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Hu H, Lai X, Yan L. Training nurses in an international emergency medical team using a serious role-playing game: a retrospective comparative analysis. BMC MEDICAL EDUCATION 2024; 24:432. [PMID: 38649943 PMCID: PMC11034038 DOI: 10.1186/s12909-024-05442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Although game-based applications have been used in disaster medicine education, no serious computer games have been designed specifically for training these nurses in an IEMT setting. To address this need, we developed a serious computer game called the IEMTtraining game. In this game, players assume the roles of IEMT nurses, assess patient injuries in a virtual environment, and provide suitable treatment options. METHODS The design of this study is a retrospective comparative analysis. The research was conducted with 209 nurses in a hospital. The data collection process of this study was conducted at the 2019-2020 academic year. A retrospective comparative analysis was conducted on the pre-, post-, and final test scores of nurses in the IEMT. Additionally, a survey questionnaire was distributed to trainees to gather insights into teaching methods that were subsequently analyzed. RESULTS There was a significant difference in the overall test scores between the two groups, with the game group demonstrating superior performance compared to the control group (odds ratio = 1.363, p value = 0.010). The survey results indicated that the game group exhibited higher learning motivation scores and lower cognitive load compared with the lecture group. CONCLUSIONS The IEMT training game developed by the instructor team is a promising and effective method for training nurses in disaster rescue within IEMTs. The game equips the trainees with the necessary skills and knowledge to respond effectively to emergencies. It is easily comprehended, enhances knowledge retention and motivation to learn, and reduces cognitive load.
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Affiliation(s)
- Hai Hu
- Emergency Management Office of West China Hospital, Sichuan University, The street address: No. 37. Guoxue Road, Chengdu City, Sichuan Province, China.
- China International Emergency Medical Team (Sichuan), Chengdu City, Sichuan Province, China.
- Emergency Medical Rescue Base, Sichuan University, Chengdu City, Sichuan Province, China.
| | - Xiaoqin Lai
- China International Emergency Medical Team (Sichuan), Chengdu City, Sichuan Province, China
- Day Surgery Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
- Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Longping Yan
- West China School of Nursing, Sichuan University, Chengdu City, Sichuan Province, China
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
- West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Albanese GA, Bucchieri A, Podda J, Tacchino A, Buccelli S, De Momi E, Laffranchi M, Mannella K, Holmes MWR, Zenzeri J, De Michieli L, Brichetto G, Barresi G. Robotic systems for upper-limb rehabilitation in multiple sclerosis: a SWOT analysis and the synergies with virtual and augmented environments. Front Robot AI 2024; 11:1335147. [PMID: 38638271 PMCID: PMC11025362 DOI: 10.3389/frobt.2024.1335147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024] Open
Abstract
The robotics discipline is exploring precise and versatile solutions for upper-limb rehabilitation in Multiple Sclerosis (MS). People with MS can greatly benefit from robotic systems to help combat the complexities of this disease, which can impair the ability to perform activities of daily living (ADLs). In order to present the potential and the limitations of smart mechatronic devices in the mentioned clinical domain, this review is structured to propose a concise SWOT (Strengths, Weaknesses, Opportunities, and Threats) Analysis of robotic rehabilitation in MS. Through the SWOT Analysis, a method mostly adopted in business management, this paper addresses both internal and external factors that can promote or hinder the adoption of upper-limb rehabilitation robots in MS. Subsequently, it discusses how the synergy with another category of interaction technologies - the systems underlying virtual and augmented environments - may empower Strengths, overcome Weaknesses, expand Opportunities, and handle Threats in rehabilitation robotics for MS. The impactful adaptability of these digital settings (extensively used in rehabilitation for MS, even to approach ADL-like tasks in safe simulated contexts) is the main reason for presenting this approach to face the critical issues of the aforementioned SWOT Analysis. This methodological proposal aims at paving the way for devising further synergistic strategies based on the integration of medical robotic devices with other promising technologies to help upper-limb functional recovery in MS.
