-
International Journal of Environmental... Jul 2021Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an... (Review)
Review
Human performance optimization of tactical personnel requires accurate, meticulous, and effective monitoring of biological adaptations and systemic recovery. Due to an increased understanding of its importance and the commercial availability of assessment tools, the use of heart rate variability (HRV) to address this need is becoming more common in the tactical community. Measuring HRV is a non-invasive, practical method for objectively assessing a performer's readiness, workload, and recovery status; when combined with additional data sources and practitioner input, it provides an affordable and scalable solution for gaining actionable information to support the facilitation and maintenance of operational performance. This narrative review discusses the non-clinical use of HRV for assessing, monitoring, and interpreting autonomic nervous system resource availability, modulation, effectiveness, and efficiency in tactical populations. Broadly, HRV metrics represent a complex series of interactions resulting from internal and external stimuli; therefore, a general overview of HRV applications in tactical personnel is discussed, including the influence of occupational specific demands, interactions between cognitive and physical domains, and recommendations on implementing HRV for training and recovery insights into critical health and performance outcomes.
Topics: Autonomic Nervous System; Heart Rate; Humans; Monitoring, Physiologic; Workload
PubMed: 34360435
DOI: 10.3390/ijerph18158143 -
JAMA Network Open Feb 2022The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based...
IMPORTANCE
The new Medicare Skilled Nursing Facility Value-Based Purchasing program (SNF VBP) seeks to improve patient outcomes by awarding financial incentives or penalties based on 30-day hospital readmission rates. Skilled nursing facilities (SNFs) can avoid a penalty through low baseline readmission rates or improvement over time.
OBJECTIVE
To assess the baseline performance and improvement over time of SNFs in the SNF VBP program.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study examined readmission rates, financial penalties and incentives, and facility and patient characteristics associated with these outcomes at 14 959 US SNFs that received Medicare payments between January 1, 2015, and December 31, 2019.
MAIN OUTCOMES AND MEASURES
Outcomes were readmission rates and financial penalties by facility. The SNFs were classified as improvers in the analysis if they had better improvement scores than baseline scores under the program and achievers if they had higher baseline scores than improvement scores.
RESULTS
Of 14 959 SNFs studied, 1849 (12.3%) were assigned their improvement score as their performance score in the first year of the program. Of these, 1167 (63.1%) received a financial penalty, whereas 374 (20.2%) received a bonus. Only 52 facilities that performed poorly at baseline (0.3% of all SNFs and 0.7% of below-median performers) were able to improve enough to avoid a financial penalty, despite large improvements in readmission rates. Improver SNFs treated larger racial minority populations (mean [SD], 74.57% [23.42%] White in the improver group vs 79.15% [22.18%] in the achiever group) and were located in counties with larger minority populations (mean [SD], 15.48% [14.05%] Black in the improver group vs 11.57% [12.72%] Black in the achiever group). The most important predictors of improvement were related to SNF finances, such as operating margin (mean [SD], -0.74 [13.87]) and occupancy rates (mean [SD], 79.93 [14.81]).
CONCLUSIONS AND RELEVANCE
This cross-sectional study suggests that the SNF VBP program did not offer a viable path for nearly all low-performing SNFs to avoid financial penalties through improved readmission rates.
Topics: Aged; Cross-Sectional Studies; Humans; Medicare; Patient Readmission; Skilled Nursing Facilities; United States; Value-Based Purchasing
PubMed: 35226075
DOI: 10.1001/jamanetworkopen.2022.0721 -
The Western Journal of Medicine Jan 1994Arts medicine has come of age, resulting from 3 important developments over the past decade: improved methods of diagnosis and treatment, an awareness that artists...
