, the instrument used in this research was based on the judgment of understanding the topic, verbal language adopted and the pertinence of including topics related to the theme ; Tell me more; Ask-Tell-Ask; Therapeutic Communication: Expression, Clarification and Validation; and Communicating Bad News).Once finished, the storyboard was forwarded to be analyzed by five female nurses with experience in the area of communication in Nursing. The instrument for its evaluation was elaborated according to the criteria suggested in a previous study. Thus, after rehearsing with the actors and making the necessary adjustments to the scenes, the video was recorded in a simulation laboratory at the educational institution, which had similar conditions to the Nursing practice scenario and favorable acoustic conditions.The production stage consists in implementing the ideas elaborated during pre-productionSubsequently, images and animations were selected, in addition to a presenter for the video.. In this way, they were selected from a search in the Google Images tool, provided that they were licensed under the Creative Commons Attribution 4.0 International License and, treated with the Adobe Illustrator and Adobe Flash programs to create images and animations, respectively.For the development of images and animations, the legislation referring to the copyright regarding use and reproduction of resources was respected. Subsequently, after implementing the necessary adjustments, the video was forwarded to nurses with experience in educational health resources. The instrument for evaluation consisted in judging whether the items – quality of the audiovisual technique employed, the simulated environment, characterization of the characters and development of the nurse-patient communication strategies – were present and desirable. It is noted that, when pertinent, the specialists’ suggestions were accepted by the researchers.The post-production stage consists in editing the scenes recorded and in validating the videoSubsequently, in order to verify understanding and scope of the video content, nine Nursing students expressed their opinions about it.The students were invited to participate in the study at a predefined moment, after the academic activities, through the Google Meet online platform. After presenting the study objectives and the invitation to participate in the research, those that showed interest in taking part received the link to the Google Forms online form. The evaluation considered an analysis of the understanding regarding each topic addressed, the number of times that it would be necessary to watch the video in order to acquire information, and the quality of the audiovisual material.The students’ understanding was evaluated by means of a questionnaire with closed questions by resorting to scale from 0 to 10. For each topic covered in the video, 0 represented “The video presented the topic in a NOT COMPREHENSIVE/COMPLETE way”, and 10 represented “The video presented the topic in an EXTREMELY COMPREHENSIVE/COMPLETE way”.The instruments used in the data collection process of all three stages were created by the authors of this research; therefore, they were not implemented in other studies or validated.The records made by the participants, both nurses and students, were stored in a spreadsheet in Microsoft Office Excel®, online version, for descriptive statistical analysis .Plataforma Brasil under Certificate of Presentation for Ethical Appraisal  No. 25629819.5.0000.5285 and approved under opinion No. 3,764,010.This proposal is part of the research entitled Intervention Strategies in Nursing Teaching and Assistance: Randomized Clinical Trials, registered in In order to reduce the risks inherent to collection carried out in a virtual format, the records were deleted from the virtual platforms and shared environments, and the data were stored on a local electronic device, thus ensuring secrecy and confidentiality.In compliance with the recommendations of the relevant legislation, the people who participated in the video scenes signed the Image Use Authorization Form; the presenter signed the Voice Usage Authorization Form; and the expert nurses and students, the Free and Informed Consent Form.It is also added that the activities developed by the authors and presenter of the video were conducted voluntarily.The process for the creation, validation, and evaluation by the target population of the educational video on nurse-patient communication strategies is presented in  shown in A scoping review was conducted to develop the script and storyboard. A total of 1,182 studies were identified in the search in the databases. After applying the inclusion criteria, 147 were selected; however, only 12 answered the guiding question and comprised the review, according to the selection flow guided by the extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guide, NURSE, Tell me more and Ask- Tell-Ask, Therapeutic Communication and Communicating Bad News,30-31. Along with them, a number of studies also presented strategies or techniques for effective communication, without any specific denomination,32-37.Different nurse-patient communication strategies were identified in this review, namely: Intercultural Communication,32-37. It is noted that, in one study, specific techniques related to surgical procedures were pointed out, which have the purpose of relieving anxiety, fear and anguish, inherent to the pre-, intra- and post-operative periods.Consequently, a category referring to the general aspects of communication was created, being the one most cited across the studies (n = 7). Among other aspects, it addresses actions and recommendations to develop good quality communication.With regard to Intercultural Communication, this was mentioned in only one study, defined as the interaction between health professionals and patients from different cultural backgrounds and characterized in three stages: intercultural awareness, intercultural sensitivity and intercultural efficacy,30-31.The Communicating Bad News category was cited in two studies and consists in the transmission of unpleasant information related to the patient; information that, in most cases, involves drastic changes in the perception of the future or health prognosis.On the other hand, Therapeutic Communication is a strategy defined as the professional’s ability to identify the patient’s needs, stimulating their coping and helping them solve their problems, autonomously, as identified by the authors in a study strategies, although not presenting any definition of this concepts; it only describes its functionality and presents examples.One of the 11 articles included indicated the NURSE, Tell me more and Ask-Tell-AskThe main information related to the nurse-patient communication strategies identified in the review is arranged in ,38-39 and a master’s dissertation that addressed the theme analyzed.The video script was prepared based on the review findings, shown in The storyboard was prepared from the script. This, consisting of 73 scenes, addressed the concept of communication, its applicability in Nursing, its importance in care, general aspects of communication and nurse-patient communication strategies . The scenes proposed 27 animations, 30 images (from third parties or developed by the authors) and 12 recorded images. Along with this, the following scenes were added: opening, references used, credits, acknowledgments and technical sheet.Once finished, the storyboard was forwarded to five female nurses with experience on the theme involving nurse-patient communication strategies. All of them were teachers, with a mean age of 35.8 (±6.0) years old, and mean times of professional training and of professional performance of 12.4 (±5.4) and 11.4 (±6.6) years, respectively. Three were specialists and there were four MSc and five PhDs. Regarding performance time in the communication area, the nurses presented a mean of 4.5 (±2.6) years, with three of them having scientific production in the area.In the storyboard evaluation, there was total agreement among all the nurses, who pointed out that the content allowed