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The purpose of this study was to investigate the hierarchical organization of digit force production and its effect on stability and performance during the simulated archery task. The simulated archery shooting task required the production of a prescribed level of force in virtual space with the left hand and an equivalent force with all 4 fingers of right hand. A single trial had 2 phases, including static force production as aiming in archery and quick force release to shoot the virtual arrow. The timing of the force release was determined by the participant's choice or response to the external cue. The coordination indices, that is, the synergy index, of force stabilization were quantified in 2 hierarchies by decomposing the variance components. The accuracy and precision of the hit position of the virtual arrow were calculated as performance-related indices. The results confirmed that the precision, that is, reproducibility, of the performance was greater when the force release time was determined by the self-selected time, suggesting the beneficial effect of the anticipatory mechanism. There was a distinct synergistic organization of digit forces for the stabilization of net forces in both bimanual and multifinger levels, which was especially correlated with the precision of performance. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of acute ischemic preconditioning (IPC) on tennis skill and physical exercise performance, as well as to explore whether 7-day repeated IPC (RIPC) accelerated fatigue recovery after a simulated tennis match. Methods: Twenty-nine male tennis-specific current students were randomly allocated into 1 of 2 groups: SHAM (n = 14, 3 × 5 min at 20 mm Hg) and IPC (n = 15, 3 × 5 min at 220 mm Hg). Participants in both groups engaged in acute IPC and RIPC interventions. After the first acute IPC intervention, assessments were conducted to evaluate tennis-specific skills and overall physical exercise capacity. Following completion of chronic RIPC interventions, all participants competed in a simulated tennis match specifically designed to induce fatigue. To evaluate recovery from this induced fatigue, physical exercise capacity tests were conducted at 24 and 48 hours postmatch, allowing for an assessment of the participants' recovery capabilities over time. Results: After the first acute intervention, notable differences were observed between the IPC and SHAM groups in their performance on the repeated-sprint ability test. Specifically, the total times recorded were significantly shorter in the IPC group compared with the SHAM group (IPC: 109.05 [2.70] vs SHAM: 114.57 [7.45] s, P =.012), and this trend was also reflected in their best times (IPC: 4.20 [0.18] s vs SHAM: 4.39 [0.30] s, P =.042), indicating an immediate benefit of the IPC intervention on sprint performance. After a 7-day RIPC intervention, significant changes were noted in the SHAM group's performance metrics postmatch. There was an increase (P <.001) in fatigue index from 22% (8%) to 30% (9%) during repeated-sprint ability test and a decrease in serve speed from 120.2 (17.5) to 106.7 (13.0) km/h (P =.002) and knee peek torque from 196.0 (49.0) to 162.7 (39) N (extension, 60°/s, P <.001) in the SHAM group 24 hours postmatch, relative to the IPC group. Moreover, compared with the SHAM group, the IPC group showed a lower rate of perceived exertion during the match (P <.001) and a decrease in visual analog scale score (P =.026) 24 hours postmatch, suggesting enhanced recovery and reduced perception of pain relative to the SHAM group. Conclusion: IPC could serve as a strategy to generate an ergogenic effect and recovery during training and competition. [ABSTRACT FROM AUTHOR]

Background: The benefits of oral caffeine intake to enhance several aspects of physical performance, such as aerobic endurance, strength, power, and muscle endurance performance, are well supported. However, how the physical performance benefits of caffeine supplementation are translated into better specific actions in intermittent sports during real or simulated competition has been the topic of fewer investigations, and their results need to be appropriately reviewed and meta-analyzed. Objective: The aim of the study was to investigate the effects of acute caffeine intake on specific actions in intermittent sports involving decision making and high-intensity efforts (eg, team, racket, and combat sports) during real or simulated competitions. Methods: All studies included had blinded and crossover experimental designs, and we conducted a risk-of-bias analysis. In total, we included 24 studies. A meta-analysis was performed using the random-effects model to calculate the standardized mean difference (SMD) estimated by Hedges g and 95% CIs. Results: Caffeine ingestion increased high-intensity sport-specific actions during competition, such as the number of sprints (SMD: 0.48; 95% CI, 0.23–0.74), body impacts (SMD: 0.28; 95% CI, 0.08–0.49), accelerations (SMD: 0.35; 95% CI, 0.06–0.63), decelerations (SMD: 0.63; 95% CI, 0.12–1.14), and high-intensity offensive efforts (SMD: 0.36; 95% CI, 0.11–0.61). Additionally, caffeine ingestion induced a higher positive or success rate of actions during real or simulated competition (SMD: 0.44; 95% CI, 0.19–0.69). Conclusion: The current meta-analysis provides evidence of caffeine supplementation in increasing high-intensity efforts and the success rate of sport-specific actions during real or simulated competition. [ABSTRACT FROM AUTHOR]

Purpose: To develop and evaluate a theory on the frequent observation that cyclists prefer cadences (RPMs) higher than those considered most economical at submaximal exercise intensities via modeling and simulation of its mathematical description. Methods: The theory combines the parabolic power-to-velocity (v) relationship, where v is defined by crank length, RPM-dependent ankle velocity, and gear ratio, RPM effects on the maximal lactate steady state (MLSS), and lactate-dependent carbohydrate oxidation (CHO). It was tested against recent experimental results of 12 healthy male recreational cyclists determining the v-dependent peak oxygen uptake (VO2PEAKv), MLSS (MLSSv), corresponding power output (PMLSSv), oxygen uptake at PMLSSv (VO2MLSSv), and CHOMLSSv-management at 100 versus 50 per minute, respectively. Maximum RPM (RPMMAX) attained at minimized pedal torque was measured. RPM-specific maximum sprint power output (PMAXv) was estimated at RPMs of 100 and 50, respectively. Results: Modeling identified that MLSSv and PMLSSv related to PMAXv (IPMLSSv) promote CHO and that VO2MLSSv related to VO2PEAKv inhibits CHO. It shows that cycling at higher RPM reduces IPMLSSv. It suggests that high cycling RPMs minimize differences in the reliance on CHO at MLSSv between athletes with high versus low RPMMAX. Conclusions: The present theory-guided modeling approach is exclusively based on data routinely measured in high-performance testing. It implies a higher performance reserve above IPMLSSv at higher RPM. Cyclists may prefer high cycling RPMs because they appear to minimize differences in the reliance on CHO at MLSSv between athletes with high versus low RPMMAX. [ABSTRACT FROM AUTHOR]

This study investigated the effects of the timing of caffeine (3 mg/kg body mass) ingestion on three-point shooting accuracy and other performance parameters during a basketball exercise simulation test (BEST). Eighteen college basketball players (mean ± SD: age = 24.4 ± 1.5 years, height = 181.7 ± 9.5 cm, body mass = 80.9 ± 13.2 kg) underwent one familiarization trial and three main conditions in a randomized order: (a) placebo (maltodextrin) and placebo, (b) caffeine and placebo, and (c) placebo and caffeine. Participants ingested either the placebo or caffeine pill 75 and 15 min before performing four quarters of the BEST and a three-point shooting protocol. During each quarter, participants completed 16 rounds of the BEST and ten three-point shots. Vertical jump height, 6 m sprint timing, BEST completion timing, three-point shooting accuracy, heart rate, rate of perceived exertion, blood glucose, blood lactate, and psychological measures pertaining to performance were measured. The BEST completion timing differed among conditions (placebo and placebo = 26.4 ± 2.0 s, caffeine and placebo = 25.8 ± 2.0 s, placebo and caffeine = 25.9 ± 2.1 s; p =.031) but not three-point shooting accuracy (placebo and placebo = 12.33 ± 4.10; caffeine and placebo = 12.61 ± 2.81; placebo and caffeine = 11.67 ± 3.77; p =.648), vertical jump height, or sprint times. Manipulating ingestion timing of caffeine did not improve three-point shooting accuracy, vertical jump height, or 6 m sprint timings, but caffeine can improve performance times during simulated basketball exercise irrespective of ingestion timing. [ABSTRACT FROM AUTHOR]

