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We aimed to examine the effects of Ramadan fasting (RF) and high-intensity short-term maximal performance on elite soccer players' shooting accuracy, executive function (EF), and perceptions. Sixteen Muslim elite players fasting during Ramadan underwent assessments before (BR), during (DR), and after Ramadan (AR). Soccer-specific technical performance was evaluated using the Loughborough Soccer Shooting Test (LSST) before and after a 5-metre shuttle run test (5mSRT), conducted at the same time-of-day (17:00 h). Performance metrics recorded included higher distance (HD), total distance (TD), and fatigue index (FI). RPE after a 5-min warm-up and each repetition of the 5mSRT were obtained, and the mean RPE score was calculated. Trail Making Test (TMT Parts A and B) were used after the warm-up and the 5mSRT. Perceived difficulty (PD) was assessed following the LSST. HD, TD, and FI were not affected by RF (p > 0.05). DR, RPE and accuracy scores in the LSST were significantly lower after the 5mSRT compared to BR (1.29 vs. 1.24 AU; 1.29 vs. 1.24, respectively). In conclusion, RF had no adverse effects on physical performance. However, when combined with high-intensity running sessions, RF may impact accuracy and PD, and these adverse effects seem to have been translated into EF.

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Background: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. Material and Methods: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Nonparametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. Results: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11 ±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. Conclusions: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty. (AU)

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BACKGROUND: Access to clean water is important for menstrual hygiene practices, an important aspect of health for adolescent girls. In Bangladesh, adolescent girls represent poor menstrual hygiene practices, whereas the practice is worse among vulnerable population groups living in areas experiencing seasonal water scarcity. This study portrays perceived difficulties in menstrual hygiene practices among indigenous adolescent girls during the period of seasonal water scarcity in Bandarban Hill District, Bangladesh. METHOD: Data was collected from 242 indigenous adolescent girls through interviews during the period of water scarcity. Backward stepwise regression model was used to identify factors associated with perceived difficulty in maintaining menstrual hygiene (PD) practices. RESULT: The study participants, mainly living in hard-to-reach areas, reported difficulty in getting adequate water during the water scarcity period, and the quality of water was reported to be poor. PD due to water scarcity was found to be significantly associated with water source degradation (ß = 0.247, < 0.001), the need for boiling/purifying water before use for menstrual hygiene (ß = 0.203, p = 0.005), and experience of water availability when it was necessary to maintain their optimal menstrual hygiene practice (ß = 0.449, p < 0.001), time required to collect water (ß = 0.209, p < 0.001), taking a bath every day (ß = -0.228, p < 0.001), and frequency of washing genitals per day (ß = - 0.094, p = 0.040). CONCLUSION: Indigenous adolescents perceive difficulty in menstrual hygiene practices during the period of water scarcity. Further research could be carried out to observe to what extent the seasonal water scarcity could be attributable to worsen the menstrual hygiene practices and to identify the need for addressing the problems.

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BACKGROUND: Establishing the level of surgical difficulty pre-operatively is an essential step in ensuring correct treatment planning. This study set out to determine whether the knowledge and experience acquired by dentists who had received different levels of training influenced, firstly, the perceived levels of difficulty of a variety of cases of mandibular third molar (MTM) extraction and, secondly, the perceived difficulty deriving from a series of factors (patient-related factors, anatomical and radiographic factors, operative factors). METHODS: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. RESULTS: A total of 389 surveys were available for analysis. Dental practioners with no surgical training saw the intervention as presenting greater difficulty. Professionals with postgraduate training in oral surgery considered patient-related factors more important than operative factors, in contrast to dentists who had not received oral surgery training. CONCLUSIONS: Dental training has a signficant influence on the perceived difficulty of MTM extraction and also affects opinions about which factors have greater or lesser influence on surgical difficulty.