understanding the topic and that the language used was easy to assimilate, being adequate to the target audience. In addition, all of them revealed that the topics addressed were pertinent to the theme; however, one indicated that the video did not follow a logical sequence. Thus, the researchers met and, in consensus, implemented the necessary adjustments, accepting those suggestions that they deemed pertinent. The changes made based on the experts’ requests were the following: inclusion of images that represented other means of communication (such as blackboard and gestures); adding the name of the creative and production team at the end of the video; and including the purpose of the NURSE strategy and its representation through examples.After validation of the storyboard, the process to create the video was initiated with the voiceover recording. Subsequently, the images were selected, the video narrator-character animations were created, and the scenes were recorded.Once finished, the video was forwarded to five female nurses with experience in educational resources in health. All of them were teachers, with a mean age of 42.8 (±10.2) years old, and mean times of professional training and of professional performance of 18.3 (±11.7) and 19.3 (±13.4) years, respectively. All of them had specialization and Master’s courses, one was a PhD student, and there were four PhDs. Regarding performance time in the area of educational resources in health, the nurses had a mean of 12.3 (±8.4) years and, in addition, a mean of 5.5 (±2.2) years in the area of active methodologies. All had scientific production in the area.In validating the video, all five nurses considered all the items evaluated as present and desirable, namely: quality of the audiovisual technique used, the simulated environment, characterization of the characters and development of the nurse-patient communication strategies, the video obtained the maximum positive evaluation score.Given the nurses’ consensus, it can be considered that the audiovisual technique, the environment, the characters and the nurse-patient communication strategies proved to be adequate and appropriate.The final version of the video lasted 13 minutes and 52 seconds.The video presented the concepts of the nurse-patient communication strategies found in the literature review by means of playful narration. In the video, the narrator-character  presents the concepts of each strategy speaking directly to the interlocutor. Subsequently, examples of situations are presented through animations in which the nurse employs the previously explained strategy. All the examples mentioned in the video resort to the hospital setting.th period, two were in the 4th period and another two were in the 3rd period of the course.Understanding and scope of the content addressed were evaluated by nine undergraduate Nursing students. Six of them were female, with a mean age of 27.4 (±6.3) years old. It becomes important to note that five were attending the 4In relation to the number of times that it would be necessary to watch the video in order to acquire information, six students indicated one or two times; and three of them indicated from three to four times. Regarding quality, all of them stated that the material was of extremely high quality.,8.When performed effectively, nurse-patient communication brings about direct benefits to care, as it favors bonding between the professional and the individual assisted highlighted the need to teach nurse-patient communication strategies in training programs and qualification courses, in addition to the approach during professional training. Other authors point to the need for a discussion about the techniques that involve such communication strategies,41-43.However, a number of research studies point to flaws in this process. The results obtained by a study highlighted the importance of the professionals showing mastery over communication, as this can assist in capturing valuable information and facing challenges. In this way, it is fundamental that the professionals have certain human skills, with communication being the major link in these relationships.A research study. In this sense, a study carried out with Nursing professors shows that the development of oral expression, non-verbal communication and listening in Nursing students is favored by active teaching methodologies, such as problem-based learning, problematization and simulation experiences in healthcare settings,44.For the development of communicative skills, it is recommended to use different teaching strategies that stimulate learning, considering that a single strategy may not be able to provide all the necessary tools for skills development. Thus, it is emphasized that, when surrounded by active teaching methodologies, the content approach favors knowledge acquisition in a pleasant way. Therefore, the proposal to create, validate and evaluate an educational video focused on nurse-patient communication strategies can favor the development of skills of nurses in training.That said, using videos as a teaching-learning strategy is considered promising for the development of knowledge involving professional training. In addition to that, using educational videos in student training can help fix technical knowledge and enable greater preparation and increased confidence in the performance of procedures.One study showed that students had greater knowledge acquisition in the area of peripheral venipuncture after using a validated educational video on the themeNURSE Strategy, the Tell me more Strategy, the Ask-Tell-Ask Strategy, the Therapeutic Communication Strategies: Expression, Clarification and Validation; and the Communicating Bad News Strategy.Among other topics, the video presents general aspects of nurse-patient communication, the Intercultural Communication Strategy, the ,32-37.It is understood that the general aspects of nurse-patient communication are related to communication techniques involving nurse-patient that do not receive a specific nomenclature; however, they can be used in most communicative processes, as they enable effective communication, easing information sending and reception, generating bonding, trust and support for the patient. Lack of understanding about the patient’s representations and beliefs generates ethnocentric care, which can compromise adherence to treatment and, consequently, the results achieved.With regard to the Intercultural Communication Strategy, it aims at facilitating egalitarian dialogue between nurse and patient, so that the differences related to the ethnic and cultural diversities of those involved are respected,16,49.Regarding the NURSE Strategy, acronym for Naming, Understanding, Respecting, Supporting and Exploring, the objective is to understand and accept the patient’s emotions. To apply it, the professional should do the following: name the perceived emotions, show understanding of the patient’s feelings, show respect for the emotions expressed by the patient, provide the necessary support and encourage coping, and demonstrate interest in what concerns the patient. For the professional to be able to employ it, it becomes necessary to recognize that communication will be based on three levels: understanding the information, understanding how the patient deals emotionally with the content conveyed, and understanding the meaning of the information for the patient.The Tell me more Strategy allows the professional to understand the patient’s emotions; there is a stimulus for verbalization. In the first stage, Ask, the professional evaluates the patient’s doubts and questions; in the second, Tell, the nurse clearly answers the information that needs to be transmitted and; in the third and last step, Ask, the patient’s understanding of the information received is verified,16,49.Similarly, the Ask-Tell-Ask Strategy is divided into three stages and aims at strengthening the nurse-patient bond,16.Regarding the Therapeutic Communication Strategies: Expression, Clarification and Validation, the focus is on helping the patient to deal with their problems, recognize own limits, adapt to the new