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11/22/2022 | In-Press Preview | PMC9843052 | ||
01/17/2023 | Electronic publication | PMC9843052 | ||
Flow diagram of Study 250-201. | In Part 1, 3 patients, i.e., 9001, 9002, and 9003, were recruited and treated with escalating doses of 30, 100, and 300 mg tralesinidase alfa as described in Results. These 3 patients were eventually recruited to Part 2 of the study and treated for an additional 48 weeks. In addition, 19 patients, i.e., patients 9004–9015 and 9017–9023, previously observed in our natural history Study 250-901 ( | PMC9843052 | ||
Drug exposure in plasma and CSF and anti-drug antibody response in serum and CSF. | ( | PMC9843052 | ||
A 300 mg dose of tralesinidase alfa administered weekly i.c.v. normalizes total HS and HS-NRE levels in the CSF and plasma. | In Study 250-201 Part 1, three patients, i.e., 9001, 9002, and 9003, were treated with 30, 100, or 300 mg tralesinidase alfa weekly. Total HS ( | PMC9843052 | ||
Changes in liver, spleen, cortical gray matter, and cerebellum gray matter volumes over the course of Study 250-201 Part 2. | LIVER | Liver ( | PMC9843052 | |
Correlation analyses of cognitive AEq scores, plasma drug exposure, plasma HS-NRE concentrations, and CGMVs over 48 weeks of tralesinidase alfa treatment. | ( | PMC9843052 | ||
CSF and plasma drug exposure in patients given a single i.c.v. dose of 30, 100, or 300 mg tralesinidase alfa | PMC9843052 | |||
Characteristics of participants ( | PMC9843052 | |||
Background | Resistance training adaptively increases muscle strength and mass, contributing to athletic performance and health promotion. Dietary intervention with natural foods provides nutrients that help accelerate muscle adaptation to training. Matcha green tea contains several bioactive factors such as antioxidants, amino acids, and dietary fibers; however, its effect on muscle adaptation is unclear. In this study, we aimed to investigate the effects of matcha beverage intake on muscle adaptation to resistance training. | PMC10320999 | ||
Methods | Healthy, untrained men were randomized into placebo and matcha groups. Participants consumed either a matcha beverage containing 1.5 g of matcha green tea powder or a placebo beverage twice a day and engaged in resistance training programs for 8 (trial 1) or 12 weeks (trial 2). | PMC10320999 | ||
Results | fatigue | In trial 1, maximum leg strength after training tended to increase more in the matcha group than that in the placebo group. In the matcha group, subjective fatigue after exercise at 1 week of training was lower than that in the placebo group. Gut microbe analysis showed that the abundance of five genera changed after matcha intake. The change in | PMC10320999 | |
Conclusion | fatigue | Daily intake of matcha green tea beverages may help in muscle adaptation to training, with modulations in stress and fatigue responses and microbiota composition. | PMC10320999 | |
Supplementary Information | The online version contains supplementary material available at 10.1186/s12937-023-00859-4. | PMC10320999 | ||
Keywords | PMC10320999 | |||
Background | sarcopenia, muscle loss | SARCOPENIA | Skeletal muscles support physical activity and act as a major metabolic organ. In athletics, increased muscle strength and mass are important factors that improve performance. Age-related muscle loss and decreased strength, referred to as sarcopenia, have been recognized as major risk factors and may necessitate nursing care in aged individuals. As a counter-intervention, resistance exercise training has been recommended to improve athletic performance and prevent sarcopenia in older adults [Adequate dietary nutrition is necessary for muscle adaptation to training. Sufficient protein intake is required to supply amino acids as substrates for protein synthesis. The timing of protein intake and complementary consumption of carbohydrates effectively activate protein anabolism [Tea beverages, which are consumed daily, are sources of bioactive micro-compounds. Green tea contains high concentrations of catechins and reportedly has various health benefits. Daily intake of green tea is beneficial for neural, cardiovascular, and metabolic functions in humans [ | PMC10320999 |
Methods | PMC10320999 | |||
Participants | muscle mass | CHRONIC DISEASES | Thirty-six young and healthy men participated in this study, which was approved by the ethics committee of Kyoto Prefectural University (No. 2017–146). All participants provided written informed consent. None of the participants suffered from current (at the time of the study) or prior chronic diseases or had a history of smoking. Furthermore, none of the participants were using any medication or supplements at the time of the study or habituated to regular exercise. The participants were randomly divided into placebo and matcha groups, and body composition parameters—body weight, body fat, muscle mass, and body mass index (BMI)—were measured using bioelectrical impedance analysis (InBody430; InBody Co., Ltd., Seoul, Korea). | PMC10320999 |
Experimental design | This study involved two randomized placebo-controlled trials (Fig. Experiment protocolDuring the trial period, the participants of both groups consumed beverages twice a day. The matcha group consumed a beverage containing 1.5 g matcha green tea powder [contents/cup; 0.06 g water, 0.4 g protein, 0.2 g fat, 4.4 g carbohydrate, 166.5 mg total polyphenols, 94.5 mg epigallocatechin gallate (EGCG), 1.1 mg lutein, 46.4 mg vitamin K, 27 mg theanine, 488 mg dietary fiber, and 45 mg caffeine] (Nestlé Japan Ltd., Kobe, Japan). The placebo group consumed a placebo tea-flavored beverage (contents/cup; 0.06 g water, 0 g protein, 0.1 g fat, 4.4 g carbohydrate, and 45 mg caffeine) daily throughout the trial period. | PMC10320999 | ||