Arts medicine has come of age, resulting from 3 important developments over the past decade: improved methods of diagnosis and treatment, an awareness that artists suffer from special problems related to their occupation and lifestyle, and the establishment of health programs emphasizing an interdisciplinary approach to these patients. We focus on the patterns of illness afflicting performing artists, specifically dancers, singers, actors, and instrumental musicians, and explain some of the things a health care team can do in treating these patients. The conditions governing these patients' lives--early exposure to high expectations of excellence, incessant demands for perfection, long periods of intense practicing, fierce competition, high levels of anxiety associated with performance, and uncertain careers--need to be understood. Levels of disease and disability are remarkably high, but artists often ignore symptoms. We discuss the musculoskeletal, neurologic, vocal, psychological, and other syndromes found among performers and some of the difficulties in treating them. The prevention of injury, conservative management, collaboration with teachers, and a psychotherapeutic approach are desirable. Arts medicine programs for professional consultation exist in several major cities of the United States and abroad. Although research is needed regarding the effectiveness of health care services for performing artists, the scientific literature devoted to this field is growing.
Topics: Dancing; Depression; Humans; Medicine; Music; Occupational Diseases; Specialization; Stress, Psychological; Wounds and Injuries
PubMed: 8128702
DOI: No ID Found -
Fungal Biology and Biotechnology 2019This review reflects several artists and their artistic research in the field of hybrid art, bio art, or science art, working with Fungi as both subject matter and... (Review)
Review
This review reflects several artists and their artistic research in the field of hybrid art, bio art, or science art, working with Fungi as both subject matter and medium. The work of Saša Spačal, Tarsh Bates and Theresa Schubert is not representational in the manner of traditional fine art, but works rather through performative, multidisciplinary and research-based strategies to produce artwork through fungal material as such. My research results are based on the series "Nonhuman subjectivities" and "Nonhuman agents" that Christian de Lutz and I conceived and realized at Art Laboratory Berlin (2016-18) in various formats-exhibitions, workshops, lectures and a conference. The work of Saša Spačal and her colleagues involves creating interactive situations of symbiosis between the fungal and the human. An example of this is , in which a biofeedback loop is related between the human participant and Oyster mushroom mycelia through a special encounter, which is mediated by non-linguistic forms of awareness and exchange-sonic, electronic and metabolic. Tarsh Bates' work with and refers to a complex and intimate relation between the human and yeasts that form part of the human microbiome. Bates considers the relationship between humans and yeast as "CandidaHomo Ecologies" and sees both partners as equals. She explores this relationship through her work examines it from historical and metabolic levels through an installation that includes the live yeast growing on agar mixed with the artist's own blood. Theresa Schubert's installations and site-specific interventions treat living organisms, especially Fungi, as collaborators and co-creators. Her work - follows the morphological development of fungal fruiting bodies through the intervention of a tattoo. Her performative forest walks, especially the and also new actions for the "Mind the Fungi" project, engage the public in an intimate and multi sensory encounter with Fungi and their surrounding environment.
PubMed: 31827811
DOI: 10.1186/s40694-019-0085-6 -
Frontiers in Psychology 2023Recent investigations on music performances have shown the relevance of singers' body motion for pedagogical as well as performance purposes. However, little is known...
Recent investigations on music performances have shown the relevance of singers' body motion for pedagogical as well as performance purposes. However, little is known about how the perception of voice-matching or task complexity affects choristers' body motion during ensemble singing. This study focussed on the body motion of choral singers who perform in duo along with a pre-recorded tune presented over a loudspeaker. Specifically, we examined the effects of the perception of voice-matching, operationalized in terms of sound spectral envelope, and task complexity on choristers' body motion. Fifteen singers with advanced choral experience first manipulated the spectral components of a pre-recorded short tune composed for the study, by choosing the settings they felt most and least together with. Then, they performed the tune in unison (i.e., singing the same melody simultaneously) and in canon (i.e., singing the same melody but at a temporal delay) with the chosen filter settings. Motion data of the choristers' upper body and audio of the repeated performances were collected and analyzed. Results show that the settings perceived as least together relate to extreme differences between the spectral components of the sound. The singers' wrists and torso motion was more periodic, their upper body posture was more open, and their bodies were more distant from the music stand when singing in unison than in canon. These findings suggest that unison singing promotes an expressive-periodic motion of the upper body.