reality and face the challenges. This strategy is divided into three groups: Expression, Clarification and Validation. In Expression, the professional encourages the patient to verbally express their thoughts and feelings, being more employed in the initial communication stage; in Clarification, the nurse tries to understand the message sent by the patient, with the possibility of requesting comparisons and descriptions in a logical sequence and; lastly, Validation seeks to ensure that the messages transmitted have been understood, and repetition of what was informed may be requested. In this case, the focus needs to be on clarity, objectivity, honesty, detail and absence of omissions, having emotional support as a sustaining element,31. In order to support transmission of this information, there are guides and protocols such as SPIKES, acronym for Setting up (preparing for the meeting), Perception (perceiving the patient), Invitation , Knowledge (transmitting the information), Emotions (expressing emotions) and Strategy and Summary (summarizing and organizing strategies),50. This has the following objectives: understanding how the patient and their family members understood the message sent, providing information according to what the patient wants/bears receiving at the moment, welcoming the reactions to the content conveyed, and establishing a care plan.The Communicating Bad News Strategy is understood as the transmission of unpleasant information, such as negative prognoses, which lead to drastic changes in the patient’s lifestyle,52.In relation to the video length, the final version lasted 13 minutes and 52 seconds, within the maximum limit recommended in studies involving the development of educational resources, which would be 15 minutes. Exceeding this time can make the experience of watching the video tiring and cause dispersion in the viewers.The steps used to create and validate videos proved to be adequate to obtain a final product that is accurate, reinforcing their use in research instruments on this theme. An example is using video as a trigger for a situation that involves the teaching-learning process, with regard to nurse-patient communication for undergraduate Nursing teachingThe contributions of the video produced from this study to the advancement of scientific knowledge for Nursing are linked to the provision of a reliable educational resource that can favor the teaching-learning process. This can be considered a tool for the development of communicative skills in Nursing students, thus contributing to improving the care provided.As limitations of the current research, the small number of evaluators in each stage of the study can be considered, even if there was a high rate of satisfactory answers regarding evaluation of the storyboard, the video and its applicability.This study covered the creation process corresponding to an educational video on nurse-patient communication strategies, positively evaluated by nurses with experience in the area regarding quality of the audiovisual technique employed, the simulated environment, characterization of the characters and development of the nurse-patient communication strategies. The material produced was also submitted to evaluation by the target audience, which pointed out a high level of understanding in each topic addressed (> 96%) and the extremely good quality of the audiovisual material (100%).However, it is recommended to conduct studies that assess changes, which can be attributed to the educational video, in the students’ knowledge acquisition in terms of nurse-patient communication strategies.


The main educational areas were respiratory therapy, invasive procedures, medications, and benefits of mobilization. Further research needs to measure the impact of the intervention on patient outcomes and MET call frequency over time in larger samples.A nurse-led critical care outreach service (NLCCOS) can support staff education and decision making in the wards, managing at-risk patients with ward nurses to avoid further deterioration. We aimed to investigate the characteristics of patients identified as at-risk, the types of treatments they required to prevent deterioration, the education initiated by the NLCCOS, and the perceived experiences of ward nurses. This prospective observational pilot study using mixed methods took place in one medical and one surgical ward at a university hospital in Denmark. Participants were patients nominated as at-risk by head nurses in each ward, the ward nurses, and nurses from the NLCCOS. In total, 100 patients were reviewed, 51 medical and 49 surgical patients, over a six-month period. Most patients (70%) visited by the NLCCOS had a compromised respiratory status, and ward nurses received teaching and advice regarding interventions. Sixty-one surveys were collected from ward nurses on their learning experience. Over 90% ( Worldwide, rapid response systems (RRS) have been designed to prevent unexpected cardiac arrests and organ failure among hospitalized patients outside the intensive care unit (ICU)  and to rRRS calls have primarily been based on respiratory challenges detected by changes in vital signs such as in the track-and-trigger algorithm, National Early Warning Score (NEWS) . HoweverTherefore, a nurse-led critical care outreach service (NLCCOS) was established at Zealand University Hospital, Koege, Denmark, in December 2018 as an adjunct to the nurse-led RRS. A critical care outreach service (CCOS) is defined as a multidisciplinary approach to ensure safe, equitable, and quality care for all acutely unwell, critically ill, and recovering patients irrespective of location or pathway . Additionally, CCOSs have shown that they can improve patient quality and safety by supporting ward nurses’ education and improving ward-based knowledge and communication ,18. TherThis study investigated four areas: (1). the characteristics of patients subjectively defined as at-risk by ward nurses and managers; (2). the types and frequency of treatments implemented by the NLCCOS; (3). the education given by the NLCCOS; and (4). ward nurses’ perceived experience of the service.A mixed-methods triangulation design was used to capture information from different but complementary sources to better inform our understanding of the intervention impact . A pragmThe study was performed in one orthopedic (30 beds) and one medical (30 beds) ward at a large university hospital in Denmark from December 2018 to May 2019. The usual practice at the hospital in terms of detecting clinical deterioration in patients is for the hospital staff to use a validated predictive tool, the National Early Warning Score (NEWS) ,24,25. HA convenience sample of 100 patients at risk of deterioration was enrolled. Patients could be rated at-risk if the ward nurse had difficulties stabilizing the patient, worried, or had other challenges regarding the patient’s physical status, regardless of the NEWS. Usually, it would be the most care-intensive, challenging patient on the ward that day but not a candidate for a MET call at the time. The patient’s name and the location were handed over by the medical and surgical ward managers to the ICU ward manager every morning, Monday to Friday, during their shared morning conference. Afterwards, the NLCCOS would leave the ICU and go and meet the ward nurse, discussing the patient’s status and possible escalation. The participating nurses in the NLCCOS were trained ICU nurses, usually part of the MET. The participating ward nurses were those nurses taking care of at-risk patients on that particular day. The included patients were those nominated as at-risk by the ward managers. Exclusion criteria were patients requiring MET or needing immediate transfer to the ICU. No patient approval was obtained, since the study only used raw data and no patient-identifying information; therefore, according to Danish law, no approval was needed.NLCCOS nurses collected data in a Case Report Form (CRF). Data included patients’ vital signs, such as respiratory rate, saturation, blood pressure, heart rate, consciousness, and temperature. Additionally, pain levels measured by a