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Emotion regulation (ER) vulnerabilities that confer risk for depression and persist into remission remain poorly understood. Prior work in depression has primarily examined ER strategies independently, leaving unclear how much each strategy is used within an individual's regulatory repertoire (relative strategy use). We examined whether individuals with remitted depression (rMDD) differ from never-depressed healthy comparisons (HC) in relative strategy use and whether sadness mediates these differences. We also explored whether strategy effectiveness is attenuated in rMDD, particularly in moments of elevated sadness in daily life. 86 young adults with rMDD and HC completed 7-day ecological momentary assessments (3×/day) of sadness and ER strategy use. Relative strategy use was calculated as each strategy's proportion of an individual's total strategy use across the week. Relative to HC, individuals with rMDD utilized a greater proportion of distraction and a lower proportion of reappraisal. Elevated sadness in individuals with rMDD mediated lower reappraisal proportional use. During moments of greater-than-usual sadness, distraction and reappraisal use predicted lower subsequent sadness in HC, whereas distraction predicted greater subsequent sadness in rMDD. Rumination exacerbated sadness for both groups, with stronger effects in rMDD under high sadness. Results suggest a skewed ER portfolio in remitted depression characterized by a greater proportion of distraction and a lower proportion of reappraisal. Further, when individuals with rMDD experience elevated sadness, distraction becomes counterproductive and reappraisal provides no benefit. Findings suggest relative strategy use and affect-contingent strategy implementation may be useful targets for improving ER effectiveness and preventing recurrence.

Pediatric dental anxiety is common and can compromise cooperation, increase distress, and contribute to avoidance of dental care. Technology-enhanced behavior guidance (virtual reality, augmented reality, biofeedback, and game-based/digital distraction) is increasingly used, but its effectiveness and safety across pediatric dental procedures remain uncertain. To determine whether technology-augmented/digital distraction reduces pediatric dental anxiety/fear and to summarize reported safety/adverse events; secondary objectives were to evaluate effects on pain and physiological arousal (pulse rate). This PRISMA 2020-compliant systematic review and meta-analysis was registered in PROSPERO (CRD420251167094). PubMed, Scopus, Web of Science, Google Scholar, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library were searched from inception to 18 December 2025, with additional searches of citation lists, Shodhaganga, and ISRCTN. Eligible English-language studies Evaluated Technology-enhanced/digital Distraction Interventions in Pediatric Dental Care. One Effect Estimate per Study per Outcome was Extracted at an Intra-procedural time Point. Random-effects meta-analyses Were Conducted Using Standardized Mean Differences (SMDs). Risk of Bias was Assessed Using RoB 2 and ROBINS-I, and certainty was rated using GRADE. Of 675 records identified (590 from databases/registers and 85 from other sources), 61 studies were included qualitatively. For quantitative synthesis, 42 studies contributed to anxiety, 18 to pain, and 30 to pulse rate. Compared with controls, digital distraction reduced anxiety (42 studies; n = 2569; SMD -0.97, 95% CI -1.41 to -0.53; I2 = 93.8%), reduced pain (18 studies; n = 1319; SMD -1.08, 95% CI -1.56 to -0.60; I2 = 92.3%), and reduced pulse rate (30 studies; n = 1727; SMD -0.61, 95% CI -0.99 to -0.23; I2 = 87.9%). Trim-and-fill for anxiety imputed six potentially missing studies and attenuated the pooled effect (adjusted SMD -0.52, 95% CI -1.06 to 0.01). Overall risk of bias was frequently high/with concerns (RoB 2: 25 high, 31 some concerns; ROBINS-I: 4 serious, 1 moderate) and certainty of evidence was very low for all outcomes. Safety reporting was limited; five studies explicitly reported device-related discomfort/adverse effects, with no serious adverse events. Technology-enhanced behavior guidance may reduce dental anxiety, pain, and physiologic arousal, but very high heterogeneity, frequent risk of bias, limited safety reporting, and sensitivity to small-study effects indicate that the magnitude of benefit is uncertain and likely context-dependent. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251167094.

