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Health professional education is transitioning to online platforms to meet students' need for flexibility and international access. However, there is a necessity for authentic presentation of educational material particularly in regard to clinical skills development. There has been major growth in the delivery of virtual simulated-based learning and assessment to provide clinical skill acquisition in an online platform. The aim of this review was to explore the use of virtual simulation to assess clinical competence in health education.

Integrative review.

Peer reviewed studies published between 2008 to March 2020 were searched across PubMed, Embase, Cochrane Library, CINAHL Medline, Scopus, and PsycINFO.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed. Twenty-three studies, which met the inclusion criteria, were downloaded, and a quality appraisal and analysis was completed by the research team.

A thematic analysis identified four themes; pedagogy differences acromes. Virtual simulation is a feasible strategy to assess students' clinical competency and support their learning in both medical and nursing programs, however simulation should be authentic and incorporate reflection.The rare earth element (REE) group is widely used for geochemical prospection and the hydrochemical differentiation of waters. Most of the currently applied methods use normalized REE patterns to determine enrichments or depletions of certain REE in comparison to standard materials, which are caused by specific environmental conditions. Contrast agents containing Gadolinium (Gd), which are used for magnetic resonance imaging (MRI), have been emitted into surface waters since the 1980s. Patients excrete these contrast agents shortly after ambulant medication in hospitals or at home. Sewage treatment is currently unable to hold back Gd from this anthropogenic source. Therefore, the Gd concentration in the receiving channel increases significantly and creates a Gd peak in the REE pattern. UNC0642 This anthropogenic peak propagates into adjacent groundwater bodies. In a karst aquifer showing a connection between a river/ponor (input) and three springs (output), such an anthropogenic Gd anomaly has been traced, the local Gd background quantified, and surface water groundwater interaction evaluated. In two sampling campaigns, water samples were taken every day at the input and output side during one week in February and three weeks in May. Sampling of springs and brooks in the vicinity of the karst aquifer proved excessive Gd from anthropogenic sources. The evaluation of concentration, mass flow and total mass of Gd show that Gd can be an environmental tracer to monitor surface water-groundwater interaction as well as the anthropogenic influence on water bodies. Further anthropogenic pollutants - diclofenac, carbamazepine, galaxolide, caffeine, and acesulfame-K - representing different classes of common organic substances were tested as co-indicators to Gd. However, out of these only acesulfame-K was detected and is related with the Gd-anomaly. Our results indicate that Gd is a more powerful indicator of surface water- groundwater interaction than most organic pollutants.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the 3rd epidemic coronavirus after severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Since December 2019, the outbreak of the Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 has aroused great attention around the world. Pregnant women and their fetuses have been concerned as a high-risk population. We explained why pregnant women are susceptible to coronavirus in terms of their adaptive changes in physiology and immune system during pregnancy, and described the associations between maternal clinical symptoms, perinatal outcomes and coronavirus infections.Affinity membrane is widely employed to promote specific adsorption of toxins and reduce the blood purification therapeutic time. However, it suffers from insufficient toxin binding and low hemocompatibility. Herein, a novel anticoagulant affinity membrane (AAM) was developed to clear bilirubin from human blood in a pore-flow-through way. Firstly, a nylon net membrane with a regularly arranged pore as the matrix was coated with poly(pyrrole-3-carboxylic acid) via chemical vapor deposition (CVD) method. Then, poly(L-arginine) (PLA) as a highly specific ligand of bilirubin, was immobilized onto the surface of the composited membrane after the modification of heparin. Owing to the 3-dimensional molecular architecture of PLA, up to 86.1 % of bilirubin was efficiently cleared. Besides, the AAM exhibited effective anticoagulant activity in the measurement of clotting time, with suppressed thrombus formation, low hemolysis ratio, minimized platelet and leukocyte adhesion, and excellent biosafety. Therefore, the AAM has enormous potential in blood purification therapy for enhancing hemocompatibility and bilirubin removal.Genomic profiling has revolutionized treatment options for patients with oncogene-driven cancers, such as epidermal growth factor receptor (EGFR) mutant carcinoma. Rearranged during transfection (RET) rearrangement, as one of the main activated oncogenes, has been well studied and found to be involved in the malignant behavior of carcinogenesis, resulting in acquired resistance to EGFR tyrosine kinase inhibitors and inducing an intrinsic resistance to immunotherapy. Thus, targeted therapies have been investigated against RET arrangement cancers, including several multi-kinase inhibitors and selective RET inhibitors. However, modest efficacy, a relatively high rate of toxicity, and poor effectiveness against brain metastasis are common limitations of multi-targeted novel molecular inhibitors. A promising prospect was shown recently in selective RET inhibitors in several ongoing clinical trials. In this review, we reviewed the concurrent dilemmas of targeted therapies against RET arrangement cancer from preclinical and clinical studies and proposed several clinical considerations for clinical practice prospectively.