numeric rating scale (NRS), level of consciousness by the Alert, Voice, Pain, Unresponsive (AVPU) score, oxygen treatment, suction, use of positive expiratory pressure (PEP) or continuous positive airway pressure (CPAP), level of resuscitation, plans for a revisit from the NLCCOS (yes/no), and finally, the treatment plan made by the NLCCOS and the ward nurse together, was described in text. NEWS was not a part of the data collection.Ward nurses were asked to answer a short questionnaire after the NLCCOS had assisted them. It contained both quantitative and qualitative questions. The questionnaire was pilot-tested on ten people, five from the medical and five from the surgical ward , before the study began, to check for clarity and feasibility of the data collection tools. No changes were needed to clarify the meaning of the questions.To what extent do you feel confident in making decisions about the treatments following the NLCCOS visit and the teaching they have provided? Within which areas did you learn something from the NLCCOS visit If you did not feel that any learning took place, please describe what you think could be the reasons for that in text.The following questions were included in the questionnaire:The questionnaires were kept in the ward until the study had ended to ensure anonymization.When the NLCCOS entered the ward, the ward nurse described the patient’s background for hospitalization and current condition. Then they went to the patient’s room together, explaining to the patient, if possible, why the NLCCOS was there and what they were going to do. After that, they reviewed the patient together and performed any interventions (such as suction and intravenous insertion). The NLCCOS described the background for the actions, showing how to perform the intervention correctly. Then, the CRF was filled out by the NLCCOS. Before the NLCCOS left the ward, s/he handed out the questionnaire to the ward nurse, who voluntarily filled it out and lodged it in a secure box within the ward.n) or percentages (%). Qualitative data were analyzed using an inductive approach inspired by thematic analysis [No formal sample-size calculation was performed, since the study was descriptive and explorative in nature. Quantitative data were analyzed using SPSS software . Non-parametric data were presented as medians and interquartile ranges (IQR). Parametric data were reported as means and standard deviations (SD). Categorical data were presented as frequencies  had a compromised respiratory status and needed supplemental oxygen, 23% used positive expiratory pressure (PEP), and 29% used continuous positive airway pressure (CPAP). Three quarters (73%) were to receive full resuscitation, if required; however, 18% had limitations on medical treatment and 2% had not had the issue considered .We only analyzed the individual vital signs which in normal practice would be used in combination as trigger score changes in the NEWS algorithm ,27. Vitan = 55) of the respondents believed they had learned something from the NLCCOS visits and felt more confident in caring for the patient afterward. From the thematic analysis, it appeared that the NLCCOS identified the main educational areas for preventative care needed by ward nurses: different kinds of respiratory therapy strategies, invasive procedures, medications, and mobilization. Sixty-one surveys were collected from ward nurses regarding their learning experiences, twenty-seven from the surgical ward and thirty-four from the medical ward. More than 90% (Thirteen nurses did not believe any learning took place during the NLCCOS visit to the ward. The leading causes were the following: the patient had improved; the ward nurse knew what to do in the current situation and, therefore, did not feel they needed the knowledge provided by the NLCCOS; the treatment of the patient had ended and was considered palliative; and the ward nurse was prevented from participating in the learning situation.In this study, we found most patients identified as at-risk had a compromised respiratory status. As a result, the main educational areas were different kinds of respiratory therapies, diagnostic and treatment procedures, medications, and the need for patient mobilization. Ward nurses’ responses reflected high satisfaction with the support and guidance provided by the NLCCOS. Four main areas will be discussed in the following sections: the type of support nurses need to assist their clinical decision making, gaps in practice, types of patients needing support, and feasibility and acceptability of the NLCCOS.When patients change from stable to unstable, decision making becomes more complex, balancing and evaluating often subtle changes with nursing interventions and medical treatments . Nurses’2 [Prompt identification of patients going from one clinical state to a worse clinical state is crucial to avoid serious adverse events and higher mortality rates . For tha2 .Wards employ many newly registered nurses. In a study which reviewed nursing education and the clinical readiness of new graduate nurses, researchers found the education of nurses did not always prepare them for the contextual challenges of caring for deteriorating ward patients . Some esDeterioration and serious adverse events are shown to be preceded by deterioration in vital signs in 60–84% of all cases . The earPatients identified as at-risk and attended to by the NLCCOS mostly had compromised respiratory status. Learning about and discussing respiratory management was often required. However, at times, other fundamental nursing skills appeared deficient, for example, mobilization, hydration and nutrition requirements. These findings indicate a need to prioritize fundamental care  and promWe found the majority of the ward nurses responding to the questionnaire felt they had obtained knowledge from the NLCCOS and consequently felt more confident caring for the patients afterward. Therefore, in this single site setting, it indicates that the NLCCOS can be considered a feasible solution to assist ward nurses in identifying patients at-risk and to facilitate improved management through education and support. These findings are supported by Mitchelle et al. and Chaboyer et al. ,55. A syThis study used a convenience non-randomized patient cohort in only two ward settings in a university hospital in Denmark. As a pilot study, we showed the approach was feasible and acceptable, but we did not collect patient outcomes. Measuring patient outcomes of those patients receiving the NLCCOS review and support compared to wards that did not receive the additional support would offer further insight into the potential effectiveness of the intervention. Another limitation was the absence of a total NEWS for each patient assessed, and it is recommended to compare patient cohorts with the wider research evidence. The response rate of 61% for the ward nurses’ surveys was considered adequate. However, more in-depth interviews with ward nurses would have complemented the data collection. Further studies could incorporate this approach to provide greater insight into the educational needs of staff and the impact of targeted training and facilitation on the wards.In this pilot study, we established the feasibility and acceptability of the NLCCOS in responding to patients identified as at risk of deterioration by ward nurses. We also identified common patient characteristics and treatments considered for a patient at-risk in the ward and the learning requirements of ward nurses to mitigate the risk of further deterioration. Furthermore, the study highlighted the perceived benefits of interactive bedside learning and reflective practice, especially for newly educated nurses. Opportunities for interactions between ward nurses and nurses from the ICU offer the potential for building relationships and confidence in caring for unstable ward patients. Accurate situation awareness is a critical component for nurses to detect deteriorating patients, but it requires training and focus to be developed in busy inpatient wards. Further research should test this model of care for effectiveness in a randomized trial.


