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Patellar tendinopathy (PT) is frequently observed among basketball players, particularly in sports involving repetitive jumping movements. However, the overall impact of accumulated exercise load on the patellar tendon is still not fully comprehended. Therefore, the goal of this study is to examine how a simulated basketball game affects the biomechanics of stop-jump movements, specifically focusing on the effects on the patellar tendon. The kinematic and kinetic data were collected immediately after the warm-up and each phase of the simulated basketball game (P1, P2, P3, and P4). A musculoskeletal model was built to calculate patellar tendon force (PTF) and the key biomechanical metrics during the horizontal landing and vertical jumping phases were explored separately, followed by correlation analyses. Linear regression analyses were performed on variables strongly correlated with PTF. The accumulation of load led to significant differences (p < 0.05) in the angles, velocities, torques, work contributions, peak patellar tendon force (PTF), and anterior-posterior ground reaction force (APGRF) observed during the landing and vertical jump phases at the hip, knee, and ankle joints. PTF showed strong correlations with knee flexion angle, knee extension angular velocity, ankle plantarflexion angular velocity, and APGRF, with R2 values of 0.50, 0.58, 0.70, and 0.56, respectively. PTF significantly decreased in P3 and P4, possibly due to the subjects’ adaptation and adjustment of their stop-jump posture strategy after load accumulation, including reducing knee and hip flexion angles and decreasing the net knee extension moment.

Successful emergency vaccination campaigns rely on effective deployment and vaccination plans. This applies to localised outbreaks as well as for pandemics. In the wake of the 2009 H1N1 influenza pandemic, analysis of the global Vaccine Deployment Initiative, through which the World Health Organization (WHO) donated pandemic influenza vaccines to countries in need, revealed that an absence of vaccine deployment plans in many countries significantly hindered vaccine deployment. Through the Pandemic Influenza Preparedness Framework adopted by the World Health Assembly in 2011, WHO is engaging in several capacity building activities to improve pandemic influenza preparedness and response and make provisions for access to vaccines and sharing of other benefits. The Framework calls for the development and exercise of operational plans for deployment of influenza vaccines to enhance pandemic preparedness. To this end, WHO has supported the development of PIPDeploy, an interactive, in-person table top simulation exercise to facilitate learning for emergency preparedness. It employs various game design elements including a game board, time pressure, leaderboards and teams to enhance participants’ motivation. PIPDeploy formed part of five WHO Pandemic Influenza Vaccine Deployment Workshops attended by national-level managers responsible for pandemic influenza vaccine response predominantly in non-producing countries. The purpose of this study was to describe the features and application of PIPDeploy, and present findings of the evaluation of participants’ experiences during the simulation involving a “hot wash” discussion and collection of quantitative data. The simulation’s instructional approach was widely accepted by participants, who reported that the format was novel and engaging. They reflected on its utility for identifying gaps in their own vaccine deployment plans and regulatory frameworks for importation of vaccine products. All participants found the simulation relevant to their professional objectives. A range of other potential applications were suggested, including PIPDeploy’s adaptation to sub-national contexts and to other epidemic diseases.

Background In recent decades, analyses of hospitals evacuations have generated valuable knowledge. Unfortunately, these evacuation case studies often lack crucial details and policies that would be helpful in evacuation preparedness. The aim of this study was to use a simulation model to illustrate how it can aid emergency planners in the development, testing, and revising of hospitals evacuation plans. This study includes evacuation exercises at two emergency hospitals in Region Stockholm, Sweden. Methods A scientifically validated simulation system for “table top” exercises was used for interactive training of hospital medical staff, prehospital staff and collaborating agencies. All participants acted in their usual professionals’ roles. The exercises were run in real-time and mirrored actual hospital resources with the aid of moveable magnetic symbols illustrating patients, staff and transport, presented on whiteboards. During the exercises, observers and independent instructors documented actions taken and post-exercise surveys were conducted to obtain reactions and compare results. Results The simulation system allowed the emergency planner to test the whole evacuation process, making it possible to train and evaluate the important functions of management, coordination, and communication. Post-exercise surveys explored participants perception of the exercises. Analysis of open-ended questions included areas for improvement and resulted in five main categories: (1) management and liaison; (2) communication; (3) logistics; (4) medical care and patient prioritisation; and (5) resource utilisation. Conclusions This study has shown that “table top” exercises using a validated simulation system can serve to guide emergency planners when developing evacuation plans, procedures, and protocols as well in training of all medical staff. The system also served to train adaptive thinking, leadership, communication, and clarification of critical functions.

