A Blended Vitamin Supplement Improves Spatial Cognitive and Short-Term Memory in Aged Mice.

Although many types of antioxidant supplements are available, the effect is greater if multiple types are taken simultaneously rather than one type. However, it is difficult to know which type and how much to take, as it is possible to take too many of some vitamins. As it is difficult for general consumers to make this choice, it is important to provide information based on scientific evidence. This study investigated the various effects of continuous administration of a blended supplement to aging mice. In 18-month-old C57BL/6 mice given a blended supplement ad libitum for 1 month, spatial cognition and short-term memory in the Morris water maze and Y-maze improved compared with the normal aged mice (spontaneous alternative ratio, normal aged mice, 49.5%, supplement-treated mice, 68.67%, p < 0.01). No significant differences in brain levels of secreted neurotrophic factors, such as nerve growth factor and brain-derived neurotrophic factor, were observed between these two groups. In treadmill durability tests before and after administration, the rate of increase in running distance after administration was significantly higher than that of the untreated group (increase rate, normal aged mice, 91.17%, supplement-treated aged mice, 111.4%, p < 0.04). However, training had no reinforcing effect, and post-mortem serum tests showed a significant decrease in aspartate aminotransferase, alanine aminotransferase, and total cholesterol values. These results suggest continuous intake of a blended supplement may improve cognitive function and suppress age-related muscle decline.

Training and asymmetrical transfer effects of working memory and inhibitory control in primary school children.

Working memory (WM) and inhibitory control (IC) are two fundamental and supportive components of executive function (EF) that are critical for school-age children. However, the direct comparison of the training and transfer effects of WM and IC training in school-age children still needs to be improved. This study adopted a "pre-, post-, and delayed posttest" design to compare the training, near-transfer, and far-transfer effects of WM and IC in school-age children. A total of 60 children aged 8 to 10 years were randomly assigned to the WM training group, IC training group, or control group. Children in the WM and IC training groups completed 12 sessions of multiple adaptive training tasks tapping different subcomponents of WM (visual-spatial and verbal WM) and IC (interference control and response inhibition) separately. In the pretraining, posttraining, and 6-month follow-up stages, we used WM and IC tasks to evaluate training and near-transfer effects and used analogical reasoning tasks to evaluate far-transfer effects. Results showed significant training effects on visual-spatial and verbal WM, near-transfer effects on response inhibition, and far-transfer effects on analogical reasoning for WM training in the posttraining stage. The improvements in verbal WM and analogical reasoning were maintained for 6 months, whereas for IC training only the training effects on response inhibition and the far-transfer effects on analogical reasoning were observed in the posttraining stage and only the training effects on response inhibition were maintained for 6 months. Results suggested positive training and asymmetrical transfer effects of WM and IC training, which provide new evidence for the effectiveness of WM and IC training in school-age children.

Evaluation of motor learning in predictable loading task using a force sense presentation device.

Neural circuits connecting the cerebellum with the cerebral cortex are important for both motor and cognitive functions. Therefore, assessment of cerebellar function is clinically important for patients with various motor and cognitive dysfunctions. Cerebellum-dependent motor learning has been studied using various tasks. The most widely used tasks are visuomotor adaptation tasks, in which subjects are required to make movements in two dimensions. Studies using simpler tasks of one-dimensional movement, which are easier for patients with motor problems to perform, have suggested that anticipatory responses in these tasks are useful to evaluate cerebellum-dependent motor control or motor learning. In this study, we examined whether the motor learning process can be evaluated in a simple loading task. Using space interface device for artificial reality (SPIDAR), a constant downward force was loaded to subjects' hands in a predictable condition, and the vertical movement of the hand was recorded. The hand deflection from the initial position was displayed on a screen for visual feedback information. We examined effects of repeated loading task training (90 times) on hand movements, by analyzing a small upward movement just before loading (anticipatory response) and a large downward movement after loading in each trial. We found that the repeated training lowered the time constant of upward movement and reduced the amplitude and time-to-peak of downward movement. These training effects were maintained into the next day. Furthermore, we found that loading task training with eyes closed was also effective, which indicates that proprioceptive information is enough for improvement of performance.

