Preliminary Danish Norms for the Odense Child Trauma Screening (OCTS).

The Odense Child Trauma Screening (OCTS) is Danish story stem screening tool applicable for assessment of preschoolers and young children in risk of being traumatized. Having shown initial evidence of validation, Danish norms are needed to strengthen the clinical assessment with the OCTS by serving as a baseline comparison for assessment of potentially traumatized children. We tested 169 children from the Danish general population aged 4-8 with the OCTS and investigated sex and age differences in play-based behavior and narrative representations. Caregivers reported electronically on child demographic information, psychosocial functioning, and history of trauma exposure using The Strengths and Difficulties Questionnaire (SDQ) and The Diagnostic Infant and Preschool Assessment (DIPA) trauma list. Across the 145 scores of the OCTS coding scheme, significant sex and age differences were only found in five and sixteen scores respectively. In the five codes where significant sex differences were observed, boys' normative scores were higher. No significant sex differences were found in the partial story scores or the OCTS total score. Three significant age differences in partial story and OCTS total scores emerged with 4-year-olds scoring higher than 6-8-year-olds. We further found 13 significant age differences in code scores with higher scores among the youngest of the two groups in question suggesting that scores tend to decrease along older age. Few significant sex and age differences were found in children's OCTS play-based behavior and narrative representations. Indicative of few sex and age biases of the OCTS coding scheme and stories, results suggest that the OCTS can be applied across the intended target group of children aged 4 to 8 years. As higher scores were found in the younger age groups, clinicians should be attentive to age in certain codes of the OCTS coding scheme in their assessment of children in clinical practice. The preliminary normative scores must be interpreted and clinically applied with caution due to our non-representative sample and lack of analyses on factors potentially influencing children's responses to the OCTS (e.g., developmental, contextual, cultural factors). Supplementary Information: The online version contains supplementary material available at 10.1007/s40653-024-00616-7.

Effect of the Partners in Play Intervention on Parents' Autonomy-Supportive Guiding Behaviour and Children's Self-Regulation.

Compelling evidence supports the foundational importance of early self-regulation (SR). It also supports parents in the home environment as having the foremost influence on early development. Yet, prevailing approaches to support early SR growth have tended to leverage early education and clinical settings. Partners in Play (PiP) was developed as a sustainable approach for parents to learn how and when to support children through experiences of self-regulation challenges in the home learning environment. This study reports the first randomised control trial evaluation of the PiP program, with 21 parent-child dyads (consisting of twelve girl-mother dyads, eight boy-mother dyads, and one boy-father dyad; mean child age = 4.12 years, SD = 0.65). Dyads were randomised to a PiP intervention group (n = 10), which entailed four online parent information sessions and four out-of-home guided practice dyadic play sessions across 8 weeks, or an active control group (n = 11). The primary outcome was parent autonomy support, and the secondary outcome was child SR. Results indicated a significant increase in parents' use of autonomy support and a non-significant but moderate-sized effect on child SR. This innovative proof-of-concept program and evaluation provides a roadmap for effecting change in parental support during children's play, to the prospective benefit of important abilities such as child SR. Analyses show promise for a parent-based model toward parent behaviour change and child SR improvement.

Chemsex Session Typologies and Associated Sociodemographic Factors in Sexual Minority Men: Latent Class Analysis From a Cultural Perspective Using a Cross-Sectional Survey.

Background: Chemsex prevalence is still not well known, and both the lack of homogeneity and cultural component of chemsex practices are usually overlooked. Objective: This study aims to estimate the proportion of sexual minority men (SMM) engaging in chemsex sessions, while understanding the cultural dimension of chemsex, and to analyze distinct session typologies with potential risk differences and the sociodemographic factors associated with engaging in them. Methods: A total of 5711 SMM residing throughout Spain participated in an anonymous web-based survey that assessed chemsex session engagement and characteristics, drug use, and sociodemographic variables. We measured the association of sociodemographic factors with engaging in chemsex sessions by calculating adjusted prevalence ratios, using multivariate Poisson regression analysis. Chemsex typologies were analyzed using latent class analysis, and sociodemographic factors were associated with the different risk classes. Results: Our results determined that 21.1% (1205/5711; 95% CI 20.0%-22.1%) of SMM engaged in chemsex sessions during their lifetime. Participating in sessions was significantly associated with being a migrant, not having a comfortable financial situation, openly living their sexuality, residing in bigger municipalities, older age, using steroids, and living with HIV (adjusted prevalence ratio: range 1.17-2.01; all P values <.05). Three typologies of sessions with different risks were identified with latent class analysis, with 23.2% of SMM engaging in sessions taking part in higher-risk ones, which was associated with younger age, using steroids, living in bigger municipalities, openly living their sexuality, and living with HIV, compared to SMM engaging in lower-risk sessions (odds ratio: range 2.75-4.99). Conclusions: Chemsex is relatively common among SMM in Spain, but it is important to differentiate typologies of sessions with varying risks, and the proportion of SMM engaging in high-risk sessions is low. Chemsex is highly associated with sociodemographic factors. Chemsex should be prioritized in public health programs, which should consider the different forms of sessions with their varying risks and prevalence, while also considering the cultural dimension inherent to chemsex.