PubMed: 38187406
DOI: 10.3389/fpsyg.2023.1220904 -
Frontiers in Physiology 2023The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite...
The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite level compared to those who are not. Longitudinal data of 29 talented sprint and middle-distance swimmers (12 males; 17 females) on season best performances (season best times) and underlying performance characteristics (anthropometrics, starts, turns, maximal swimming velocity, stroke index [SI, an indirect measure of swimming efficiency] and lower body power) were collected over four swimming seasons (median of = 3 seasons per swimmer). Based on their season best performance at early senior age (males aged 18-19; females aged 17-18), some swimmers were considered to be on track to reach the elite level (referred to as high-performing seniors; 6 males and 10 females), whereas others were not (referred to as lower-performing seniors; 6 males and 7 females). Retrospectively studying these swimmers (males and females separately), we found that all high-performing seniors were already on track to the elite level at late junior age (males aged 17; females aged 16), evidenced with faster season best performances throughout their transition compared to their lower-performing peers ( < 0.05). Independent sample -tests revealed that high-performing seniors significantly outscored their lower-performing peers on maximal swimming velocity (males and females), starts and turns (males), SI (females) and lower body power (females) at late junior age ( < 0.05). Additionally, multilevel models showed faster rates of development for high-performing seniors on turns and maximal swimming velocity (males), and SI (females) compared to lower-performing peers during the junior-to-senior transition ( < 0.05). Particularly, the higher initial levels of swim performance and underlying characteristics at late junior age as well as the ability to keep progressing on season best performances (males and females), turns and maximal swimming velocity (males), and SI (females) during the junior-to-senior transition, may be crucial factors in the attainment of swimming expertise.
PubMed: 37621763
DOI: 10.3389/fphys.2023.1221567 -
Frontiers in Psychology 2021The following text explores performative art works commissioned within a specific "arts and health" cultural setting, namely that of a medical school within a British... (Review)
Review
The following text explores performative art works commissioned within a specific "arts and health" cultural setting, namely that of a medical school within a British university. It examines the degree to which the professional autonomy of the artists (and curator) was "instrumentalized" and diminished as a result of having to fit into normative frames set by institutional agendas (in this case, that of "the neoliberal university"). We ask to what extent do such "entanglements," feel more like "enstranglements," suffocating the artist's capacity to envision the world afresh or any differently? What kinds of pressures allow for certain kinds of "evidence" to be read and made visible, (and not others)? was a 2016 programme curated by Frances Williams, challenging simplistic expectations that the arts hold any automatic power of their own to make "things better" in healthcare. It included two performative projects - The Secret Society of Imperfect Nurses, by Anthony Schrag with student nurses at Kings College London, and Hiding in Plain Sight by Becky Shaw (plus film with Rose Butler) with doctoral researchers in nursing and midwifery. These projects were situated in a climate of United Kingdom National Health Service cuts and austerity measures where the advancement of social prescribing looks dangerously like the government abnegating responsibility and offering art as amelioration. The text therefore examines the critical "stage" on which these arts-health projects were performed and the extent to which critical reflection is welcomed within institutional contexts, how learning is framed, expressed aesthetically, as well as understood as art practice (as much as "education" or "learning"). It further examines how artistic projects might offer sites of resistance, rejection and mechanisms of support against constricting institutional norms and practices that seek to instrumentalise artistic works to their own ends.
PubMed: 35095636
DOI: 10.3389/fpsyg.2021.732957 -
Journal of Robotic Surgery Aug 2023RAPN training usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee capacity to perform RAPN...
