Delivering a Home-Based Exercise Program to Youth With Osteogenesis Imperfecta: Protocol for a Comparative-Approach Study.

BACKGROUND: Osteogenesis imperfecta (OI) is a rare bone fragility disorder associated with muscle weakness. Individuals with OI may therefore benefit from exercise interventions aiming to improve muscle and bone strength. Given the rarity of OI, many patients do not have access to exercise specialists who are familiar with the disorder. As such, telemedicine, the provision of health care through technology to provide care at a distance, may be well suited for this population. OBJECTIVE: The main objectives are (1) to investigate the feasibility and cost-effectiveness of 2 telemedicine approaches for the delivery of an exercise intervention for youth with OI and (2) to assess the impact of the exercise intervention on muscle function and cardiopulmonary fitness in youth with OI. METHODS: Patients with OI type I (the mildest form of OI; n=12, aged 12-16 years) from a pediatric orthopedic tertiary hospital will be randomized to receive a 12-week remote exercise intervention in either (1) a supervised group (n=6), monitored every session, or (2) a follow-up group (n=6), receiving monthly progress update appointments. Participants will undergo the following pre- and postintervention evaluations: sit-to-stand test, push-up test, sit-up test, single-legged balance test, and a heel-rise test. Both groups will be given the same 12-week exercise regimen, which includes cardiovascular, resistance, and flexibility training. For each exercise training session involving the supervised group, a kinesiologist will provide instructions to participants through live video sessions using a teleconferencing application. On the other hand, the follow-up group will discuss their progress with the kinesiologist every 4 weeks over a teleconferencing video call. Feasibility will be assessed by recruitment, adherence, and completion rates. A cost-effectiveness analysis of both approaches will be computed. Changes in muscle function and cardiopulmonary fitness will be examined between the 2 groups, pre- and postintervention. RESULTS: It is anticipated that the supervised group will have higher adherence and completion rates compared to the follow-up group, which may be associated with greater physiological benefits; however, it may not be as cost-effective compared to the follow-up approach. CONCLUSIONS: By determining the most feasible telemedicine approach, this study may serve as a basis for providing increased access to specialized adjunct therapies for individuals with rare disorders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40262.

Medical students as simulation educators: students' experience of a 7-week simulation-based education rotation.

Medical students will have future roles as clinician educators, and need to develop knowledge and skills for that role. Specific skills in simulation-based education (SBE) may be valuable in many educational settings. We aimed to understand the impact of a 7-week placement in SBE on the development of medical students' knowledge, skills and perspectives as educators. We reviewed the experience of three graduated students (also coauthors of this article) who participated in the rotation in 2018. This case study includes analysis of the students' electronic portfolios, rotation reports and subsequent reflections of the student coauthors. Five themes were identified:-'Development as a professional', 'Active participation in an educator team', 'Diverse experience in simulation skills and techniques', 'Role models and mentoring' and 'Rethinking feedback'. Students describe the development of practical knowledge and skills, and more fundamental reflections on the nature of learning, feedback and their personal professional development. We suggest that integration of a simulation education elective within a medical school curriculum helps build capacity for effective SBE delivery, and has positive impacts on students for their future roles as doctors, educators and lifelong learners.

To help or punish in the face of unfairness: men and women prefer mutually-beneficial strategies over punishment in a sexual selection context.

Consistent with a sexual selection account of cooperation, based on female choice, men, in romantic contexts, in general display mutually-beneficial behaviour and women choose men who do so. This evidence is based on a two-choice-architecture (cooperate or not). Here we extend this to include punishment options using a four-choice-architecture ('punishing a transgressor', 'compensating a victim', 'both punishing and compensating' or 'doing nothing'). Both compensation (a self-serving mutually-beneficial behaviour) and self-serving punishment, are associated with positive mate qualities. We test which is preferred by males and chosen by female undergraduates. We further explore effects of trait empathy and political ideology on these preferences. In a series of three studies using a third-party punishment and compensation (3PPC) game we show (Study One), that romantically-primed undergraduate males, express a preference to either 'compensate' or 'both compensate and punish', and undergraduate women find males who 'compensate' or 'compensate and punish' the most attractive (Studies Two and Three). Compensating men are perceived as compassionate, fair and strong by undergraduate women (Study Three). High trait empathy (Studies One and Three) and a left-wing political ideology (Study Three) are associated with a preference for compensation. Thus, self-serving mutually-beneficial behaviour can be preferred over self-serving punishment as a signal of mate quality in undergraduates. Implications for the evolution of cooperation are discussed with respect to sexual selection.