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BACKGROUND: A method for prescribing the difficulty or intensity of standing balance exercises has been validated in a healthy population, but requires additional validation in individuals with vestibular disorders. OBJECTIVE: This study validated the use of ratings of perceived difficulty for estimation of balance exercise intensity in individuals with vestibular disorders. METHODS: Eight participants with a confirmed diagnosis of a vestibular disorder and 16 healthy participants performed two sets of 16 randomized static standing exercises across varying levels of difficulty. Root Mean Square (RMS) of trunk angular velocity was recorded using an inertial measurement unit. In addition, participants rated the perceived difficulty of each exercise using a numerical scale ranging from 0 (very easy) to 10 (very difficult). To explore the concurrent validity of rating of perceived difficulty scale, the relationship between ratings of perceived difficulty and sway velocity was assessed using multiple linear regression for each group. RESULTS: The rating of perceived difficulty scale demonstrated moderate positive correlations RMS of trunk velocity in the pitch (r = 0.51, p < 0.001) and roll (r = 0.73, p < 0.001) directions in participants with vestibular disorders demonstrating acceptable concurrent validity. CONCLUSIONS: Ratings of perceived difficulty can be used to estimate the intensity of standing balance exercises in individuals with vestibular disorders.

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In the current study, we have decided to investigate the relationship between cardiorespiratory fitness and executive functions in young adults as a function of mental workload. To achieve our objectives, we have solicited 29 young adults (18-25 years; 12 women) who have first realized the Random Number Generation (RNG) task with two levels of complexity. After each level of complexity, the participants were asked to report on their perceived difficulty. Secondly, participants performed the RABIT® test, during which oxygen consumption was measured through the Metamax 3B-R2. The results showed that executive performance and perceived difficulty deteriorate with increasing task complexity. Additionally, oxygen consumption increased significantly to reach a peak during the hardest phase of the RABIT® test. Finally, as in previous studies, we could not observe a correlation between cardiorespiratory fitness and executive functions. Our findings support the lack of a direct relationship between cardiorespiratory fitness and executive functions. Future studies should explore the relationship between the composite measure of executive function, hemodynamic activity, and cardiorespiratory fitness in healthy youth and their peers with cardiovascular disease. This will examine an indirect effect of Cardiorespiratory fitness (CRF) on Executive functions (EFs) through brain activity.

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Behaviors we perform each day, such as manipulating an object or walking, require precise control of the interaction forces between our bodies and the environment. These forces are generated by muscle contractions, specified by the nervous system, and by joint mechanics, determined by the intrinsic properties of the musculoskeletal system. Depending on behavioral goals, joint mechanics might simplify or complicate control of movement by the nervous system. Whether humans can exploit joint mechanics to simplify neural control remains unclear. Here we evaluated if leveraging joint mechanics simplifies neural control by comparing performance in three tasks that required subjects to generate specified torques about the ankle during imposed sinusoidal movements; only one task required torques that could be generated by leveraging the intrinsic mechanics of the joint. The complexity of the neural control was assessed by subjects' perceived difficulty and the resultant task performance. We developed a novel approach that used continuous estimates of ankle impedance, a quantitative description of the joint mechanics, and measures of muscle activity to determine the mechanical and neural contributions to the net ankle torque generated in each task. We found that the torque resulting from changes in neural control was reduced when ankle impedance was consistent with the task being performed. Subjects perceived this task to be easier than those that were not consistent with the impedance of the ankle and were able to perform it with the highest level of consistency across repeated trials. These results demonstrate that leveraging the mechanical properties of a joint can simplify task completion and improve performance.

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In soccer, accurate kicking skills are important determinants of successful performance. A successful kick must meet several criteria, including speed, accuracy, and timing. In fact, players who are able to kick the ball more accurately under various difficulties, such as time pressure, space constraints, the opponent's pressure, and the distance between the kicking point and the goal, have a clear advantage during soccer games. The aim of the present study was to investigate the effect of exercise difficulty and time-of-day on perceived task difficulty and kicking performance. Accordingly, 32 boys (age: 11 ± 0.7 years; height: 1.45 ± 0.07 m; body-mass: 38.9 ± 7.8 kg) performed shooting accuracy tests under two difficulty levels (distance (long-distance (LD) vs. short-distance (SD)) and time pressure (Without-time-pressure (WTP) vs. With-time-pressure (TP)) at 08:00 h and 17:00 h. Absolute-error, variable-error, and constant-error were evaluated during the kicking tasks, in addition to ball velocity and shooting quality. Moreover, rating-of-perceived-exertion score (RPE), feeling-scale (FS), and perceived difficulty were completed immediately at the end of each test. The results showed that shooting quality was not affected by the time-of-day, but it was better in WTP vs. TP (p < 0.05), and in SD vs. LD (p < 0.05), respectively. Higher values for FS and lower values for RPE were observed in the morning compared to the afternoon (p < 0.05) and in WTP vs. TP (p < 0.05). In conclusion, specific soccer skills of boys were not time-of-day dependent, but they may be associated with time pressure and task difficulty.