Detection of Horse Locomotion Modifications Due to Training with Inertial Measurement Units: A Proof-of-Concept.

Detecting fatigue during training sessions would help riders and trainers to optimize their training. It has been shown that fatigue could affect movement patterns. Inertial measurement units (IMUs) are wearable sensors that measure linear accelerations and angular velocities, and can also provide orientation estimates. These sensors offer the possibility of a non-invasive and continuous monitoring of locomotion during training sessions. However, the indicators extracted from IMUs and their ability to show these locomotion changes are not known. The present study aims at defining which kinematic variables and indicators could highlight locomotion changes during a training session expected to be particularly demanding for the horses. Heart rate and lactatemia were measured to attest for the horse's fatigue following the training session. Indicators derived from acceleration, angular velocities, and orientation estimates obtained from nine IMUs placed on 10 high-level dressage horses were compared before and after a training session using a non-parametric Wilcoxon paired test. These indicators were correlation coefficients (CC) and root mean square deviations (RMSD) comparing gait cycle kinematics measured before and after the training session and also movement smoothness estimates (SPARC, LDLJ). Heart rate and lactatemia measures did not attest to a significant physiological fatigue. However, the statistics show an effect of the training session (p < 0.05) on many CC and RMSD computed on the kinematic variables, indicating a change in the locomotion with the training session as well as on SPARCs indicators (p < 0.05), and revealing here a change in the movement smoothness both in canter and trot. IMUs seem then to be able to track locomotion pattern modifications due to training. Future research should be conducted to be able to fully attribute the modifications of these indicators to fatigue.

Distinguishing drug/non-drug-like small molecules in drug discovery using deep belief network.

The advent of computational methods for efficient prediction of the druglikeness of small molecules and their ever-burgeoning applications in the fields of medicinal chemistry and drug industries have been a profound scientific development, since only a few amounts of the small molecule libraries were identified as approvable drugs. In this study, a deep belief network was utilized to construct a druglikeness classification model. For this purpose, small molecules and approved drugs from the ZINC database were selected for the unsupervised pre-training step and supervised training step. Various binary fingerprints such as Macc 166 bit, PubChem 881 bit, and Morgan 2048 bit as data features were investigated. The report revealed that using an unsupervised pre-training phase can lead to a good performance model and generalizability capability. Accuracy, precision, and recall of the model for Macc features were 97%, 96%, and 99%, respectively. For more consideration about the generalizability of the model, the external data by expression and investigational drugs in drug banks as drug data and randomly selected data from the ZINC database as non-drug were created. The results confirmed the good performance and generalizability capability of the model. Also, the outcomes depicted that a large proportion of misclassified non-drug small molecules ascertain the bioavailability conditions and could be investigated as a drug in the future. Furthermore, our model attempted to tap potential opportunities as a drug filter in drug discovery.

The learning curves of a validated virtual reality hip arthroscopy simulator.

INTRODUCTION: Decreases in trainees' working hours, coupled with evidence of worse outcomes when hip arthroscopies are performed by inexperienced surgeons, mandate an additional means of training. Though virtual reality simulation has been adopted by other surgical specialities, its slow uptake in arthroscopic training is due to a lack of evidence as to its benefits. These benefits can be demonstrated through learning curves associated with simulator training-with practice reflecting increases in validated performance metrics. METHODS: Twenty-five medical students with no previous experience of hip arthroscopy completed seven weekly simulated arthroscopies of a healthy virtual hip joint using a 70° arthroscope in the supine position. Twelve targets were visualised within the central compartment, six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. Task duration, number of collisions (bone and soft-tissue), and distance travelled by arthroscope were measured by the simulator for every session of each student. RESULTS: Learning curves were demonstrated by the students, with improvements in time taken, number of collisions (bone and soft-tissue), collision length and efficiency of movement (all p < 0.01). Improvements in time taken, efficiency of movement and number of collisions with soft-tissue were first seen in session 3 and improvements in all other parameters were seen in session 4. No differences were found after session 5 for time taken and length of soft-tissue collision. No differences in number of collisions (bone and soft-tissue), length of collisions with bone, and efficiency of movement were found after session 6. CONCLUSIONS: The results of this study demonstrate learning curves for a hip arthroscopy simulator, with significant improvements seen after three sessions. All performance metrics were found to improved, demonstrating sufficient visuo-haptic consistency within the virtual environment, enabling individuals to develop basic arthroscopic skills.