Impacted mandibular third molars pose significant clinical challenges, often leading to complications such as pericoronitis, adjacent tooth caries, and inferior alveolar nerve (IAN) injury during extraction. This study evaluates the effectiveness of the Kyola Distraction System, an innovative approach designed to gradually move impacted third molars away from the IAN, reducing surgical risks. A retrospective analysis of 100 cases was conducted at Changhua Christian Hospital. Patients underwent Kyola Distraction, which combines coronectomy with orthodontic traction using an elastic-based anchorage system. The movement of the third molar relative to the inferior alveolar canal was assessed through panoramic radiographs. The study analyzed the distraction period, scooting distance, and potential nerve complications. Among 100 patients (57 male, 43 female, aged 18-60 years), 32 cases involved single-root third molars, and 68 cases had double-rooted teeth. The average distraction period was 61.3 days for single-root cases and 61.1 days for double-root cases. The estimated scooting distance was 1.38 mm for the mesial root and 1.59 mm for the distal root in double-root cases, while single-root molars moved an average of 1.42 mm. No cases of nerve damage were reported. The Kyola Distraction System presents a safe and effective alternative to conventional odontectomy for impacted mandibular third molars. By reducing the risk of IAN injury, minimizing postoperative complications, and promoting bone regeneration, this approach offers a promising advancement in third molar management. Further studies are recommended to evaluate its long-term clinical outcomes.

Background and Clinical Significance: Reconstruction of large segmental bone defects following oncologic resection in pediatric patients remains a major challenge. Although distraction osteogenesis with bone transport is a well-established biological reconstructive option, regenerate formation may be compromised in patients receiving chemotherapy. The accordion maneuver, consisting of alternating cycles of compression and distraction, has been described as a method to stimulate bone regeneration, primarily in association with external fixation systems. However, its use in internal bone transport systems using intramedullary lengthening nails following oncologic resection, particularly in the setting of perioperative chemotherapy, remains rarely reported. Case Presentation: We report a case of a 12-year-old boy with high-grade telangiectatic osteosarcoma of the distal femur who underwent neoadjuvant chemotherapy followed by limb-salvage surgery, resulting in a 14 cm segmental bone defect. Reconstruction was performed using plate-assisted bone transport with a motorized intramedullary magnetic nail. During distraction osteogenesis, delayed and asymmetric regenerate formation developed. An accordion maneuver was subsequently initiated, resulting in progressive improvement in regenerate density and corticalization without the need for revision surgery. Conclusions: This case highlights the successful application of the accordion maneuver using internal bone transport following oncologic resection. It represents a minimally invasive technique to stimulate bone healing and may reduce the need for revision surgery; however, larger series are needed to confirm this potential benefit, particularly in biologically compromised patients receiving chemotherapy.

Limiting distraction while driving through in-vehicle information and communication systems is of critical importance for road safety. At the same time, touchscreens are increasingly used for the driver-car interaction in cars while driving. Operating touchscreens while driving uses the same human resources as driving itself. Therefore, it seems highly likely that the operation of touch displays can be more distracting than the operation of physical devices. The present simulation study investigates, how performing complex tasks requiring text entry on a touch display changes driving performance as compared to driving, only, and to a simple task using a physical haptic input device. In order to quantify the effects, the ISO certified lane change task was used. In addition, a subjective measure of distraction was analyzed. Twenty-six students participated in a repeated-measures experiment with the distraction factor comprising a baseline, music title selection by touch, navigation adress input by touch, and selecting a radio station with an analogue button. The results show significant differences between these four conditions. Touch operation leads to greater mean deviation, longer reaction time, and poorer lane keeping compared to baseline driving and also compared to radio operation. Thus, operation of these somewhat complex functions via touch displays in the vehicle is not recommended due to the strong distracting effect. An alternative for the complex tasks could be speech input. Additionally, only simple tasks should be allowed on touchscreens while driving. However, further research is required to find out what implementations are exactly required.