Resistance exercise training | The training program consisted of eight resistance exercises: chest press, fly, back extension, seated rowing, leg press, leg extension, leg curl, and sit-up, performed using a combined exercise machine (Senoh Co., Ltd., Chiba, Japan). The participants performed 3 sets of 10 repetitions at a 10-repetition maximum (RM). Training frequency was twice a week at 2–3-day intervals, and weight load was gradually increased according to the 10 RM of individuals. Maximum leg extension strength was measured in both legs using a knee-extension strength meter (ST 200R; Meiko Co., Ltd., Osaka, Japan). The grip strength of both hands was assessed using GRIP D (T.K.K. 5401; Takei Scientific Instruments Co., Ltd., Osaka, Japan). | PMC10320999 | ||
Indirect metabolic performance | The participants were instructed to refrain from intense physical activities, eating, and drinking, except for water, from 22:00 until breakfast in the morning. In addition, they were requested to eat 200 g of steamed rice (energy, 312 kcal; protein, 5.0 g; fat, 0.6 g; and carbohydrate, 74.2 g) without caffeine and alcohol 1 h before visiting the laboratory. After sitting for 30 min, the oxygen consumption and carbon dioxide production levels of the participants were measured in the supine position using a breath-by-breath respiromonitor system (AE-310 s; Minato Medical Sciences Co., Ltd., Osaka, Japan) for 15 min. Respiratory quotient and substrate use (carbohydrate and fat oxidation) were calculated from the levels of oxygen consumption and carbon dioxide production, as described previously [ | PMC10320999 | ||
Blood parameters | BLOOD | The participants were instructed to refrain from intense physical activity and fast from 22:00 h on the day before blood sample collection. On the day of blood sampling, each participant ate 200 g of steamed rice and rested for 1 h. Blood samples were collected before and after resistance exercise (8 exercises, 3 sets of 10 repetitions at 10 RM, as mentioned above) during the pre- and post-intervention periods. The collected blood was injected into a vacuum blood collection tube and centrifuged at 1,800 × | PMC10320999 | |
Subjective fatigue | fatigue | The degree of subjective fatigue before exercise (at rest) was measured using a visual analog scale. The participants were asked to indicate their degree of subjective fatigue on a 100-mm horizontal line, with the left end (0 mm) indicating “no fatigue” and the right end (100 mm) indicating “maximum fatigue.” | PMC10320999 | |
Analysis of fecal microbiota | Brushes and sheets for stool collection were distributed to the participants, and stool samples were collected before, at week 4, and at week 8 of the intervention. Stool samples were refrigerated, and bacterial DNA was extracted within 3 weeks after collection. Metagenomic analyses of 16S rRNA of the extracted DNA samples were performed using a next-generation sequencer (MiSeq; Illumina K.K., Tokyo, Japan). Bacterial DNA extraction from feces, library preparation, and deep sequencing were performed as previously described [ | PMC10320999 | ||
Saliva parameters | STERILE | To avoid the effect of the circadian rhythm, saliva was collected at the same time of day before and after the intervention, using a saliva collection kit (Salivette, Sarstedt, Germany) consisting of a centrifuge tube and sterile cotton. After rinsing the mouth with distilled water for 30 s, each participant, wearing rubber gloves, placed a sterile cotton swab in their mouth and chewed for 1 min at a mastication rate of 1 chew/s. The cotton swab, which absorbed saliva secreted in response to the chewing stimulus, was centrifuged (4 °C, 1,800 × | PMC10320999 | |
Visual function | ocular motor skills, OMS | EYE | Two methods were used to evaluate the participants' ability to visually discern a moving object. Forward and backward kinetic visual acuity (KVA) was measured using a dynamic vision meter (AS-4; Kowa Co., Ltd., Tokyo, Japan). Lateral dynamic visual acuity (DVA) and ocular motor skills (OMS) were evaluated on a computer monitor using sports vision software (ArrowZeye; Diamond Eye Co., Ltd., Tokyo, Japan) [ | PMC10320999 |
Dietary assessment | A dietary assessment was conducted to calculate nutrient intake before trial commencement. All participants were permitted to eat freely, and their food intake was recorded for 3 days using a food diary and camera. Thereafter, a dietitian reviewed the recorded data to follow up and estimate participants' nutrient intake using Excel add-in software (Excel Eiyou-kun Ver. 6.0; Kenpakusha Co., Ltd., Tokyo, Japan). | PMC10320999 | ||
Statistical analyses | All data are reported as mean ± standard deviation. A two-way analysis of variance (ANOVA) was conducted to assess the significance of the interaction between drink intervention (group) and time. Post hoc analyses were conducted using Bonferroni’s test to compare significant interactions following ANOVA. An intra-group comparison was conducted if the main effect of time without interaction was observed. Differences in changes between the placebo and matcha groups were evaluated using the Mann–Whitney U test or an independent samples | PMC10320999 | ||
Results | PMC10320999 | |||
Blood and fatigue parameters during the 8-week intervention | fatigue | BLOOD | The concentration of serum carbonylated proteins and creatine kinase activity neither showed significant interactions nor training-induced changes (Fig. Blood and subjective fatigue parameters in trial 1. Serum carbonylated protein concentration (No differences in resting oxygen consumption, respiratory quotient, carbohydrate oxidation, and fat oxidation were observed between the groups before and after the intervention (Table S | PMC10320999 |