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Affiliation(s)
| | - Anna Bucchieri
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kailynn Mannella
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Giacinto Barresi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
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Saussez G, Bailly R, Araneda R, Paradis J, Ebner-Karestinos D, Klöcker A, Sogbossi ES, Riquelme I, Brochard S, Bleyenheuft Y. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil 2023; 20:98. [PMID: 37516873 PMCID: PMC10385889 DOI: 10.1186/s12984-023-01218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. METHODS Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch®" experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch®" group versus the "HABIT-ILE" control group. RESULTS We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). CONCLUSIONS Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. TRIAL REGISTRATION Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.
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Affiliation(s)
- G Saussez
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium.
- Motor Sciences department, FfH Lab, CeREF Santé, HELHa, Rue Trieu Kaisin, 136, 6061, Montignies-Sur-Sambre, Belgium.
| | - R Bailly
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - R Araneda
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - J Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - D Ebner-Karestinos
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - A Klöcker
- Haute Ecole Leonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - E S Sogbossi
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - I Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - S Brochard
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - Y Bleyenheuft
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
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Hsin LJ, Chao YP, Chuang HH, Kuo TBJ, Yang CCH, Huang CG, Kang CJ, Lin WN, Fang TJ, Li HY, Lee LA. Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial. VIRTUAL REALITY 2022; 27:1-17. [PMID: 36118174 PMCID: PMC9470506 DOI: 10.1007/s10055-022-00688-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/28/2022] [Indexed: 06/02/2023]
Abstract
Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.
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Affiliation(s)
- Li-Jen Hsin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, 33302 Taiwan
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan
| | - Hai-Hua Chuang
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
- Department of Family Medicine, Taipei Branch and Linkou Main Branch, Linkou Medical Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan, 33305 Taiwan, Republic of China
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, 10608 Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan
| | - Terry B. J. Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
| | - Cheryl C. H. Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, 33305 Taiwan
- Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Wan-Ni Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
| | - Li-Ang Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Sleep Center, Linkou Medical Center, Linkou Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Gueishan District, Taoyuan City, 33305 Taiwan, Republic of China
- Faculty of Medicine, Graduate Institute of Clinical Medicine Sciences, Chang Gung University, Taoyuan, 33302 Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, 11221 Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, 300044 Taiwan
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Teaching Disaster Evacuation Management Education to Nursing Students Using Virtual Reality Mobile Game-Based Learning. Comput Inform Nurs 2022; 40:705-710. [PMID: 35485942 DOI: 10.1097/cin.0000000000000856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to explore the effectiveness of a virtual reality mobile game-based application for teaching disaster evacuation management education to nursing students. A pre-test, post-test, and final-test study design was used to compare traditional lecture group and game group instructional knowledge delivery effectiveness and instructional mode satisfaction. The statistical comparison of pre-test and post-test knowledge and decision-making scores did not reveal significant group differences for short-term improvement (P ≥ .05); however, final test scores revealed that the virtual reality mobile game-based application group had significantly higher knowledge and decision-making retention scores compared with the traditional lecture group (P = .000). The game group also had significantly higher instructional mode satisfaction scores for course interest and cooperation with others (P < .05). The virtual reality mobile game-based application was more effective for teaching nursing students about disaster evacuation management educational training than lecture instruction. The greater satisfaction expressed by nursing students when using this instructional mode suggests that it may better facilitate self-initiated lifelong disaster evacuation learning behaviors.
