Insight into the sorption and desorption pattern of pyrrolizidine alkaloids and their N-oxides in acidic tea (Camellia sinensis) plantation soils.

Pyrrolizidine alkaloids (PAs) and their N-oxides (PANOs) are phytotoxins produced by various plant species and have been emerged as environmental pollutants. The sorption/desorption behaviors of PAs/PANOs in soil are crucial due to the horizontal transfer of these natural products from PA-producing plants to soil and subsequently absorbed by plant roots. This study firstly investigated the sorption/desorption behaviors of PAs/PANOs in tea plantation soils with distinct characteristics. Sorption amounts for seneciphylline (Sp) and seneciphylline-N-oxide (SpNO) in three acidic soils ranged from 2.9 to 5.9 µg/g and 1.7 to 2.8 µg/g, respectively. Desorption percentages for Sp and SpNO were from 22.2% to 30.5% and 36.1% to 43.9%. In the mixed PAs/PANOs systems, stronger sorption of PAs over PANOs was occurred in tested soils. Additionally, the Freundlich models more precisely described the sorption/desorption isotherms. Cation exchange capacity, sand content and total nitrogen were identified as major influencing factors by linear regression models. Overall, the soils exhibiting higher sorption capacities for compounds with greater hydrophobicity. PANOs were more likely to migrate within soils and be absorbed by tea plants. It contributes to the understanding of environmental fate of PAs/PANOs in tea plantations and provides basic data and clues for the development of PAs/PANOs reduction technology.

Barrierless reactions of C2 Criegee intermediates with H2SO4 and their implication to oligomers and new particle formation.

The formation of oligomeric hydrogen peroxide triggered by Criegee intermediate maybe contributes significantly to the formation and growth of secondary organic aerosol (SOA). However, to date, the reactivity of C2 Criegee intermediates (CH3CHOO) in areas contaminated with acidic gas remains poorly understood. Herein, high-level quantum chemical calculations and Born-Oppenheimer molecular dynamics (BOMD) simulations are used to explore the reaction of CH3CHOO and H2SO4 both in the gas phase and at the air-water interface. In the gas phase, the addition reaction of CH3CHOO with H2SO4 to generate CH3HC(OOH)OSO3H (HPES) is near-barrierless, regardless of the presence of water molecules. BOMD simulations show that the reaction at the air-water interface is even faster than that in the gas phase. Further calculations reveal that the HPES has a tendency to aggregate with sulfuric acids, ammonias, and water molecules to form stable clusters, meanwhile the oligomerization reaction of CH3CHOO with HPES in the gas phase is both thermochemically and kinetically favored. Also, it is noted that the interfacial HPES- ion can attract H2SO4, NH3, (COOH)2 and HNO3 for particle formation from the gas phase to the water surface. Thus, the results of this work not only elucidate the high atmospheric reactivity of C2 Criegee intermediates in polluted regions, but also deepen our understanding of the formation process of atmospheric SOA induced by Criegee intermediates.

Terapia de Aceptación y Compromiso en conducta suicida: una revisión sistemática / Acceptance and Commitment Therapy on suicidal behavior: a systematic review

El suicidio se ha convertido en un problema social y de salud pública a nivel mundial. En este sentido, la Terapia de Aceptación y Compromiso (ACT) podría ser eficaz en su abordaje, existiendo evidencia sobre la relación entre algunos de sus componentes y la conducta suicida. Así, el presente estudio tuvo por objetivo realizar una revisión sistemática sobre la eficacia de ACT en conducta suicida. Para ello se siguió el protocolo PRISMA, empleando las siguientes bases de datos: PsycInfo, PubMed, Scopus y PsicoDoc. Inicialmente se obtuvieron 108 publicaciones potencialmente relevantes, de las cuales, finalmente, 13 fueron incluidas en la revisión. La calidad de los estudios se analizó a través de un instrumento de evaluación de riesgo de sesgos. Como resultados, a nivel general se observaron disminuciones estadísticamente significativas en ideación suicida (IS) y factores de riesgo de suicidio. Además, algunos estudios señalaron relaciones estadísticamente significativas entre un aumento de flexibilidad psicológica y la disminución de IS. Si bien los datos apuntaron a una posible eficacia de ACT en la reducción de IS, es necesario llevar a cabo mayor número de estudios experimentales que contemplen la complejidad de la conducta suicida y exploren los procesos de cambio implicados.(AU)

