Measuring Lethal Force Performance in the Lab: The Effects of Simulator Realism and Participant Experience.

OBJECTIVE: The goal of the current study was to compare two types of shooting simulators to determine which is best suited for assessing different aspects of lethal force performance. BACKGROUND: Military and law enforcement personnel are often required to make decisions regarding the use of lethal force. A critical goal of both training and research endeavors surrounding lethal force is to find ways to simulate lethal force encounters to better understand behavior in those scenarios. METHOD: Participants of varying degrees of experience completed both marksmanship and shoot/don't shoot scenarios on both a video game and a military-grade shooting simulator. Using signal detection theory, we assessed sensitivity as a measure of lethal force performance overall. We used hit rate to assess shooting accuracy and false alarm rate to assess decision making. RESULTS: Results demonstrated that performance was correlated across simulators. Results supported the notion that shooting accuracy and decision making are independent components of performance. Individuals with firearms expertise outperformed novices on the military-grade simulator, but only with respect to shooting accuracy, not unintended casualties. Individuals with video game experience outperformed novices in the video game simulator, but again only on shooting accuracy. CONCLUSION: Experience played a crucial role in the assessment of shooting accuracy on a given simulator platform; decision-making performance remained unaffected by experience level or type of simulator. APPLICATION: We recommend that in expert populations or when assessing shooting accuracy, a military-grade shooting simulator be used. However, with a novice population and/or when interested in decision making in lethal force, a video game simulator is appropriate.

Postural Instability and Seasickness in a Motion-Based Shooting Simulation.

BACKGROUND: Motion sickness is a problem for many; however, it is especially pressing for military personnel who need to operate in life and death environments. The current study investigated the underlying cause of motion sickness by testing postural instability theory.METHODS: Subjects experienced realistic motion profiles while performing a virtual reality shooting task and reporting any motion sickness symptoms. Postural instability was manipulated within 20 subjects across 2 conditions. In one condition, subjects could readily adapt their posture to the motion profile by adjusting their feet on the platform (Free), and in the other condition, their feet were fixed in place on the moving platform (Fixed). This Free condition decreased postural instability by allowing adjustment, while the Fixed condition increased postural instability by restricting adjustment. The same subjects completed both conditions to control for individual differences in motion sickness susceptibility.RESULTS: Overall, motion sickness was mild as measured by SSQ (M 14.41, Free; M 18.89, Fixed), and no statistically significant differences were observed between the conditions. Performance on the shooting task was reduced in accuracy by approximately 40%, although this result did not differ between conditions.DISCUSSION: The results do not support postural instability as a contributing factor in motion sickness symptomology. They also demonstrate the importance of accounting for motion when conducting training.Pettijohn KA, Pistone DV, Warner AL, Roush GJ, Biggs AT. Postural instability and seasickness in a motion-based shooting simulation. Aerosp Med Hum Perform. 2020; 91(9):703709.

Failure modes for total ankle arthroplasty: a statistical analysis of the Norwegian Arthroplasty Register.

BACKGROUND: It is imperative to understand the most common failure modes of total ankle arthroplasty (TAA) to appropriately allocate the resources, healthcare costs, enhancing surgical treatment methods, and improve design and longevity of the implant. The objective of this study was to investigate the primary mode or modes of failure (Loose talar component, loose tibial component, dislocation, instability, misalignment, deep infection, Fracture (near implant), Pain, defect polyethylene (PE), other, and missing information) of TAA implants, so these failure mode/modes can be targeted for future improvement. METHODS: The Norwegian Total Hip Arthroplasty Register 2008 was chosen as the primary source of data since the register have been in existence for 20 years and also gives more specific failure modes than other registries. Tukey-Kramer method was applied to Norwegian Arthroplasty Register. RESULTS: After the application of the Tukey-Kramer method, it is evident that there is no significant difference between any of the failure modes that are pertinent to the ankle. However, there is significant evidence that the number of ankle arthroplasties are increasing with time. CONCLUSIONS: Since there is no statistical evidence showing which failure mode contributes most to revision surgeries, it is concluded that more information/data is needed to further investigate failure modes in ankle arthroplasties. Since the numbers of such surgeries are increasing, sufficient data should become available in time.

Comparison of transfer sites for flexor digitorum longus in a cadaveric adult acquired flatfoot model.

Posterior tibialis tendon (PTT) dysfunction (PTTD) is associated with adult acquired flatfoot deformity. PTTD is commonly treated with a flexor digitorum longus (FDL) tendon transfer (FDLTT) to the navicular (NAV), medial cuneiform (CUN), or distal residuum of the degraded PTT (rPTT). We assessed the kinetic and kinematic outcomes of these three attachment sites using cadaveric gait simulation. Three transfer locations (NAV, CUN, rPTT) were tested on seven prepared flatfoot models using a robotic gait simulator (RGS). The FDLTT procedures were simulated by pulling on the PTT with biomechanically realistic FDL forces (rPTT) or by pulling on the transected FDL tendon after fixation to the navicular or medial cuneiform (NAV and CUN, respectively). Plantar pressure and foot bone motion were quantified. Peak plantar pressure significantly decreased from the flatfoot condition at the first metatarsal (NAV) and hallux (CUN). No difference was found in the medial-lateral center of pressure. Kinematic findings showed minimal differences between flatfoot and FDLTT specimens. The three locations demonstrated only minimal differences from the flatfoot condition, with the NAV and CUN procedures resulting in decreased medial pressures. Functionally, all three surgical procedures performed similarly.

Second metatarsal osteotomies for metatarsalgia: a robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure.

Symptom relief of recalcitrant metatarsalgia can be achieved through surgical shortening of the affected metatarsal, thus decreasing plantar pressure. Theoretically an oblique metatarsal osteotomy can be oriented distal to proximal (DP) or proximal to distal (PD). We characterized the relationship between the amount of second metatarsal shortening, osteotomy plane, and plantar pressure. We hypothesized that the PD osteotomy is more effective in reducing metatarsal peak pressure and pressure time integral. We performed eight DP and eight PD second metatarsal osteotomies on eight pairs of cadaveric feet. A custom designed robotic gait simulator (RGS) generated dynamic in vitro simulations of gait. Second metatarsals were incrementally shortened, with three trials for each length. We calculated regression lines for peak pressure and pressure time integral vs. metatarsal shortening. Shortening the second metatarsal using either osteotomy significantly affected the metatarsal peak pressure and pressure time integral (first and third metatarsal increased, p < 0.01 and <0.05; second metatarsal decreased, p < 0.01). Changes in peak pressure (p = 0.0019) and pressure time integral (p = 0.0046) were more sensitive to second metatarsal shortening with the PD osteotomy than the DP osteotomy. The PD osteotomy plane reduces plantar pressure more effectively than the DP osteotomy plane.