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In many situations, engaging cognitive control is required to override automatic responses and to behave in an adaptive manner. However, cognitive control is also effortful and costly which makes it aversive. A fundamental question is how individuals decide to engage or not in cognitive control based on the costs of this effort and the motivation to achieve the goals. In the present study, we explored the hypothesis that affective states can influence this decision by changing participants' subjective experiences during the task. Participants performed a conflict task (arrow priming) and judged their feeling of difficulty after each trial. Affective states were induced by presenting emotional faces (happy, fearful or neutral) at the beginning of each trial. We found that participants subjectively judged happy trials as easier even though they objectively made more errors in this condition. Follow-up analyses revealed that participants engaged less cognitive control with happy than with neutral or fearful faces. We conclude that affective states influence the recruitment of cognitive control and associated metacognitive experiences.

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PURPOSE: To evaluate the difficulty perceived of each step of phacoemulsification and analyze the factors affecting them. METHODS: Overall, 12 trainee residents were allotted 10 cases of phacoemulsification of eyes with senile cataract, under a single observer, and the steps of each surgery were rated from very easy to very difficult with a questionnaire. The completion rates of steps and complications of each surgery were noted. Principal component analysis of the responses to the difficulty level questionnaire was conducted to obtain factors resulting in the perceived difficulty. RESULTS: The lowest difficulty scores were for initial step of incision creation (1.63 ± 0.84), followed by intraocular lens insertion (2.51 ± 0.8). The most difficult step was divide/chop of the nucleus (3.74 ± 0.97) followed by phacoemulsification (3.32 ± 0.82). Highest completion rates were seen for the initial steps of the surgery and the lowest for divide/chop. We identified two major patterns of difficulty among the trainees - one for steps involving high amount of binocularity and the other, for steps involving high precision of hand control. The rate of complication of our study was within acceptable range. CONCLUSION: Although trainees have practiced phacoemulsification steps on simulation, real-life situation may bring in unprecedented level of difficulty and challenges, which may be documented and used for targeted improvement of surgical skills. Stereopsis and hand control training should form a major part of training modules of cataract surgery both on simulation and real-life scenarios.

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The current study examined the relationship between cognitive performances (executive function, selective attention and reaction time), fine motor coordination skills and perceived difficulty after active transport to school. Method: Fifteen right-handed children's underwent session, 15-min walking session at 30% (WS1) and 15-min walking session (WS2) at 50% of maximal aerobic speed. Subjects performed tests to evaluate executive function, reaction time and selective attention. After each trial, a questionnaire of perceived difficulty (PD) was completed. Results: Average time in TMT part A (F(2,22) = 4.44; p = 0.024; η2= 0.288) and TMT part B (F(2,22) = 4.54; p = 0.022; η2= 0.292), and committed errors (F(2,22) = 7.78; p = 0.003; η2= 0.414) was improved after walking sessions in comparison by CS. The mean scores were significantly higher after walking sessions for both long and short-distance throws (p < 0.05). Moreover, a significant negative correlation was found between committed errors (TMT part B) and both dart throwing consistency and accuracy (r = - 0.6; r = - 0.64; p < 0.05) (respectively). Post-hoc analysis showed that PD was better after walking sessions with low intensity for both short and long throwing distance. However, it seems that walking session with sustained intensity allows speed and accuracy improvement of cognitive processing. Conclusion: Thus, active walking to school with low intensity was sufficient to produce positives changes in psychomotor performance and decrease in perceived difficulty scores. By including individual differences in gross motor coordination as well as physical activity level, the exact nature of the link between psychomotor skills and cognitive performance could be more addressed.(AU)