Gut microbiota during the 8-week intervention | The Chao1 and Shannon indices, which indicate the alpha diversity of gut bacteria, were not altered by the intervention within or between groups. However, the abundance of five genera changed significantly after the intervention. The abundance of Abundance of gut microbiota genera in trial 1. Proportion of the genera | PMC10320999 | ||
Body composition, stress-related parameters, and visual function during the 12-week intervention | muscle hypertrophy | Generally, the adaptation of skeletal muscles to resistance training results in an initial increase in muscle strength, followed by muscle hypertrophy with an extended training period. Therefore, we conducted trial 2 with an intervention period of 12 weeks. Stress-related parameters in saliva and visual ability were also examined because the outcomes of trial 1 and previous studies suggested that matcha may suppress the stress response [Muscular, stress, and visual parameters in trial 2. Muscle weight (Among stress-related parameters, the salivary cortisol secretion rate showed a trend indicating interaction ( | PMC10320999 | |
Discussion | muscle mass gain, fatigue | OXIDATIVE STRESS | In this study, we investigated the effects of matcha green tea consumption on adaptation to resistance training in young men. After the 8-week intervention (trial 1), a greater change in leg strength was found in the matcha group. Furthermore, a higher muscle weight in response to training for 12 weeks was found in the matcha group (trial 2). These results suggest that dietary matcha green tea may accelerate muscle adaptation to resistance training. During adaptation to resistance exercise training, more muscle fibers are mobilized in the early stage. Muscle fibers become thicker with continued training; therefore, an extended training period results in significant muscle mass gain, further increasing muscle strength [The change in salivary cortisol secretion was lower in the matcha group than that in the placebo group. This salivary indicator indirectly reflects the activation of the sympathetic nervous and hypothalamic-adrenal systems associated with stress [Oxidative stress may cause fatigue owing to excessive exercise [Visual function is also associated with physical fatigue and has been shown to be lower in fatigued individuals than in their non-fatigued counterparts [Metagenomic analysis of gut microbiota revealed significant changes in five genera of bacteria following matcha intake. | PMC10320999 |
Conclusions | fatigue | Collectively, matcha green tea consumption during resistance training modulates muscle adaptation. Compounds in matcha can moderate exercise-induced stress and fatigue responses, which may promote recovery after exercise and training-induced adaptation. In addition, positive correlations were found between changes in muscle adaptation and microbiota. Further studies should examine the detailed mechanism of action of matcha and the significance of microbiota modulation. Although the amounts of some compounds in matcha are less than the effective amount, beneficial effects may still be obtained as the compounds are taken in combination. | PMC10320999 | |
Authors’ contributions | M.S. and W.A. designed and coordinated the study. M.S., W.A., C.M., K.S., and R.I. performed the experiments and analyzed the data. Y.F., Y.K., and M.K. evaluated and interpreted the data. M.S. and W.A. wrote the manuscript with input from other authors. All authors critically reviewed and approved the final version of the manuscript. | PMC10320999 | ||
Funding | This work was supported by the Matcha and Health Research Group and the Japan Society for the Promotion of Science (JSPS) KAKENHI: Grant-in-Aid for Scientific Research (B) (grant numbers 20H04080 and 17H02176). | PMC10320999 | ||
Availability of data and materials | The datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request. | PMC10320999 | ||
Declarations | PMC10320999 | |||
Ethics approval and consent to participate | This intervention study was approved by the ethics committee of the Kyoto Prefectural University (No. 2017–146) and conducted following the tenets of the Declaration of Helsinki. Written informed consent was obtained from all participants. | PMC10320999 | ||
Consent for publication | Not applicable. | PMC10320999 | ||
Competing interests | Although the Matcha and Health Research Group was not involved in conducting experiments or data analysis, test samples were supplied from Nestlé Japan Ltd., a constituent organization of the Matcha and Health Research Group. | PMC10320999 | ||
References | PMC10320999 | |||
Introduction | Sexual double standards are social norms that impose greater social opprobrium on
women versus men or that permit one sex greater sexual freedom than the other.
This study examined sexual double standards when choosing a mate based on their
sexual history. Using a novel approach, participants (N = 923, 64% women) were
randomly assigned to make evaluations in long-term or short-term mating contexts
and asked how a prospective partner's sexual history would influence their own
likelihood of having sex (short-term) or entering a relationship (long-term)
with them. They were then asked how the same factors would influence the
appraisal they would make of male and female friends in a similar position. We
found no evidence of traditional sexual double standards for promiscuous or
sexually undesirable behavior. There was some evidence for small sexual double
standard for self-stimulation, but this was in the opposite direction to that
predicted. There was greater evidence for sexual hypocrisy as sexual history
tended to have a greater negative impact on suitor assessments for the self
rather than for same-sex friends. Sexual hypocrisy effects were more prominent
in women, though the direction of the effects was the same for both sexes.