Dental anxiety associated with dental implant surgery can adversely affect patient comfort, cooperation, and overall procedural outcomes. Both pharmacological and non-pharmacological interventions are commonly employed to manage preoperative anxiety; however, their comparative effectiveness remains unclear. A systematic evaluation of these approaches is important to determine their relative benefits in terms of anxiety reduction, onset of action, safety profile, and patient acceptability. Existing evidence suggests that pharmacological interventions may provide rapid anxiolytic effects, whereas non-pharmacological approaches, such as relaxation techniques, mindfulness-based interventions, and audio distraction, may reduce anxiety without the potential adverse effects associated with medication use. Therefore, this systematic review aims to compare the effectiveness of pharmacological and non-pharmacological anxiety control strategies in dental implant surgery and evaluate their clinical applicability in optimizing patient management. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library to identify randomized controlled trials evaluating the effectiveness of pharmacological and non-pharmacological interventions for the management of dental anxiety in adult patients undergoing dental implant surgery, up to September 2025. The systematic review was conducted according to a pre-specified protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The methodological quality and risk of bias of the included studies were assessed using the revised Cochrane Risk of Bias tool (RoB 2.0). The electronic database search identified a total of 225 articles related to anxiety management during dental implant placement. By evaluating titles, abstracts, and full texts, 15 articles met the inclusion criteria; however, no relevant studies were found through hand searching. The evidence suggested that that multimodal anxiety-reduction strategies, particularly dexmedetomidine sedation and behavioural distraction techniques, are effective in reducing dental anxiety during implant procedures. Both non-pharmacological and pharmacological anxiety management strategies demonstrate considerable potential in reducing dental anxiety during implant placement. Behavioural interventions, including effective communication, relaxation techniques, distraction methods, and complementary therapies, appear beneficial for patients with mild to moderate anxiety, whereas pharmacological sedation is particularly effective for managing moderate to severe dental fear, thereby enhancing patient cooperation, procedural comfort, and overall acceptance of implant therapy. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261376502, identifier CRD420261376502.

Rapid digital transformation has generated pervasive attentional disruption in research and professional settings, raising the question of how the temporal conditions that support deep scientific thinking can be preserved. Our narrative review aimed to (i) synthesize neurobiological evidence on the mechanisms through which task-irrelevant digital interruption impairs deep thinking; (ii) discuss the conditions required for deep thinking and the potential threats posed by contemporary developments, including generative artificial intelligence-related cognitive offloading; and (iii) elaborate evidence-based, multi-level recommendations for research institutions. Targeted searches of PubMed, Google Scholar, and Web of Science (January 2010-September 2025) were conducted using terms spanning attentional neuroscience, digital distraction, neuroplasticity, and cognitive performance, supplemented by forward and backward citation tracking. Peer-reviewed empirical studies, meta-analyses, and theoretical frameworks addressing neurobiological mechanisms of sustained attention and the cognitive effects of digital interruption in professional and/or research settings were included. Deep thinking and protected thinking time are treated as distinct constructs: the former as a sustained, integrative cognitive process supported by coordinated executive control and default mode network activity, the latter as uninterrupted temporal intervals within which that process can occur. Repeated engagement with task-irrelevant digital stimuli is associated with cortico-striatal strengthening and prefrontal-parietal under-consolidation, producing a plasticity paradox in which attentional fragmentation becomes self-reinforcing. The emergence of generative artificial intelligence introduces a qualitatively distinct threat through voluntary cognitive offloading, which reduces deep engagement independently of attentional distraction. Evidence-based strategies spanning individual, team, organizational, technological, and assessment levels are available to preserve protected thinking time. Direct evidence linking these intervals to specific research-impact outcomes remains limited, and institutional interventions should be prospectively evaluated.