Increase in muscle power is associated with myofibrillar ATPase adaptations during resistance training.

NEW FINDINGS: What is the central question of this study? The aim of this study was to examine the effects of resistance training on gains in the external mechanical power output developed during climbing and myofibrillar ATPase activity in rats. What is the main finding and its importance? Using rapid flow quench experiments, we show that resistance training increases both the power output and the myofibrillar ATPase activity in the flexor digitorum profundus, biceps and deltoid muscles. Data fitting reveals that these functional ameliorations are explained by an increase in the rate constant of liberation of ATP hydrolysis products and contribute to performance gains. ABSTRACT: Skeletal muscle shows a remarkable plasticity that permits functional adaptations in response to different stimulations. To date, modifications of the proportions of myosin heavy chain (MHC) isoforms and increases in fibre size are considered to be the main factors providing sarcomeric plasticity in response to exercise training. In this study, we investigated the effects of a resistance training protocol on the myofibrillar ATPase (m-ATPase) cycle, muscle performance (power output) and MHC gene expression. For this purpose, 8-week-old Wistar Han rats were subjected to 4 weeks of resistance training, with five sessions per week. Muscle samples of flexor digitorum profundus (FDP), biceps and deltoid were collected and subjected to RT-qPCR analyses and assessment of m-ATPase activity with rapid flow quench apparatus. Training led to a significant increase in muscle mass, except for the biceps, and in total mechanical power output (+135.7%, P < 0.001). A shift towards an intermediate fibre type (i.e. MHC2x-to-MHC2a isoform transition) was also observed in biceps and FDP but not in the deltoid muscle. Importantly, rapid flow quench experiments revealed an enhancement of the m-ATPase activity during contraction at maximal velocity (kF ) in the three muscles, with a more marked effect in FDP (+242%, P < 0.001). Data fitting revealed that the rate constant of liberation of ATP hydrolysis products (k3 ) appears to be the main factor influencing the increase in m-ATPase activity. In conclusion, the data showed that, in addition to classically observed changes in MHC isoform content and fibre hypertrophy, m-ATPase activity is enhanced during resistance training and might contribute significantly to performance gains.

Effects of saccade training on express saccade proportions, saccade latencies, and peak velocities: an investigation of nasal/temporal differences.

Express saccades have very short latencies and are often considered a special population of saccadic eye movements. Recent evidence suggests that express saccade generation in humans increases with training, and that this training is independent of the actual saccade vector being trained. We assessed the time course of these training-induced increases in express saccade generation and how they differ between the nasal and temporal hemifields, and second whether they transfer from the trained to the untrained eye. We also measured the effects of training on saccade latencies more generally, and upon peak velocities. The training effect transferred between the nasal and temporal hemifields and between the trained and untrained eyes. More surprisingly, we found an asymmetric effect of training on express saccade proportions: Before training, express saccade proportions were higher for saccades made into the nasal hemifield but with training this reversed. This training-induced asymmetry was also observed in overall saccade latencies, showing how training can unmask nasal/temporal asymmetries in saccade latencies. Finally, we report for the first time that saccadic peak velocities increased with training, independently of changes in amplitude.

Effect of resistance ladder training on sparc expression in skeletal muscle of hindlimb immobilized rats.