Purpose: To investigate performance-determining variables of an on-snow sprint cross-country skiing competition and the evolvement in their relationship with performance as the competition progresses from the individual time trial (TT) to the final. Methods: Sixteen national-level male junior skiers (mean [SD] age, 18.6 [0.8] y; peak oxygen uptake [VO2peak], 67.6 [5.5] mL·min−1·kg−1) performed a simulated sprint competition (1.3 km) in the skating style, comprising a TT followed by 3 finals (quarterfinals, semifinals, and final) completed by all skiers. In addition, submaximal and incremental roller-ski treadmill tests, on-snow maximal speed tests, and strength/power tests were performed. Results: VO2peak and peak treadmill speed during incremental testing and relative heart rate, rating of perceived exertion, blood lactate concentrations, and gross efficiency during submaximal testing were all significantly correlated with performance in the TT and subsequent finals (mean [range] r values:.67 [.53–.86], all P <.05). Relative VO2peak and submaximal relative heart rate and blood lactate concentration were more strongly correlated with performance in the semifinals and final compared with the TT (r values:.74 [.60–.83] vs 0.55 [.51–.60], all P <.05). Maximal speed in uphill and flat terrain was significantly correlated with performance in the TT and subsequent finals (r values:.63 [.38–.70], all P <.05), while strength/power tests did not correlate significantly with sprint performance. Conclusions: VO2peak and high-speed abilities were the most important determinants of sprint cross-country skiing performance, with an increased importance of VO2peak as the competition format progressed toward the final. [ABSTRACT FROM AUTHOR]

The present randomized study investigated the effect of acute supplementation of 800 mg/kg of ketone monoester ingestion (KE) or placebo (PL) and 210 mg/kg of NaHCO3 co-ingestion on cycling performance of WorldTour cyclists during a road cycling stage simulation. Twenty-eight cyclists participated in the study (27.46 ± 4.32 years; 1.80 ± 0.06 m; 69.74 ± 6.36 kg). Performance, physiological, biochemical, and metabolism outcomes, gut discomfort, and effort perceived were assessed during a road cycling simulation composed of an 8-min time-trial (TT) performance + 30-s TT + 4.5 hr of outdoor cycling + a second 8-min TT + a second 30-s TT. Greater absolute and relative mean power during the first 8-min TT (F = 5.067, p =.033, η p 2 =.163 , F = 5.339, p =.029, η p 2 =.170 , respectively) was observed after KE than after PL (KE: 389 ± 34, PL: 378 ± 44 W, p =.002, d = 0.294 and KE: 5.60 ± 0.42, PL: 5.41 ± 0.44 W/kg, p =.001, d = 0.442). Additionally, greater concentration of β-hydroxybutyrate blood concentration (F = 42.195, p <.001, η p 2 =.619) was observed after KE than after PL during the first steps of the stage (e.g., after warm-up KE: 1.223 ± 0.642, PL: 0.044 ± 0.058 mM, p <.001, d = 2.589), although the concentrations returned to near baseline after 4.5 hr of outdoor cycling. Moreover, higher values of anion gap were observed (F = 2.333, p =.026, η p 2 =.080) after KE than after PL ingestion, after the warm-up and after the first 8-min and 30-s TT. Additionally, lower concentrations of HCO 3 − were reported in the KE condition after warm-up and after the first 8-min and 30-s TT. During the initial phase of the stage simulation, acute supplementation with KE + NaHCO3 co-ingestion enhanced 8-min TT cycling performance (3.1%) in WorldTour cyclists with a concomitant hyperketonaemia. [ABSTRACT FROM AUTHOR]

Purpose: There has been a proliferation in technologies in the sport performance environment that collect increasingly larger quantities of athlete data. These data have the potential to be personal, sensitive, and revealing and raise privacy and confidentiality concerns. A solution may be the use of synthetic data, which mimic the properties of the original data. The aim of this study was to provide examples of synthetic data generation to demonstrate its practical use and to deploy a freely available web-based R Shiny application to generate synthetic data. Methods: Openly available data from 2 previously published studies were obtained, representing typical data sets of (1) field- and gym-based team-sport external and internal load during a preseason period (n = 28) and (2) performance and subjective changes from before to after the posttraining intervention (n = 22). Synthetic data were generated using the synthpop package in R Studio software, and comparisons between the original and synthetic data sets were made through Welch t tests and the distributional similarity standardized propensity mean squared error statistic. Results: There were no significant differences between the original and more synthetic data sets across all variables examined in both data sets (P >.05). Further, there was distributional similarity (ie, low standardized propensity mean squared error) between the original observed and synthetic data sets. Conclusions: These findings highlight the potential use of synthetic data as a practical solution to privacy and confidentiality issues. Synthetic data can unlock previously inaccessible data sets for exploratory analysis and facilitate multiteam or multicenter collaborations. Interested sport scientists, practitioners, and researchers should consider utilizing the shiny web application (SYNTHETIC DATA—available at https://assetlab.shinyapps.io/SyntheticData/). [ABSTRACT FROM AUTHOR]

In this review, we elaborate on how musculoskeletal (MSK) modeling combined with dynamic movement simulation is gradually evolving from a research tool to a promising in silico tool to assist medical doctors and physical therapists in decision making by providing parameters relating to dynamic MSK function and loading. This review primarily focuses on our own and related work to illustrate the framework and the interpretation of MSK model-based parameters in patients with 3 different conditions, that is, degenerative joint disease, cerebral palsy, and adult spinal deformities. By selecting these 3 clinical applications, we also aim to demonstrate the differing levels of clinical readiness of the different simulation frameworks introducing in silico model-based biomarkers of motor function to inform MSK rehabilitation and treatment, with the application for adult spinal deformities being the most recent of the 3. Based on these applications, barriers to clinical integration and positioning of these in silico technologies within standard clinical practice are discussed in the light of specific challenges related to model assumptions, required level of complexity and personalization, and clinical implementation. [ABSTRACT FROM AUTHOR]

The increase in repetitive strain injuries to the hand underscores the need for assessing and preventing musculoskeletal overuse associated with hand-intensive tasks. This study investigates the risk of overload injuries in soft tissue structures of the hand by analyzing the pressure distribution and location of peak pressure in the hand during snap-fit connection assembly in the automotive industry. The influence of the surface geometry of automotive trim components the pressure distribution and force imparted during strikes with the palm and the fist are investigated in a cohort of 30 subjects with extensive experience installing trim parts with snap-fit connections. Using the palm or fist (ulnar hand side) of the dominant hand, the subjects struck a simulation device with a flat, rounded, or edged surface geometry. The average peak force applied was 600 N (±122 N), nearly 3 times the force required to overcome the technical resistance of the snap-fit connector (220 N). Fist strikes exerted a 40% higher mean peak pressure and 18% higher mean pressure than did palm strikes. The pressure distribution in the region of the thenar eminence and soft tissue of the ulnar side of the hand did not differ between fist strikes on flat and edged surfaces. Considering the delicate anatomy of the hand, especially the hypothenar muscles on the ulnar side, assembling connection claps using the fist instead of the palm may prevent repetitive blunt trauma to the sensitive blood vessels and nerves in the palm. [ABSTRACT FROM AUTHOR]

