Balancing Time for Health Behaviors: Associations of Time Perspective With Physical Activity and Weight Management in Older Adults.

PURPOSE: To examine associations between time perspective and health promotion behaviors of physical activity and weight management. DESIGN: Quantitative cross-sectional. SETTING: This study is part of the Betula project on aging, memory, and dementia in Northern Sweden. SUBJECTS: 417 older adults aged between 55 and 85 years. MEASURES: Swedish-Zimbardo Time Perspective Inventory; Physical Activity in the past year, past week, and in comparison with others of similar age; Weight Management = Body Mass Index (BMI; kg/m2). RESULTS: After controlling for age, sex, and years of education, hierarchical linear regression indicated a Balanced Time Perspective was significantly associated with more physical activity in the past year (P = .04), the past week (P < .001), and in comparison with others (P < .01). Past Negative time perspective was associated with less physical activity in the past year (P = .03), and in comparison with others (P = .03). Present Fatalistic was associated with less physical activity during the past week (P = .03), and in comparison with others (P = .01). Present Hedonistic was associated with more physical activity the past week (P = .03), and in comparison with others (P = .03). Past Negative was associated with higher BMI (P = .02), and Future Negative were associated with lower BMI (P = .01). Taken collectively, greater positivity and flexibility across time perspectives was associated with more physical activity, whereas negative oriented time perspectives related with less physical activity and poorer weight management. CONCLUSION: Time perspective can be associated with health behaviors in older adults and have implications for health across the lifespan. Health promotion interventions may target older adults' enjoyment of exercise and weight management in the present, rather than highlight potential negative health outcomes in the future.

KovaaK's aim trainer as a reliable metrics platform for assessing shooting proficiency in esports players: a pilot study.

Esports research lacks game-based metrics platforms appropriate for adequately capturing esports performance. The aim of this pilot study was to assess the reliability of the KovaaK's first-person shooter (FPS) aim trainer as a metrics platform for assessing shooting proficiency in esports players. Ten FPS esports players completed two identical experimental trials (T) separated by three to five days. Each trial included four rounds (R) of testing, evaluating four shooting tasks: Micro Flicking, Macro Flicking, Strafe Tracking, and Wall Peeking. Reliability of performance outcomes (e.g., accuracy, headshot accuracy, hits per second, and total shots hit) were assessed using the intraclass correlation coefficient (ICC) and their 95% confidence intervals (CI), and significant differences were identified using repeated-measures analysis of variance (RM-ANOVA). Results indicated excellent, or good to excellent reliability for all outcome variables with the ICC estimates ranging between 0.947-0.995, with lower and upper bound 95% CIs ranging between 0.876-0.988, and 0.984-0.999, respectively. Significant improvements were seen between experimental trials in the Macro Flicking task for accuracy (p = .005) and hits per second (p = .009) only. Significant interactions between trial and round were identified in the Micro Flicking task for accuracy (p = .006), with post hoc analysis showing accuracy was significantly higher in T1R1 compared to T2R1 (87.74 ± 3.13 vs. 85.99 ± 3.05, respectively, p = .02), and in T2R4 compared to T2R2 (87.99 ± 2.89 vs. 84.70 ± 4.25, respectively, p = .049). Significant interactions were also identified in the Strafe Tracking task for headshot accuracy (p = .002), with post hoc analysis showing headshot accuracy was significantly higher in T1R2 compared to T2R2 (78.48 ± 8.15 vs. 76.79 ± 12.16, respectively, p = .003), and in T1R2 compared to T1R1 (78.48 ± 8.15 vs. 73.68 ± 17.94, respectively, p = .023). In summary, this study demonstrates that KovaaK's provides a reliable metrics platform for assessing shooting proficiency in esports, however, some variability in performance was observed.

Parental support in esports through the lens of the theory of planned behaviour.

Esports have grown substantially in the last decade and may be an effective way of engaging and exposing the youth, who is not actively participating in traditional sports, to the benefits of sports related performance environments. However, due to negative stereotypes about gamers and concerns about esports, parents might be hesitant to support their children's esports participation and may instead actively discourage it. The purpose of this perspective article was to discuss the determinants of parental support based on the theory of planned behaviour. Parents attitudes seem to be mostly negative and their perceived behavioral control is likely low due to a lack of knowledge about esports. The subjective norms are mixed and seem to be growing progressively more positive. Based on the theory of planned behaviour, parents seem unlikely to support their children's esport participation, however, more research is needed. Recommendations on how to increase the likelihood of parental support are discussed.