INTRODUCTION: Secreted protein acidic and rich in cysteine (SPARC) is associated with skeletal muscle atrophy. Here we examined possibility that resistance training could regulate SPARC expression in muscle atrophy in an immobilized hindlimb model. METHODS: Sprague-Dawley rats underwent resistance ladder training and hindlimb immobilization. Cross sectional area and grip strength were measured. SPARC protein levels in the plantaris and soleus, and serum after exercise and immobilization were then analyzed. RESULTS: Resistance training decreased body weight (P < 0.001) and increased muscle quality (P < 0.001). In the plantaris, muscle atrophy (31.82%) and up-regulated SPARC expression (P < 0.05) after immobilization were alleviated by resistance training. CONCLUSIONS: Resistance training led to suppression of SPARC expression in the plantaris and showed a pretraining effect in atrophied rat muscle. Thus, SPARC may play a pivotal role in muscle homeostasis. Muscle Nerve 53: 951-957, 2016.

Olfactory function in Parkinson's Disease - effects of training.

BACKGROUND: Up to 90% of patients with Parkinson's disease (PD) exhibit olfactory dysfunction, but little is known about the effects of olfactory training. The study aim was to investigate whether the ability to identify olfactory stimuli can be improved by means of a brief training session. Furthermore, the impact of hyposmia on quality of life in PD was investigated by means of a questionnaire. METHODS: Olfactory function was rated in 34 patients with PD and in 26 controls before and after a training session. An additional 20 patients with PD served as a control group and were tested twice without an intervening training session. Long-term effects were evaluated in a small subset of patients. Cognitive tests and DaT SPECT scans were performed. RESULTS: We demonstrated significant same-day and long-term training effects in trained PD patients compared with non-trained PD patients. A slightly significant correlation was seen between the training effect and DaT putamen values, but not with cognitive test scores. Furthermore, patients with PD reported that hyposmia significantly decreased their quality of life. CONCLUSIONS: Patients with PD improved the number of correctly identified odors in an olfactory test through a brief training session. Olfactory training may have potential in rehabilitation of patients with PD.

The training and detraining effects of 8 weeks of water exercise on obstacle avoidance in gait by the elderly.

[Purpose] This study aimed to provide useful information for fall prevention for the elderly by investigating how safely the elderly cross an obstacle after 8 weeks water exercise, and how much of the training effect remained 8 weeks after finishing the exercise. [Subjects] Eleven elderly participants participated in this study. [Methods] To identify the training and detraining effect of 8 weeks of water exercise, a 3-D motion analysis with 7 infrared cameras and one force plate, was performed. [Results] In most of all variables, statistically significant training and detraining effects at obstacle heights of 30% leg length were found. At obstacle heights of 40% leg length, statistically significant training effects were found but only improvement pattern of detraining effects were found for all variables. [Conclusion] The findings of this study indicate that 8 weeks of water exercise at the level of RPE 12-13 may help the elderly to safely cross obstacles at the most common height associated with falls (30% of leg length) for at least 8 weeks after training termination. The training effect, however, should not be expected to last for 8 weeks after the training at obstacle heights of 40% height of their leg length, which is a more difficult height for the elderly to cross.

Role of 2-day critical ultrasound training curriculum in guiding clinical activities in China.

BACKGROUND: The effectiveness of critical care ultrasound has been demonstrated and training for it is urgent. Critical Care Ultrasound Study Group (CCUSG) has been dedicated to ultrasound training. The aim of the study was to evaluate course structure and training effect and provide improvement suggestions for future training. METHODS: A multicenter retrospective study was conducted. All participants went through a 2-day training curriculum based on the critical care ultrasonic examination (CCUE) protocol. Pre- and post-class evaluation were applied and data were collected. Non-parametric tests were adopted for the comparison, and a Generalized Linear Model (GLM) was used for further analysis. RESULTS: A total number of 792 trainees, with a mean age of 35.8, participated in the study. There were more males in the study population. Most of the trainees were attendings, and most of them had bachelor's degrees, worked at tertiary hospitals and had a mean working experience of 6.9 years. The scores of all trainees were improved to various degrees after the course. An increase from 50% to 72% (P≤0.001) was seen in theory test scores. All the competency assessment scores, including IAS (34% to 50% for cardiac images and 30% to 60% for pulmonary images), IPS (30% to 50%) and AAS (31% to 44%), were improved. A questionnaire after class suggested that 88.0% of the participants found the training course very useful. CONCLUSION: 2-day training course can improve the ability of physicians to assess critically ill patients with the help of the ultrasound.