RAPN training usually takes place in-vivo and methods vary across countries/institutions. No common system exists to objectively assess trainee capacity to perform RAPN at predetermined performance levels prior to in-vivo practice. The identification of objective performance metrics for RAPN training is a crucial starting point to improve training and surgical outcomes. The authors sought to examine the reliability, construct and discriminative validity of objective intraoperative performance metrics which best characterize the optimal and suboptimal performance of a reference approach for training novice RAPN surgeons. Seven Novice and 9 Experienced RAPN surgeons video recorded one or two independently performed RAPN procedures in the human. The videos were anonymized and two experienced urology surgeons were trained to reliably score RAPN performance, using previously developed metrics. The assessors were blinded to the performing surgeon, hospital and surgeon group. They independently scored surgeon RAPN performance. Novice and Experienced group performance scores were compared for procedure steps completed and errors made. Each group was divided at the median for Total Errors score, and subgroup scores (i.e., Novice HiErrs and LoErrs, Experienced HiErrs and LoErrs) were compared. The mean inter-rater reliability (IRR) for scoring was 0.95 (range 0.84-1). Compared with Novices, Experienced RAPN surgeons made 69% fewer procedural Total Errors. This difference was accentuated when the LoErr Expert RAPN surgeon's performance was compared with the HiErrs Novice RAPN surgeon's performance with an observed 170% fewer Total Errors. GEARS showed poor reliability (Mean IRR = 0.44; range 0.0-0.8), for scoring RAPN surgical performance. The RAPN procedure metrics reliably distinguish Novice and Experienced surgeon performances. They further differentiated performance levels within a group with similar experiences. Reliable and valid metrics will underpin quality-assured novice RAPN surgical training.
Topics: Humans; Robotic Surgical Procedures; Robotics; Reproducibility of Results; Surgeons; Clinical Competence; Nephrectomy
PubMed: 36689078
DOI: 10.1007/s11701-023-01521-1 -
BJS Open Jul 2021Eye-tracking offers a new list of performance measures for surgeons. Previous studies of eye-tracking have reported that action-related fixation is a good measuring tool...
BACKGROUND
Eye-tracking offers a new list of performance measures for surgeons. Previous studies of eye-tracking have reported that action-related fixation is a good measuring tool for elite task performers. Other measures, including early eye engagement to target and early eye disengagement from the previous subtask, were also reported to distinguish between different expertise levels. These parameters were examined during laparoscopic surgery simulations in the present study, with a goal to identify the most useful measures for distinguishing surgical expertise.
METHODS
Surgical operators, including experienced surgeons (expert), residents (intermediate), and university students (novice), were required to perform a laparoscopic task involving reaching, grasping, and loading, while their eye movements and performance videos were recorded. Spatiotemporal features of eye-hand coordination and action-related fixation were calculated and compared among the groups.
RESULTS
The study included five experienced surgeons, seven residents, and 14 novices. Overall, experts performed tasks faster than novices. Examining eye-hand coordination on each subtask, it was found that experts managed to disengage their eyes earlier from the previous subtask, whereas novices disengaged their eyes from previous subtask with a significant delay. Early eye engagement to the current subtask was observed for all operators. There was no difference in action-related fixation between experienced surgeons and novices. Disengage time was strongly associated with the surgical experience score of the operators, better than both early-engage time and action-related fixation.
CONCLUSION
The spatiotemporal features of surgeons' eye-hand coordination can be used to assess level of surgical experience.
Topics: Clinical Competence; Eye Movements; Humans; Laparoscopy; Surgeons
PubMed: 34476467
DOI: 10.1093/bjsopen/zrab068 -
European Journal of Medical Research May 2023The tumor microenvironment is a result of dynamic interaction between different cellular and non-cellular components. In its essence it is not a solo performer, but an... (Review)
Review
The tumor microenvironment is a result of dynamic interaction between different cellular and non-cellular components. In its essence it is not a solo performer, but an ensemble of performers that includes cancer cells, fibroblasts, myo-fibroblasts, endothelial cells and immune cells. The short review highlights important immune infiltrates within the tumor microenvironment that shape cytotoxic t lymphocyte (CTL)-rich immune hot and CTL-deficient immune cold tumors and novel strategies that have potential role in enhancing our immune responses in both immune hot and immune cold tumors.
Topics: Humans; Tumor Microenvironment; Endothelial Cells; T-Lymphocytes, Cytotoxic; Neoplasms
PubMed: 37179365
DOI: 10.1186/s40001-023-01125-3