Overall, men were more positive about women's self-stimulation than women were,
particularly in short-term contexts. Socially undesirable sexual behavior
(unfaithfulness, mate poaching, and jealous/controlling) had a large negative
impact on appraisals of a potential suitor across all contexts and for both
sexes. Effects of religiosity, disgust, sociosexuality, and question order
effects are considered.Sexual double standards (SDS) are social norms that permit greater sexual freedom
for, or impose greater social opprobrium on, one sex over the other. Traditional
reasoning and widespread belief in Western cultures suggests that societies restrict
and negatively sanction female more than male sexuality (Previous research has revealed that humans possess a distinct mating psychology for
both short-term and long-term mating contexts (MCs) which impacts their mating
preferences and choices ( | PMC10303487 | ||
Sexual Double Standards at the Societal and Personal Level | SDS can exist as social norms at a Various methods have been applied for measuring SDS at a personal level. Studies using between-subject designs have offered insights into factors affecting
SDS. For instance, Marks and colleagues (Only a small number of individual differences have been studied as potential
moderators of the standards men and women hold for their own and others’ sexual
behavior. Studies from Spain have found effects of education and social dominance
orientation (Sociosexuality is perhaps the most well-studied personality trait shown to influence
sexual standards. Further, in a study of Scottish teenagers (Another factor which adds a layer of complexity to personal SDS effects is how one
applies one's standards to other people when giving advice. The extant literature suggests that evidence for SDS effects is neither clear nor
straightforward and might depend on a number of factors including specific acts,
context (e.g., when giving advice), country-level traits (e.g., sexual
egalitarianism), and experimental design. With few exceptions (e.g., | PMC10303487 | ||
Applying Sexual Strategies Theory to Sexual Double Standards | When and where SDS exist can be informed by evolutionary theory (Sex differences in levels of parental investment depend not only on biological
differences, but on contextual ones as well. Sexual strategies theory (SST)
makes an important distinction between committed long-term relationships and
noncommitted short-term sexual encounters and posits that the sexes have evolved
distinct mating strategies to cope with the demands of each ( | PMC10303487 | ||
Applying Sexual Standards to Self Versus Same-Sex Others | The sexual standards one holds for oneself can differ from one's own
We do not currently have any specific hypotheses on how this effect will look
though. Primarily we aim to establish this specific appraisal for self. While
one might believe that for both sexes reducing other's sexual opportunities in
competition with oneself might take priority, especially by men in a short-term
setting, our current methodology does not make such a competitive approach clear
to participants. Also, there might even be a lack of sexual hypocrisy, no
differences in how one appraises partners for self versus same-sex other for the
least negative sexual histories, and there might be more risk willingness or
sexual liberal attitudes on behalf of others. We will therefore explore this
self versus same-sex other constellation. | PMC10303487 | ||
Methods | PMC10303487 | |||
Participants | A convenience sample of Norwegian students ( | PMC10303487 | ||
Design | This was a quasi-experimental design where we applied four versions of a
questionnaire. The participants were randomly assigned to respond to questions
referring to either long-term or short-term MCs, and to one of the two question
order versions. In the latter, participants answered about a female friend
meeting up with a man followed by a male friend meeting up with a woman or vice
versa. | PMC10303487 | ||
Procedure | STILL | The participants received information about the study orally in classes during a
break (and in writing on the first page of the questionnaire). The questionnaire
was then handed out to volunteers and returned in a box within 15 min. The
students did not receive any course credit or compensation for their
participation. To ensure the respondents’ anonymity no personal information was
provided. As long as anonymity is secured and the research is not carried out to
examine health issues, this kind of research is not subject to ethical approval
in Norway. Still, the research was carried out in line with the APA ethical
standards. | PMC10303487 | |
Results | PMC10303487 | |||
Sexual Acts | Principal component analysis (maximum likelihood) suggested three common factors
among the sexual history items. Items measuring prior history of STI, being
bisexual, or having been cheated on in a prior relationship had low
communalities and was not included in the analyses. Internal consistency for the
three scales was acceptable: Means (SDs) for the Nine Outcome Variables Across Mating Context and
Participant Sex. | PMC10303487 | ||
Discussion | The study of SDS has yielded several important results. First, we found a lack of
evidence for SDS effects in the traditional direction. Second, we found that people
were more discerning of a prospective mate's sexual history in long-term versus
short-term contexts and that women were more discerning than men. Third, we found
that participants showed some level of hypocrisy—being more cautious when making
appraisals for themselves compared to a same-sex friend. Fourth, we found that
sexual histories could be reduced to three factors: self-stimulation, promiscuity,
and cheating & controlling, and that these factors affected appraisals and were
the subjects of SDS and hypocrisy effects in different ways. Finally, we found
little evidence that covariates affected the pattern of the results in a meaningful
way. We now discuss these key findings in turn. | PMC10303487 | ||
A Lack of SDS at the Personal Level | Generally, when people are asked what norms, they believe exist in society, they
tend to confirm traditional SDS (the | PMC10303487 | ||
Mating Context and Participant Sex Moderate Appraisals of Sexual
History | tided | In this study, we were able to address the fact that little research has
considered the role of short-term versus long-term contexts when studying SDS,
taking for granted differences in sexual mating psychology that varies both by
sex and mating strategy (Another moderator was the sex of the participant. In line with our second
prediction, facts about a prospective partner's sexual history generally led to
women toward more negative appraisals of than men, regardless of whether they
were making judgments for themselves or for same-sex friends. This sex
difference was particularly evident for self-stimulating behavior. These sex
differences likely reflect the historical asymmetries in the risks associated
with sex for men and women. In terms of their reproductive health, having