Promoting mental health in esports.

There is growing recognition of the demands and health challenges experienced by esports athletes. The purpose of this perspective paper is to draw specific attention to the mental health of competitive gamers and spur on both future research and applied initiatives focussing on this important but under-addressed topic. We will briefly discuss the prevalence of mental health concerns, domain-specific stressors, and the need for comprehensive mental health support systems tailored to the esports context. It is our hope that, with this perspective paper, we can help set a new research agenda addressing mental health in esports.

Self-regulation, stress appraisal, and esport action performance.

Electronic sport has seen substantial growth in market value and popularity in the last 10 years. With this growth has come the pursuit of elite esports performance, especially from a psychological perspective. This study aimed to investigate potential variations in self-regulation levels among athletes of different levels (national vs. student), compare the self-regulation profiles of CS:GO players in the current study to an international sample of e'athletes and to assess the predictive capacity of self-regulation on performance outcomes. A total of 53 esports athletes (student competitors, n = 27 and national-level CS:GO competitors, n = 26), participated in an experiment exploring self-regulation, DRES, and action performance. Furthermore, analysis comparing our collective findings against a larger global sample of e'athletes (n = 993) was conducted. Results demonstrated that CS:GO players who displayed higher levels of self-regulation tended to perceive stressful situations as challenges, consequently showcasing superior accuracy and time trial performance. In contrast, individuals with lower self-regulation tended to perceive such situations as threats, which correlated with less favorable performance outcomes. On a broader scale, the study observed that CS:GO competitors generally exhibited lower levels of self-regulation when compared to the larger global sample. Furthermore, self-regulation was identified as a mediating variable in the relationship between stress appraisal and performance, suggesting that improved self-regulation skills can lead to enhanced accuracy and quicker time trial performance. This may imply that competitors with greater self-regulatory abilities perceive themselves as having more personal resources, enabling them to effectively assess challenging situations and employ problem-focused coping strategies. Overall, this research underscores the significance of self-regulation in optimizing esports performance, while providing valuable insights for player development, action performance, and overall outcomes in the field.

Coaching and talent development in esports: a theoretical framework and suggestions for future research.

Esports is a growing phenomenon that is capturing the attention of individuals worldwide, and has grown to provide professional and lucrative careers for those who reach the upper echelons. One question that arises, is how esports athletes develop the necessary skills required to improve and compete. This perspective piece opens the door to skill acquisition within esports and how research through an ecological approach can benefit researchers and practitioners as they understand the various perception-action couplings and decision-making challenges faced by esports athletes. We will identify and discuss what constraints look like in esports, the role of affordances, and theorize the implementation of a constraints-led approach in contrasting esports genres. As esports is technology-heavy in nature and generally sedentary, the use of eye-tracking technology is argued to represent an effective method to better understand perceptual attunement between individuals and teams. Future research into skill acquisition in esports is needed to develop a clearer picture of what makes the greatest esports player so great, and how newer players can be developed effectively.

Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the Emergency Department.

INTRODUCTION: Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited. METHODS: A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked. RESULTS: Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (P < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (P < .03). DISCUSSION: V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

Treatment of pulmonary artery pseudoaneurysms and stenosis with balloon-expandable stents.

We describe our use of balloon-expandable stents in pulmonary arteries for a variety of indications. This is an endovascular technique that provides an alternative treatment option to treat some forms of complex pulmonary artery disease when standard surgical or other endovascular options are not possible. This case series describes the successful treatment of four patients with different pulmonary artery diseases. Indications for stent placement include multiple broad-necked pulmonary artery pseudoaneurysms, symptomatic malignant pulmonary artery narrowing and post-surgical iatrogenic pulmonary artery stenosis. No stent-related complication had been identified from 3 months to 4 years of follow-up. All surviving patients have experienced sustained symptomatic improvement.

A qualitative analysis of the perceived determinants of success in elite esports athletes.