Suicide has emerged as a pressing global issue affecting both so-ciety and public health.In this context, Acceptance and Commitment Therapy (ACT) could prove effective in its approach, supported by evi-dence of the relationship between certain components of ACT and suicidal behavior. Thus, the present study aims to conduct a systematic review on the efficacy of ACT in suicidal behavior. For this, the PRISMA protocol was followed, using thefollowing databases: PsycInfo, PubMed, Scopus and PsicoDoc. Initially, 108 potentially relevant publicationswereobtained,13ofwhichwerefinallyincludedinthereview.Weanalyzedstudy qualityus-ingariskofbiasassessmentinstrument.Asaresult,statisticallysignificantdecreases in suicidal ideation (SI) and suicide risk factors were observed. In addition, some studies indicated statistically significant relationships be-tween increased psychological flexibility and decreasedSI.WhilethedatasuggestedthepotentialeffectivenessofACTinreducingsuicidal ideation (SI), more experimental studies are needed to consider the complexity of suicidal behavior and explore the processes of changeinvolved.(AU)

A new look at the theoretical causes of endometriosis: Narrative review.

Endometriosis is a major health concern in women who have it. Unfortunately, there is no definitive cure except panhysterectomy with its sequelae including induction of premature menopause due to loss of ovaries. Therefore, revealing the causes of this puzzling disease is necessary to avoid contracting it, and to spare women the health disorders resulting from it and the difficulties of treating it. We aimed to study endometriosis with a focus on its theoretical causes. Its classification reports and theories of pathogenesis were identified and studied from available database searches. The causes of endometriosis remain mysterious. Many theories have been proposed to explain the etiology, but retrograde menstruation (RM) remains the closest in this regard. Although this theory is the most accepted in the pathogenesis of endometriosis, its causes are still a matter of debate, especially in women who do not suffer from obstructions to menstrual outflows, such as cases of congenital cervical stenosis and imperforate hymen. It is suggested in some studies that there may be a relationship between women who engage in sexual activity during menstruation and the development of endometriosis. It is concluded that endometriosis is a painful and debilitating disease. Identifying its causes is essential to control the disease and avoid any burdens on health. RM is the main theory for its pathogenesis but its causes are still uncertain. Sexual activity during menstruation may be a possible cause of RM but needs more evidence. Future studies are recommended to reveal all aspects of the pathogenesis of endometriosis.

Investigating seasonal changes in factors associated with COVID-19 concerns: Results from a serial cross-sectional survey study in Germany between 2020 and 2023.

Objective: COVID-19 risk perceptions are discussed to be volatile and have been shown to be connected to the adoption of preventive public health behaviors. This study aimed to investigate changes in COVID-19 concerns and influencing factors as a function of season among the German public. Methods: Sixty-three waves of cross-sectional telephone surveys with German participants aged 14 years and older conducted at least monthly between June 2020 and April 2023 provided the data basis (N = 63,471). After pooling participants of different waves by season (spring, summer, fall, winter), data were analyzed with regard to changes in physical health, mental health, economic, and social COVID-19 concerns. Individual characteristics (e.g., age), COVID-19 behavior (e.g., hygiene practices), and related perceptions (e.g., controllability of risk) were considered as predictors of composite concerns in different seasons. Results: Results showed a higher between-seasons than within-seasons variability in concerns, with rises in physical and mental health and social concerns during fall. Multivariate regressions revealed being female, lower education, adopting protective measures, and higher perceived probability of infection in both public and private settings to be consistent predictors of higher COVID-19 concerns. Coefficients of these predictors remained comparatively stable over seasons and years. Conclusion: Results indicate re-occurring changes in concerns during a prolonged crisis, with distinct characteristics being consistently associated with higher reported concerns. To ensure the application of protective measures, communicators should consider that risk perceptions are subject to fluctuations, but that certain groups of individuals tend to develop them and therefore deserve particular focus.

The effect of educational intervention based on the PRECEDE-PROCEED model on self-care behaviors and quality of life of hypertensive patients.