somatic resources “tided up,” and social reputation, the risks of poor sexual
decisions for men have historically been much lower than those for women,
causing them to evolve to be more cautious about how, when, and with whom they
procreate ( | PMC10303487 | |
Is Sexual Hypocrisy a Specific Form of Sexual Double Standard? | ’ behavior | By asking participants to make appraisals for themselves, we were in the unique
position to examine sexual hypocrisy. Generally, we found that the participants
were less willing to pursue an opposite-sex target following sexual history
information but were less cautious when appraising same-sex friends in the same
situation. This was also true for men in the short-term context, although these
men made relatively fewer negative appraisals for self versus male friend
compared to women in both MCs and men in a long-term MC. The reason for this
difference we suspect lies with the relative risk to the participant associated
with the choice. It would pay to be particularly cautious when making decisions
for oneself because one must bear the consequences of that decision. The
consequences for even the most beloved friend will always have less of an effect
on the self. If this explanation holds then further research should find that
appraisals of others’ behavior and choices should track the extent to which
negative consequences would impact the decision maker—such as degree of genetic
relatedness and interdependence (Further, appraisals differed for the three behaviors, suggesting that SDS and
sexual hypocrisy was not similar for promiscuity, self-stimulation, and cheating
& controlling behaviors. The (reversed) SDS effect was more evident for
self-stimulation, and more evident in the short-term context, and the sexual
hypocrisy effect was stronger for women than for men albeit less pronounced for
self-stimulation. Evidently, sexual history is not necessarily best
conceptualized as negative information, sometimes sexual history is clearly
negative (cheating & controlling behavior), however, self-stimulation is
generally not considered negative behavior. The SST perspective highlights the
importance of how both sex of actor and MC will influence appraisals of sexual
history, for example a woman's sexual availability cues will be assessed more
positive for men in a short-term setting than men's sexual availability will be
assessed by women. There is more insight to be garnered about further specific
sex acts. | PMC10303487 | |
Effects of Individual Differences | During our analyses, we included several covariates that one might expect to
influence how people use information about sexual history including religiosity,
sexual disgust, and sociosexuality. Our third prediction regarding the effect of
these individual differences was supported on an overall level. Higher levels of
religiosity and sexual disgust, and more restricted sociosexuality were all
associated with more negative appraisals of targets with a sexual history.
Contrary to our expectation however, the effect of religiosity was not limited
to short-term sexual relationships. Overall, while there was evidence that these
individual differences affect how sexual history information is used more
broadly, these did not seem to enhance or reduce SDS or sexual hypocrisy
effects.Overall, these findings, although original, dovetail neatly with the general
finding in the literature that people rarely express the traditional double
standard when they judge sexually active others. Further, considering both sexes
in both MCs reveals predictable sex differences, where especially men are less
negative toward sexually active women in a short-term context. Sexual
availability is considered attractive and signaling this is an effective way for
women to self-promote or flirt in short-term contexts (The most interesting aspect of these findings may be that so many expect to find
the traditional pattern expressed in modern society. An implicit negative
attitude toward short-term sexual relations might be part of the explanation of
why people continue to believe in the traditional sexual double standard.
Intrasexual competition between women is probably also a driving mechanism,
attempting to downregulate inflation for sexual access. However, the narrative
might be leftover norm expectations from an era when there actually was more
sexual control over women than men, for example because of religiosity. There
are two aspects of the current findings that suggest that this explanation may
be too simple. First, while the participants in the current study are from a
highly secularized society, egalitarian and sexually liberal society compared to
the United States ( | PMC10303487 | ||
Limitations | sexual behavior | The main limitation of the current work is that it was conducted on a convenience
sample from a secular country which is high in sexual liberalism and has high
gender egality. It is entirely possible that SDS are reduced in such countries
and would reveal themselves more in countries which are more conservative and
religious. Thus, a key future direction would be to replicate these findings in
other countries to test for cross-cultural consistency, though often such
research demonstrates that mating psychology is remarkably canalized (Despite sample characteristics, the random assignment procedure into short-term
or long-term MCs and question-order manipulation ensures comparability of these
factors. Another possible limitation is the comparison for testing hypocrisy;
self-suitor versus same-sex friend appraisals that are not directly comparable
regarding content. In the self-suitor appraisal, we asked the respondent to
consider to what extent the target's sexual behavior reduced or increased the
likelihood of pursuing ONS/relationship, while in the same-sex friend appraisal
we asked the respondent to report the degree that their friend
| PMC10303487 | |
Conclusion | The current study considers both SDS and hypocrisy. We have different standards for
our own versus same-sex friends’ partners, and this study suggests that people are
more lenient toward friends’ partners. An active sexual history represents not only
opportunities but is also a risk factor. It would seem we are more risk aversive for
ourselves than for same-sex peers.Women differentiate less between MCs, and a man's active sexual history thus reduces
his partner value or attractiveness also in short-term contexts; this is the
reversed double standard. For the long-term context there seems to be a single
standard between the sexes, as both women and men assess men and women more
negatively based on an active sexual history. However, for the short-term context,
women are rated by both sexes as more attractive partners when they have an active
sexual history. This suggests a context specific reversed double standard. This last
finding is predicted from a sexual strategies perspective, and it highlights the
need to consider the implicit values toward short-term mating in previous studies
and highlights the importance of MC as specified by SST. | PMC10303487 | ||
References | PMC10303487 | |||