The diagnosis of medical conditions and subsequent treatment often involves radionuclide imaging techniques. To refine localisation accuracy and improve diagnostic confidence, compared with the use of a single scanning technique, a combination of two (or more) techniques can be used but with a higher risk of misalignment. For this to be reliable and accurate, recorded data undergo processing to suppress noise and enhance resolution. A step in image processing techniques for such inverse problems is the inclusion of smoothing. Standard approaches, however, are usually limited to applying identical models globally. In this study, we propose a novel Laplace and Gaussian mixture prior distribution that incorporates different smoothing strategies with the automatic model-based estimation of mixture component weightings creating a locally adaptive model. A fully Bayesian approach is presented using multi-level hierarchical modelling and Markov chain Monte Carlo (MCMC) estimation methods to sample from the posterior distribution and hence perform estimation. The proposed methods are assessed using simulated γ-eye™ camera images and demonstrate greater noise reduction than existing methods but without compromising resolution. As well as image estimates, the MCMC methods also provide posterior variance estimates and hence uncertainty quantification takes into consideration any potential sources of variability. The use of mixture prior models, part Laplace random field and part Gaussian random field, within a Bayesian modelling approach is not limited to medical imaging applications but provides a more general framework for analysing other spatial inverse problems. Locally adaptive prior distributions provide a more realistic model, which leads to robust results and hence more reliable decision-making, especially in nuclear medicine. They can become a standard part of the toolkit of everyone working in image processing applications. [ABSTRACT FROM AUTHOR]

Immuno-positron emission tomography (immunoPET) enables imaging of specific targets that play a role in targeted therapy and immunotherapy, such as antigens on cell membranes, targets in the disease microenvironment, or immune cells. The most common immunoPET applications use a monoclonal antibody labeled with a relatively long-lived positron emitter such as 89Zr (T1/2 = 78.4 h), but smaller antibody-based constructs labeled with various other positron emitting radionuclides are also being investigated. This molecular imaging technique can thus guide the development of new drugs and may have a pivotal role in selecting patients for a particular therapy. In early phase immunoPET trials, multiple imaging time points are used to examine the time-dependent biodistribution and to determine the optimal imaging time point, which may be several days after tracer injection due to the slow kinetics of larger molecules. Once this has been established, usually only one static scan is performed and semi-quantitative values are reported. However, total PET uptake of a tracer is the sum of specific and nonspecific uptake. In addition, uptake may be affected by other factors such as perfusion, pre-/co-administration of the unlabeled molecule, and the treatment schedule. This article reviews imaging methodologies used in immunoPET studies and is divided into two parts. The first part summarizes the vast majority of clinical immunoPET studies applying semi-quantitative methodologies. The second part focuses on a handful of studies applying pharmacokinetic models and includes preclinical and simulation studies. Finally, the potential and challenges of immunoPET quantification methodologies are discussed within the context of the recent technological advancements provided by long axial field of view PET/CT scanners. [ABSTRACT FROM AUTHOR]

Background: Extracting the premolars is an effective strategy for patients with bimaxillary dentoalveolar protrusion. Clear aligners (CAs) close the extraction spaces through shortening the length of aligners. The contraction force generated by the terminal of aligners makes the posterior teeth tip mesially, which is known as the roller coaster effect. This phenomenon is even worse in the 2nd premolar extraction cases. Posterior anchorage preparation is commonly used to protect the angulation of molars, taking the form of presetting distal tipping value. However, the distal tipping design aggravates the anchorage loss of anterior teeth simultaneously. This study aimed to explore the different anchorage loss of the posterior teeth when the 1st or 2nd premolars were extracted using CAs, respectively in maxillary and mandibular arches, further providing guidance for anchorage preparation design in clinical practice. Methods: Two bimaxillary finite element models with different extraction patterns were established to simulate the anterior en-masse retraction process of the CAs. In Model 1, the maxillary and mandibular 1st premolars were extracted, while in Model 2, the 2nd premolars were extracted. Finite element analysis methods were utilized to analyze the tipping angle of the anterior and posterior teeth. Results: Compared between two models, the anterior teeth exhibited a greater lingual inclination tendency and the posterior teeth exhibited a slighter mesial tipping tendency in Model 1 regarding individual tooth. The closer to the extraction spaces, the greater the tip, and the distal tipping tendency of the 1st premolars was more evident than the mesial tipping tendency of the 1st molars in Model 2. Compared between the maxillary and mandibular arches, the mesial tipping tendency of individual posterior tooth was more evident in the maxilla. In addition, the highest hydrostatic stress of the periodontal ligaments was concentrated on the cervical and apical parts directly adjacent to the extraction spaces, and it exhibited relatively uniform distribution in Model 1. Conclusions: The individual posterior tooth showed the same mesial tipping direction but to different degree when the 1st or the 2nd premolars were extracted during clear aligner treatment. Presetting anchorage preparation design for the posterior teeth is essential to alleviate the roller coaster effect, especially in the 2nd premolar extraction cases. Furthermore, larger anchorage preparation value should be proposed for the maxillary posterior teeth. [ABSTRACT FROM AUTHOR]

Background: Secondary schools are important settings for promoting varied physical activity (PA) opportunities for adolescents to promote PA throughout life. However, research on the effect of secondary school-based interventions on future PA is limited. This study examined the potential impact of secondary school-based interventions on the determinants of future PA participation of Aotearoa New Zealand (NZ) adolescents using simulated modelling. Methods: We used data from a nationally representative sample of secondary school students (n = 5035) aged 12–17 between 2017 and 2020 in NZ. We modelled four secondary school-based interventions and their projected impact on five determinants of future PA. Modelled interventions were the technological augmentation of physical education (TAPE), a peer-led PA mentoring programme (PL), physically active learning (PAL) and the inclusion of a natural environment play area (NE). Results: Total weekly PA increased the most from the NE intervention (+ 0.2 h/week), followed by TAPE (+ 0.08 h/week), PAL (+ 0.05 h/week) and PL (-0.06 h/week). Current number of PA settings increased the most in NE (+ 1.75 settings/week), followed by TAPE (+ 1.29 settings/week), PAL (+ 1.21 settings/week) and PL (+ 0.73 settings/week). Current number of PA types increased the most in NE (+ 1.57 types/week), followed by PL (+ 1.05 types/week), TAPE (+ 0.34 types/week) and PAL (+ 0.15 types/week). Physical literacy scores increased the most from PL (+ 3.6%), followed by PAL (+ 3.3%), TAPE (+ 0.43%) and NE (+ 0.12%). Social support scores increased the most from PAL (+ 5%), followed by PL (+ 1.9%), TAPE (+ 1.46%) and NE (+ 0.57%). Conclusions: On average, all interventions benefitted determinants of future PA participation to a small degree. Results show differing magnitudes of the intervention effect by determinant, indicating the complexities surrounding the promotion of PA adherence. Future interventions could be improved through detailed consultation alongside, and involving, adolescents and stakeholders within schools. Researchers should also prioritise the collection of longitudinal PA data and explore its connection with sociodemographic differences between adolescents. [ABSTRACT FROM AUTHOR]

Background: Exposure of the hepatic artery is a fundamental step in many surgeries, during which iatrogenic hepatic artery injury may occur. Although the incidence of hepatic artery haemorrhage is low, its occurrence can lead to life-threatening haemorrhage. It is difficult and dangerous to accumulate clinical experience in laparoscopic hepatic artery repair in actual patients, and simulation training models for laparoscopic hepatic artery repair are currently lacking. In this study, a 3D printed model was designed to simulate the training curriculum for sudden hepatic artery haemorrhage, but whether training with the 3D printed model could yield superior skill improvement for surgeons remained to be determined. Methods: A new 3D printed model was designed for this study. Surgeons from the General Surgery Department of Sir Run Run Shaw Hospital participated in this simulation training. The surgical performance of each model was compared, and the authenticity of the model was evaluated and mechanically tested. Results: Experienced surgeons performed better on the 3D printed model. After repeated training, inexperienced surgeons showed significant improvement of their laparoscopic hepatic artery repair skills. The authenticity of the model was generally satisfactory, but shortcomings persisted in the mechanical testing of artery wall tearing, necessitating further improvement. Conclusions: Few studies have investigated laparoscopic simulation training for sudden hepatic artery haemorrhage. This simulation model distinguishes surgeons with different levels of experience and allows those with less experience to improve their laparoscopic hepatic artery repair skills through training on the model. [ABSTRACT FROM AUTHOR]

