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Virtual worlds are relatively recent developments, and so it is tempting to believe that they need to be understood through newly developed theories and philosophies. However, humans have long thought about the nature of reality and what it means to be "real." This paper examines the three persistent philosophical concepts of Metaxis, Liminality and Space that have evolved across more than 2,000 years of meditation, contemplation, and reflection. Our particular focus here is on the nature of the interface between the virtual and the physical: at the interstices, and how the nature of transactions and transitions across those interfaces may impact upon learning. This may, at first, appear to be an esoteric pursuit, but we ground our arguments in primary and secondary data from research studies in higher education.

Background. Many people with spinal cord injury (PW-SCI) in the Gaza Strip in Palestine are discharged from inpatient rehabilitation with limitations in their ability to meet basic needs, and reach their full potential. There is limited evidence of how clinicians can promote occupational justice for PW-SCI. Purpose. To describe participants' perspectives revealed during a participatory action research (PAR) process used to develop an education manual for PW-SCI in Gaza, using Participatory Occupational Justice as a lens. Methods. Following ethical approval, a four-step PAR design was utilized by eight researchers to co-construct the Spinal Cord Injury Activities of Daily Living-education Manual with 54 participants from SCI rehabilitation settings in Gaza. Qualitative data from eight focus groups were analyzed using inductive thematic analysis. Findings. Two main themes were evident in the participants' viewpoints: Enabling occupational justice and Removing barriers to occupational justice. Implications. Occupational justice is a central value that needs to be considered when developing occupational therapy educational interventions for this client group. PW-SCI health education may facilitate occupational justice in practical and culturally relevant ways when participatory methods are used to develop educational resources.

Background: Spinal cord injury (SCI) is a catastrophic injury associated with functional loss and life-threatening complications. Many people with SCI in the Gaza Strip of Palestine are discharged from inpatient rehabilitation to the community while still lacking many daily life skills. This randomized controlled trial (RCT) seeks to test the impact of the Spinal Cord Injury Activities of Daily Living Education Manual (SADL-eM)-an evidence-based occupational therapy patient educational intervention-on rehabilitation outcomes., Objective: The proposed trial aims to evaluate the SADL-eM intervention compared with standard treatment among people with SCI., Methods: This is a parallel RCT with two study arms: intervention and control. A total of 90 patients treated in inpatient rehabilitation settings will be randomly allocated to two study groups. Both groups will receive standard care. The intervention group will also use the SADL-eM with their treating occupational therapist during rehabilitation. The SADL-eM is a comprehensive activities of daily living (ADL) educational tool that was codeveloped with people with SCI and stakeholders across Gaza. The self-report version of the Spinal Cord Independence Measure will be used on admission (ie, baseline measure) and after 6 weeks as the primary outcome measure. Secondary outcomes include the third version of the Spinal Cord Independence Measure, the Private Religiousness Practices Scale, the Organizational Religiousness Short-Form, additional ADL domains covered by the education manual, and adherence to the intervention. The effect of the intervention will be determined using repeated-measures analysis of variance., Results: This study will be conducted from April 2021 through December 2022, with results expected to be available in January 2023., Conclusions: If the SADL-eM is demonstrated as clinically effective, this will have significant implications for occupational therapy interventions in low- and middle-income countries., Trial Registration: ClinicalTrials.gov NCT04735887; https://clinicaltrials.gov/ct2/show/NCT04735887., (©Moussa Abu Mostafa, Nicola Ann Plastow, Maggi Savin-Baden, Birhanu Ayele. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 22.07.2022.)

Blended learning in which online education is combined with face-to-face education is especially useful for (future) health care professionals who need to keep up-to-date. Blended learning can make learning more efficient, for instance by removing barriers of time and distance. In the past distance-based learning activities have often been associated with traditional delivery-based methods, individual learning and limited contact. The central question in this paper is: can blended learning be active and collaborative? Three cases of blended, active and collaborative learning are presented. In case 1 a virtual classroom is used to realize online problem-based learning (PBL). In case 2 PBL cases are presented in Second Life, a 3D immersive virtual world. In case 3 discussion forums, blogs and wikis were used. In all cases face-to-face meetings were also organized. Evaluation results of the three cases clearly show that active, collaborative learning at a distance is possible. Blended learning enables the use of novel instructional methods and student-centred education. The three cases employ different educational methods, thus illustrating diverse possibilities and a variety of learning activities in blended learning. Interaction and communication rules, the role of the teacher, careful selection of collaboration tools and technical preparation should be considered when designing and implementing blended learning.

Collaborative learning through case-based or problem-based learning (PBL) scenarios is an excellent way for students to acquire knowledge and develop decision-making skills. However, the process is threatened by the movement towards more self-directed learning and the migration of students from campus-based to workplace-based learning. Paper-based PBL cases can only proceed in a single direction which can prevent learners from exploring the impact of their decisions. The PREVIEW project, outlined in this article, trialled a replacement to traditional paper PBL with virtual patients (VPs) delivered through a virtual world platform. The idea was that an immersive 3D environment could provide (a) greater realism (b) active decision-making and (c) a suitable environment for collaboration amongst work-based learners meeting remotely. Five VP scenarios were designed for learners on a Paramedic Foundation Degree within the virtual world second life (SL). A player using the MedBiquitous VP international standard allowed cases to be played both within SL and on the web. Three testing days were run to evaluate the scenarios with paramedic students and tutors. Students unfamiliar with the SL environment worked through five PBL scenarios in small groups, shadowed by 'in-world' facilitators. Feedback indicated that the SL environment engages students effectively in learning, despite some technology barriers. Students believed SL could provide a more authentic learner environment than classroom-based PBL.