During workplace-based clinical placements, best practice assessment states students should expect consistency between assessors rating their performance. To assist clinical educators (CEs) to provide consistent assessment of physiotherapy student performance, nine paediatric vignettes depicting various standards of simulated student performance, as assessed by the Assessment of Physiotherapy Practice (APP), were developed. The APP defines adequate on the global rating scale (GRS) as the minimally acceptable standard for an entry-level physiotherapist. The project aimed to evaluate consistency of paediatric physiotherapy educators assessing simulated student performance using the APP GRS.Three paediatric scenarios representing neurodevelopment across three age ranges, infant, toddler and adolescent, were developed and scripted that depicted a ‘not adequate’, ‘adequate’ and ‘good-excellent’ performance based on the APP GRS. An expert panel (n = 9) conducted face and content validation. Once agreement was reached for all scripts, each video was filmed. A purposive sample of physiotherapists providing paediatric clinical education in Australia were invited to participate in the study. Thirty-five CEs, with minimum 3-years clinical experience and had supervised a student within the past year, were sent three videos at four-week intervals. Videos depicted the same clinical scenario, however performance varied with each video. Participants rated the performance on the four categories: ‘not adequate’, ‘adequate’, ‘good’ and ‘excellent’ Consistency among raters was assessed using percentage agreement to establish reliability.The vignettes were assessed a combined total of 59 times. Across scenarios, percentage agreement at the not adequate level was 100%. In contrast, the adequate scenarios for the Infant, Toddler and Adolescent video failed to meet the 75% agreement level. However, when combining adequate or good-excellent, percentage agreement was > 86%. The study demonstrated strong consensus when comparing not adequate to adequate or better performance. Importantly, no performance scripted as not adequate was passed by any assessor.Experienced educators demonstrate consistency in identifying not adequate from adequate or good-excellent performance when assessing a simulated student performance using the APP. Recommendation for practice: These validated video vignettes will be a valuable training tool to improve educator consistency when assessing student performance in paediatric physiotherapy.The online version contains supplementary material available at 10.1186/s12909-023-04149-9. Quality clinical education in paediatric physiotherapy is integral to the development of competent health professional graduates. In physiotherapy programs across Australia and New Zealand, students are assessed on their ability to deliver entry-level physiotherapy services to the paediatric population across a variety of clinical settings. The minimally competent standard is defined within the Physiotherapy Practice Threshold Statements . HoweverGrade integrity defines a grade as “representing the quality, breadth and depth of the level of achievement a student reaches” . EssentiEvidence supports the benefit of consensus moderation to deliver consistent, accurate and effective assessment . This isIn response to a gap in the literature, the aim of this study was to determine the level of consistency among paediatric clinical educators when assessing a simulated student performance using the APP GRS.Ethical approval was granted by The Human Research Ethics Committee of Queensland Children’s Hospital (protocol number - HREC/16/QRCH/362) and Griffith University (protocol number 2016/941) prior to the study’s commencement. All methods were carried out in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants as per the ethics guidelines.Three paediatric scenarios representing the core area of neurodevelopment across three age ranges, infant, toddler and adolescent, were developed and scripted into performances that depicted a ‘not adequate’, ‘adequate’ and ‘good to excellent’ performance based on the APP GRS. The GRS was used in lieu of scoring in each domain on the whole APP as not all domains may be shown in an individual performance and so this may skew the results of the performance results if participants rated what they didn’t see as a 0 on the APP. The scenarios included an infant with failure to thrive, a pre-school aged child with developmental coordination disorder and an adolescent with Cerebral Palsy. An expert panel of clinical educators (n = 9), experienced in one of the three areas of paediatrics mentioned, sought from paediatric hospitals and universities within Australia, was convened to conduct face and content validation. Each panel member independently reviewed each of the three performance levels from their clinical area of expertise (n = 3 scripts per panel member). Panel feedback on the level of performance, clinical authenticity and accuracy of the script was collected and recommendations to improve the face and content validity were collected for incorporation into the final scripts.Once all experts reached agreement for all nine scripts, each video was filmed using a standardised actor to portray the student physiotherapist. Children who portrayed patients during filming were known to the project team and consented to participate. This included one child with a known neurological condition and two children who were typically developing. Clinical staff from Queensland Children’s Hospital played the role of clinical educator and parent. During the filming of each scenario, the authors were present to direct each scene to ensure adherence to the script. Each video was on average 18 min in length.A purposive sample of physiotherapists providing paediatric clinical education in Australia were invited to participate in the study. The inclusion criteria were a minimum three years clinical experience in paediatrics and 1-year experience in the clinical education of physiotherapy students. Participants who did not meet the inclusion criteria were excluded to ensure the sample population was familiar with the assessment of student performance using the APP.Paediatric physiotherapists identified as meeting the inclusion criteria were invited to participate via email correspondence. Participants were provided with a Participant Information sheet detailing their involvement including the nature of the study and the total time commitment. Consent to participate was achieved via an ‘opt in’ approach with a response to the sent email indicating consent to participate. Consent was confirmed from the participants prior to completing the study survey (Supplementary 1). Participants included in the study were allocated to a clinical scenario in their nominated area of expertise .Following provision of consent and group allocation, participants were emailed detailed directions for reviewing the video vignette and completing the evaluation via Survey Monkey®. Each participant was sent a total of three videos vignettes, representing ‘not adequate’, ‘adequate’ and ‘good to excellent’, over a 12-week period of time. The vignettes were sent in a randomly allocated order to minimise bias. At the completion of the first vignette, participants were asked to provide demographic information in addition to a global rating scale based on the APP, key factors used to determine the global rating and feedback on video quality and clinical relevance that was collected for all three video vignettes. Vignettes were securely stored on Google Drive and distributed by email in the form of a closed link.Participants were required to independently watch and complete a survey for three video vignettes in the same clinical area. A wash out period of four weeks between the sending of each video was selected to ensure that it was unlikely that participants would be able to recall specific information of the previously watched video , 11.The video and survey links were closed two weeks after the initial email. After a 4 week wash out period, the same process was repeated with the second video with a new video and survey link. To maximize response, a reminder email was sent to all participants one week after the initial email. Furthermore, all participants who completed the study by watching all three videos were provided a financial incentive equating to $50AUD.