Background: To prevent the harmful consequences of hypertension and enhance the quality of life of hypertensive patients, the use of educational models is highly suggested. Therefore, the present study was designed to determine the effect of education based on the PRECEDE-PROCEED on self-care behaviors and the quality of life of hypertensive patients in Kazeroon city, Iran, in 2023. Methods: A total of 120 hypertensive individuals who were referred to Kazeroon city health centers participated in the current quasi-experimental study. The participants were divided into two experimental and control groups using a random sampling technique (60 participants in each group). The self-care behaviors questionnaire, the quality of life questionnaire, and a questionnaire based on the PRECEDE-PROCEED model were used as the data acquisition techniques. Both groups completed the questionnaires before and 2 months after the intervention. The educational program included a six-session, 50-60 min training program using three different teaching methods (speaking, Q&A, group discussion, and peer training) in health facilities. The data were examined using paired t, independent t, and chi-square statistical tests after being entered into the SPSS 24 statistical program. Results: Following the intervention, the experimental group showed significantly higher values in quality of life, knowledge, attitude, enabling and reinforcing factors, and self-care behaviors compared to the control group (p < 0.001 for all comparisons). The experimental group also exhibited a significant reduction in systolic blood pressure measures compared to the control group (p < 0.001). Conclusion: In the present study, education based on the PRECEDE-PROCEED model and focusing on blood pressure self-care behavior in patients with hypertension led to a decrease in their systolic blood pressure measures and improved their quality of life.

Chemical Immobilization Effects on Cougar (Felis concolor) Movement.

Capturing and handling wildlife is a common practice for both management and research. As telemetry use has become common, the need to capture and chemically immobilize wildlife has increased. Understanding how long the effects of immobilizing agents last after releasing the animal is often poorly understood but needed to ensure that analyses use data that reflect natural behavior. Between 2016 and 2021, 87 cougars (Puma concolor) were chemically immobilized with medetomidine, zolazepam, and tiletamine (MZT) and collared across west-central Alberta, Canada, 27 of which were individuals being recollared. We examined the distance an individual traveled per day and compared equivalent periods before and after the recollaring event to determine whether postcapture movement rates were significantly different from precapture rates. Within 1 d of the recollaring, daily movement rates had returned to precapture rates (t20=2.09, P=0.18). Our results provide insight on how MZT used in cougars affects their postcapture movement and thus may be helpful in interpreting movement data after release.

A pheromone receptor in cichlid fish mediates attraction to females but inhibits male parental care.

Reproductive behaviors differ across species, but the mechanisms that control variation in mating and parental care systems remain unclear. In many animal species, pheromones guide mating and parental care. However, it is not well understood how vertebrate pheromone signaling evolution can lead to new reproductive behavior strategies. In fishes, prostaglandin F2α (PGF2α) drives mating and reproductive pheromone signaling in fertile females, but this pheromonal activity appears restricted to specific lineages, and it remains unknown how a female fertility pheromone is sensed for most fish species. Here, we utilize single-cell transcriptomics and CRISPR gene editing in a cichlid fish model to identify and test the roles of key genes involved in olfactory sensing of reproductive cues. We find that a pheromone receptor, Or113a, detects fertile cichlid females and thereby promotes male attraction and mating behavior, sensing a ligand other than PGF2α. Furthermore, while cichlid fishes exhibit extensive parental care, for most species, care is provided solely by females. We find that males initiate mouthbrooding parental care if they have disrupted signaling in ciliated sensory neurons due to cnga2b mutation or if or113a is inactivated. Together, these results show that distinct mechanisms of pheromonal signaling drive reproductive behaviors across taxa. Additionally, these findings indicate that a single pheromone receptor has gained a novel role in behavior regulation, driving avoidance of paternal care among haplochromine cichlid fishes. Lastly, a sexually dimorphic, evolutionarily derived parental behavior is controlled by central circuits present in both sexes, while olfactory signals gate this behavior in a sex-specific manner.

Effect of temperature on the rheological, textural, and sensory properties of butters from New Zealand market.

