Background -The theory of Threshold Concepts (TC) proposes that there are ideas necessary for a student to learn which enable them to think like a professional. Studies of TC in higher education have appeared since 2003. Studies in medical education are more recent.

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Background and Objectives Behavioral and psychological symptoms of dementia (BPSD) commonly occur in persons living with dementia Bright light (BL) interventions have shown some positive impact on BPSD. Ambient lighting is a more efficient approach to delivering BL with better compliance and less staff workload than individual-based lighting interventions. Yet, its effect has not been systematically reviewed. This review synthesized research evidence on the effect of ambient BL on BPSD. Research Design and Methods This review searched literature from PubMed (Medline), CINAHL, Scopus, Web of Science, and Cochrane in February 2021. Original research testing the effect of ambient BL on BPSD in persons with dementia was included. Two reviewers independently screened, extracted data, and assessed the quality of each article. Results Nine studies were reviewed with one randomized controlled trial and eight quasi-experimental studies. The sample size ranged from 14-89 participants across care settings. While not all studies showed positive results, evidence from multiple studies revealed the positive effect of ambient BL on depressive symptoms and agitation in persons with dementia. The ambient BL that showed positive effect targeted at approximately 350-750lux, 4500-9325K, and/or CS=0.375-0.4 for 10-12 hours a day for 4 weeks or longer. Evidence on other BPSD was mixed or too limited to draw conclusions. Discussion and Implications A preponderance of evidence suggests that, when properly designed and implemented, ambient BL shows promise in reducing depressive symptoms and agitation. Future research, using more rigorous designs, is needed to further test the effect of ambient BL on BPSD with attention to lighting parameters, measurement approaches, and intervention fidelity.

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