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Development of a Virtual Ecological Environment for Learning the Taipei Tree Frog. SUSTAINABILITY 2021. [DOI: 10.3390/su13115911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The learning objectives of environmental education emphasize investigation in real life to enhance students’ skills and experiences in solving practical problems. This study used the virtual reality (VR) technology to develop a virtual ecological environment for learning about the Taipei tree frog, supported by situated learning and game-based learning design to enhance students’ learning interest and motivation. Users can wear the head-mounted display (HMD) to explore the virtual environment for learning the Taipei tree frog’s ecological behavior, such as foraging and mating as well as its habitats and predators. A teaching experiment was conducted to investigate students’ learning effectiveness and the senses of presence and anxiety after using the virtual ecological environment. The experimental group (wearing the HMD) contained 40 students, the control group (using the desktop VR) contained 40 students, and both groups were used as samples to learn about the Taipei tree frog. The results indicated that using HMD VR and desktop VR could both enhance learning achievements, but the learning effectiveness of the former was significantly higher than that of the latter. The levels of anxiety for both groups were about the same, but the level of presence for the experimental group was higher than that of the control group because the HMD VR provided a more immersive experience than the desktop VR. The virtual ecological environment can save the time and effort of travelling to the natural habitat for observing the Taipei tree frog, and the design of role-playing game (RPG) can enhance learners’ interest and motivation. Therefore, it is a useful tool for promoting environmental education.
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Wang W, Yang K, Zhu Y. Optimal Frequency and Amplitude of Vertical Viewpoint Oscillation for Improving Vection Strength and Reducing Neural Constrains on Gait. ENTROPY (BASEL, SWITZERLAND) 2021; 23:541. [PMID: 33924864 PMCID: PMC8145014 DOI: 10.3390/e23050541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
Inducing self-motion illusions referred as vection are critical for improving the sensation of walking in virtual environments (VE). Adding viewpoint oscillations to a constant forward velocity in VE is effective for improving vection strength under static conditions. However, the effects of oscillation frequency and amplitude on vection strength under treadmill walking conditions are still unclear. Besides, due to the visuomotor entrainment mechanism, these visual oscillations would affect gait patterns and be detrimental for achieving natural walking if not properly designed. This study was aimed at determining the optimal frequency and amplitude of vertical viewpoint oscillations for improving vection strength and reducing gait constraints. Seven subjects walked on a treadmill while watching a visual scene. The visual scene presented a constant forward velocity equal to the treadmill velocity with different vertical viewpoint oscillations added. Five oscillation patterns with different combinations of frequency and amplitude were tested. Subjects gave verbal ratings of vection strength. The mediolateral (M-L) center of pressure (CoP) complexity was calculated to indicate gait constraints. After the experiment, subjects were asked to give the best and the worst oscillation pattern based on their walking experience. The oscillation frequency and amplitude had strong positive correlations with vection strength. The M-L CoP complexity was reduced under oscillations with low frequency. The medium oscillation amplitude had greater M-L CoP complexity than the small and large amplitude. Besides, subjects preferred those oscillation patterns with large gait complexity. We suggested that the oscillation amplitude with largest M-L CoP complexity should first be chosen to reduce gait constraints. Then, increasing the oscillation frequency to improve vection strength until individual preference or the boundary of motion sickness. These findings provide important guidelines to promote the sensation of natural walking in VE.
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Affiliation(s)
| | - Kaiming Yang
- Beijing Key Laboratory of Precision and Ultra-Precision Manufacturing Equipment and Control, Department of Mechanical Engineering, Tsinghua University, Beijing 100084, China; (W.W.); (Y.Z.)
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Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6631835. [PMID: 33815554 PMCID: PMC7990546 DOI: 10.1155/2021/6631835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 11/25/2022]
Abstract
Interdisciplinary combinations of medicine and engineering are part of the strategic plan of many universities aiming to be world-class institutions. One area in which these interactions have been prominent is rehabilitation of stroke hemiplegia. This article reviews advances in the last five years of stroke hemiplegia rehabilitation via interdisciplinary combination of medicine and engineering. Examples of these technologies include VR, RT, mHealth, BCI, tDCS, rTMS, and TCM rehabilitation. In this article, we will summarize the latest research in these areas and discuss the advantages and disadvantages of each to examine the frontiers of interdisciplinary medicine and engineering advances.