ABSTRACT Objectives: to highlight the effect of using clinical simulation in the training of undergraduate nursing students for the development of skills in cardiovascular health assessment. Methods: a systematic review was conducted in the PubMed/MEDLINE, LILACS, Scopus, EBSCO, Web of Science, and Science Direct databases from August to September 2023. Of the 685 articles identified, 6 were selected, consisting of 4 experimental studies and 2 quasi-experimental studies, all of good methodological quality according to the Joanna Briggs Institute. Results: clinical simulation increased nursing students’ levels of knowledge and confidence. Most studies indicated that simulated practices improve learning compared to traditional methodologies. Conclusions: clinical simulation requires more robust methodological designs, and more multicenter clinical trials on cardiovascular assessment in nursing need to be published. RESUMEN Objetivos: evidenciar el efecto del uso de la simulación clínica en la enseñanza de estudiantes de pregrado en enfermería para el desarrollo de habilidades en la evaluación de la salud cardiovascular. Métodos: revisión sistemática realizada en las bases de datos PubMed/ MEDLINE, LILACS, Scopus, EBSCO, Web of Science y Science Direct, de agosto a septiembre de 2023. De los 685 artículos identificados, se seleccionaron 6, siendo 4 estudios experimentales y 2 cuasi-experimentales, todos con buena calidad metodológica según el Instituto Joanna Briggs. Resultados: la simulación clínica aumentó los niveles de conocimiento y confianza de los estudiantes de enfermería. La mayoría de los estudios indicaron que las prácticas simuladas mejoran el aprendizaje en comparación con las metodologías tradicionales. Conclusiones: la simulación clínica requiere diseños metodológicos más robustos, y es necesaria la publicación de más ensayos clínicos multicéntricos sobre la evaluación cardiovascular en enfermería. RESUMO Objetivos: evidenciar o efeito da utilização da simulação clínica no ensino de estudantes de graduação em enfermagem para o desenvolvimento de habilidades na avaliação em saúde cardiovascular. Métodos: revisão sistemática realizada nas bases PubMed/MEDLINE, LILACS, Scopus, EBSCO, Web of Science e Science Direct, de agosto a setembro de 2023. Dos 685 artigos identificados, 6 foram selecionados, sendo 4 estudos experimentais e 2 quase-experimentais, todos de boa qualidade metodológica, conforme o Instituto Joanna Briggs. Resultados: a simulação clínica aumentou os níveis de conhecimento e confiança dos estudantes de enfermagem. A maioria dos estudos indicou que as práticas simuladas melhoram a aprendizagem em comparação com metodologias tradicionais. Conclusões: a simulação clínica necessita de desenhos metodológicos mais robustos, sendo necessária a publicação de mais ensaios clínicos multicêntricos sobre avaliação cardiovascular em enfermagem.

Introduction: Due to the pandemic, academic challenges arose, and virtual simulation was used to replace the clinical experiences, offering innovative learning strategies and standardized teaching. Objective: To compare the perception and the level of satisfaction in the acquisition of knowledge, abilities and skills through face-to-face and virtual simulation among medical students. Methods: Analytical cross-sectional study including medical students who received virtual and face-to-face simulation practices. A survey was con-ducted to investigate the sociodemographic and academic characteristics, institutional physical conditions, self-assessment regarding the acquisition of technical and soft skills, and quality and satisfaction with clinical simulation. Results: 105 students with a median age of 22 years were included, who reported greater acquisition of technical skills through face-to-face simulation compared to the virtual modality. In-person simulation resulted in an 85% mastery of some topics compared to virtual simulation (65.7%, p < 0.001). However, for medication presentation and dosage scenarios, 80% reported mastery of the topic through virtual practice compared to 53.3% in the face-to-face modality (p < 0.001). The development of soft skills was similar in both scenarios, such as problem solving (83.8%), effective communication (78.1%), among others. Conclusions: Clinical simulation is crucial to medical training, its face-to- face application is perceived as the most suitable way to use it in the educational environment.