™ . The data was cleaned and separated into percentage agreement, demographic, key performance indicators (KPIs) and video vignette evaluation data. Percentage agreement was calculated for each of the nine videos using SPSS 21.0 software package®  and a priori agreement of 75% was considered acceptable as per the previous study [Data from SurveyMonkey® was extracted as a comma-separated value (CSV) file and converted to Microsoft Excelus study .Forty-three clinicians across various clinical settings were identified as meeting the inclusion criteria and invited to participate, of which 39 consented to participate. Four participants (11%) withdrew from the study citing time constraints (n = 3) and technical issues (n = 1) as primary reason. Seventeen (48.6%) completed more than one video and 7 went on to complete all three videos assessments (20%). In total, the suite of videos was viewed a total of 59 times for the purposes of data collection.Responses were received from participants in four states of Australia . Most participants reported working in the public hospital setting (66%), however there was representation from a variety of clinical settings as outlined in Fig. A total of 59 complete responses were collected across the nine video vignettes and included for analysis.Percentage agreement for the Infant, Toddler and Adolescent videos at the not adequate and good-excellent level achieved greater than the 75% agreement. In contrast, the adequate scenarios for the Infant, Toddler and Adolescent video failed to meet the 75% agreement level Table . HoweverAll participants either agreed (56%) or strongly agreed (44%) that the clinical scenario they viewed were realistic and believable. Most participants (98%) reported that the clinical scenario was professional and well presented.The aim of the project was to undertake a reliability study for a suite of video vignettes depicting paediatric physiotherapy student performance based on the APP GRS. The study demonstrated acceptable consensus among participants at the not adequate and good to excellent level. However, at the adequate level there was insufficient exact agreement. If ratings of adequate and good-excellent were combined consensus once again reached an acceptable level when comparing ‘not adequate’ to ‘adequate’ or better.In line with previous research investigating consensus in the adult clinical setting, the study showed strong agreement in rating the not adequate and the good-excellent performance across all three clinical scenarios . This isThere was insufficient consensus for the adequate video scenarios, which is a similar outcome to the previous adult video vignettes research . SimulatWhen adjusting the data in the adequate scenarios to compare an adequate or good-excellent versus a not adequate performance, strong consensus was achieved. This indicates that it is more difficult to differentiate an adequate performance from a good-excellent performance than from a not adequate performance. Our data shows that clinical educators with paediatric experience are able to differentiate competent and not competent student performance, when viewing a vignette.However, as consistency has been achieved in determining a not adequate and good-excellent performance and the variability in scoring an adequate performance has been noted, these vignettes would be an important resource to educate clinical educators. In particular, the different levels of performance and the key criteria when assessing a student performance could be addressed.While use of short video vignettes of simulated student performance is a recognised method used for consensus moderation and training of assessors to assess student performance during practical/OSCE examinations, determining if a student is performing at an adequate level in the clinical setting requires longitudinal assessment of performance , 13. TheExperienced educators demonstrated consistency in identifying a not adequate from adequate or better performance when assessing a simulated student performance using the APP GRS. However, variability existed when assessing the ‘adequate’ performance with a lack of consensus in differentiating ‘adequate’ from ‘good/excellent’.https://www.applinkup.com/Resources.aspx). A corresponding training package is available to be utilised by physiotherapists and universities for paediatric clinical educator support and training, student learning and development, and delivery of training and workshops.The resources developed for this body of research are freely available online (The developed suite of simulated student performance vignettes will be used as part of an already well established clinical educator training program. This training program assists clinical educators in determining appropriate levels of student performance in an adult population. This suite of vignettes can now be used for those working in a paediatric environment.Below is the link to the electronic supplementary material.Supplementary 1: APP Vignettes Validity and Reliability Testing


IntroductionDental plaque biofilms are a collection of microorganisms that are adhered to the tooth enamel surface. Inhibition of plaque biofilms is required to prevent dental caries and periodontitis and currently, there are many chemical and herbal products in use for inhibition of biofilms but with limited success.Materials and methodsStreptococcus mutans. Isolated S. mutans were subjected to disk diffusion assay with 4-HCA (baseline 10mg/mL) for the zone of inhibition and broth micro-dilution to evaluate the minimum inhibitory concentration (MIC) and sub-MIC. Crystal violet staining was done for biofilm inhibition assay.Dental plaque collection was done from subjects undergoing orthodontic therapy followed by isolation of ResultsS. mutans was inhibited by 4-HCA at concentrations as low as 0.31 mg/mL. 4-HCA (40μL) inhibited the bacterial growth and a clear zone (15 mm) was observed. 4-Hydroxycinnamic acids treated culture showed progressive reduction in the biofilm production at the concentration of 0.01 mg/mL. The 4-HCA concentration as low as 4 mg and 2 mg has remarkably inhibited biofilm formation of 49.3% and 34.3%, respectively.Growth of ConclusionS. mutans isolated from subjects undergoing orthodontic treatment showed a remarkable result.The anti-quorum sensing and anti-biofilm activity of 4-Hydroxycinnamic acid against  Streptococcus mutans (S. mutans), can essentially alter the process of tooth enamel demineralization because of its acid production and tooth adhesion capabilities [The persistence of oral bacterial infections is significantly influenced by biofilms, a collection of microorganisms that are permanently adhered to the surfaces of host cells  are polyphenols that include caffeic acid, isoferulic acid, coumaric acid, and ferulic acid present in fruits, vegetables, and coffee. They have antioxidant, antimicrobial, anti-inflammatory, and cytoprotective properties, which are used in the treatment of diseases such as cancer, chronic inflammation, neurodegenerative and cardiovascular disorders. There are two types: Natural or synthetic 4-Hydroxycinnamic acid (4-HCA). Natural 4-HCA is excreted as metabolites by some microorganisms like Phomopsis liquidambari or extracted from reproductive flowers, seeds and leaves . Hence tStudy design and clinical isolatesS. mutans in orthodontic patients. The collected samples were inoculated into Brain Heart Infusion (BHI)  broth and incubated for 24 hours at 37°C. The BHI broth samples were then inoculated in the Mutans-sanguis Agar (HiMedia) plates, which were then incubated for 24 hours at 37°C. For examination, based on the colony morphology S. mutans colonies were isolated and were stored at 4°C. Further, the S. mutans colonies were identified by a standard identification test [Dental plaque samples were collected from the upper molar and lower incisor teeth of 5 patients undergoing orthodontic treatment with 0.022-inch MBT  metal brackets at the Department of Orthodontics, Saveetha Dental College, and hospitals. Plaque samples were collected using a sterile No. 23 Shepherd's hook explorer. The plaque samples were collected for isolation of the caries causing ion test .Collection of synthetic compound4-HCA was purchased from Sigma-Aldrich . Disk diffusion assayS. mutans was done on a Mueller-Hinton agar (HiMedia) plate. Wells were cut in the plate using a well-cutter. 