Abnormal femoral torsion is associated with labral and chondral tears, hip pain, and early onset arthritis. Derotational femoral osteotomy (DFO) is the surgical treatment of choice to correct femoral torsional deformity, restore normal hip joint mechanics, and improve clinical outcomes. DFO is often performed in conjunction with hip arthroscopy to address intra-articular pathology, which requires hip joint distraction for visualization. In these cases, the same setup can be carried out seamlessly, allowing for an easy transition between procedures, thus increasing operative efficiency. Traditionally, this combined approach was performed using perineal post traction beds, which carry risks of groin complications and pudendal nerve injury, occasionally resulting in severe consequences. To avoid these complications, postless traction beds were developed to provide safe and reliable distraction without the morbidity associated with perineal posts. This technical note describes the operative management of dual hip arthroscopy and DFO with a postless traction bed offering a safe, reproducible, and efficient surgical technique for managing patients requiring concurrent hip arthroscopy and DFO. Additionally, this paper describes the advantages of the postless traction bed for DFO surgery, even if arthroscopy is not performed concurrently.

Abortions are one of the most common gynecological treatments worldwide. Although many studies investigate risk factors (RF) for a negative abortion-related psychosocial outcome (APO), less is known about protective factors (PF) and the interplay of RFs and PFs. From May to August 2022, we conducted a semi-structured interview study in Germany and interviewed 23 women (21-43 years) who had undergone an elective abortion within the last 12 months, asking them about their experiences, perceived RF, PF and APO. The data was analyzed using qualitative content analysis. We found three different patterns: The first group of women found the process, especially the legal requirements, stressful but reported a mostly positive outcome with sufficient social support as PF. Women who reported neuroticism-related personality factors as RF sought less social support and more frequently used emotion-focused coping strategies such as self-care and distraction and often showed a mixed outcome. A third group of women experienced intimate partner violence (IPV) and also reported distraction as PF. Regardless, all women who survived IPV reported a negative APO. The majority of women find the legal requirements (e.g., mandatory counseling, waiting periods) burdensome. At the same time, they offer no benefit to women who find themselves in critical situations such as coercion and domestic violence, which was a major RF. The protection of women who survived IPV should therefore be improved and the access to abortion improved. Further research is needed to include effects on more vulnerable groups such as migrants or queer individuals.

Generative artificial intelligence [GenAI] is increasingly treated as a primary explanation for students' perceived difficulties with sustained attention in nursing education. The author contends that such a framing risks misdiagnosing a longerstanding educational concern. While GenAI raises legitimate issues related to misinformation, overreliance, academic integrity, privacy, and critical thinking, students' attentional difficulties should also be understood within the broader history of the attention economy, short-form media, and digitally saturated learning environments. Drawing on literature on sustained attention, cognitive effort, attention regulation, digital distraction, short-form media, and GenAI in healthcare education, the author highlights a chronological mismatch between the recent emergence of widely accessible GenAI tools and earlier shifts in digital environments that reward novelty, rapid attentional switching, and low-friction engagement. Rather than reducing the issue to shortened attention span, the author examines how digitally saturated learning environments reshape sustained attention, attention regulation, and tolerance for cognitive effort in nursing education. This reframing matters because nursing education depends on students' capacity to sustain attention during clinical reasoning, patient assessment, communication, documentation, simulation-based learning, and safe decision-making. GenAI may amplify or make visible pre-existing challenges, but restriction alone is unlikely to address the broader attentional conditions shaping students' learning. Thus, the author calls for attention-supportive pedagogy that scaffolds cognitive effort, makes reasoning visible, supports digital and AI literacy, and deliberately cultivates sustained attention, critical evaluation, and clinical judgment in nursing education. Drawing on literature on sustained attention, cognitive effort, attention regulation, digital distraction, short-form media, and GenAI in healthcare education, the author highlights a chronological mismatch between the recent emergence of widely accessible GenAI tools and earlier shifts in digital environments that reward novelty, rapid attentional switching, and lowfriction engagement. Rather than treating declining attention span as a fixed cognitive trait or uniform population-level decline, the paper focuses on difficulties with sustained attention and attention regulation in contemporary nursing education. This reframing matters because nursing education depends on students' capacity to sustain attention during clinical reasoning, patient assessment, communication, documentation, simulation-based learning, and safe decision-making. GenAI may amplify or make visible pre-existing challenges, but restriction alone is unlikely to address the broader attentional conditions shaping students' learning. The paper therefore calls for attention-supportive pedagogy that scaffolds cognitive effort, makes reasoning visible, supports digital and AI literacy, and deliberately cultivates sustained attention, critical evaluation, and clinical judgment in nursing education.