Aim | The aim was to investigate whether second-year undergraduate nursing students practicing the Identification-Situation-Background-Assessment-Recommendation (ISBAR) communication approach in a desktop virtual reality (VR) application had a non-inferior learning outcome compared with the traditional paper-based method when sorting patient information correctly based on the ISBAR structure. | PMC10731819 | ||
Methods | A non-inferior parallel group assessor blinded randomized controlled trial, conducted in simulation sessions as part of preparation for clinical placements in March and April 2022. After a 20-minute introductory session, the participants were randomized to self-practice the ISBAR approach for 45 minutes in groups of three in either an interactive desktop VR application (intervention) or traditional paper-based (TP) simulation. The primary outcome concerned the proportion of nursing students who sorted all 11 statements of patient information in the correct ISBAR order within a time limit of 5 min. The predefined, one-sided, non-inferiority limit was 13 percentage points in favor of traditional paper-based simulation. | PMC10731819 | ||
Results | Of 210 eligible students, 175 (83%) participated and were allocated randomly to the VR ( | PMC10731819 | ||
Conclusions | Self-practicing with the ISBAR approach in desktop VR was non-inferior to the traditional paper-based method and gave a superior learning outcome. | PMC10731819 | ||
Trial registration number | ISRCTN62680352 registered 30/05/2023. | PMC10731819 | ||
Supplementary Information | The online version contains supplementary material available at 10.1186/s12909-023-04966-y. | PMC10731819 | ||
Keywords | PMC10731819 | |||
Background | Handover of patients from one healthcare professional or organization to another is a situation in which patient safety can be threatened [When a patient undergoes surgery, a structured handover is an essential skill for healthcare workers [Within nursing education lie challenges related to resources, e.g., time, instructors, and available simulation locations to practice skills, such as the ISBAR approach [VR utilizes 3D computer technology to construct an interactive virtual world, allowing users to engage with a simulated environment [Desktop VR has been used in situations, such as computer-based simulation [Therefore, the aim was to investigate whether second-year nursing students self-practicing the ISBAR approach during handovers in a preoperative setting in a desktop VR application experienced a non-inferior learning outcome compared with self-practicing the traditional paper-based (TP) method to sort patient information. | PMC10731819 | ||
Method | PMC10731819 | |||
Study design | A non-inferior, parallel group assessor blinded randomized controlled trial (RCT) was conducted at three education sites. The non-inferior approach was chosen because desktop VR simulation is done virtual and thus may have some disadvantages compared with real-life skill practice [ | PMC10731819 | ||
Setting | The study was conducted as part of simulation sessions that prepared second-year undergraduate nursing students for clinical placement in medical-surgical settings. It took place in nursing programs at a university in Southern Norway (two sites) and at a university in Western Norway (one site). At the fall semester in 2020, there were 175, 153 and 145 students enrolled at the three sites, respectively. However, about half of these students were eligible, as only those undergoing clinical placements at somatic hospitals during that period could be included, in accordance with the curriculum and learning outcomes.At all the universities, the students had been taught preoperative nursing care for surgical patients, communication between health care providers, and the ISBAR approach before the research study was launched.The simulation set-up at each site comprised one lecture room with 12 computers with headsets for virtual desktop simulation and a room for paper-based simulation (one large room or smaller group rooms). Four instructors were used to facilitate the sessions and collect data for the study. | PMC10731819 | ||
Usability and pilot study | A usability study of the desktop VR application, used in the intervention in this study describes details regarding the development of the intervention [A pilot study was conducted in February 2022 with 15 third-year undergraduate nursing students at two of the sites to try out the planned RCT activities. The pilot study’s results indicated that the planned RCT activities worked well, but it was found that the primary outcome’s difficulty level was too low. It was estimated that 20% of the participants in both groups would get everything correct on the primary outcomes [ | PMC10731819 | ||
Participants | The inclusion criteria were second-year undergraduate nursing students enrolled in the nursing study program at the participating universities who had no or limited experience in supervised clinical practice in somatic hospitals. Third-year undergraduate nursing students with substantial experience in supervised clinical practice, indicating a level of competence already surpassing the specific learning outcomes targeted in this intervention, were excluded. | PMC10731819 | ||
Recruitment | General information about the simulation session, including that the students would be asked about participating in this study, was presented verbally during a lecture and presented in the digital learning management system for the study program. Specific information about time and place, in addition to repetition of general information, was provided in the study program schedule (at two of the sites) or sent by email (at one of the sites).Information about the study, including voluntary study participation, was repeated at the start of the simulation session. The students were told that participation allowed the researchers to collect and use their identified data from the simulation session. Consent was provided by pressing “send” on the first questionnaire. | PMC10731819 | ||
Randomization and allocation | Randomization had to consider practical organization in which students participated at different times in batches of nine, 12, or 15 students; therefore, separate computer-generated randomization lists were made for each batch of students using the Microsoft Excel RAND function. Using these lists, stickers with identification (ID) numbers and allocation codes were printed. The stickers were then put in separate containers for each batch.To allocate students into the intervention and control groups, students in the same batch got a random ID sticker from the container. Depending on the site, one ID sticker was taken out of the container and given to the student upon entering the lecture room (one site) or the stickers were given to the students after the students were seated in the lecture room (two sites). In the first case, the order the students came to the room could not be influenced and were random, and in the second case, the ID stickers were drawn from the container to ensure random order. The students wore the ID stickers visibly to allow for inspection and ensure that they participated according to allocation. The students were informed that they would be divided into two different groups that would self-practice using the ISBAR approach after the introduction, when the participants were followed to their simulation sites based on the allocation code on their ID stickers. The allocation on each ID sticker was checked again when students entered their designated sites. No errors were reported. | PMC10731819 | ||