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Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis. J Adv Nurs 2021; 77:3255-3273. [PMID: 33675076 DOI: 10.1111/jan.14800] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/22/2020] [Accepted: 01/20/2021] [Indexed: 01/17/2023]
Abstract
AIMS To explore the beneficial effects of virtual reality (VR) interventions on upper- and lower-limb motor function, balance, gait, cognition and daily function outcomes in stroke patients. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES English databases (PubMed, EMBASE, the Cochrane Library, CINAHL, Web of Science, Physiotherapy Evidence Database, ProQuest Dissertations and Theses) and Chinese databases (Chinese BioMedical Literature Service System, WANFANG, CNKI) and the Clinical Trial Registry Platform were systematically searched from inception until December 2019. Additionally, reference lists of the included studies were manually searched. REVIEW METHODS The methodological quality of studies was scored with the Cochrane 'risk-of-bias tool' and PEDro scale from the Physiotherapy Evidence Database by two independent evaluators. RESULTS In total, 87 studies with 3540 participants were included. Stroke patients receiving VR interventions showed significant improvements in Fugl-Meyer assessment of Upper Extremity, Action Research Arm Test, Wolf Motor Function Test, Fugl-Meyer Assessment of Lower Extremity, Functional Ambulation Classification, Berg Balance Scale, Time Up and Go, Velocity, Cadence, Modified Barthel Index and Functional Independence Measure. However, differences between VR intervention and traditional rehabilitation groups were not significant for Box-Block Test, 10 m Walk Test, Auditory Continuous Performance Test, Mini-Mental State Examination and Visual Continuous Performance Test. CONCLUSION This review suggests that VR interventions effectively improve upper- and lower-limb motor function, balance, gait and daily function of stroke patients, but have no benefits on cognition. IMPACT This review identified the positive effects of VR-assisted rehabilitation on upper- and lower-limb motor function, balance, gait and daily function of stroke patients. And, we verified the duration of VR intervention affects some health benefits. The benefit of VR on cognitive function requires further investigation through large-scale multicentre RCTs.
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Affiliation(s)
- Bohan Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Dan Li
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
| | - Yue Liu
- School of Nursing, Capital Medical University, Beijing, China
| | - Jiani Wang
- Fuwai Hospital, CAMS &PUMC, Beijing, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
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Xu D, Zheng Y, Jia Y. The Bibliometric Analysis of the Sustainable Influence of Physical Education for University Students. Front Psychol 2021; 12:592276. [PMID: 33746825 PMCID: PMC7971110 DOI: 10.3389/fpsyg.2021.592276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
With the awakening of people's health consciousness, the concept and practice of health promotion has become the main target of health policies throughout the world. In this study, the relationship between physical education and health promotion was examined. Art students from a university in Taoyuan were selected for research, and a total of 320 questionnaires were issued. Invalid and incomplete questionnaires were eliminated, with a total of 227 valid questionnaires. Finally, the LISREL (Linear Structural Relations) model was used to analyze the correlation between various factors and health promotion. The results of the model analysis show that in terms of basic fit, the three factors of physical education (course design, teaching content, and activity design) have a high correlation with the influence of physical education, reaching a significant level (t > 1.96, p < 0.05). In terms of influence on sports participation, the three factors (physiological factors, psychological factors, social factors) of sports participation reached a significant level (t > 1.96, p < 0.05). The two factors of health promotion (physiological health, and mental health and practical ideas) have a high correlation with the influence of health promotion, reaching a significant level (t > 1.96, p < 0.05). In terms of overall mode fit, the overall mode fit standard χ2/Df was 1.344, less than the standard value of 3 or less, and the RMR value was 0.007, indicating that the χ2/DF and RMR result standards were appropriate, and the chi-square value was very sensitive to the sample size. Therefore, there was a positive correlation among physical education, sports participation, and health promotion. In conclusion, physical activities can improve the human body's immune function, reduce the symptoms of chronic diseases, and positively promote health. The research result is important for emphasizing the benefit of sports to art students, and provides reference for improving the quality of school physical education, and the physical and mental health level of people in Taiwan.