Texture and sensory studies at various temperatures are important in evaluating and improving the functionality of butter. While literature is scarce, we evaluated and compared the effect of temperature (5-25°C) on the texture, rheological and sensory properties of commercial butter samples (salted, unsalted, cultured, and spreadable) from the New Zealand market. In addition, the instrumental analyses were compared with the sensory evaluation, to understand the possibility of using instrumental analysis to evaluate consumer liking for different butters. Butter type, temperature, and their type-temperature interaction exhibited significant differences for all instrumental textural parameters. As expected, higher temperature produced softer butter that was more spreadable, liquid-like, less adhesive, less cohesive, had lower storage modulus (G') and lower loss modulus (G″) with the melting of milk fat crystals; however, the rate of change varied for the different butter samples. We have established meltability as the parameter for evaluating butter selection for different applications. The spreadable butter sample exhibited the lowest hardness and G', and highest spreadability (p < .05) at all temperatures, owing to its low solid fat content and the abundance of low-melting triglycerides. The cultured butter sample had the highest melting point, owing to compositional differences. The instrumental and sensory texture analyses were highly correlated, indicating the comparative effectiveness of both approaches for studying the effects of different temperatures on butter textural properties. Overall, our findings provide detailed reference to the dairy industry for butter manufacture, considering variation in fatty acid composition, texture analysis, rheology, and sensory analysis, over the range of storage/usage temperatures.

Synthesized alternative reinforcement and resurgence.

In treatments based on differential reinforcement of alternative behavior, applied researchers and clinicians often provide multiple, qualitatively different reinforcers (i.e., synthesized reinforcement) rather than a single reinforcer (i.e., isolated reinforcement) contingent on alternative behavior. Some research shows that providing synthesized reinforcement for alternative responses within such treatments produces more rapid and complete suppression of target behavior; however, there is limited research evaluating the durability of these effects during treatment disruptions. Conceptual explanations of resurgence (e.g., resurgence as choice, context theory) suggest that treatments that include synthesized alternative reinforcement may lead to more resurgence of target behavior when alternative reinforcement is disrupted relative to treatments using isolated reinforcement. We evaluated this hypothesis within a three-phase resurgence evaluation. We exposed rats to isolated or synthesized reinforcement for alternative responding in the second phase, and we exposed rats to extinction in the third phase. Synthesized alternative reinforcement produced more rapid and complete suppression of target behavior than did isolated reinforcement in the second phase; however, exposure to extinction following synthesized reinforcement produced more resurgence. We discuss these results in terms of their implications for applied research and their support for current conceptual explanations for resurgence.

Adolescent Peer Relationship Difficulties, Prosociality, and Parental Emotion Socialization: Moderating Roles of Adolescent Gender.

The present study examined longitudinal, transactional associations between youth social adjustment (prosociality, peer relationship difficulties) and parental emotion socialization in early adolescence. Adolescent gender was considered as a potential moderator. Eighty-seven adolescent-parent dyads (50 girls, 37 boys) participated in 8th grade, with follow-up waves in 9th and 10th grade. Adolescents reported their experiences of peer victimization and their parents' emotion socialization responses, and parents reported youth prosocial behavior and peer relation problems. Hierarchical linear modeling results indicated transactional associations between parent supportive/unsupportive responses and adolescent peer relations and prosociality over time, some of which were moderated by adolescent gender. Increases in parental supportive emotion socialization corresponded to decreased experiences of peer victimization over time for girls, but not boys. When peer victimization increased over time, girls reported less parental supportive responses and all adolescents reported receiving more unsupportive responses from parents. For all adolescents, parents' increased supportive responses also corresponded to decreased peer problems and increased prosocial behavior. As prosocial behavior increased, so did parental supportive responses. Increases in parents' unsupportive responses related to decreased prosocial behavior, and increases in adolescent prosocial behavior related to decreases in parents' unsupportive responses. Results suggest that there is mutual influence between parent emotion socialization and adolescent social adjustment. Adolescent girls appear to uniquely benefit from parents' supportive emotional socialization in relation to their experiences of peer victimization. Potential mechanisms and implications are discussed.

Computational modeling and uncertainty prediction of hyperelastic constitutive responses of damaged brain tissue under different temperature and strain rates.

The effect of strain rate and temperature on the hyperelastic material stress-strain characteristics of the damaged porcine brain tissue is evaluated in this present work. The desired constitutive responses are obtained using the commercially available finite element (FE) tool ABAQUS, utilizing 8-noded brick elements. The model's accuracy has been verified by comparing the results from the previously published literature. Further, the stress-strain behavior of the brain tissue is evaluated by varying the damages at various strain rates and temperatures (13, 20, 27, and 37°C) under compression test. Additionally, the sensitivity analysis of the model is computed to check the effect of input parameters, that is, the temperature, strain rate, and damages on the material properties (shear modulus). The modeling and discussion sections enumerate the inclusive features and model capabilities.