Feminization of social play behavior depends on microglia.

Many sex differences in brain and behavior are established developmentally by the opposing processes of feminization and masculinization, which manifest following differential steroid hormone exposure in early life. The cellular mechanisms underlying masculinization are well-documented, a result of the fact that it is steroid-mediated and can be easily induced in newborn female rodents via exogenous steroid treatment. However, the study of feminization of particular brain regions has largely been relegated to being "not masculinization" given the absence of an identified initiating trigger. As a result, the mechanisms of this key developmental process remain elusive. Here we describe a novel role for microglia, the brain's innate immune cell, in the feminization of the medial amygdala and a complex social behavior, juvenile play. In the developing amygdala, microglia promote proliferation of astrocytes equally in both sexes, with no apparent effect on rates of cell division, but support cell survival selectively in females through the trophic actions of Tumor Necrosis Factor α (TNFα). We demonstrate that disrupting TNFα signaling, either by depleting microglia or inhibiting the associated signaling pathways, prevents the feminization of astrocyte density and increases juvenile play levels to that seen in males. This data, combined with our previous finding that male-like patterns of astrocyte density are sculpted by developmental microglial phagocytosis, reveals that sexual differentiation of the medial amygdala involves opposing tensions between active masculinization and active feminization, both of which require microglia but are achieved via distinct processes.

Developmental trends in young children's device-measured physical activity and sedentary behaviour.

BACKGROUND: Knowledge of developmental trends in meeting age-specific 24-hour movement behaviour guidelines is lacking. This study describes developmental trends in device-measured physical activity and sedentary time over a three-year period among Western Australian children aged two to seven years, including differences between boys and girls. The proportion of children meeting age-specific physical activity guidelines before and after they transition to full-time school was also examined. METHODS: Data from waves 1 and 2 of the Play Spaces and Environments for Children's Physical Activity (PLAYCE) cohort study were used (analysis n = 1217). Physical activity and sedentary time were measured by accelerometry at ages two to five (preschool, wave 1) and ages five to seven (commenced full-time school, wave 2). Accelerometer data were processed using a validated machine-learning physical activity classification model. Daily time spent in sedentary behaviour, energetic play (moderate-to-vigorous physical activity (MVPA)), total physical activity, and meeting physical activity guidelines were analysed using linear and generalised linear mixed-effects models with age by sex interaction terms. RESULTS: All movement behaviours changed significantly with increasing age, and trends were similar in boys and girls. Total daily physical activity increased from age two to five then declined to age seven. Mean daily total physical activity exceeded 180 min/day from ages two to five. Daily energetic play increased significantly from age two to seven, however, was below 60 min/day at all ages except for seven-year-old boys. Daily sedentary time decreased to age five then increased to age seven but remained lower than at age two. All two-year-olds met their age-specific physical activity guideline, decreasing to 5% of girls and 6% of boys at age four. At age seven, 46% of boys and 35% of girls met their age-specific physical activity guideline. CONCLUSIONS: Young children's energetic play and total physical activity increased with age, but few children aged three to seven met the energetic play (MVPA) guideline. Interventions should focus on increasing children's energetic play in early childhood. Clearer guidance and strategies are needed to support young children as they change developmentally and as they transition from one age-specific movement guideline to the next.

Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training.