Effect of 6-Week Instrument-Assisted Soft Tissue Mobilization on Joint Flexibility and Musculotendinous Properties.

Instrument-assisted soft tissue mobilization (IASTM) stimulates soft subcutaneous tissues by applying pressure to the skin with a specialized bar or spurtle-like instrument. No studies have verified whether several weeks of continuous IASTM alone can alter joint flexibility and musculotendinous properties in healthy participants. We examined the effect of a 6-week IASTM program on joint flexibility and the musculotendinous properties of the lower limbs. Fourteen healthy men (aged 19-35 years) who participated in a 6-week IASTM program (3 days weekly) for the soft tissue of the posterior aspect of one lower leg were included. The other leg served as the control. Before and after the intervention, we measured the maximal ankle joint dorsiflexion angle (dorsiflexion range of motion: DFROM) and maximal passive torque (MPT), a measure of stretch tolerance. We measured muscle and tendon stiffness using shear wave elastography on the gastrocnemius and Achilles tendon. IASTM significantly increased the DFROM and MPT (p < 0.05 for both). However, no significant changes were observed in muscle and tendon stiffness. None of the parameters changed significantly in the control group. The 6-week IASTM program increased stretch tolerance and joint flexibility but did not change muscle and tendon stiffness.

Potential Moderators of the Effects of Blood Flow Restriction Training on Muscle Strength and Hypertrophy: A Meta-analysis Based on a Comparison with High-Load Resistance Training.

BACKGROUND: While it has been examined whether there are similar magnitudes of muscle strength and hypertrophy adaptations between low-load resistance training combined with blood-flow restriction training (BFR-RT) and high-load resistance training (HL-RT), some important potential moderators (e.g., age, sex, upper and lower limbs, frequency and duration etc.) have yet to be analyzed further. Furthermore, training status, specificity of muscle strength tests (dynamic versus isometric or isokinetic) and specificity of muscle mass assessments (locations of muscle hypertrophy assessments) seem to exhibit different effects on the results of the analysis. The role of these influencing factors, therefore, remains to be elucidated. OBJECTIVES: The aim of this meta-analysis was to compare the effects of BFR- versus HL-RT on muscle adaptations, when considering the influence of population characteristics (training status, sex and age), protocol characteristics (upper or lower limbs, duration and frequency) and test specificity. METHODS: Studies were identified through database searches based on the following inclusion criteria: (1) pre- and post-training assessment of muscular strength; (2) pre- and post-training assessment of muscular hypertrophy; (3) comparison of BFR-RT vs. HL-RT; (4) score ≥ 4 on PEDro scale; (5) means and standard deviations (or standard errors) are reported or allow estimation from graphs. In cases where the fifth criterion was not met, the data were requested directly from the authors. RESULTS: The main finding of the present study was that training status was an important influencing factor in the effects of BFR-RT. The trained individuals may gain greater muscle strength and hypertrophy with BFR-RT as compared to HL-RT. However, the results showed that the untrained individuals experienced similar muscle mass gains and superior muscle strength gains in with HL-RT compared to BFR-RT. CONCLUSION: Compared to HL-RT, training status is an important factor influencing the effects of the BFR-RT, in which trained can obtain greater muscle strength and hypertrophy gains in BFR-RT, while untrained individuals can obtain greater strength gains and similar hypertrophy in HL-RT.

Bipolar magnetic switching and large exchange-bias in Fe-substituted SmCrO3.

Rare-earth orthochromite is an interesting system in the view of its complex magnetic ordering due to competing interaction between different magnetic ions. Here, Fe-substituted SmCrO3samples were prepared by solid-state route to investigate their intriguing magnetic properties towards exploring its application potential. The magnetic studies revealed antiferromagnetic (AFM) ordering at Nèel temperature (TN) ∼ 181 K, magnetic compensation temperatures (TCOMP) at ∼137 K and 50 K, and spin-reorientation temperature (TSR) at 64 K in SmCr0.8Fe0.2O3sample. Additionally, the system exhibited negative magnetization under field-cooled conditions which allowed the field as well as temperature controllable magnetization switching behavior. Notably, the Fe-substituted SmCrO3sample displayed a remarkable exchange bias (HEB) value of ∼1.39 T at 10 K due to the coexistence of ferromagnetic and AFM ordering at different cationic sites. TheM-Hloops recorded under positive and negative field-cooled conditions ruled out the minor-loop effect. Theoretical models applied on the training effect studies confirmed the observed exchange-bias effect.