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Affiliation(s)
- Dekai Xu
- General Graduate School, Hoseo University, Asan, South Korea
| | - Yingying Zheng
- College of Physical Education and Health, Wenzhou University, Wenzhou, China
- Graduate Institute of Physical Education, National Taiwan Sport University, Taoyuan, Taiwan
| | - Yunli Jia
- Dance Academy, Northwest Minzu University, Lanzhou, China
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Nuara A, Fabbri-Destro M, Scalona E, Lenzi SE, Rizzolatti G, Avanzini P. Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines. J Neurol 2021; 269:627-638. [PMID: 33449202 PMCID: PMC7809551 DOI: 10.1007/s00415-021-10397-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.
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Affiliation(s)
- Arturo Nuara
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy. .,Department of Biomedical, Metabolic, and Neuronal Sciences, University of Modena and Reggio Emilia, Modena, Italy. .,Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Maddalena Fabbri-Destro
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Emilia Scalona
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Stefano Elio Lenzi
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy
| | - Giacomo Rizzolatti
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Pietro Avanzini
- Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, via Volturno 39/E, 43125, Parma, Italy.,Istituto Clinico Humanitas, Rozzano, Italy
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Abstract
Standard video games are applications whose development process often follows a traditional software methodology. Serious Games (SGs) are a tool with an immensely positive impact and great success. SGs enable learning and provide entertainment and self-empowerment, which motivates students. The development of an SG consists of complex processes requiring multi-disciplinary knowledge in multiple domains, including knowing the learning domain and adding the appropriate game mechanics to foster high intrinsic motivation and positive player experience that makes the players feel like they are having fun while learning. Otherwise, the game is viewed as boring and not as a fun and engaging activity. Nevertheless, despite their potential, the application of SGs in education has been limited in terms of pedagogy. Several authors assert that this lack is because SG standards and guidelines have not been developed. There is an imbalance between experts’ contributions to education and game design specialists for the SG development. Not all the SGs that have been developed have applied appropriate design methodologies that incorporate both the entertainment mechanics and the serious component. To ensure that an SG meets the user’s expectations, it must be designed using an appropriate method. This work aims to present iPlus, a methodology for designing SGs based on a participatory, flexible, and user-centered approach. Additionally, this paper analyses several case studies with the iPlus methodology.
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Teaching Disaster Medicine With a Novel Game-Based Computer Application: A Case Study at Sichuan University. Disaster Med Public Health Prep 2020; 16:548-554. [PMID: 33191895 DOI: 10.1017/dmp.2020.309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study evaluates the effectiveness of our game-based pedagogical technique by comparing the learning, enjoyment, interest, and motivation of medical students who learned about best practices for patient surge in a natural disaster with a novel game-based computer application, with those of medical students who learned about it with a traditional lecture. METHODS We conducted our study by modifying an existing optional course in disaster medicine that we taught at Sichuan University. More specifically, in 2017, while our application was still in development, we taught this course by lecture. In this iteration, 63 third-grade medical students voluntarily joined our course as our 'lecture group.' Once our application was complete in 2018, 68 third-grade medical students voluntarily joined this course as the 'game group.' We examined the different effects of these learning methods on student achievement using pre -, post -, and final tests. RESULTS Both teaching methods significantly increased short-term knowledge and there was no statistical difference between the 2 methods (p > 0.05). However, the game group demonstrated significantly higher knowledge retention than the traditional lecture group (p < 0.05). CONCLUSION Our game-based computer application proved to be an effective tool for teaching medical students best practices for caring for patient surge in a natural disaster.
