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Regular mindfulness practice has been demonstrated to be beneficial for mental health, but mindfulness can be challenging to adopt, with environmental and personal distractors often cited as challenges. Virtual reality (VR) may address these challenges by providing an immersive environment for practicing mindfulness and by supporting the user to orient attention to the present moment within a tailored virtual setting. However, there is currently a limited understanding of the ways in which VR can support or hinder mindfulness practice. Such an understanding is required to design effective VR apps while ensuring that VR-supported mindfulness is acceptable to end users. This study aimed to explore how VR can support mindfulness practice and to understand user experience issues that may affect the acceptability and efficacy of VR mindfulness for users in the general population. A sample of 37 participants from the general population trialed a VR mindfulness app in a controlled laboratory setting. The VR app presented users with an omnidirectional video of a peaceful forest environment with a guided mindfulness voiceover that was delivered by a male narrator. Scores on the State Mindfulness Scale, Simulator Sickness Questionnaire, and single-item measures of positive and negative emotion and arousal were measured pre- and post-VR for all participants. Qualitative feedback was collected through interviews with a subset of 19 participants. The interviews sought to understand the user experience of mindfulness practice in VR. State mindfulness (P<.001; Cohen d=1.80) and positive affect (P=.006; r=.45) significantly increased after using the VR mindfulness app. No notable changes in negative emotion, subjective arousal, or symptoms of simulator sickness were observed across the sample. Participants described the user experience as relaxing, calming, and peaceful. Participants suggested that the use of VR helped them to focus on the present moment by using visual and auditory elements of VR as attentional anchors. The sense of presence in the virtual environment (VE) was identified by participants as being helpful to practicing mindfulness. Interruptions to presence acted as distractors. Some uncomfortable experiences were discussed, primarily in relation to video fidelity and the weight of the VR headset, although these were infrequent and minor. This study suggests that an appropriately designed VR app can support mindfulness practice by enhancing state mindfulness and inducing positive affect. VR may help address the challenges of practicing mindfulness by creating a sense of presence in a tailored VE; by allowing users to attend to visual and auditory anchors of their choice; and by reducing the scope of the content in users' mind-wandering. VR has the unique capability to combine guided mindfulness practice with tailored VEs that lend themselves to support individuals to focus attention on the present moment.

A review of literature from the past 30 years establishes psychological distress as both a longstanding and current issue affecting university students worldwide. Poorer academic outcomes and problematic health behaviours are linked to students’ distress, and these wider implications also highlight the need for appropriate policies and services to support students during what is clearly a challenging time. Further review identified various socio-demographic, situational and academic factors as potential bases of students’ distress. Undoubtedly, the demands of the university lifestyle are inherently stressful; yet experiencing these as distressing is not inevitable. Rather, a review of links between university students’ psychological attributes and psychological distress indicates such attributes might be ideal points of intervention to ensure students are best equipped to manage the stressors of university, and greater attention in this area is recommended.

The aim of this qualitative study was to address the lack of consensus on the current cyberbullying definition and the limited research on definitions of cyberbullying made by emerging adults in Australia. Six focus groups were conducted with a total of 39 participants aged 18 to 25 years. The focus groups used a semi-structured question protocol to gain a deeper understanding of emerging adults’ perceptions, observations, and opinions related to cyberbullying. A thematic analysis revealed that participants perceive cyberbullying to be an extension of traditional bullying comprising similar key components (i.e., intent to harm, repetition, and power imbalance). However, despite a consensus on the components involved, the operationalization of these key components differed among participants depending on whether they adopted a perpetrator, target, or bystander perspective. The current study extends on previous research by focusing on the different perspectives of cyberbullying (i.e., perpetrators, targets, and bystanders) rather than assuming a single perspective, and in turn integrating these perspectives to propose a multifaceted definition of cyberbullying.