Audiovisual n-Back Training Alters the Neural Processes of Working Memory and Audiovisual Integration: Evidence of Changes in ERPs.

(1) Background: This study investigates whether audiovisual n-back training leads to training effects on working memory and transfer effects on perceptual processing. (2) Methods: Before and after training, the participants were tested using the audiovisual n-back task (1-, 2-, or 3-back), to detect training effects, and the audiovisual discrimination task, to detect transfer effects. (3) Results: For the training effect, the behavioral results show that training leads to greater accuracy and faster response times. Stronger training gains in accuracy and response time using 3- and 2-back tasks, compared to 1-back, were observed in the training group. Event-related potentials (ERPs) data revealed an enhancement of P300 in the frontal and central regions across all working memory levels after training. Training also led to the enhancement of N200 in the central region in the 3-back condition. For the transfer effect, greater audiovisual integration in the frontal and central regions during the post-test rather than pre-test was observed at an early stage (80-120 ms) in the training group. (4) Conclusion: Our findings provide evidence that audiovisual n-back training enhances neural processes underlying a working memory and demonstrate a positive influence of higher cognitive functions on lower cognitive functions.

Emergent, Non-Aging, Extendable, and Rechargeable Exchange Bias in 2D Fe3 GeTe2 Homostructures Induced by Moderate Pressuring.

As a crucial concept in magnetism and spintronics, exchange bias (ExB) measures the asymmetry in the hysteresis loop of a pinned ferromagnet (FM)/antiferromagnet (AFM) interface. Previous studies are mainly focused on FM/AFM heterostructures composed of conventional bulk materials, whose complex interfaces prohibit precise control and full understanding of the phenomenon. Here, the enabling power of 2D magnets is exploited to demonstrate the emergence, non-aging, extendability, and rechargeability of ExB in van der Waals Fe3 GeTe2 homostructures, upon moderate pressuring. The emergence of the ExB is attributed to a local stress-induced FM-to-AFM transition, as validated using first-principles calculations, and confirmed in magneto-optical Kerr effect and second harmonic generation measurements. It is also observed that, negligible ExB aging before the training effect suddenly takes place through avalanching, pronounced delay of the avalanche via timed pressure repetition (extendability), ExB recovery in the post-training sample upon refreshed pressuring (rechargeability), and demonstrate its versatile tunability. These striking findings offer unprecedented insights into the underlying principles of ExB and its training, with immense technological applications in sight.

Trait representation of embodied cognition in dancers pivoting on the extended mirror neuron system: a resting-state fMRI study.

Introduction: Dance is an art form that integrates the body and mind through movement. Dancers develop exceptional physical and mental abilities that involve various neurocognitive processes linked to embodied cognition. We propose that dancers' primary trait representation is movement-actuated and relies on the extended mirror neuron system (eMNS). Methods: A total of 29 dancers and 28 non-dancer controls were recruited. A hierarchical approach of intra-regional and inter-regional functional connectivity (FC) analysis was adopted to probe trait-like neurodynamics within and between regions in the eMNS during rest. Correlation analyses were employed to examine the associations between dance training, creativity, and the FC within and between different brain regions. Results: Within the eMNS, dancers exhibited increased intra-regional FC in various brain regions compared to non-dancers. These regions include the left inferior frontal gyrus, left ventral premotor cortex, left anterior insula, left posterior cerebellum (crus II), and bilateral basal ganglia (putamen and globus pallidus). Dancers also exhibited greater intrinsic inter-regional FC between the cerebellum and the core/limbic mirror areas within the eMNS. In dancers, there was a negative correlation observed between practice intensity and the intrinsic FC within the eMNS involving the cerebellum and basal ganglia. Additionally, FCs from the basal ganglia to the dorsolateral prefrontal cortex were found to be negatively correlated with originality in dancers. Discussion: Our results highlight the proficient communication within the cortical-subcortical hierarchy of the eMNS in dancers, linked to the automaticity and cognitive-motor interactions acquired through training. Altered functional couplings in the eMNS can be regarded as a unique neural signature specific to virtuoso dancers, which might predispose them for skilled dancing performance, perception, and creation.