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Multimodal teaching, learning and training in virtual reality: a review and case study ☆. VIRTUAL REALITY & INTELLIGENT HARDWARE 2020; 2:421-442. [PMCID: PMC7556823 DOI: 10.1016/j.vrih.2020.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/13/2020] [Accepted: 07/02/2020] [Indexed: 06/06/2023]
Abstract
It is becoming increasingly prevalent in digital learning research to encompass an array of different meanings, spaces, processes, and teaching strategies for discerning a global perspective on constructing the student learning experience. Multimodality is an emergent phenomenon that may influence how digital learning is designed, especially when employed in highly interactive and immersive learning environments such as Virtual Reality (VR). VR environments may aid students' efforts to be active learners through consciously attending to, and reflecting on, critique leveraging reflexivity and novel meaning-making most likely to lead to a conceptual change. This paper employs eleven industrial case-studies to highlight the application of multimodal VR-based teaching and training as a pedagogically rich strategy that may be designed, mapped and visualized through distinct VR-design elements and features. The outcomes of the use cases contribute to discern in-VR multimodal teaching as an emerging discourse that couples system design-based paradigms with embodied, situated and reflective praxis in spatial, emotional and temporal VR learning environments.
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Lowe J, Peng C, Winstead‐Derlega C, Curtis H. 360 virtual reality pediatric mass casualty incident: A cross sectional observational study of triage and out-of-hospital intervention accuracy at a national conference. J Am Coll Emerg Physicians Open 2020; 1:974-980. [PMID: 33145548 PMCID: PMC7593497 DOI: 10.1002/emp2.12214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE With adolescent mass casualty incidents (MCI) on the rise, out-of-hospital readiness is critical to optimize disaster response. We sought to test the feasibility and acceptability of a 360 Virtual Reality (360 VR) platform for disaster event decisionmaking. METHODS This was a cross-sectional observational assessment of a subject's ability to triage and perform out-of-hospital interventions using a 360 VR MCI module. A convenience sample of attendees was recruited over 1.5 days from the American College of Emergency Physicians (ACEP) national conference in San Diego, CA. RESULTS Two hundred and seven (207) subjects were enrolled. Ninety-six (46%) subjects identified as attendings, 66 (32%) as residents, 13 (6%) as medical students, 4 (2%) as emergency medical technicians and 28 (14%) as other. When comparing mean scores between groups, physicians who were <40 years old had mean scores higher than physicians who were >40 years old (8.7 vs 6.5, P < 0.001). Residents achieved higher scores than attendings (8.6 vs 7.5, P = 0.005). Based on a 5-point Likert scale, participants felt the 360 VR experience was engaging (median = 5) and enjoyable (median = 5). Most felt that 360 VR was more immersive than mannequin-based simulation training (median = 5). CONCLUSION We conclude that 360 VR is a feasible platform for assessing triage and intervention decisionmaking for adolescent MCIs. It is well received by subjects and may have a role as a training and education tool for disaster readiness. In this era of distanced learning, 360 VR is an attractive option for future immersive educational experiences.