BACKGROUND: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. OBJECTIVE: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. METHODS: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses' performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. RESULTS: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94%) and White (n=13, 72%). Of the 17 nurses who started the training, 82% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (≥14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). CONCLUSIONS: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/33695.

A Qualitative Study on the Impact and Feasibility of a Simulation-Based Program for Shared Decision-Making in Non-Small Cell Lung Cancer Care.

BACKGROUND: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. METHODS: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. RESULTS: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. CONCLUSIONS: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

Child play and caregiver support to promote convalescence following severe acute malnutrition in Zimbabwe: The Tamba-SAM pilot study.

Children hospitalised for severe acute malnutrition (SAM) have a high risk of mortality, relapse and rehospitalisation following hospital discharge. Current approaches fail to promote convalescence, or to address the underlying social determinants of SAM, meaning that restoration of long-term health, growth and neurodevelopment is not achieved. Although guidelines recommend play and stimulation to promote recovery, most caregivers are not supported to do this at home. We set out to evaluate the feasibility and acceptability of a codesigned intervention package aimed at providing child stimulation through play, and strengthening caregiver capabilities through problem-solving skills, peer support and income-generating activities. We evaluated the intervention in two phases, enroling 30 caregiver-child pairs from paediatric wards in Harare, Zimbabwe, once children who had been hospitalised with SAM were ready for discharge. Children were median 17.8 months old, and 28.6% had human immunodeficiency virus. Trained intervention facilitators (IFs)-lay workers whose own children had previously had SAM-delivered the intervention over 12 weeks with nurse supervision. Qualitative interviews with caregivers and IFs showed that the intervention was feasible and acceptable. Participants reported benefiting from the psychosocial support and counselling, and several started income-generating projects. Caregivers appreciated the concept of play and caregiver-child interaction, and all reported practising what they had learned. By Week 12, caregiver mental health and caregiver-child interaction improved significantly. Overall, the intervention was feasible, acceptable and showed promise in modifying caregiver knowledge, attitudes and practice. An efficacy trial is now needed to evaluate whether the intervention can improve child convalescence following complicated SAM.

Synchrony within, synchrony without: establishing the link between interpersonal behavioural and brain-to-brain synchrony during role-play.

Interpersonal synchrony is a crucial construct in understanding social interactions, which has been used in clinical studies to measure the quality of the therapeutic alliance. However, there is a lack of studies investigating the correlation between synchrony expressed on different levels: behavioural and neurophysiological. Furthermore, there are no studies that examine how the implementation of psychodramatic role-playing techniques, when individuals adopt the persona of a different character, may influence intrinsic biobehavioural synchrony between two parties. The present study, therefore, aims to uncover the relationship between behavioural and brain-to-brain synchrony across different role-playing techniques and elucidate the impact of these synchronies on participants' levels of anxiety and empathy. By using functional near-infrared imaging and behavioural coding in a dyadic role-playing paradigm (n = 41 dyads), the study found correlations between behavioural and brain-to-brain synchrony during naturalistic conversations, but not during role-play, implying a qualitative change in interpersonal synchrony when implementing role-playing techniques. Additionally, the study noted significant contributions of both behavioural and brain-to-brain synchrony as well as peripheral factors such as dyadic sex make-up and role immersion in predicting dyadic anxiety and empathy changes. Findings call for future studies to consider role-playing scenarios as a qualitatively different form of social interaction.

Creative puppet therapy reduces hallucinations in patients diagnosed with schizophrenia: Preliminary findings.

Anomalous experiences and hallucinations characterize schizophrenia. This study aimed at determining the efficacy of creative puppet therapy (CPT; creation of a puppet with malleable DAS) to reduce severe anomalous experiences and hallucinations among patients diagnosed with schizophrenia. Double-blinded, controlled trials were performed on a convenience sample of 24 patients from a mental health center. The intervention group of 12 patients (who created puppets) and the pseudo-treatment group of 12 patients (who were involved in outdoor leisure trips) were compared to the control group of 12 control participants (who created puppets). Cardiff Anomalous Perceptions Scale (CAPS) assessed hallucinations; Emotional Expression Inventory (EEXI) assessed the emotional expression of one's own puppet. Puppet facial features were measured. Results showed that CPT effectively reduced (d = -4.00) hallucination frequency in patients. Hallucination reduction occurred across all sensory modalities, but touch and bodily interoception. Exteroceptive vs. interoceptive hallucinations was the most valuable classification in patients. Compared to controls, puppets created by patients expressed more negative emotions and had larger eye diameters, shorter noses, and larger whole face width. Eye diameter was correlated with fear, sadness, anger, and disgust, and whole face width with boredom. Fragmented-self integration of schizophrenia through CPT treatment might exploit aggregative dominance of the patient's own body.