Assessment of Probiotics' Impact on Neurodevelopmental and Behavioral Responses in Zebrafish Models: Implications for Autism Spectrum Disorder Therapy.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder; the prevalence of which has been on the rise with unknown causes. Alterations in the gut-brain axis have been widely recognized in ASD patients, and probiotics are considered to potentially benefit the rescuing of autism-like behaviors. However, the effectiveness and mechanisms of multiple probiotics on zebrafish models are still not clearly revealed. This study aims to use the germ-free (GF) and conventionally raised (CR) AB wild-type zebrafish and the mutant Tbr1b-/- and Katnal2-/- lines as human-linked ASD animal models to evaluate the effects of multiple probiotics on mitigating developmental and behavioral defects. Results showed that the addition of probiotics increased the basic important developmental indexes, such as body length, weight, and survival rate of treated zebrafish. Moreover, the Lactobacillus plantarum and Lactobacillus rhamnosus affected the behavior of CR zebrafish by increasing their mobility, lowering the GF zebrafish manic, and mitigating transgenic zebrafish abnormal behavior. Moreover, the expression levels of key genes related to gamma-aminobutyric acid (GABA), dopamine (DA), and serotonin (5-HT) as important neuropathways to influence the appearance and development of autism-related disorders, including gad1b, tph1a, htr3a, th, and slc6a3, were significantly activated by some of the probiotics' treatment at some extent. Taken together, this study indicates the beneficial effects of different probiotics, which may provide a novel understanding of probiotic function in related diseases' therapy.

Community Senior Center Intervention to Address Factors Related to Memory Screening Engagement.

There are many individual and societal benefits to screen older adults for memory problems. Four theoretically derived psychosocial factors are predictive of dementia screening intention: perceived benefits, perceived susceptibility, self-efficacy, and knowledge about memory. The current study tested whether these factors could be modified with an educational memory screening intervention given in community senior centers. An educational presentation was designed to address these factors by increasing knowledge about memory and aging, discussing the benefits of screening and older adults' susceptibility to memory issues, and increasing self-efficacy by teaching about the memory screening process, discussing a vignette, and fielding participants' questions. The educational presentation was offered four times at three community senior centers. Quantitative data on the psychosocial factors were collected before and after the presentation from 44 older adult participants (age M = 78.70, SD = 7.21). Narrative data on satisfaction and feedback about the intervention were collected. Hierarchical linear modeling analyses were performed to measure change from pre- to post-presentation and follow-up 1 to 2 weeks after the intervention. The educational presentation effectively increased knowledge about aging memory, perceived benefits of screenings, and self-efficacy to seek screening. The presentation intervention was well received by community participants. Results provide guidance about how an intervention based in community senior centers can be refined to address factors predictive of memory screening intention in older adults.

Cultivating Innovative Employees: The Influence of Regulatory Focus and Institutional Empowerment.

The relationship between regulatory focus, a pivotal trait, and innovative behavior has been long recognized, with previous scholars often emphasizing the reluctance of individuals possessing a prevention focus to engage in innovation due to their risk-averse tendencies. This study introduces a research model proposing that the relationship between promotion focus, prevention focus, and innovation behavior, is positively mediated by knowledge sharing. Additionally, institutional empowerment is posited as a moderating variable that enhances the positive relationship between regulatory focus and knowledge sharing. Empirical investigation of a moderated-mediation model reveals that the impact of regulatory focus on innovation behaviors is mediated by knowledge sharing, with this mediation being more pronounced under conditions of elevated perceptions of institutional empowerment. This research significantly advances the understanding of regulatory focus and its implications for innovation behavior. In addition, it highlights the significance of institutional empowerment as a boundary condition that encourages individuals with diverse regulatory focus to expand their behavioral boundaries. It specifically emphasizes the managerial capacity to leverage the needs and motivations of individuals with a pronounced prevention focus through institutional empowerment, resulting in transformative outcomes even in unfavorable situations.

Hectogram-Scale Synthesis of Visible Light Excitable Room Temperature Phosphorescence Carbon Dots.