Interventions | Both the intervention and control groups participated in a 20-minute introduction session that comprised information about the simulation’s practicalities and the possibility of participating in this study, answering a questionnaire, and watching a nine-minute video that explains the ISBAR approach [The simulation started after the introduction and lasted for 50 minutes. The students were informed that they should resolve any questions they had on their own, as it was a self-training situation. An instructor was present who was given a manual on what to do, including the main directive that they should only help students solve major technical problems and otherwise let the students arrive at solutions themselves.During the simulation, the participants were divided into groups of three because the desktop VR application used in the study was designed for three participants. Previous studies had reported no difference in performance between groups of three, four, or five participants [ | PMC10731819 | ||
Desktop VR application | The intervention group practiced using a desktop VR simulation called the As the tasks involved a substantial amount of written text, including instructions and patient information, and the relatively little interactions with the virtual environment, it was chosen to use a desktop VR application. The academic content was developed by the research group in collaboration with a panel of seven healthcare professionals and educators. The technical solution was developed by the research group with the assistance of a hired programmer utilizing the Description of the different activities in the | PMC10731819 | ||
Traditional paper-based group | The participants in the traditional paper-based group met in-person and were placed around a table in groups of three. Due to uneven numbers, two groups comprised four students. They were given printed papers with the same explanation and tasks––including an explanation of the ISBAR approach and a list of suggestions for correct sorting (Supplementary file | PMC10731819 | ||
Differences between the groups | The main difference between the groups was that the desktop VR group practiced in a virtual environment. Furthermore, in VR, the participants were represented by avatars, with their names displayed above the avatars’ heads, and instructions were delivered through animations featuring voiceovers and pop-up windows. Feedback was provided, allowing for comparing results and suggestions for correct sorting. Furthermore, feedback was also given by highlighting the first statement in each player’s handover and through debriefing sessions. Another mechanism unique to desktop VR practice was the automatic guidance between activities, with an allocated time limit, indicating progress through the practice sessions. In the VR solution, repetition was promoted through time limits, and by encouraging them to practice again after the session ended by providing a click button to start over. | PMC10731819 | ||
Data collection | At the beginning of the introduction, the participants completed a baseline characteristics questionnaire online. The outcome data were collected immediately after the simulation training through an online questionnaire and a written test, both with a time limit of 5 min. The ISBAR categories were not visible, i.e., the students had to remember the order and meaning.During the data collection process, one staff member was present to provide instructions to the participants. They did not interact with the students during the data collection process and were instructed only to answer “do as you think best” in response to any questions from the students. | PMC10731819 | ||
Outcomes | PMC10731819 | |||
Written test and scoring rules | SECONDARY | The written test (Supplementary file The primary and some of the secondary outcomes concerned sorting patient information within correct ISBAR categories. A score of “Everything correct” was assigned if the patient information was sorted into the correct ISBAR category, independent of the order of the patient information within the category. Furthermore, some of the patient information could be sorted correctly within two of the ISBAR categories (S and A). | PMC10731819 | |
Participant characteristics | Participant characteristics included sex, age, mother tongue (Norwegian or other), previous experience working in health care, previous experience working in a surgical ward, previous experience practicing using the ISBAR approach, and previous experience playing multiplayer PC games. | PMC10731819 | ||
Implementation of the intervention | Technical and other problems were registered by asking the instructors who were present if any such issues were experienced. | PMC10731819 | ||
Primary outcome | The primary outcome was the proportion of nursing students who sorted all 11 statements of patient information into the correct ISBAR order within a time limit of five minutes on the written test (Supplementary file | PMC10731819 | ||
Secondary outcomes |
The proportion that placed the correct patient information within each of the ISBAR categories: This outcome reports the results for each ISBAR category and provides additional information on the primary outcome by identifying the category that was best understood, as determined by the highest proportion of correct patient information placements. The outcome variable was based on prior research [The proportion that arranged the ISBAR words correctly: This outcome came from the online questionnaire. The students were presented with the five words that comprise ISBAR, sorted in the following order “Recommendation-Background-Identification-Situation-Assessment.” They were instructed; “Sort in correct order.” A similar outcome was used in earlier research [The proportion that sorted five statements of patient information (one for each ISBAR category) correctly based on ISBAR: This outcome was from the online questionnaire. The students were presented with the patient information sorted in the following order: “AIRBS” and asked to “sort the patient information correctly based on what you have learned today.” This outcome was made for this study and tested during the pilot study.Students’ experiences with the self-perceived learning outcome on five questions: This outcome came from the online questionnaire:” To which degree did you think: 1. the video about ISBAR gave you enough knowledge before you started to practice; 2. you had enough time to practice; 3. the practice method was likable; 4. the teaching activity (introduction and practice) were a good way to learn the ISBAR approach; and 5. you are confident in conducting communication in the ISBAR approach.” Five answer options were provided: 1 (The proportion of complete runs of the practice: This outcome came from the online questionnaire. The students were asked to type the number of complete runs of the practice. A similar outcome was used in earlier research [The simulation method’s perceived usability: This outcome came from the online questionnaire and was measured using the System Usability Scale (SUS) [ | PMC10731819 | ||