The role of the play therapist in supporting children and families following a natural disaster: A scoping review.

BACKGROUND: The predicted rise in weather-related disasters indicates that many Australian children and their families will be affected by these events in the future. Play therapy, an emerging profession in Australia, may provide valuable support to children exposed to these events. METHODS: A scoping review was designed to map the existing literature and the role of the play therapist in supporting children (aged 3-12 years) and families following natural disasters, and to formulate a model to guide play therapists in the future. RESULTS: A systematic search of the literature was performed and a total of 25 articles were identified as relevant to the role of the play therapist in response to natural disasters. CONCLUSION: Play therapists must be mindful of the different phases of natural disaster response and how their role may vary across these phases. In the early stages post-disaster, a play therapist may be involved in psychoeducation, facilitating therapeutic play and community involvement. More formal clinical play therapy interventions that focus on the individual child or family are better suited to the latter stages of disaster response. There is a need for further research into the impact of natural disasters on children and families and interventions that aid mental health and well-being, especially for children who may be more vulnerable and potentially overlooked in the wake of such disasters. Further research is also needed into the effectiveness of play therapy as a post-disaster intervention for children.

Medical Students' Confidence After "CardioSim": A Low-Fidelity, Peer Role-Play Simulation.

INTRODUCTION: Plans to increase medical student numbers will increase costs and potentially reduce clinical exposure. Simulation can be utilised to fill that gap. Low-fidelity simulation with peer role-play (PRP) provides reduced costs and standardisation of experience compared to high-fidelity or simulated patient RP simulation. This study aimed to assess changes in confidence in common graduate-level skills following a low-fidelity PRP scenario. METHODS: Forty-three fourth-year medical students were divided into groups of three and five students. A Likert-scale questionnaire was completed at the start of the session. During the simulation, they had the opportunity to be the doctor and the patient and observe the remaining scenarios. Finally, the same questionnaire was answered. RESULTS: All students gained confidence in at least two aspects. All students were confident in history taking and ST-elevation myocardial infarction (STEMI) management at the end of the session. The biggest improvement in overall confidence was in the management of non-ST-elevation myocardial infarction (NSTEMI) (62.8%) and Situation-Background-Assessment-Recommendation (SBAR) handover (60.5%). Six students improved their confidence by at least one ranking in every question, and one student improved their confidence by three rankings in four questions. SBAR handover and management of pneumothorax had the biggest improvements. CONCLUSION: Low-fidelity RP simulation allows the development of confidence in technical and non-technical skills. Given increasing student numbers and increasing medical education costs, it can be utilised effectively as part of a simulation syllabus that helps prepare students for clinical practice. Areas of further research include focus groups, knowledge tests and comparisons to other forms of simulation.

The effect of safety modifications on head kinematics experienced during common skills in women's artistic gymnastics.

The objective of this study was to evaluate the effect of skill modifications on head motion experienced during women's artistic gymnastics skills. Nine gymnasts (four beginner and five advanced) completed three trials of up to 24 skill progressions, each consisting of a skill and two progressive safety modifications. Gymnasts were instrumented with mouthpiece sensors embedded with an accelerometer and gyroscope collecting motion data at 200, 300, and 500 Hz during each skill performance. Peak-to-peak linear and rotational kinematics during contact phases and peak rotational kinematics during non-contact phases were computed. A mixed-effects model was used to compare differences in modification status nested within skill categories. Timer skills (i.e. drills that simulate performance of a gymnastics skill) resulted in the highest median ΔLA and ΔRA of all skill categories, and 132 skill performances exceeded 10 g ΔLA during a contact phase. Modifications were associated with significant reductions in head kinematics during contact phases of timers, floor skills, bar releases, and vault skills. Gymnasts can be exposed to direct and indirect head accelerations at magnitudes consistent with other youth contact sports, and common safety modifications may be effective at reducing head motion during contact and non-contact phases of gymnastics skills.