Background: Softball pitchers frequently pitch at high volumes. Previous research has demonstrated changes in mechanics, range of motion, and perceived levels of fatigue and pain at high workloads. To date, little research has assessed changes in kinetics at high workloads across pitch types to understand the injury risk. Purpose: To examine changes in peak kinetics of the shoulder, elbow, and wrist of the pitching arm throughout a simulated game and doubleheader inning. Study Design: Descriptive laboratory study. Methods: A total of 19 high school softball pitchers (mean age, 15.1 ± 1.5 years; mean height, 1.6 ± 0.2 m; mean weight, 76.3 ± 16.9 kg) participated. Pitchers threw 4 innings of 25 randomly assigned pitches to mimic a game's high pitch count. Participants then rested for 30 minutes before subsequently proceeding to pitch the first inning of a doubleheader. Each pitcher threw a fastball, drop ball, curveball, and changeup. Peak shoulder, elbow, and wrist kinetics were compared across the first, last, and doubleheader innings and pitch types. Results: Compared with the first inning, significant decreases in kinetics were observed at the shoulder, elbow, and wrist in the last (P <.016) and doubleheader (P <.016) innings, particularly for shoulder and elbow compression force during the drop ball and curveball pitch types and wrist net force for all pitch types but the changeup. Significant decreases in elbow and wrist kinetics were observed during the changeup between the last and doubleheader innings (P <.016). Furthermore, differences in kinetics were observed between pitch types (P <.008); notably, the changeup had reduced kinetics compared with the fastball and breaking ball pitch types (drop ball, curveball) across innings. Conclusion: Across innings, attenuations in select joint kinetics of the pitching arm occurred that were specific to the pitch type. Across pitch types, peak kinetics was often greater during the fastball, while the changeup displayed the lowest peak kinetics. Clinical Relevance: The joints examined in this study are common sites of overuse injuries in pitchers. This work adds to previous findings on decrements in neuromuscular function as well as self-reported fatigue and pain with tournament-style pitching that may increase the injury risk. Collectively, these findings support developing a protocol combining functional testing and player-reported outcomes to aid sports specialists' decisions for pitchers to continue to pitch or return to play, which may help prevent musculoskeletal injuries and time loss from sports participation. [ABSTRACT FROM AUTHOR]

Behavioral skills training (BST) has been used to improve football players' performance in one prior study, but limited data were collected on how the skill generalized from the training environment to the natural environment. The purpose of this study was to further evaluate the effects of BST in enhancing football players' performance while also evaluating the generalization of a skill taught in a training environment (i.e., practice) to the natural environment (i.e., game‐simulated scrimmage). This study included five high school offensive line football players and recorded their run‐blocking skills in the training context and a game context in baseline and following BST. The results showed that BST improved performance in the training environment, with run‐blocking skills slightly generalizing from the training environment to game‐simulated scrimmages. When BST was conducted in the natural environment, it further improved the participants' run‐blocking skills. [ABSTRACT FROM AUTHOR]

Purpose: Reduction of AO/OTA 61-B2.3 (APC2) pelvic fractures is challenging in the setting of anterior ring comminution. The anterior ring is visually much simpler to evaluate for flexion or extension hemipelvis deformity than the posterior ring, except in the setting of comminution, necessitating some other visual reference to judge hemipelvis reduction. We sought to test whether pelvic inlet and outlet fluoroscopy of the contours of the sacroiliac joint could be used in isolation to judge hemipelvis flexion or extension. Methods: Symphyseal and anterior SIJ ligaments were cut (6 cadaveric pelvis). The symphysis was held malreduced to produce one centimeter flexion and extension deformity: 1 cm was selected to mimic a maximum clinical scenario. The SIJ was assessed using inlet and outlet fluoroscopy. The scaled width of the SIJ was assessed at the joint apertures and midjoint on both inlet and outlet views. Joint widths in flexion and extension were compared against joint widths measured on the reduced SIJ using paired t-tests. Results: There was no statistical difference in the superior (p = 0.227, 0.675), middle (p = 0.203, 0.693), and inferior (p = 0.232, 0.961) SIJ widths between hemipelvis flexion or extension models against reduced SIJ on outlet views. There was no statistical difference in the anterior (p = 0.731, 0.662), middle (p = 0.257, 0.655), and posterior (p = 0.657, 0.363) SIJ widths between flexion or extension models against reduced SIJ on inlet views. Conclusion: Inspection of SIJ width on inlet and outlet fluoroscopy cannot detect up to one centimeter of hemipelvis flexion or extension malreduction in the setting of AO/OTA 61-B2.3 (APC2) pelvic fractures with complex anterior injuries. [ABSTRACT FROM AUTHOR]

Purpose: To describe the construction and use of a percutaneous pelvic fixation model, evaluate its translational validity among fellowship-trained orthopedic trauma surgeons, and investigate the importance of specific criteria for effective competency-based assessment of pelvic fixation techniques. Methods: Five orthopedic trauma surgeons were asked to place percutaneous wires on a pelvic fixation model, including anterior column (antegrade/retrograde), posterior column (antegrade/retrograde), supra-acetabular, transsacral, and iliosacral. Evaluation criteria included successful wire placement, redirections, cortical breaches, procedure duration, radiation exposure, and quality of fluoroscopic views. Following completion, participants were provided a survey to rate the model. Results: There were no differences between approaches on successful screw placement, wire redirections, or fluoroscopic quality. Antegrade approaches to the anterior and posterior columns took longer (p = 0.008) and used more radiation (p = 0.02). There was also a trend toward more cortical breaches with the antegrade anterior column approach (p = 0.07). Median ratings among surgeons were 4 out of 5 for their overall impression and its accuracy in tactile response, positioning constraints, and fluoroscopic projections. Learning parameters considered most important to the progression of trainees (most to least important) were successful screw placement, corridor breaches, wire redirections, quality of fluoroscopic views, radiation exposure, and procedure duration. Conclusion: In being affordable, accessible, and realistic, this percutaneous pelvic fixation model represents an opportunity to advance orthopedic surgery education globally. Future research is needed to validate the findings of this pilot study and to expand upon how trainees should be evaluated within simulations and the operating room to optimize skill progression. [ABSTRACT FROM AUTHOR]

Given the benefits of neuroendovascular simulation to resident education, this study aimed to assess the efficacy of simulation-based training for neuroendovascular intervention with primary and secondary catheters using a transradial approach (TRA). Five neurosurgical residents (PGY 1–3) from our institution enrolled in a standardized pilot training protocol. Trainees used the Mentice (Gothenburg, Vastra Gotaland, Sweden) Visit G5 simulator with a type II arch using a right TRA. All participants improved their total time to complete the task from the first trial to the last trial. Residents improved the overall time required to complete the task by 111.8 ± 57 seconds (52% improvement; P = 0.012). Participants reported improved knowledge of Simmons catheter formation from 1.6 ± 0.8 to 2.8 ± 1 (P = 0.035) and improved knowledge of transradial vessel selection technique from 1.6 ± 0.9 to 2.8 ± 1.1 (P = 0.035). All residents were able to illustrate a bovine arch and types 1–3 arches post-simulation. Residents rated the simulation usefulness as 4.6 ± 0.548 (scale 1 [not useful] to 5 [essential]) with 4 of the 5 residents (80%) identifying this exercise as essential. All residents rated the hands-on component of the training exercise as the most important. Residents demonstrated proficiency at Simmons catheter formation and vessel selection in a type II arch over a short time period (4 attempts and <1 hour total). Residents can use simulator-based training to increase their proficiency of vessel selection using a primary or secondary catheter for a TRA. [ABSTRACT FROM AUTHOR]