The extraordinary genetic diversity of the HIV-1 envelope spike [Env; trimeric (gp160)₃, cleaved to (gp120/gp41)₃] poses challenges for vaccine development. Envs of different clinical isolates exhibit different sensitivities to antibody-mediated neutralization. Envs of difficult-to-neutralize viruses are thought to be more stable and conformationally homogeneous trimers than those of easy-to-neutralize viruses, thereby providing more effective concealment of conserved, functionally critical sites. In this study we have characterized the antigenic properties of an Env derived from one of the most neutralization-resistant HIV-1 isolates, CH120.6. Sequence variation at neutralizing epitopes does not fully account for its exceptional resistance to antibodies. The full-length,membrane-bound CH120.6 Env is indeed stable and conformationally homogeneous. Its antigenicity correlates closely with its neutralization sensitivity, and major changes in antigenicity upon CD4 engagement appear to be restricted to the coreceptor site. The CH120.6 gp140 trimer, the soluble and uncleaved ectodomain of (gp160)₃, retains many antigenic properties of the intact Env, consistent with a conformation close to that of Env spikes on a virion, whereas its monomeric gp120 exposes many nonneutralizing or strain-specific epitopes. Thus, trimer organization and stability are important determinants not only for occluding many epitopes but also for conferring resistance to neutralization by all but a small set of antibodies. Env preparations derived from neutralization-resistant viruses may induce irrelevant antibody responses less frequently than do other Envs and may be excellent templates for developing soluble immunogens.

Background Airway management is a key skill in any helicopter emergency medical service (HEMS). Intubation is successful less often than in the hospital, and alternative forms of airway management are more often needed. Methods Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patient charts were analysed for all calls to the scene ( n  = 9,035) taking place between June 2016 and May 2017 (12 months). The primary outcome parameter was intubation success rate. Secondary parameters included the number of alternative techniques that eventually secured the airway, and comparison of patients with and without difficulties in airway management. Results A total of 365 patients receiving invasive ventilatory support were identified. Difficulties in airway management occurred in 26 patients (7.1%). Severe traumatic brain injury was the most common indication for out-of-hospital Intubation ( n  = 130, 36%). Airway management was performed by 129 different Rega physicians and 47 different Rega paramedics. Paramedics were involved in out-of-hospital airway manoeuvres significantly more often than physicians: median 7 (IQR 4 to 9) versus 2 (IQR 1 to 4), p  < 0.001. Conclusion Despite high overall success rates for endotracheal intubation in the physician-staffed service, individual physicians get only limited real-life experience with advanced airway management in the field. This highlights the importance of solid basic competence in a discipline such as anaesthesiology.

Background The human external cargo (HEC) operations conducted by Helicopter Emergency Medical Services (HEMS) rarely take place at night, making it difficult for crew members to attain and maintain the level of expertise needed to perform winch operations in the dark. As EASA requirements for training cannot currently be met, we evaluated whether simulation training could be an option. Methods This paper reports on a training concept using indoor simulation for the training of nighttime HEC operations. Participants’ experience and perceptions were evaluated with a survey and the procedural and economic advantages of the simulation approach were compared with those of the usual outdoor HEC training. Results Most participants had limited exposure to real-life nighttime HEC missions before undergoing the simulation-based training. The frequency of training cycles in simulation was much higher compared to conventional training (60 cycles indoors vs. 20 outdoors for HEMS-TC, 20 cycles indoors vs. 4 outdoors for MCM). Trainees perceived that their technical and non-technical skills (NTS) improved with the training. The estimated costs of standard outdoor-based nighttime HEC training (138€ per cycle) are at least 6.5 times higher than the costs of indoor simulated training (approximately 21€ per cycle). With a change to simulation, carbon dioxide emissions could potentially be reduced by more than 35 tons. Conclusions Indoor simulation training of night HEC operations has advantages with regard to cost-effectiveness, environmental friendliness, and self-reported improvements in skills and knowledge. Its use is feasible and could improve crew and patient safety and fulfill regulatory demands for training intensity.

A common first step in time series signal analysis involves digitally filtering the data to remove linear correlations. The residual data is spectrally white (it is ``bleached''), but in principle retains the nonlinear structure of the original time series. It is well known that simple linear autocorrelation can give rise to spurious results in algorithms for estimating nonlinear invariants, such as fractal dimension and Lyapunov exponents. In theory, bleached data avoids these pitfalls. But in practice, bleaching obscures the underlying deterministic structure of a low-dimensional chaotic process. This appears to be a property of the chaos itself, since nonchaotic data are not similarly affected. The adverse effects of bleaching are demonstrated in a series of numerical experiments on known chaotic data. Some theoretical aspects are also discussed.