The current study aimed to qualitatively investigate the perceived determinants of success in professional esports athletes. Guided by the bioecological model (Bronfenbrenner & Morris, 2006), thematic analysis was used to explore elite esports athletes' perceptions of success determinants. Semi-structured interviews were conducted with seven elite esports athletes. The interviews were used to investigate players' psychology when playing well, training in elite esports, and working in esports teams. Deductive and inductive analyses were conducted to capture the core themes of success in esports within the bioecological model. When playing well, elite esports athletes experienced high levels of confidence, uninterrupted focus, and flow states. Elite esport athletes use mental strategies to help regulate their emotions and remain mindful in the presence of "tilt". Furthermore, breathing techniques and tactical breaks were used when players felt nervous or when trying to "reset" from a stressful situation. When working in elite esport teams, players reported using strategies to improve team cohesion and that the biggest challenge was interpersonal disagreements. The results contribute to the growing body of literature highlighting the psychological similarities between elite esports and traditional sports athletes and serve as an index for future research into high-performance in esports.

Social Support, Self-Regulation, and Psychological Skill Use in E-Athletes.

The aims of the present study were twofold. First, to investigate self-reported social support, self-regulation, and psychological skill use in esports athletes (e-athletes) compared to traditional athletes. Second, to determine if self-reported social support, self-regulation, and psychological skill use influenced e-athlete in-game rank. An online survey was used to collect data from an international sample of e-athletes (n = 1,444). The e-athletes reported less social support, self-regulation, and psychological skill use than reported by traditional athletes in previous studies. E-athletes with higher scores in social support, self-regulation, and psychological skill use was associated with higher in-game rank. The lack of an organisational structure in esports may be a contributing factor as to why e-athletes score lower than traditional athletes on social support, self-regulation, and psychological skill use. Future research is warranted to explore the development of esports programs aiming to promote athletes' social support, self-regulation, and use of psychological skills to enhance in-game performance and well-being.

Examining the Impact of School Esports Program Participation on Student Health and Psychological Development.

This study examined the influence of 7 high school esports developmental programs on student self-regulation, growth mindset, positive youth development (PYD), perceived general health and physical activity (PA), and sport behaviour. A total of 188 students (male n = 120; female n = 68) originally participated (89 enrolled in an esports program in their school and 99 acted as aged-matched controls), with 58 participants (n = 19 esports group; n = 39 controls) completing both pre- and post-program information. At baseline, no significant differences were found between youth e-athletes and their aged-matched controls. The analysis for the observation period showed a significant interaction effect for the PYD confidence scale, with post-hoc comparisons showing a significant decrease in the control group from pre- to post assessment whereas the esports group remained the same. Time main effects showed a decrease in the self-regulation motivation factor, PYD connection factor and PA for all participants. Overall, this study showed that students enrolled in their respective school esports program did not differ from those who did not in self-regulation, growth mindset, PYD, perceived health and PA, and sport behaviour. It was likely that all participants showed a decrease in motivation, connection, and PA due to COVID19 lockdown during the study period. This study is the first to investigate the longitudinal impact of student involvement in high school esports and showed that esports participation did not have a negative impact on any health or psychological factors.

The Association between Esports Participation, Health and Physical Activity Behaviour.

We investigated the association between obesity, self-reported physical activity, cigarette smoking, alcohol consumption, and perceived health in esports players, and the influence of player in-game rank. Data was collected with an online survey with an international participant sample of esports players representing five esports and all skill levels (n = 1772). Esports players were more likely to be categorized as normal weight, or obesity class 2 and 3 and as non-smokers (92%) and non-drinkers (65.1%) compared to international reference data. Esports players met international physical activity guidelines less than global general population. Esports players ranked in the top 10% were more physically active compared to the remaining esports players. As esports player in-game rank increased, so did the amount of time spent playing esports. Although esports players appear generally healthy, a small group was significantly obese and most esports players did not meet physical activity guidelines, indicating potential future health risks.

Stress and Coping in Esports and the Influence of Mental Toughness.