Sample size calculation | A non-inferior limit of 13 percentage points was chosen for the sample size calculation based on other studies on clinical observation [ | PMC10731819 | ||
Analysis | The participant characteristics are presented descriptively. Independent sample proportion tests were used for categorical data, and independent samples t-tests were used for continuous data. The absolute difference is presented. The one-sided | PMC10731819 | ||
Results | PMC10731819 | |||
Recruitment and baseline characteristics | Altogether, 210 (78, 68, and 64 from each site) second-year undergraduate nursing students were eligible to participate in the study (Fig. The flow of participants. Abbreviations: The participants’ characteristics are presented in Table Participant characteristicsHave you previously(number answering yes):Abbreviations: The groups’ characteristics were similar, but those in the VR group were somewhat younger, and a larger proportion had played multiplayer PC games earlier (Table | PMC10731819 | ||
Implementation of intervention | The implementation of both groups was executed without major technical or practical problems. The desktop VR program had to be restarted for two of the 29 desktop VR groups because the participants could not talk to each other. | PMC10731819 | ||
Outcomes | SECONDARY | For the primary outcome, the group self-practicing on the desktop VR application (36% had everything correct) was non-inferior to the traditional paper-based group (22% had everything correct), with a difference of 14.2% points (one-sided 95% CI 2.9 to 14.2) on the primary outcome (Fig. The difference between the VR and TP groups on sorting patient information, based on ISBAR. Legends: If the horizontal one-sided 95% confidence interval (CI) had crossed or been to the left of the vertical non-inferior limit, desktop virtual reality (VR) would not be non-inferior. Abbreviations: VR = desktop virtual reality; Primary outcome and secondary outcomes. Numbers (%) of participants for each group and difference in percentage points with a two-sided 95% confidence interval (95% CI) between the groupsAbbreviations: For the secondary outcomes, the desktop VR groups had an average of 1.8 complete runs of the practice (distribution in Table The number of completed runs (briefing-rehearsal-debriefing)Abbreviations: The outcomes placing the correct patient information within its correct ISBAR category were similar in the two groups, except for the category The outcomes from the students’ experiences with the self-perceived learning outcome indicated that the desktop VR group performed either non-inferior or better than the TP group (Table Secondary outcomes on the students’ experiences with self-perceived learning outcomes and perceived usability of simulation methods. Numbers (%) of participants for each group and difference in percentage points with a two-sided 95% confidence interval (95% CI) between groupsPerceived usability of the simulation method: - System Usability Scale (range 0–100, higher better) mean score (standard deviation SD)Mean 78.6(SD 14.2)Mean 76.3(SD 18.4)**Abbreviations: | PMC10731819 | |
Discussion | There was a superior learning outcome of the | PMC10731819 | ||
More likeable, yet better learning outcome | It was somewhat surprising that desktop VR was found to be superior to traditional practice. The study was designed as a non-inferior study, as VR can offer some disadvantages due to technical and comprehension issues [Although desktop VR has the same learning outcome as traditional simulation, in this study and others [ | PMC10731819 | ||
Potential mechanisms behind the findings | Aside from the possibility of a chance finding, we suggest five possible mechanisms to explain the superior effect and likability of desktop VR found in this study.The first is automated individual feedback. A VR application, like the one in this study, can be programmed to provide instant feedback. Feedback on performance is crucial to learning and can be enhanced by timely, specific, and learner-targeted feedback [The second mechanism is that in a virtual environment, players are represented by avatars, which can create a sense of anonymity that can increase enjoyment of the experience [The third suggested mechanism is related to how information is provided during the simulation. The use of visual instructions as a tool for learning has been investigated in several studies, and it has been found that both visual appearance of educational content in VR [The fourth mechanism is automatic guidance supporting progression during practice. Automatic guidance in VR can exert both positive and negative effects on learning, depending on the context and the type of guidance provided [The fifth and final mechanism that we suggest is repetition. A notable finding in this study and others [ | PMC10731819 | ||
Strengths and limitations | This study’s main strength was the randomized controlled trial design, a relatively high number of students and a blinded assessment of the primary outcome. However, although recent findings suggest that blinding is less important than previously thought [ | PMC10731819 | ||
Conclusion | This study was designed to investigate whether nursing students, self-practicing the ISBAR approach in desktop VR, achieved a non-inferior learning outcome compared with self-practicing traditional practice, which was confirmed. However, it also was found that desktop VR provided superior learning outcomes. Furthermore, the students preferred using desktop VR and practiced more within the given time limit. This interactive desktop VR can be recommended as a practical and engaging way for second-year undergraduate nursing students to self-practice the ISBAR approach. | PMC10731819 | ||
Authors’ contributions | EMA | All the authors helped design the study. EMA and HB collected the data. EMA, HB, and AS analyzed and interpreted the data. All the authors helped write the manuscript and read and approved the final version. | PMC10731819 | |
Funding | EMA | The University of Agder funded the study for EMA’s doctorate, and the Norwegian University of Science and Technology funded the application with financial support from the Research Council of Norway (260370). | PMC10731819 | |
Availability of data and materials | The datasets used during the current study available from the corresponding author on reasonable request. It is also available from the Service Provider for the Education Sector (SIKT, reference 305866) repository at | PMC10731819 |
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