40μL of 4-HCA and sterile water (control) was added into the separate wells and incubated at 37°C for 24 hours. A zone of inhibition was recorded. In accordance with the Clinical and Laboratory Standards Institute (CLSI) Guidelines, the Kirby Baur Disk diffusion method was used to conduct the antibiotic susceptibility test . The lawDetermination of minimum inhibitory concentration (MIC)S. mutans broth culture with the cell mass equivalent to 0.5 McFarland turbidity standard units (1.5 × 108 CFU/mL) was added to tubes containing Luria Bertani (LB) (HiMedia) broth and serially diluted (two-fold) to attain final concentrations starting from 0.01875 to 9.6 mg/mL. Similarly, 4-HCA was added (10-0.015 mg/mL) to LB broth tubes containing S. mutans. All the tubes were incubated (shaker incubator) at 37 °C for 24 h. The growth of the 4-HCA-treated S. mutans was compared with that of an untreated control by measuring the bacterial cell density at 600 nm (data not shown). For further confirmation, 10μL of 2,3,5-triphenyl tetrazolium chloride (TTC) was added to the tubes, which were observed for a cherry-red color change. The lowest concentration with no visible growth of S. mutans was recorded as MIC. Further, the anti-biofilm experiments were performed at the sub-MIC concentrations of 4-HCA.According to previously published literature, the MIC of 4-HCA were determined  and MethBiofilm inhibition assayS. mutan's ability to produce biofilms was investigated. Briefly, tryptic soy broth (TSB) (190 mL) with or without 4-HCA (starting from 0.15mg/mL) was dispensed into the wells of a 96-well microtiter plate with an overnight culture of the test S. mutans strain . Without agitation, the plate was incubated at 37 °C for 24 hours before being cleaned three times with deionized water. After dissolving crystal violet in 95% ethanol, the absorbance was measured at 595 nm as previously mentioned [Using a standard micro-titer plate test, the impact of the 4-HCA on entioned ,14.S. mutansMICs of 4-HCA on S. mutans. Growth of S. mutans was inhibited by 4-HCA at concentrations as low as 0.31 mg/mL  and negative control (sterile water) against Crystal violet staining4-HCAs treated culture showed progressive reduction in the biofilm production till the concentration of 0.01 mg/mL Figure .S. mutansEffect of synthetic compound (4-HCA) on biofilm formation in Noticeable reduction in biofilm formation was observed when the organisms were grown in the presence of 4-HCA. The 4-HCA concentration as low as 4 mg and 2 mg has remarkably inhibited biofilm formation of 49.3% and 34.3%, respectively (Figure S. mutans is most commonly implicated in the pathogenesis of dental caries and enamel white spot lesions in subjects undergoing orthodontic treatment. These subjects harbor S. mutans in dental plaque as oral hygiene maintenance is challenging due to the presence of appliances thereby making the teeth susceptible to WSLs. Prevention and management of WSLs is an integral part of orthodontic treatment and many agents have been used in the past with limited success. In the present study, an investigation of 4-HCA for its in vitro effects of Quorum sensing-controlled virulence factors and biofilm inhibitory activities against S. mutans was done. It is crucial to find compounds that inhibit QS, which limit bacterial growth in order to avoid medication resistance. Agents that reduce bacterial virulence without encouraging resistance could potentially offer significant therapeutic benefits. It is possible that virulence attenuation will have significant therapeutic benefits without developing resistance [S. mutans with the broth microdilution method. Growth of S. mutans was inhibited by 4-HCA at concentrations as low as 0.31 mg/mL and higher concentrations resulted in no inhibition. A zone of inhibition of 15 mm was established for 40μL of 4-HCA in this study. At concentrations as low as 4 mg and 2 mg/dL 4-HCA has remarkably inhibited biofilm formation. With these significant findings, we can conclude that 4-HCA has a remarkable anti-bacterial and anti-biofilm activity against S. mutans and hence can be therapeutically used for the prevention and treatment of dental caries and white spot lesions.sistance . In the M. tuberculosis and are proven to inhibit the fatty acid synthase type II which is essential for the organism’s survival [S. mutans the present study was done. According to the study by Lavertyet al., cinnamic peptides had an increased activity against S. aureus and methicillin-resistant Staphylococcus aureus [Agrobacterium tumefaciens [S. mutans was inhibited by 4-HCA at concentrations as low as 0.31 mg/mL.Cinnamic acid and its structural derivatives are phenolic acids that are lipophilic and have potent antioxidant effects they act as chelators and scavengers of free radicals demonstrating inherent antimicrobial activity . Cinnamisurvival . Previous aureus . A studyefaciens . The antefaciens . Whereas reported the effects of 4-methoxy cinnamic acid and dimethylamino cinnamic acid on biofilms as determined by crystal violet staining. The biofilms were significantly diminished by 42%, 48%, and 64% after exposure to 4-methoxy cinnamic acid at concentrations of 50, 100, and 200 g/ mL, respectively. Dimethylamino cinnamic acid was more effective than 4-methoxycinnamic acid and at concentrations of 25, 50, and 100 g/mL, respectively, the biofilms were reduced by 60%, 72%, and 75% [S. mutans at MICs as low as 0.31 mg/mL and the concentration of 4 mg and 2 mg of 4-HCA had remarkably inhibited biofilm formation of 49.3% and 34.3% against S. mutans, respectively. This demonstrates its QS-inhibition and anti-biofilm properties.Cheng et al.In the present in vitro study, limited experimental methods were used to study the QS activity of 4-HCA. Being an in-vitro study in itself is a limitation and hence the synthetic compound should be subjected to further evaluation involving experimental animals and then human clinical trials must be conducted. The future scope includes further evaluation of the compound and exploring its potential for using it as an active compound for oral hygiene maintenance in subjects undergoing orthodontic treatment.S. mutans isolated from subjects undergoing orthodontic treatment showed a remarkable result and it inhibited growth of S. mutans at concentrations as low as 0.31 mg/mL. Hence, 4-HCA can be used as a potent anti-microbial agent against S. mutans, and it can be incorporated into oral prophylactic devices after further testing.The anti-quorum sensing and anti-biofilm activity of 4-HCA against