This study explored stress and coping in electronic sports (esports) athletes and the influence of mental toughness (MT), as defined by two prominent conceptualizations: the 4/6Cs and Mental Toughness Index (MTI) frameworks. Participants were 316 esports athletes, ranked in the top 40% of one of five major esports: Defense of the Ancients 2, League of Legends (LoL), Counter Strike: Global Offensive, Overwatch and Rainbow Six: Siege. Participants completed the MTI, Mental Toughness Questionnaire 6 (MTQ6), Stress Appraisal Measure, and Brief COPE inventory. Results showed that MT (via both MT frameworks) was associated with perceived control, and MTQ6 subscales were associated with stress intensity. Mental toughness (both frameworks) was associated with the selection of more problem-focused and emotion-focused coping strategies and less avoidance coping strategies. The results indicate there is some overlap between the MT and stress-coping process in high-performing traditional sports and competitive esports athletes. These results suggest that esports athletes could benefit from sports psychology interventions designed for traditional sports athletes. Finally, the MTQ6 and MTI had low shared variance (20%), suggesting that the two questionnaires appear to measure different aspects of MT.

Effectiveness of epoprostenol in the management of pulmonary arterial hypertension: findings of an Australian retrospective chart review.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressively fatal disease. Parenteral prostanoids, including intravenous (IV) epoprostenol, are the most effective therapies for PAH. As epoprostenol requires continuous infusion, therapy is challenging and use is managed by specialist units. AIMS: To describe the clinical outcomes for the use of IV epoprostenol in an Australian pulmonary vascular disease unit and identify opportunities to improve its use. METHOD: We conducted a retrospective chart review of all adult patients who received IV epoprostenol for PAH at Prince Charles Hospital. Data were collected at baseline, initiation of epoprostenol and quarterly to the end of the audit period or the discontinuation of epoprostenol. Descriptive statistics were performed and comparisons made to epoprostenol initiation. Kaplan-Meier curves were used to estimate survival outcomes. RESULTS: Thirty-nine patients received epoprostenol therapy. Most (87.2%) were female, had connective tissue disease (46.2%) or idiopathic PAH (35.9%) and had a World Health Organization functional Class of III or IV at initiation. The mean duration of epoprostenol therapy was 2.9 years. Intravenous epoprostenol was associated with favourable outcomes; 1, 3 and 5-year survival rates since initiation of 90.0, 75.8 and 68.2%; robust improvements in functional class; and improvements in 6-min walking distance of 160.4 m at 3 years; 94.9% patients experienced at least one drug-related adverse event and line complications were common. CONCLUSION: Epoprostenol therapy was associated with impressive survival rates and durable improvements in functional outcomes. Epoprostenol therapy is challenging; however, it is manageable by the majority of patients with most experiencing positive, sustainable outcomes.

Real-World Evidence of Prostatic Urethral Lift Confirms Pivotal Clinical Study Results: 2-Year Outcomes of a Retrospective Multicenter Study.

Introduction: This study expands results from recent prostatic urethral lift (PUL) clinical trials by examining outcomes within a large unconstrained multicenter data set. Methods: Retrospective chart review and analysis of 1413 consecutive patients who received PUL in North America and Australia was performed. International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) were evaluated at 1, 3, 6, 12, and 24 months post-procedure for all nonurinary retention subjects (Group A) and retention subjects (Group B). Within Group A outcomes were further analyzed using paired t-tests and 95% mean confidence intervals under the following parameters: IPSS baseline ≥13, age, prostate size, site of service, prostate cancer treatment, and diabetic status. Adverse events, surgical interventions, and catheterization rates were summarized in detail. Results: Compared with the randomized controlled prosatic urethral lift (L.I.F.T.) study, subjects in this retrospective study were older and less symptomatic. After PUL, mean IPSS for Group A improved significantly from baseline by at least 8.1 points throughout follow-up. No significant differences were observed between Group A and B follow-up symptom scores. Within Group A, subjects with an IPSS baseline ≥13 behaved similarly to L.I.F.T. subjects. Age, prostate volume, site of service, prior cancer treatment, and diabetic status did not significantly affect PUL outcomes. When completed in a clinic office, PUL resulted in less side effects and catheter placement compared to other sites of service. Previous prostate cancer treatment did not elevate adverse events of high concern such as incontinence and infection. Conclusion: PUL performs well in a real-world setting in terms of symptom relief, morbidity, and patient experience for all studied patient cohorts.