Background Anthrax is a zoonotic disease caused by Bacillus anthrac is that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda. Methods We conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported. Results The overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects. Conclusion We found that the district’s preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study’s insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings.

Operation based exercises represent simulation activities, which are of great importance for emergency preparedness, as they simulate real experiences in a guided manner. Whereas their primary purpose is to address the organizational emergency preparedness, little is known about the personal benefits of involved participants and whether these positive changes endure over time. Immediate and medium term assessment of the effectiveness on individual preparedness and benefits of participants, based on self-perception, after participating in a set of 4 interdisciplinary field exercises organized as part of the MSc in Global Health-Disaster Medicine of the Medical School of the National and Kapodistrian University of Athens, Greece. The field exercises were carried out yearly, from 2016 to 2019. Data were collected via questionnaires pre- and post-exercise (1 week and 10 months after participation). The sample size was 228 trainees, with a response rate of 88%. The majority (95%) stated that Mass Casualty Incident (MCI) exercises are appropriate for disaster management training in terms of comprehending theory, and for team-building training. In the case of a real MCI, 22% of the participants declared themselves to be ready to respond prior to MCI exercises. Upon completion, the overall perception of readiness among the participants increased to 77%. Trainee feedback indicated enhancement of both technical and non-technical skills (87%), which were persistent over time, and revealed a high level of satisfaction with the training. This study shows a positive immediate and medium-term impact of operation-based exercises on technical, non-technical skills, and self-perception of participants.

Introducción: debido a la pandemia se presentaron desafíos académicos y se recurrió al uso de la simulación virtual para sustituir las experiencias clínicas que se suspendieron, lo que ofreció estrategias de aprendizaje innovadoras y una estandarización de la enseñanza.Objetivo: comparar la percepción y el nivel de satisfacción en la adquisición de conocimientos, habilidades y destrezas mediante la simulación en modalidad presencial y virtual de los estudiantes de medicina.Métodos: estudio transversal analítico que incluyó estudiantes de medicina que recibieron prácticas de simulación virtuales y presenciales. Posterior al aval ético y a la firma del consentimiento se aplicó una encuesta para indagar las características sociodemográficas y académicas del estudiante, las condiciones físicas de la institución, la autoevaluación frente a la adquisición de habilidades técnicas y blandas y la calidad y satisfacción con la simulación clínica.Resultados: se incluyeron 105 estudiantes con mediana de edad de 22 (RIC: 21 - 23 años), quienes manifestaron una mayor adquisición de habilidades técnicas mediante la simulación presencial frente a la virtual. De manera presencial se obtuvo un 85% de dominio de algunos temas en comparación con la virtualidad (65,7%, p < 0,001). Sin embargo, en el escenario de presentación y dosis de medicamentos, el 80% refirió dominio del tema mediante la práctica virtual comparado con el 53,3% en la modalidad presencial (p < 0,001). El desarrollo de habilidades blandas fue similar en ambos escenarios, como fue el caso de resolución de problemas (83,8%), comunicación efectiva (78,1%), entre otros.Conclusiones: la simulación clínica es clave para la formación médica y su aplicación presencial es percibida como la forma más adecuada de emplearla en el entorno educativo.