Use of Virtual Reality in the Education of Orthopaedic Procedures: A Randomised Control Study in Early Validation of a Novel Virtual Reality Simulator.

Background Virtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system. Methods Thirty-one surgical trainees were randomised to two groups: traditional-training group (control group) and a VR-training group (intervention group) for insertion of a short cephalomedullary TFNA nail. Both groups then inserted the same TFNA system into saw-bone femurs. Surveys evaluated validity of the relevant activities, perception of simulation, confidence, stress and anxiety. The primary outcomes were tip-apex distance (TAD) and user anxiety/confidence levels. Secondary outcomes included number of screw- and nail-guidewire insertion attempts, the time taken to complete and user validity of the VR system. Results There was no statistical difference in TAD between the intervention and control groups (9mm vs 15mm, p=0.0734). The only TAD at risk of cut-out was in the control group (25mm). There was no statistical difference in time taken (2547.5ss vs 2395ss, p=0.668), nail guide-wire attempts (two for both groups, p=0.355) and screw guide-wire attempts (one for both groups, p=0.702). The control group versus intervention had higher anxiety levels (50% vs 33%) and had lower confidence (61% vs 84%). Interpretation There was no objective difference in performance on a saw-bone model between groups. However, this VR simulator resulted in more confidence and lower anxiety levels whilst performing a simulated TFNA. Whilst further studies with larger sample sizes and exploration of transfer validity to the operating theatre are required, this study does indicate potential benefits of VR within surgical training.

Effect evaluation of case-based learning with situated cognition theory on competence training for student nurses in pediatric surgery.

Objective: The case-based learning with situated cognition theory (CBL-SCT) approach focuses on teaching over learning, making it suited to student nurse education. However, it is rare in student nurse training in pediatric surgery, and some subjective evaluations of the learning effect are still affected by the assessor. This study investigated the effect of the CBL-SCT approach on improving the nursing quality/safety and comprehensive performance of student nurses, and explored a method for analyzing the reliability of subjective evaluations. Methods: Thirty-six student nurses were divided into a control group and an experimental group and received seven days of orientation via conventional and CBL-SCT training, respectively. The learning effect was evaluated via examining their implementation of nursing quality criteria within the following month and their comprehensive clinical performance after six months. Among the evaluation indicators, professional skills, job competency, and professional quality were evaluated by assessors, whose scores were tested for consistency using Cronbach's alpha. Results: Among the 11 nursing quality criteria, the correct implementation of patient identification and communication (t = 2.257, P = 0.031), medication-checking (t = 5.444, P < 0.001), tumbles/bed-falling prevention (t = 3.609, P = 0.001), pressure injury prevention (t = 3.834, P = 0.001), catheter management (t = 3.409, P = 0.002), and nursing record writing (t = 2.911, P = 0.006) in the experimental group were all higher than in the control group. Six months after training, the experimental group was also higher in professional theory (t = 4.889, P < 0.001), professional skills (t = 2.736, P = 0.010), job competency (t = 5.166, P < 0.001), and professional quality (t = 16.809, P < 0.001). Cronbach's alpha test verified that the assessors' evaluations had good internal consistency and reliability for job competency (alpha = 0.847, 95% CI lower limit = 0.769), professional quality (alpha = 0.840, 95% CI lower limit = 0.759), and professional skills (alpha = 0.888, 95% CI lower limit = 0.822). Conclusions: The CBL-SCT method can help student nurses quickly change their nursing role, and Cronbach's alpha test can verify the reliability of subjective evaluations, thus indirectly reflecting the training effect equitably and objectively.