Endothelial Glycocalyx Shedding Predicts Donor Organ Acceptability and Is Associated With Primary Graft Dysfunction in Lung Transplant Recipients.

BACKGROUND: The endothelial glycocalyx, a sieve-like structure located on the luminal surface of all blood vessels, has been found to be integral to regulation of capillary permeability and mechanotransduction. Given this, we investigated the role of endothelial glycocalyx breakdown products in organ donors and recipients in terms of acceptability for transplant and risk of primary graft dysfunction (PGD). METHODS: Endothelial glycocalyx breakdown products were measured in the peripheral blood of 135 intended and actual organ donors. Breakdown product levels were tested for association with donor demographic and clinical data, organ acceptability for transplant along with lung recipient outcomes (n = 35). Liquid chromatography mass spectrometry analysis was performed to confirm glycosaminoglycan levels and sulfation patterns on donor samples (n = 15). In transplant recipients (n = 50), levels were measured pretransplant and daily for 4 days posttransplant. Levels were correlated with PGD severity and intubation time. RESULTS: Decreased hyaluronan levels in peripheral blood independently predicted organ acceptability in intended and actual donors (odds ratio, 0.96; [95% confidence interval, 0.93-0.99] P = 0.026). Furthermore, high donor syndecan-1 levels were associated with PGD in recipients (3142 [1575-4829] versus 6229 [4009-8093] pg/mL; P = 0.045). In recipient blood, levels of syndecan-1 were correlated with severe (grades 2-3) PGD at 72 hours posttransplant (5982 [3016-17191] versus 3060 [2005-4824] pg/mL; P = 0.01). CONCLUSIONS: Endothelial glycocalyx breakdown occurs in lung transplant donors and recipients and predicts organ acceptability and development of PGD. Glycocalyx breakdown products may be useful biomarkers in transplantation, and interventions to protect the glycocalyx could improve transplant outcomes.

Frank G. Slaughter, M.D., FACS: Medical Novelist and Surgeon Writer.

"The curiosity of the public about things medical is probably greater than on any other single subject-except perhaps sex." This quote by Frank Gill Slaughter, M.D., is indicative of the foresight, intuitiveness, and intelligence of one of the medical profession's most prolific and successful surgeon writers. His primary genre was historical fiction, and he incorporated medical and surgical history into nearly all of his writings with a "surgeon-hero" consistently the lead character. Slaughter published 65 books between 1941 and 1987 and sold 75 million copies in 23 languages. Slaughter received his medical degree from Johns Hopkins University in 1930 and completed general surgery training at Jefferson Hospital in Roanoke, Virginia, in 1934. He moved to Jacksonville, Florida, in 1934, where he would remain for the rest of his life, excepting military service in World War II. He became a Fellow of the American College of Surgeons in 1938 and was certified by the American Board of Surgery in 1940. Slaughter died in 2001 at the age of 93. This contribution examines the keen intellect and prolific authorship of this important and significant surgeon writer and medical novelist.

Advanced therapies for COPD-What's on the horizon? Progress in lung volume reduction and lung transplantation.

Advanced chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity. Treatment options beyond conventional medical therapies are limited to a minority of patients. Lung volume reduction surgery (LVRS) although effective in selected subgroups of patients is not commonly undertaken. Morbidity associated with the procedure has contributed to this low utilisation. In response to this, less invasive bronchoscopic lung volume techniques are being developed to attempt to mitigate some of the risks and costs associated with surgery. Of these, endobronchial valve therapy is the most comprehensively studied although the presence of collateral ventilation in a significant proportion of patients has compromised its widespread utility. Bronchial thermal vapour ablation and lung volume reduction (LVR) coils are not dependent on collateral ventilation. These techniques have shown promise in early clinical trials; ongoing work will establish whether they have a role in the management of advanced COPD. Lung transplantation, although effective in selected patients for palliation of symptoms and improving survival, is limited by donor organ availability and economic constraint. Reconditioning marginal organs previously declined for transplantation with ex vivo lung perfusion (EVLP) is one potential strategy in improving the utilisation of donor organs. By increasing the donor pool, it is hoped lung transplantation might be more accessible for patients with advanced COPD into the future.