Experimental study of magnetic hydrogel assisted magnetic anchorguided endoscopic submucosal dissection in colonic tumors.

BACKGROUND: Endoscopic submucosal dissection (ESD) is a well-established treatment for gastrointestinal tumors and enables en bloc resection. Adequate counter traction with good visualization is important for safe and effective dissection. OBJECTIVE: Based on magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD), we would like to explore the feasibility of magnetic hydrogel as an internal magnetic anchor that can be injected into the submucosa through an endoscopic needle to assist colonic endoscopic submucosal dissection. METHODS: This prospective trial was conducted on 20 porcine colons ex vivo. We injected magnetic hydrogel into submucosa of the porcine colons ex vivo for MAG-ESD to evaluate the traction effect and operation satisfaction. RESULTS: Magnetic hydrogel assisted ESD was successfully performed on 20 porcine colons ex vivo. Adequate counter traction with good visualization was successfully obtained during the procedure of dissection. CONCLUSION: Magnetic hydrogel assisted MAG-ESD is feasible and effective.

Supporting literacy development in kindergarten through teacher-facilitated play.

Teacher-facilitation of play is proposed as an effective method for supporting early literacy learning, however, educators remain uncertain how to balance child-autonomy in play while also directing play toward explicit academic objectives. In response, this study sought to understand how kindergarten teachers can successfully facilitate play to support early literacy development. Classroom observations and semistructured interviews were gathered and qualitatively analyzed to identify key perspectives and classroom practices that lead to the educators' successful facilitation of play to support literacy. Results of this study showed how different core literacy skills can be supported through different types of play, with each offering unique and critical opportunities for learning. Results also demonstrated how a multitude of core literacy skills can be supported through guided approaches to play, and begin to illustrate how teachers are facilitating a continuum of guided play to support literacy learning.

Einstein's combinatory play: A promising practice for creativity and well-being among public health professionals.

The purpose of this commentary is to describe combinatory play as a practice for elevating creativity and well-being among public health professionals. Albert Einstein introduced combinatory play in a letter to a colleague, and, in this commentary, we define it as engagement in an intrinsically enjoyable, cognitively stimulating artistic activity that is distinct from one's job tasks and conducive to connecting ideas toward insight and creative problem-solving. Combinatory play aligns with empirical and experiential evidence demonstrating connections between art and science. We present combinatory play in the context of research on creativity and well-being, including the growing issue of work-related stress among public health professionals. To provide an example of combinatory play, we recount how Robert Frost's poem "Mending Wall" inspired email blackout periods and an intervention for health researchers. Finally, we outline concrete strategies for public health professionals to integrate combinatory play into their lives. Overall, combinatory play is a promising practice for catalyzing novel solutions to public health issues while fueling the well-being of public health professionals themselves.

Return to Play at Preinjury Level After Anterior Cruciate Ligament Reconstruction in Divisions II and III National Collegiate Athletic Association Student-Athletes.

Background: The rates of return to play (RTP) after anterior cruciate ligament (ACL) reconstruction among professional and National Collegiate Athletic Association (NCAA) Division I athletes are well described in the orthopaedic literature. Less is known about these rates and risk factors for failure to RTP in Division II and III collegiate athletes. Purpose: To determine the RTP rate after ACL reconstruction among Division II and III collegiate athletes and to explore the factors associated with RTP. Study Design: Case series; Level of evidence, 4. Methods: Demographic and RTP data were retrospectively reviewed for collegiate athletes who underwent ACL reconstructions across high-risk sports over 6 years (2015/16 to 2021/22 seasons) at 5 northeastern NCAA Division II and III institutions. Clinical data collected included Patient Acceptable Symptom State (PASS) on the Knee injury and Osteoarthritis Outcome Score (KOOS) Sport and Recreation questionnaire, graft type, concomitant reparative surgery, reinjury, need for reoperation, and time to RTP and return to preinjury level. Participants completed the survey using a secure web-based questionnaire sent via email or over the telephone at a minimum 6-month follow-up. Descriptive frequencies were calculated for all documented variables, with chi-square and analysis of variance statistics used to assess for associations and significant differences between variables. Results: A total of 61 eligible student-athletes with primary ACL reconstructions were identified in this study period, and 40 knees were enrolled for analysis with a mean time from surgery to survey completion of 45.0 months. The overall RTP rate was 77.5% (31/40) at a mean of 10.1 months. However, only 50.0% (20/40) returned to their preinjury level of competitive play. There was a graft failure rate of 20% (8/40). Of the 32 athletes who did not reinjure their ACL, 81.25% (26/32) demonstrated a PASS on KOOS Sports and Recreation. Graft rerupture (P < .001) and reoperation (P = .007) had significant effects on rates of RTP. Concomitant procedures (P = .010) influenced return to preinjury level of sports. Injury during the active season versus the off-season significantly influenced KOOS PASS status (P = .038). Conclusion: This study demonstrated that the rate of RTP after ACL reconstruction in this patient population of Division II and III collegiate athletes was 77.5%, with only 50% returning to their preinjury level of competitive play. The graft failure rate in this population was 20%. Surgical factors, such as concomitant surgeries and reinjury of ACL graft, as well as athlete-specific data, such as injury in the off-season, were statistically significant negative influences on patient outcomes. Further research is needed to evaluate other potential factors that may play a role in RTP after ACL reconstruction.