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Affiliation(s)
- Jason Lowe
- Stanford University Department of Emergency MedicinePalo AltoCaliforniaUSA
| | - Cynthia Peng
- Stanford University Department of Emergency MedicinePalo AltoCaliforniaUSA
| | | | - Henry Curtis
- Stanford University Department of Emergency MedicinePalo AltoCaliforniaUSA
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Benefits and Limitations of Transurethral Resection of the Prostate Training With a Novel Virtual Reality Simulator. Simul Healthc 2019; 15:14-20. [PMID: 31743314 DOI: 10.1097/sih.0000000000000396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Profound endourological skills are required for optimal postoperative outcome parameters after transurethral resection of the prostate (TURP). We investigated the Karl Storz (Tuttlingen, Germany) UroTrainer for virtual simulation training of the TURP. MATERIALS AND METHODS Twenty urologists underwent a virtual reality (VR) TURP training. After a needs analysis, performance scores and self-rated surgical skills were compared before and after the curriculum, the realism of the simulator was assessed, and the optimal level of experience for VR training was evaluated. Statistical testing was done with SPSS 25. RESULTS Forty percent of participants indicated frequent intraoperative overload during real-life TURP and 80% indicated that VR training might be beneficial for endourological skills development, underlining the need to advance classical endourological training. For the complete cohort, overall VR performance scores (P = 0.022) and completeness of resection (P < 0.001) significantly improved. Self-rated parameters including identification of anatomical structures (P = 0.046), sparing the sphincter (P = 0.002), and handling of the resectoscope (P = 0.033) became significantly better during the VR curriculum. Participants indicated progress regarding handling of the resectoscope (70%), bleeding control (55%), and finding the correct resection depth (50%). Although overall realism and handling of the resectoscope was good, virtual bleeding control and correct tissue feedback should be improved in future VR simulators. Seventy percent of participants indicated 10 to 50 virtual TURP cases to be optimal and 80% junior residents to be the key target group for VR TURP training. CONCLUSIONS There is a need to improve training the TURP and VR simulators might be a valuable supplement, especially for urologists beginning with the endourological desobstruction of the prostate.
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Levac DE, Huber ME, Sternad D. Learning and transfer of complex motor skills in virtual reality: a perspective review. J Neuroeng Rehabil 2019; 16:121. [PMID: 31627755 PMCID: PMC6798491 DOI: 10.1186/s12984-019-0587-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 09/05/2019] [Indexed: 12/11/2022] Open
Abstract
The development of more effective rehabilitative interventions requires a better understanding of how humans learn and transfer motor skills in real-world contexts. Presently, clinicians design interventions to promote skill learning by relying on evidence from experimental paradigms involving simple tasks, such as reaching for a target. While these tasks facilitate stringent hypothesis testing in laboratory settings, the results may not shed light on performance of more complex real-world skills. In this perspective, we argue that virtual environments (VEs) are flexible, novel platforms to evaluate learning and transfer of complex skills without sacrificing experimental control. Specifically, VEs use models of real-life tasks that afford controlled experimental manipulations to measure and guide behavior with a precision that exceeds the capabilities of physical environments. This paper reviews recent insights from VE paradigms on motor learning into two pressing challenges in rehabilitation research: 1) Which training strategies in VEs promote complex skill learning? and 2) How can transfer of learning from virtual to real environments be enhanced? Defining complex skills by having nested redundancies, we outline findings on the role of movement variability in complex skill acquisition and discuss how VEs can provide novel forms of guidance to enhance learning. We review the evidence for skill transfer from virtual to real environments in typically developing and neurologically-impaired populations with a view to understanding how differences in sensory-motor information may influence learning strategies. We provide actionable suggestions for practicing clinicians and outline broad areas where more research is required. Finally, we conclude that VEs present distinctive experimental platforms to understand complex skill learning that should enable transfer from therapeutic practice to the real world.
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Affiliation(s)
- Danielle E Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Meghan E Huber
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Bldg 3, Rm 143, Cambridge, MA, 02139, USA
| | - Dagmar Sternad
- Biology, Electrical and Computer Engineering, and Physics, Northeastern University, 503 Richards Hall, 360 Huntington Avenue, Boston, MA, 02118, USA
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De Keersmaecker E, Lefeber N, Geys M, Jespers E, Kerckhofs E, Swinnen E. Virtual reality during gait training: does it improve gait function in persons with central nervous system movement disorders? A systematic review and meta-analysis. NeuroRehabilitation 2019; 44:43-66. [DOI: 10.3233/nre-182551] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Emma De Keersmaecker
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Nina Lefeber
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Marion Geys
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Elise Jespers
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Eric Kerckhofs
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
| | - Eva Swinnen
- Rehabilitation Research – Neurological Rehabilitation, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium
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