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The promotion of home cooking is a strategy used to improve diet quality and health. However, modern home cooking typically includes the use of processed food which can lead to negative outcomes including weight gain. In addition, interventions to improve cooking skills do not always explain how theory informed their design and implementation. The Behaviour Change Technique (BCT) taxonomy successfully employed in other areas has identified essential elements for interventions. This study investigated the effectiveness of different instructional modes for learning to cook a meal, designed using an accumulating number of BCTs, on participant's perceived difficulty, enjoyment, confidence and intention to cook from basic ingredients. 141 mothers aged between 20 and 39 years from the island of Ireland were randomised to one of four conditions based on BCTs (1) recipe card only [control condition]; (2) recipe card plus video modelling; (3) recipe card plus video prompting; (4) recipe card plus video elements. Participants rated their enjoyment, perceived difficulty, confidence and intention to cook again pre, mid and post experiment. Repeated one-way factorial ANOVAs, correlations and a hierarchical regression model were conducted. Despite no significant differences between the different conditions, there was a significant increase in enjoyment (P < 0.001), confidence (P < 0.001) and intention to cook from basics again (P < 0.001) and a decrease in perceived difficulty (P = 0.001) after the experiment in all conditions. Intention to cook from basics pre-experiment, and confidence and enjoyment (both pre and post experiment) significantly contributed to the final regression model explaining 42% of the variance in intention to cook from basics again. Cooking interventions should focus on practical cooking and increasing participants' enjoyment and confidence during cooking to increase intention to cook from basic ingredients at home.

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With increasing text digitization, digital libraries can personalize materials for individuals with different education levels and language skills. To this end, documents need meta-information describing their difficulty level. Previous attempts at such labeling used readability formulas but the formulas have not been validated with modern texts and their outcome is seldom associated with actual difficulty. We focus on medical texts and are developing new, evidence-based meta-tags that are associated with perceived and actual text difficulty. This work describes a first tag, term familiarity , which is based on term frequency in the Google corpus. We evaluated its feasibility to serve as a tag by looking at a document corpus (N=1,073) and found that terms in blogs or journal articles displayed unexpected but significantly different scores. Term familiarity was then applied to texts and results from a previous user study (N=86) and could better explain differences for perceived and actual difficulty.

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En esta investigación se midió la respuesta cardiovascular al estrés, autoeficacia computacional y la percepción de dificultad de la tarea, en una muestra de 115 estudiantes de pregrado de la Universidad Simón Bolívar. Los resultados evidencian que en cuanto a los parámetros fisiológicos cardiovasculares, hubo elevación en la presión arterial y la frecuencia cardíaca en ambas versiones del test de stroop (clásico y computarizado). En general, la percepción de la dificultad de la tarea en estos sujetos fue más elevada ante el stroop clásico. Finalmente, en relación con la autoeficacia computacional los sujetos presentan valores altos, lo cual indica una percepción de habilidades para trabajar frente a un computador. Estos resultados representan una contribución importante, pues están indicando la relación de las variables cognitivas y las respuestas fisiológicas del estudiante universitario ante situaciones demandantes o difíciles. De esta manera, las situaciones vividas en el ambiente académico pueden tener un impacto relevante en los estados de salud, y debemos tomar en consideración estos aspectos para el beneficio integral del estudiante

In this investigation of the Cardiovascular Response to Stress, Perceived Task Difficulty and physiological responding were measured. The study used a sample of 115 undergraduate students of a Simon Bolivar University. Results show that a great elevation of heart rate and blood pressure was observed during exposure to the two versions of the Stroop Test (classical and computerized). In general, ratings of perceived difficulty of the Stroop task were higher in response to the Classical administration. Finally, subjects rated their Computer Self-Efficacy as high, indicating confidence and comfort working with computers. These results represent an important contribution that illustrate the relation of cognitive factors to physiological responses during cognitively demanding or difficult situations. In terms of the practical implications of these findings, situations experienced in academic environments can have a prominent impact in cardiovascular responding, and thus, health. As such, it is indicating that the medium of academic assessment might be an appropriate target for change in some settings for the benefit of the Student

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