Commemorating the monkey bars, catalyst of debate at the intersection of human evolutionary biology and public health.

Play is an essential part of childhood, and growing attention has focused on the potential health benefits of 'risky' or 'thrill-seeking' play. Such play behavior is readily observed on any playground, where it can sometimes lead to injuries--most often from fall impacts--that require medical attention. Monkey bars account for ~7% of childhood arm fractures in the USA, an alarming statistic that raises difficult questions over its costs and benefits. Many authors view monkey bars as a public health hazard, but it is plausible that our childhood impulse toward thrill-seeking play is a result of selective pressures throughout our primate evolutionary history. Indeed, emerging evidence suggests that the developmental benefits of thrill-seeking play extend into adulthood, outweighing the occasional costs of injury. Disparate and consequential, these dueling perspectives have fueled debate among health professionals and policymakers, but with little attention to the work of biological anthropologists. Here we call attention to the hominin fossil record and play behaviors of non-human primates, providing a novel perspective that bolsters arguments for the adaptive significance of thrill-seeking play. The moment for such a review is timely, for it commemorates the centennial anniversaries of two playground icons: the jungle gym and monkey bars.

Identifying and resolving conflict in mobile application features through contradictory feedback analysis.

As mobile applications proliferate and user feedback becomes abundant, the task of identifying and resolving conflicts among application features is crucial for delivering satisfactory user experiences. This research, motivated to align application development with user preferences, introduces a novel methodology that leverages advanced Natural Language Processing techniques. The paper showcases the use of sentiment analysis using RoBERTa, topic modeling with Non-negative matrix factorization (NMF), and semantic similarity measures from Sentence-BERT. These techniques enable the identification of contradictory sentiments, the discovery of latent topics representing application features, and the clustering of related feedback instances. The approach detects conflicts by analyzing sentiment distributions within semantically similar clusters, further enhanced by incorporating antonym detection and negation handling. It employs majority voting, weighted ranking based on rating scores, and frequency analysis of feature mentions to resolve conflicts, providing actionable insights for prioritizing requirements. Comprehensive evaluations on large-scale iOS App Store and Google Play Store datasets demonstrate the approach's effectiveness, outperforming baseline methods and existing techniques. The research improves mobile application development and user experiences by aligning features with user preferences and providing interpretable conflict resolution strategies, thereby introducing a novel approach to the field of mobile application development.

Using behavioural network mapping to investigate dyadic play in girls with congenital adrenal hyperplasia.

Examining mechanisms underlying sex differences in children's play styles, we studied girls with congenital adrenal hyperplasia (CAH) who provide a test of the relative effects of prenatal androgens versus rearing, and of behavioural similarity versus gender identity and cognitions. In this exploratory study, 40 focal children (girls and boys with and without CAH), aged 3-8 years, played for 14 min with a same-sex peer in a task designed to elicit rough-and-tumble play. Time-indexed ratings of positive affect and vigour of activity were evaluated via network mapping for sex-related differences in both levels and play dynamics (temporal relations among behaviours). Results suggest influences of both gender identity-aligned social cognitions and prenatal androgens: there was greater dyadic synchrony between positive affect for girls (regardless of CAH status) than boys, but girls with CAH displayed positive affect levels and directed vigorous peer play dynamics similar to boys.