Whole body vibration (WBV) is linked to short- and longer-term adverse health outcomes, including cognitive impairment, stress and memory loss, loss of balance, reduced proprioception, visual and vestibular disturbances, gastrointestinal problems, and musculoskeletal disorders. Epidemiological evidence supports the link between WBV and headache and head discomfort, but few experimental studies have examined this relationship, particularly with increased muscle tension, as an intermediary. This study aimed to investigate the relationship between muscle tension and vibration intensity, between perceived neck pain and headache/head discomfort and vibration intensity, and between muscle tension and reported neck pain and headache symptoms from simulated WBV based on field measurements of all-terrain vehicle operation on farm terrain. We observed significantly higher electromyography amplitude in the High condition (equivalent to EU Directive's Exposure Limit Value) compared to both Low (equivalent to EU Directive's Exposure Action Value) and Control (quiet sitting) conditions at the left upper trapezius muscle but there were no significant time effects. Neck pain and headache/head discomfort significantly increased after both Low (91% increase from baseline) and High (154% increase from baseline) vibration conditions but there were no significant differences between conditions. Based on simple regression modeling, the relationship between muscle activity and neck pain or headache was very weak (R 2 = 0–0.093). Given the possibility of multiple factors contributing to headache symptoms, future research should not only consider the role of muscle tension but also sensory conflict, excessive noise, biodynamic responses, and a combination of these factors. [ABSTRACT FROM AUTHOR]

Simple Summary: With advances in radiological imaging and its increased use, small nodules are being detected more frequently. Surgical resection is often the final option for diagnosis and treatment; however, small nodules may be too small to be detected during surgery. The lungs are soft, deformable organs that can change shape during respiratory phases and surgical procedures. Thus, surgeons rely on preoperative or intraoperative markings for nodule identification and precise resection. Furthermore, two randomized clinical trials found that sublobar resection could be an alternative treatment for early-stage non-small-cell lung cancer. Therefore, the demand for preoperative or intraoperative marking techniques is increasing, particularly for wedge resection or segmentectomy. In this study, we provide a narrative review of the current status and future perspectives of preoperative and intraoperative markings in thoracic surgery. The widespread implementation of lung cancer screening and thin-slice computed tomography (CT) has led to the more frequent detection of small nodules, which are commonly referred to thoracic surgeons. Surgical resection is the final diagnostic and treatment option for such nodules; however, surgeons must perform preoperative or intraoperative markings for the identification of such nodules and their precise resection. Historically, hook-wire marking has been performed more frequently worldwide; however, lethal complications, such as air embolism, have been reported. Therefore, several surgeons have recently attempted to develop novel preoperative and intraoperative markers. For example, transbronchial markings, such as virtual-assisted lung mapping and intraoperative markings using cone-beam computed tomography, have been developed. This review explores various marking methods that have been practically applied for a better understanding of preoperative and intraoperative markings in thoracic surgery. Recently, several attempts have been made to perform intraoperative molecular imaging and dynamic virtual three-dimensional computed tomography for the localization, diagnosis, and margin assessment of small nodules. In this narrative review, the current status and future perspectives of preoperative and intraoperative markings in thoracic surgery are examined for a better understanding of these techniques. [ABSTRACT FROM AUTHOR]

Background: Bleeding during laparoscopic surgery is stressful and requires immediate efficient management. Skills for complication management are rarely trained. This study aims to investigate the impact of video-assisted coaching on laparoscopic skills acquisition and performance in emergency bleeding situations. Methods: Participants faced simulated emergency scenarios during laparoscopy involving bleeding management in porcine aorta/kidney specimens. Four sequences were conducted over two days, with a structured video-assisted coaching provided between sequences. Performance was assessed using the Global Operative Assessment of Laparoscopic Skills (GOALS) score. The study involved 27 participants attending the advanced colorectal surgery module at the 40th Annual Davos Course in 2023. Results: 54 video sequences were analyzed. Structured video-assisted coaching improved the GOALS sum score by 0.36 (95%CI: 0.21–0.50, P < 0.001) in contrast to simple repetition (0.05 with 95%CI: −0.43 to 0.53, P = 0.826). This association was observed for depth of perception (P < 0.001), bimanual dexterity (P < 0.001), tissue handling (P < 0.001), overall performance (P < 0.001), and efficiency (P < 0.001). Autonomy did not significantly improve (P = 0.55). Findings were consistent regardless of age, gender, and overall laparoscopic experience of the participants. However, a weaker effect of structured video-assisted coaching was observed in participants with experience in laparoscopic surgery. Conclusion: Structured video-assisted coaching improved performance in laparoscopic skills in complex and stress-inducing bleeding scenarios. The findings of this study support the incorporation of video-assisted coaching and complication management exercises into surgical training curricula. [ABSTRACT FROM AUTHOR]

Background: Nowadays, video-assisted thoracic surgery (VATS) lobectomy represents the treatment of choice for early-stage lung cancer. Over the years, different methods for VATS training have evolved. The aim of this study is to present an innovative beating-heart filled-vessel cadaveric model to simulate VATS lobectomies. Methods: Via selective cannulation of the cadaver heart, the pulmonary vessels were filled with a gel to improve their haptic feedback. An endotracheal tube with a balloon on its tip then allowed movement of the heart chambers, transmitting a minimum of flow to the pulmonary vessels. A simulated OR was created, using all instrumentation normally available during surgery on living patients, with trainees constantly mentored by experienced surgeons. At the end of each simulation, the participants were asked 5 questions on a scale of 1 to 10 to evaluate the effectiveness of the training method ("1" being ineffective and "10" being highly effective). Results: Eight models were set up, each with a median time of 108 min and a cost of €1500. Overall, 50 surgeons were involved, of which 39 (78%) were consultants and 11 (22%) were residents (PGY 3–5). The median scores for the 5 questions were 8.5 (Q1; IQR1–3 8-9), 8 (Q2; IQR1–3 7–9), 9 (Q3; IQR1–3 8–10), 9 (Q4; IQR1–3 8–10), and 9 (Q5; IQR1–3 8–10). Overall, the model was most appreciated by young trainees even though positive responses were also provided by senior surgeons. Conclusions: We introduce a new beating-heart filled-vessel cadaveric model to simulate VATS lobectomies. From this initial experience, the model is cost effective, smooth to develop, and realistic for VATS simulation. [ABSTRACT FROM AUTHOR]

Background: Simulation and video-based assessment (VBA) offer residents the opportunity to develop operative skills while ensuring patient safety. This study aims to determine whether simulation training can predict residents' operative performance, focusing on the gastrojejunal (GJ) anastomosis during robotic pancreatoduodenectomy. Methods: Twenty-seven general surgery residents completed simulated robotic GJ drills and subsequently performed GJs in the operating room (OR). Both simulated and intraoperative performances were video recorded and retrospectively assessed by two blinded graders using the Objective Structural Assessment of Technical Skills (OSATS) scale, time to completion, and occurrence of errors. Intraoperative GJ OSATS scores were compared in cases with and without Clinically Relevant Delayed Gastric Emptying (CRDGE). Statistical analysis was performed using Spearman's rho, Chi-square, and Kruskal–Wallis tests. Results: For simulated GJs, the median OSATS score was 29 (IQR 27–33), time to completion was 30 min (IQR 27–35), and 11 cases had at least one error. Intraoperative GJs had a median OSATS of 30 (IQR 27–31), time to completion of 41 min (IQR 36–51), and errors occurred in nine cases. The OSATS score on the simulated GJs demonstrated a significant positive correlation to the OSATS score on the operative GJs (r = 0.74; p < 0.001) and less time to completion (r = − 0.68; p < 0.001). A shorter simulated GJ completion time significantly correlated with a higher intraoperative OSATS score (r = − 0.52; p < 0.01). Residents with at least one error in the simulated GJs had lower OSATS scores and higher times intraoperatively. Those cases with CRDGE had significantly lower intraoperative OSATS scores than those without CRDGE. Conclusion: Performance on a simulated robotic GJ environment is a robust predictor of OR GJ performance, demonstrating predictive validity. VBA of residents' operative GJ performance is associated with the presentation of CRDGE. Simulation-based training may be crucial to optimizing surgical outcomes before operating on patients. [ABSTRACT FROM AUTHOR]