For ultra-reliable high-data-rate communication, the beyond fifth generation (B5G) and the sixth generation (6G) wireless networks will heavily rely on beamforming, with mobile users often located in the radiative near-field of large antenna systems. Therefore, a novel approach to shape both the amplitude and phase of the electric near-field of any general antenna array topology is presented. Leveraging on the active element patterns generated by each antenna port, the beam synthesis capabilities of the array are exploited through Fourier analysis and spherical mode expansions. As a proof-of-concept, two different arrays are synthesized from the same active antenna element. These arrays are used to obtain 2D near-field patterns with sharp edges and a 30 dB difference between the fields’ magnitudes inside and outside the target regions. Various validation and application examples demonstrate the full control of the radiation in every direction, yielding optimal performance for the users in the focal zones, while significantly improving the management of the power density outside of them. Moreover, the advocated algorithm is very efficient, allowing for a fast, real-time modification and shaping of the array’s radiative near-field. Key performance indicators for the evolved fifth generation E5G) and upcoming sixth generation 6G) mobile wireless communications networks promote continuous connection availability, strong reliability, huge device density and low air interface latency . To unleG and upcG mobile To enable antenna arrays to set up wireless communication in the Fresnel region, an appropriate focusing technique is essential to obtain properly shaped focal spots exhibiting high energy concentrations in the near-field region . MoreoveThis stimulated the development of a vast amount of numerical techniques, shaping these strong Fresnel-zone fields to concentrate elevated energy densities at one specific spot. These include methods based on the optimization of the power transmission efficiency (PTE) ,15, enerTo ensure a proper simultaneous manipulation of the electric near-field’s levels over an entire 2D or 3D region of space, a full-fledged, field-shaping technique is required. This, however, often implies costly iterative optimizations or complex, impractical setups, which conflict with the rapid-response requirements of modern applications. Based on the alternate projection method , the worIn this paper, a novel method is presented, based on active far-field radiation pattern data, to determine the complex current excitations required to shape the electric near-field produced by general antenna arrays. The proposed method constitutes an important extension of the conventional far-field beam-shaping technique, enabling the generation of arbitrary field shapes on a sphere located in the array’s radiative near-field. Specifically, the amplitude and phase of the electric field radiated by the array are controlled on a spherical surface centered at the array’s phase center and with a radius such that the surface is located in the array’s radiative near-field. The novel technique smoothly transitions between near- and far-field shaping by modifying the radius of said sphere. In contrast to , the inpThis paper is organized as follows. Consider the application scenario of global coordinate system R. In the following sections, R  b. To obtk is the wavenumber, The electric field n (EFIE) , which r (EFIE) [En(rn)=−jy. In nd kind Substituting  into 1)1) yields Fn, as ≈∑lficients  are compadrature . The valic field . As a rurm, as ([Fn(k^)≈∑lWhereas a higher value of m(r^) in  assumes N antenna elements, as inr ≥ R ≥ Owing to linearity, the total electric field where pn b is the  algebra:En(rn)=Enorem for ). For r ficient =Encumulative power spectrum To determine the optimal value of ined as  an anu^. Wegiven byEco(RTr^)R, meaning that it is possible to obtain the values It is important to note that the only restriction imposed by the addition theorem is that ombining  and 24)RT ≥ R, mxpansion  of T obtained from the experiment of U different spots. Furthermore, through a proper implementation of the feeding architecture of the array system, this permits us to deliver U different data streams to the users. The outcome of such a scenario, with U = 4, is shown in When comparing target patterns, numerical solutions and full-wave results, an excellent agreement is observed, in both amplitude and phase. Any small difference is due to the approximation made by employing the center element active radiation pattern to represent all the remaining elements. This choice is, however, justified by both the enormous amount of time saved in performing the simulations of the antenna patterns and by the very good match between the numerical results and the full-wave simulations. Note that compared to the previous section, there is a loss of resolution as the sharp edges of the target fields are less accurately reproduced. Nevertheless, this is merely due to the use of a smaller array aperture rather than to the algorithm’s loss of accuracy.N = 200 and Novel method: The number of operations required is approximately M are the variables to optimize, and L is the amount of control points used. As the computational time scales exponentially with L, several hours are required to achieve shaping, hence excluding this algorithm from real-time applications. A variation of this technique, being O-mt-LSM [O-mt-TR : The amoO-mt-LSM , does noSmart skin holography : While aMethod of Moments (MoM) : A radiaAngular spectrum projection method : This meAll the methods referenced in this work, including the presented technique, require a one-time set-up operation. While an accurate description of this set up is not always provided by the respective authors, it can be estimated to be approximately the same across all algorithms. Therefore, we focus the following comparison on the time required for the actual electric near-field shaping process across different methods:Therefore, we conclude that when compared to other available near-field shaping methods, the technique proposed in this work excels in terms of computational efficiency, resolution and suitability. Furthermore, in contrast to most state-of-the-art literature, an accurate quantification of the number of operations, computational time and memory usage were provided.A novel algorithm was developed to obtain near-field intensity shaping through general antenna array topologies, outperforming traditional techniques. The method leverages the simulated active far-field radiation patterns of the antenna elements. By making use of a spherical Fourier transform and multipole expansion of these radiation patterns, the advocated algorithm performs a far-to-near-field transform to quickly determine the amplitude and phases required to shape the co-polar component of the electromagnetic field produced by general array topologies. Specifically, and as an extension of conventional far-field beam-shaping techniques, the proposed algorithm achieves an accurate shaping over the surface of a sphere with a prescribed radius located in the array’s radiative near-field region. The novel method produces sharp patterns, while consuming a very small amount of resources, making it suitable for real-time operation.As a proof-of-concept, 197-dipoles arrays were exploited to implement near-field focusing for two different intricate shapes. The undesired secondary beams within the target region were significantly suppressed by around 30 dB. Furthermore, intensity-shaping with smaller arrays, comprising 49 dipoles, was also validated using commercial full-wave software. The complex currents required for the shaping and obtained by the novel method were used to excite the full-wave models of the 49 element arrays. A very good agreement between the electric near-fields resulting from both the implemented algorithm and the full-wave calculations was obtained. In an important application scenario, it was shown that the method manages to target individual users who are distributed close to one another in the radiative near-field of the antenna array, as such ensuring the best quality of communication. The method has thus been validated via numerical and full-wave experiments, clearly demonstrating its applicability in (future) B5G and 6G real-time applications and communications scenarios.Future plans include employing an accurate system impulse response to model applications defined in domains with specific shapes and symmetries. Moreover, an extension to 3D shaping is possible by making use of efficient optimization procedures owing to the algorithm’s impressive computation speed.