Carbon dots (CDs) based room temperature phosphorescence (RTP) materials can be prepared via facile procedures and exhibit excellent photostability and biocompatibility. Furthermore, doping of hetero-atoms into CDs can afford multiple triplet levels. The RTP emission generated from the resultant CDs always displays outstanding dynamic behaviors and even can be efficiently excited by visible light. Given this, CDs-based RTP materials not only can be used for anti-counterfeiting but also exhibit great application potential in signage and illumination fields. In this contribution, a type of B, N, and P co-doped CDs are prepared in hectogram scale. Upon excitation by UV lamp and white LED, the obtained CDs emit green and yellow RTP, respectively, the lifetime of which are 851 and 481 ms, respectively. It is found that the luminescence color of the CDs can be further tuned. By controlling the degree of carbonization, the RTP color of the CDs can be facilely tuned from green to orange-red. Based on an energy transfer strategy, the luminescence color can be further tuned to red. Benefited from the dynamic and visible-excited colorful RTP emission, the application of these obtained CDs in anti-counterfeiting, fingerprint collection, and luminescent traffic signage are also explored.

A Family-Based Intervention for Early Elementary Students With Reading and Behavioral Difficulties: A Pilot Study.

We created and tested a family-based intervention with families of children in Grades 1 and 2 with reading and behavioral difficulties to investigate its impact on text comprehension. Developed with input from parents, reading experts, and behavior specialists, Family-RISE (Reading Intervention with Supports for Engagement) integrates evidence-based practices for enhancing students' knowledge of narrative texts with effective behavioral supports to maximize student engagement and minimize disruptive behaviors to help parents engage successfully in shared storybook reading. We assessed the effects of Family-RISE on children's narrative text comprehension using a multiple-baseline design. A functional relation was established between Family-RISE and narrative text comprehension, indicating Family-RISE substantially improved narrative text comprehension. Furthermore, nonoverlap of all pairs, Tau-U, and standard mean difference effect sizes were all considered large in favor of the intervention. Family members reported that the intervention was highly usable, feasible to implement, and socially valid. These findings underscore the promise of the Family-RISE intervention and the value of developing interventions that simultaneously support reading and behavior for children with co-occurring difficulties in these areas.

Acute Neurobehavioral and Glial Responses to Explosion Gas Inhalation in Rats.

Military personnel, firefighters, and fire survivors exhibit a higher prevalence of mental health conditions such as depression and post-traumatic stress disorder (PTSD) compared to the general population. While numerous studies have examined the neurological impacts of physical trauma and psychological stress, research on acute neurobehavioral effects of gas inhalation from explosions or fires is limited. This study investigates the early-stage neurobehavioral and neuronal consequences of acute explosion gas inhalation in Sprague-Dawley rats. Rats were exposed to simulated explosive gas and subsequently assessed using behavioral tests and neurobiological analyses. The high-dose exposure group demonstrated significant depression-like behaviors, including reduced mobility and exploration. However, neuronal damage was not evident in histological analyses. Immunofluorescence revealed increased density of radial glia and oligodendrocytes in specific brain regions, suggesting hypoxia and axon damage induced by gas inhalation as a potential mechanism for the observed neurobehavioral changes. These findings underscore the acute impact of explosion gas inhalation on mental health, highlighting the habenula and dentate gyrus of hippocampus as the possible target regions. The findings are expected to support early diagnosis and treatment strategies for brain injuries caused by explosion gas, offering insights into early intervention for depression and PTSD in affected populations.

First iteration of a User-Centered Design process to develop an in-bed leg press.

BACKGROUND: Physical inactivity is prevalent among hospitalized patients and the daytime spent lying should be utilised for exercise. However, implementing new interventions in hospitals' complex daily routines is difficult and requires a participatory approach. OBJECTIVE: Exploring clinical settings and clinicians' perspectives regarding exercise in hospitalized patients to gauge the potential of further development of an in-bed training device and to formulate development goals. METHODS: A User-Centered Design approach was employed, consisting of work shadowing and focus groups with physiotherapists and nurses. Content and network analyses of the focus group data were performed. Personas were then developed and used to create clinical scenarios. RESULTS: Some clinicians perceived in-bed exercise counterproductive, while others recognized potential for unsupervised training. The most important design characteristics appeared to be a small size, low weight and simplicity of use to facilitate storage, transportation, and administration, respectively. The scenarios revealed that the device's use could increase the physical activity time by 1.4%, although it would also increase the working time of clinicians. CONCLUSION: The study highlighted the difficulties in developing a usable training device but encouraged the authors to pursue their efforts under the strict condition of following the formulated development goals.