Background Under the International Health Regulations (2005) [IHR (2005)] Monitoring and Evaluation Framework, after action reviews (AAR) and simulation exercises (SimEx) are two critical components which measure the functionality of a country’s health emergency preparedness and response under a “real-life” event or simulated situation. The objective of this study was to describe the AAR and SimEx supported by the World Health Organization (WHO) globally in 2016–2019. Methods In 2016–2019, WHO supported 63 AAR and 117 SimEx, of which 42 (66.7%) AAR reports and 56 (47.9%) SimEx reports were available. We extracted key information from these reports and created two central databases for AAR and SimEx, respectively. We conducted descriptive analysis and linked the findings according to the 13 IHR (2005) core capacities. Results Among the 42 AAR and 56 SimEx available reports, AAR and SimEx were most commonly conducted in the WHO African Region (AAR: n  = 32, 76.2%; SimEx: n = 32, 52.5%). The most common public health events reviewed or tested in AAR and SimEx, respectively, were epidemics and pandemics (AAR: n  = 38, 90.5%; SimEx: n  = 46, 82.1%). For AAR, 10 (76.9%) of the 13 IHR core capacities were reviewed at least once, with no AAR conducted for food safety, chemical events, and radiation emergencies, among the reports available. For SimEx, all 13 (100.0%) IHR capacities were tested at least once. For AAR, the most commonly reviewed IHR core capacities were health services provision ( n  = 41, 97.6%), risk communication ( n  = 39, 92.9%), national health emergency framework ( n  = 39, 92.9%), surveillance ( n  = 37, 88.1%) and laboratory ( n  = 35, 83.3%). For SimEx, the most commonly tested IHR core capacity were national health emergency framework ( n  = 56, 91.1%), followed by risk communication ( n  = 48, 85.7%), IHR coordination and national IHR focal point functions ( n  = 45, 80.4%), surveillance ( n  = 31, 55.4%), and health service provision ( n  = 29, 51.8%). For AAR, the median timeframe between the end of the event and AAR was 125 days (range = 25–399 days). Conclusions WHO has recently published guidance for the planning, execution, and follow-up of AAR and SimEx. Through the guidance and the simplified reporting format provided, we hope to see more countries conduct AAR and SimEx and standardization in their methodology, practice, reporting and follow-up.

The European Food Safety Authority (EFSA) within the framework of the Preparatory measures for the participation of IPA beneficiaries in the European Food Safety Authority 2023–2026 will organize a total of 3 crisis preparedness training events for the IPA countries (Albania, Bosnia and Herzegovina, Kosovo,* Montenegro, North Macedonia, Serbia, Türkiye). For 2024, EFSA requested to organise a simulation exercise focused on a multi‐country incident related to biological risks in products of animal origin. The overall objectives of the training were: 1) to increase IPA countries' knowledge and understanding of crisis handling concepts and of EFSA's crisis handling procedures; 2) to improve preparedness and response planning for crisis situations in the domain of biological hazards; 3) to improve coherence, interoperability and coordination, to be prepared for communication and decision‐making challenges in crisis situations. Working with the contractor Opera srl, EFSA organised a 2‐day training on 26–27 June 2024 in Sarajevo (Bosnia and Herzegovina), attended by 24 participants (3 online) from 7 IPA countries, 2 representatives from EFSA and 1 representative from the hosting competent authority from Bosnia and Herzegovina. Participants were briefed on the IPA crisis preparedness training scheme, EFSA's crisis handling procedures, principles of crisis communication (remote mode), EFSA – ECDC Rapid Outbreak Assessment (remote mode), food safety risk assessment structures in Bosnia and Herzegovina and Serbia. Most of the workshop was dedicated to the simulation exercise, that was organized in a tabletop format, with injects describing an evolving food safety incident and a debriefing after each inject. During the exercise, 1 audio‐conference meeting and a TV debate were simulated. The exercise was concluded with a brainstorming session between the tutors and participants. Three recommendations were done to improve the organization of future events. Six recommendations were given for the improvement of risk assessment, risk management and risk communication in IPA countries. The objectives were achieved, based on the results of the knowledge test and on the feedback provided by participants in the course evaluation questionnaire.