Introduction: A minimally invasive alternative to surgery for treating pneumothorax has been developed, aiming to reduce risks while maintaining efficacy. This study conducted basic experiments using ex vivo and in vivo pig lung employing a super-thin catheter for treatment. This new device injects fibrin glue directly into the responsible lesion to close the air leak, which has two features: thin design and double-lumen. Methods: The experimental setup involved utilizing trachea and both lung specimens from pigs under positive pressure ventilation. To simulate pneumothorax, artificial fistulas were created on the lung surfaces. The super-thin catheter, guided through a bronchoscope near the fistula, was used to embolize the peripheral bronchus by injecting a fibrin preparation. Then, an air leak test was conducted afterward to assess the efficacy of the treatment. Additionally, a similar pneumothorax model was induced in alive pig under general anesthesia to evaluate its curability. Results: In the extracted pig lungs, embolization was performed in 21 cases, resulting in the cessation of air leaks in 19 cases, corresponding to a 90.5% cure rate. Notably, no major adverse events occurred with the treatment devices. Similarly, in living pigs, pneumothorax was successfully treated, with no recurrence observed up to the seventh postoperative day. Conclusion: The novel treatment device utilizing a super-thin catheter offers a minimally invasive and highly curative option for pneumothorax. These promising results suggest the potential for further development and human clinical trials, which could revolutionize the treatment of pneumothorax, reducing risks and improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal Membrane Oxygenation (ECMO) is a high-risk, low-volume procedure requiring repetition, skill and multiple disciplines with fidelity of communication. Yet many barriers exist to maintain proficiency and skills with variable cost and fidelity. We designed and implemented a low-cost monthly ECMO simulation and hypothesized providers would have increased familiarity and improved teamwork. We also review some key elements of cost, fidelity and evaluation of effectiveness. Methods: A structured, 1-hour ECMO simulation was performed on a customized mannikin on a monthly basis in 2022. Qualitative surveys were administered to each member post-simulation. Answers were categorized by theme, including satisfaction of patient care, evaluation of self and team dynamics, and areas for improvement. Results: Most participants were satisfied with their ability to take care of the patient, with common themes of communication and coordination of roles. Identified areas of improvement were mostly limited to technical skills, and soft skills such as communication and teamwork. Conclusions: We designed and implemented a low-cost, monthly and multi-disciplinary ECMO simulation program with overall positive feedback and identified areas for improvement. There remains variability in cost, fidelity and evaluation of performance and retention. There may be a need to create guidelines for ECMO simulation training that can be applied at all institutions utilizing ECMO for patient care. [ABSTRACT FROM AUTHOR]

Background: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care–associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature. Objective: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital. Methods: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting. Results: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience. Discussion: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures. Conclusions: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients. [ABSTRACT FROM AUTHOR]

Heightened stress during air pistol competitions may impair shooters' abilities to maintain gun stability, resulting in inferior performance. This study aimed to compare the pre-trigger muscle activation levels of upper muscles in 10-m air pistol shooters between training and simulated competition conditions. Seven sub-elite shooters from the Singapore National Youth Air Pistol Team shot 30 shots in a training versus simulated competition condition in randomised orders on separate days. Muscle activation for the forearm and shoulder muscles, namely extensor carpi radialis, flexor carpi ulnaris, anterior deltoid, and posterior deltoid, were recorded using electromyography (EMG). Shooting performance was evaluated by total shot scores. Stress level was monitored via heart rate and the Mental Readiness Form-3. No statistically significant differences were found in EMG, performance, or stress-related variables between conditions, although moderate-to-large effect sizes were observed in some muscle activation and self-reported stress indicators. Analysis of individual performances using smallest worthwhile change showed that two participants improved under the simulated competition condition, while two declined, and three remained unaffected. In conclusion, sub-elite youth air pistol shooters were able to exhibit good neuromuscular control under high anxiety situations and thus their performance was largely unaffected. [ABSTRACT FROM AUTHOR]

Ice hockey is a fast-paced sport with a high incidence of collisions between players. Shoulder checks are especially common, accounting for a large portion of injuries including concussions. The forces generated during these collisions depend on the inertial and viscoelastic characteristics of the impacting bodies. Furthermore, the effect of shoulder pads in reducing peak force depends on the baseline (unpadded) properties of the shoulder. We conducted experiments with nine men's ice hockey players (aged 19–26) to measure their effective shoulder stiffness, damping and mass during the impact stage of a shoulder check. Participants delivered a style of check commonly observed in men's university ice hockey, involving lateral impact to the deltoid region, with the shoulder brought stationary by the collision. The effective stiffness and damping coefficient of the shoulder averaged 12.8 kN/m and 377 N-s/m at 550 N, and the effective mass averaged 47% of total body mass. The damping coefficient and stiffness increased with increasing force, but there was no significant difference in the damping coefficient above 350 N. Our results provide new evidence on the dynamics of shoulder checks in ice hockey, as a starting point for designing test systems for evaluating and improving the protective value of shoulder pads. [ABSTRACT FROM AUTHOR]

Simulation is an established transformational and experiential learning strategy in health education, drawing on creative and innovative teaching techniques. This article discusses a large-scale unfolding case study using real-time simulation with a multiprofessional facilitation team, to explore how using several simulation techniques can provide a rich learning experience for both midwifery students and their facilitators. Many midwifery students find the application of theoretical learning to practice settings a challenge, and report lacking confidence in certain elements of clinical practice, which can become more concerning in the latter stages of their training. By using multiple approaches with a student-centred outlook, this immersive simulation event positively impacted students' clinical confidence and assurance in their assessment skills, and enabled them to feel more fully prepared for everyday midwifery practice. [ABSTRACT FROM AUTHOR]

Tropospheric ozone is an air pollutant that poses a public health problem in Europe. Climate change could increase the formation of ozone. Applying past and predicted annual total (all-cause) mortality data and modeled daily ozone concentrations, we performed a nationwide health impact assessment estimating annual ozone-related (attributable) deaths in Austria. Different approaches were compared. Estimates were based on maximal 1-h averages of ozone. Until the decade from 2045 till 2055, more people will die in Austria because of the demographic trends. Therefore, more deaths will also be attributable to ozone. Higher greenhouse gas emission scenarios (e.g. Representative Concentration Pathway RCP8.5 compared to RCP2.6) will lead to more ozone-related deaths, mostly due to the national emission of ozone precursors (a difference of 250–340 cases per year, depending on the model), but to a lesser extent because of global climate change. Increases in attributable deaths will be affected mostly by national, not global mitigation measures. National emission reduction will certainly have a strong and beneficial effect on local atmospheric chemistry, air quality, and public health. [ABSTRACT FROM AUTHOR]

The multidimensional forced-choice (MFC) format is an alternative to rating scales in which participants rank items according to how well the items describe them. Currently, little is known about how to detect careless responding in MFC data. The aim of this study was to adapt a number of indices used for rating scales to the MFC format and additionally develop several new indices that are unique to the MFC format. We applied these indices to a data set from an online survey (N = 1,169) that included a series of personality questionnaires in the MFC format. The correlations among the careless responding indices were somewhat lower than those published for rating scales. Results from a latent profile analysis suggested that the majority of the sample (about 76–84%) did not respond carelessly, although the ones who did were characterized by different levels of careless responding. In a simulation study, we simulated different careless responding patterns and varied the overall proportion of carelessness in the samples. With one exception, the indices worked as intended conceptually. Taken together, the results suggest that careless responding also plays an important role in the MFC format. Recommendations on how it can be addressed are discussed. [ABSTRACT FROM AUTHOR]