This systematic review assesses the effectiveness of immersive tools, including virtual reality (VR) and augmented reality (AR), in reducing dental anxiety among children aged 3-10 years, and compares immersive VR with conventional behaviour management techniques. A comprehensive search was conducted across various databases from inception to date. Randomised and non-randomised controlled studies evaluating dental anxiety in children using immersive VR or AR for behaviour management were included. The risk of bias was assessed using the Cochrane RoB 2.0 tool for randomised controlled trials and the ROBINS-I tool for non-randomised controlled trials. A meta-analysis was conducted with heart rate as the primary outcome measure, and certainty of the evidence was evaluated using GRADEpro. Thirty-seven studies involving 2,505 children were included, of which 13 studies (n = 819) were pooled for meta-analysis. Immersive VR resulted in a significant reduction in heart rate compared with non-immersive VR (mean difference:  - 8.12 bpm; 95% CI -14.69 to- 1.56; p = 0.02) with moderate certainty of the evidence. Comparisons with kaleidoscope distraction favoured immersive VR (mean difference: - 1.59 bpm; 95% CI-4.84 to 1.66). Compared with the Tell-Show-Do technique, immersive VR showed a trend toward lower heart rate (mean difference: -7.92 bpm; 95% CI-16.16 to 0.32). As a non-pharmacological adjunct for reducing dental anxiety in children, immersive VR may be superior to non-immersive distraction techniques, supporting its integration into paediatric dental practice. However, the evidence is primarily based on VR studies, and findings related to AR remain limited and preliminary.

Osteoporosis significantly challenges fracture healing, particularly in the regeneration of critical-size bone defects. It remains unclear whether osteoporotic woven bone weakness results from impaired intrinsic quality, reduced formation rate, or both, including its effect on the adjacent bone tissue. To address this question in a translational context, we employed an osteoporotic sheep model, widely recognized as one of the closest animal analogs to human bone biology and physiology. Using an ex vivo multimodal characterization, this study analyzed the woven tissue formed within the distraction callus and the adjacent cortical bone. Bone samples were harvested at 40 and 100 days of osteoporotic bone regeneration and analyzed by nanoindentation, Raman spectroscopy, μCT and chemical composition analyses. Osteoporotic data were compared with non-osteoporotic references. Results revealed that the intrinsic elastic mechanical properties, microstructure and chemical quality of the regenerated osteoporotic woven bone were preserved at the tissue level. However, composition analysis indicated a significantly higher water content and significantly lower bone matrix volume, apparently delayed by the disease. In contrast, cortical tissue adjacent to the defect showed significant mineral loss, likely due to mineral mobilization to support woven tissue formation, although the remaining bone matrix appears to be unaltered. These findings suggest that osteoporotic impairment in bone regeneration is driven by a logistical failure in the woven formation rate and adjacent tissue degradation, rather than an intrinsic woven quality deficiency. Consequently, therapies should prioritize anabolic acceleration of woven bone formation and antiresorptive protection of the adjacent bone tissue, whose fixation is compromised. STATEMENT OF SIGNIFICANCE: Treating large fractures in patients with osteoporosis is challenging due to impaired bone regeneration. This study aimed to determine whether compromised healing results from impaired material quality of newly formed bone, reduced bone formation rate, or both, and to evaluate effects on adjacent bone tissue. Using an osteoporotic sheep model, we found that new bone quality is comparable to healthy bone, but bone formation occurs at a significantly reduced rate. Furthermore, adjacent bone deteriorates structurally, likely mobilizing minerals to support repair, becoming porous and fragile. These results suggest that treatments should focus on accelerating bone formation while preserving bone integrity.