Simulation-based education (SBE) is common in healthcare education and is increasingly being incorporated in preclinical curriculum. Preclinical students typically have had little exposure to the clinical setting (i.e. hospital patient rooms, equipment) and often feel uncomfortable when first placed in the simulated clinical environment. Prebriefing, a standard of best practice in simulation, prepares learners for simulation exercises. To successfully integrate SBE in preclinical education, we recommend expanding the prebriefing to include: multiple activities that orient learners to the learning space and the structure of a simulation activity, the goals of simulation as a learning process, faculty modeling of a simulated patient encounter, and expected learner outcomes. This approach increases student familiarity with the simulation learning environment and performance expectations, which can reduce cognitive load and improve learning outcomes. We describe 12 tips for increasing the scope of the prebriefing to promote effective learner participation and development during preclinical SBE. [ABSTRACT FROM AUTHOR]

The Coronavirus Disease 2019 (COVID-19) has caused massive losses for the global economy. Scholars have used different methods to study the transmission mode and influencing factors of the virus to find effective methods to provide people with a healthy built environment. However, these studies arrived at different or even contradictory conclusions. This review presents the main research methodologies utilized in this field, summarizes the main investigation methods, and critically discusses their related conclusions. Data statistical analysis, sample collection, simulation models, and replication transmission scenarios are the main research methods. The summarized conclusion for prevention from all reviewed papers are: adequate ventilation and proper location of return air vents, proper use of personal protective equipment, as well as the reasonable and strict enforcement of policies are the main methods for reducing the transmission. Recommendations including standardized databases, causation clarification, rigorous experiment design, improved simulation accuracy and verification are provided. [ABSTRACT FROM AUTHOR]

The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations. [ABSTRACT FROM AUTHOR]

Conversation AI such as ChatGPT is a disruptive technology that has the potential to influence the field of counseling. The present article examines how AI based chatbot ChatGPT can be used by counselor educators in helping counselors-in-training practice counseling skills through role play. The author developed a model, ChatGPT Client Simulation (CCS), to support counselors-in-training learn and practice counseling skills. The CCS model can be used both in synchronous online as well as in-person counseling courses. [ABSTRACT FROM AUTHOR]

Background: Patient-centred care must consider service consumers' needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain. Objectives: The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students. Design: a one-group pre-postintervention design with no control group was conducted. Methods: A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings. Results: A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction. Conclusions: The educational 9-month intervention was effective in reducing students' stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities. [ABSTRACT FROM AUTHOR]

Introduction: At the beginning of the COVID-19 pandemic, student placements in the Master of Music Therapy at the University of Melbourne were rapidly redesigned to create alternative online opportunities. Two online placement models; a simulated practicum (or SimPrac) and telehealth placement; were arranged. With little previous literature to draw upon, data was gathered to explore student and supervisor experiences of online placements and develop understanding of pedagogical considerations to inform future planning. Methods: Quantitative data were collected via an adapted Satisfaction with Simulation Experience Scale (SSES) and qualitative data via open-ended survey questions and semi-structured focus group interviews. Results: SSES results indicated high satisfaction from all cohorts with the online placement experience. Qualitative analysis led to the development of four pedagogical considerations for supporting student learning: Respond to Context with Creativity and Flexibility; Scaffold Student Learning; Foster Peer Relationships; and Supplement Online Learning. Discussion: Findings aligned with recent scholarship in the wider field of Work Integrated Learning (WIL) and indicate a need for questioning prevailing modes of music therapy placement delivery in line with the contemporary context. While online placements were not always understood to provide authentic music therapy experiences, this perspective may need further contemplation given the ongoing need for online music therapy service provision. [ABSTRACT FROM AUTHOR]

The Competencies and Recommendations for Educating undergraduate Nursing Students (CARES) was originally designed for nursing students' palliative and end-of-life care education. The competencies were later revised to align with the 2021 American Association of Colleges of Nursing Essentials core competencies for baccalaureate nursing education. This project aimed to (1) review the courses in an accelerated baccalaureate nursing program for alignment with CARES, (2) determine any gaps, and (3) make program recommendations. The CARES competencies and Essentials were mapped according to the nursing program's 12 core curriculum courses and evaluated. Three CARES competencies were not met, and 12 were partially met. Areas of improvement were identified across the curriculum. Results of the mapping included palliative concepts needing earlier program introduction, reflective journaling was recommended for clinical practice courses, and incorporation of palliative care simulations was proposed to bridge the gaps. [ABSTRACT FROM AUTHOR]

Background/objectives: International guidelines recommend cardiopulmonary resuscitation [CPR] training every sixth month. However, research indicates that more training is needed to maintain CPR competence. The objectives of this pilot study were (a) to assess health personnel's self-reported competence and need for more training in CPR before and after interprofessional in situ CPR simulation and (b) to assess time since the last CPR course and respondent's reported need for more training. Also, we wanted a pilot to assess areas of improvement in a future, larger study. Methods: A questionnaire was administered to healthcare personnel in hospital wards receiving CPR training using a purposeful sampling strategy. Results: In total, 311 respondents answered the pre-intervention and 45 respondents answered the post-intervention survey. The respondents believed they had good knowledge, skills, and training in CPR, and about 2/3 of the respondents reported a need for more knowledge, skills, and training. There was a weak positive correlation between the time since the last CPR course and the perceived need for more training [p < 0.05]. There were no significant differences in self-reported competence or perceived need for more training pre- and post-intervention. The pilot detected several limitations that need improvement in a future study. Conclusions: The authors suggest that regular training is important for maintaining competence in CPR. Also, in a future study, comparisons at an individual level, as well as assessments by experts and of non-technical skills, should be included. [ABSTRACT FROM AUTHOR]

Background: Japan's rising health expenditure, driven by an aging population, coincides with growing demands for increased spending. Reducing smoking-related costs could alleviate the burden on the health care system. Despite efforts to promote smoking cessation, success has been limited, indicating a need for strategies beyond cessation. Methods: Using a status quo simulation based on hospital resource data from the Japanese Ministry of Health, Labor, and Welfare, we examine the impact of heated tobacco products (HTPs) on the prevalence of four smoking-attributable diseases (chronic obstructive pulmonary disease, ischemic heart disease, stroke, and lung cancer) and the related direct health care costs. The baseline scenario assumes a 50% switch from combustible cigarettes to HTPs, with a 70% risk reduction. A sensitivity analysis was conducted to assess the effects of parameter variations. Results: If 50% of smokers replaced combustible tobacco products with HTPs, 12 million patients could be averted equivalent to JPY 454 billion in health care savings. Prefectures located in the north and south of Japan would benefit the most. Conclusions: Considering the heterogeneous prevalence rates, a one-size-fits-all tobacco control approach is ineffective. Japan should prioritize cost-efficient measures that promote public health and economic benefits. Encouraging smokers to switch to reduced-risk products, raising awareness of health risks, and adopting a harm-based taxation model can drive positive change. Public–private partnerships can further enhance harm reduction efforts. With a combination of tax reforms, revised regulations, collaborations, and ongoing research, Japan can create a more effective and comprehensive approach to tobacco control. [ABSTRACT FROM AUTHOR]

BACKGROUND: The effects of traffic sign information volume (TSIV) on the visual characteristics and workload of novice and experienced drivers were investigated in this study. TSIV plays a crucial role in road traffic safety, and understanding its impact on drivers is essential for designing effective traffic sign systems. OBJECTIVE: This research aimed to compare the visual characteristics and workload of novice and experienced drivers under varying TSIV doses through simulated driving tests. The objective was to provide insights for optimizing the design of road TSIV. METHODS: Six TSIV levels were considered: S0, S1, S2, S3, S4, and S5, representing different workload levels. Participants, including both novice and experienced drivers, were involved in simulated driving scenarios with varying TSIV levels. Eye movement data was collected using an eye tracker device. The study was conducted in China, and appropriate driving simulators and equipment were utilized. RESULTS: The findings revealed several valuable results. Experienced drivers exhibited a higher proportion of saccade behavior in the 30–90 ms time period and did not show rapid saccade behavior during the 0–30 ms period, indicating superior visual search strategies. Both novice and experienced drivers demonstrated improved visual cognitive abilities at the S3 level of TSIV, which corresponds to normal and safe driving conditions. Furthermore, a majority of both groups had saccade amplitudes in the range of 0°–4°, with experienced drivers showing a slightly higher proportion. About 82% of experienced drivers had saccade behavior within the range of 0°–2°, compared to 75% of novice drivers. CONCLUSIONS: The study concludes that the S3 level of TSIV, corresponding to 30 bits/km, is optimal for both novice and experienced drivers. This level promotes better visual performance and reduces visual workload, indicating that drivers' information acquisition capacity and visual search strategies are maximized while keeping the workload associated with driving at a minimum. These findings have significant implications for enhancing driving safety. [ABSTRACT FROM AUTHOR]

Background: Hot debriefing occurs shortly after simulations or real-life events, whereas cold debriefings occur after 24 hours. This integrative review examined the effects of hot versus cold debriefing after simulation on prelicensure students. Method: Whittemore and Knafl's five-stage method was followed. Databases searched included PubMed, CINAHL, Scopus, and PsycINFO. The inclusion criteria were studies published in English that involved prelicensure nursing students and measured the effect of hot or cold debriefing. Results: Themes emerged from 10 studies and included clinical judgment and decision making, knowledge and skills, participant experiences, reflection, and psychological safety and self-efficacy. Conclusion: Hot debriefing was preferred by participants, but cold debriefing resulted in higher knowledge and skills scores. In addition, students in the cold debriefing group were more conformable and in a safe environment compared with the hot debriefing group. Drawing a strong conclusion was difficult due to heterogeneity in study designs and methods. [J Nurs Educ. 2024;63(10):653–658.] [ABSTRACT FROM AUTHOR]

Background: Examining nursing students' perceptions of prebriefing and what components are most effective in preparation for simulation may help standardize prebriefing and enhance learning experiences. Method: This qualitative descriptive study explored the perceptions of prebriefing, prework assignments, and what methods of prebriefing increased self-confidence when undergraduate nursing students participated in simulation. An inductive approach to content analysis was used to interpret the data. Results: Two themes that emerged from the data were preparation is essential to simulation success and preparation is essential to future success. Additionally, five subthemes were identified: understanding content in advance, logistical clarity, well-prepared students are invested, increased self-confidence, and pride in education and learning. Conclusion: Prebriefing is essential to simulation and undergraduate nursing student success. Although prebriefing practices vary between educators, undergraduate nursing students valued prework and expressed a preference for written assignments. Overall, students perceived prework as increasing their self-confidence during simulation. [J Nurs Educ. 2024;63(10):693–697.] [ABSTRACT FROM AUTHOR]

Prolonged standing in surgery has been linked to an increased risk of musculoskeletal disorders. The aim of this study was to determine whether sitting could serve as an alternative work posture in laparoscopic procedures. Twenty medical students in their third and fourth years were recruited. Sitting and standing were compared at two task complexity levels on a laparoscopic surgery simulator. Measured variables included user posture preferences, perceived discomfort, performance and biomechanics. Electromyography data from the upper trapezius and erector spinae muscles were analysed. Results showed that posture did not affect surgical performance and erector spinae muscle activation. Sitting showed higher muscle activation at the trapezius muscles; however, perceived discomfort was unaffected. Most participants preferred sitting for the difficult task and standing for the easy task. Findings showed that sitting, with appropriate seat design considerations, could serve as an alternative or even as a preferred work posture for simulated laparoscopic procedures. Practitioner Summary: Prolonged standing in surgery has been linked to increased musculoskeletal disorder risks. This study investigated sitting as a potential alternative work posture to standing. Both postures were tested during simulated laparoscopic procedures. Results showed that sitting can serve as an alternative or even preferred work posture for simulated laparoscopic surgery. [ABSTRACT FROM AUTHOR]

This study investigated the number of operator errors, task completion time, and workload of subjects at different levels by imposing conditions such as focused text boldness, noise disturbance, and time pressure to simulate a realistic cloud change business process in the laboratory. Results of the study showed that the text bolding of important content reduced the number of errors, whereas noise interference increased the number of errors. Text boldness only reduced the number of corrected errors, and noise interference only increased the number of uncorrected errors. Moreover, bolding was found to have different effects on the number of errors under different noise levels and time pressure levels, with text boldness significantly reducing the number of total errors only in quiet or low time pressure states. Time pressure had no effect on cloud change task error counts, but high time pressure resulted in higher subjective workload. Practitioner Summary: Operator error is one of the main causes of service failure, and reducing operator error in cloud change operations is of practical importance. In this study, we found focused text boldness could reduce operator errors, while noise could increase the number of errors. High time pressure would lead to a high workload. [ABSTRACT FROM AUTHOR]

The visual approach is the most accident-prone phase of a flight, especially in low-visibility conditions. This preliminary study aimed to examine the effects of flight experience on pilots' decision-making and visual scanning pattern in low-visibility approaches. Twenty pilots were separated into two groups based on their flight experience and completed the high- and low-visibility approaches in balanced order using a high-fidelity flight simulator. Pilots' mental workload and visual scanning patterns were recorded via an eye tracker. The results showed that, compared to less flight-experienced pilots (20%, 3/15), experienced pilots (80%, 4/5) were more likely to make go-around decisions in the low-visibility approaches. Furthermore, they exhibited a more flexible and adaptable visual scanning pattern by quickly shifting their attention, as evidenced by decreased fixations and increased saccades. These findings suggest that the integration of visual scanning strategy and training solution with a marginally meteorological approach may enhance decision-making safety for novice pilots. PRACTITIONER SUMMARY: This study investigates the 'expertise effects' in visual scanning pattern, mental workload and decision-making among pilots with different levels of flight experience in a modern flight simulator. For safer decision-making, less flight-experienced pilots should enlarge their visual scanning span in a more unburdened manner, especially in low-visibility approaches. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effect of a simulation game called "The Ward" on reflective thinking skills of senior nursing students. Methods: A convergent mixed methods parallel research design was conducted between February-April 2018. The sample for this study was a convenience sample (n = 23) of senior nursing students. Student Information Form, Reflective Thinking Scale and a structured interview form were used as data collection tools. During study, simulation game was played once a week for seven weeks. Descriptive statistics (frequency, percentage, mean) were used for analyzing data, t test for dependent groups tests were applied to determine differences within group and qualitative data was analyzed with content analysis. Results: After playing the simulation game, nursing students' reflective thinking scores (pre-test = 39.70 ± 5.15; post-test = 67.39 ± 8.13) increased significantly (p < 0.05). It was found students noticed their shortcomings and mislearnings by comparing their existing knowledge in setting of teamwork and cooperation created by the game, and consequently students' motivation increased or decreased. The teamwork and collaboration created with in the simulation game caused students to gain self-confidence, to expand their perspectives, to develop effective decision-making skills, to increase their motivation, to discover their own incomplete knowledge, skills or mislearnings. Conclusions: These results support that the simulation games can be used to improve reflective thinking level of students. This finding shows that nursing education curriculum needs to be restructured using new methods such as simulation games aimed at improving students' reflective thinking skills. In this direction nurse educators should be involved with policy making and policy makers to develop strategies to ensure that graduated nursing students should gain reflective thinking skills. In addition nurse executives should encourage using simulation and simulation games in service training to improve nurses' reflective thinking skills and life long learning. [ABSTRACT FROM AUTHOR]