https://sms.carm.es/ricsmur/handle/123456789/17304 2026-09-19T19:01:19Z https://sms.carm.es/ricsmur/handle/123456789/28178 Impact of virtual reality on risk perception, stress and neurophysiological patterns in driving situations during floods: a quasi-experimental study López-López, Carmen-Amalia; Semeraro, Federico; Hernández-Fernández, Antonio; de-Barros-Camargo, Claudia; Lóopez-Guardiola, Pablo; Cerón-Madrigal, José-Joaquín; Botía-González, María; Ocampo-Cervantes, Ana-Belén; Pardo-Ríos, Manuel; Guillén-Martínez, Daniel 2026-06-01T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/28145 Immersive virtual reality for assessing decision-making in mass casualty incident and tactical combat casualty care scenarios among military personnel López-López, Carmen-Amalia; Semeraro, Federico; Ocampo-Cervantes, Ana-Belén; Pardo-Ríos, Manuel; Guillén-Martínez, Daniel; Sánchez-Gómez, Marina; Venero-Sánchez, Nereo; Mendoza-López, Miriam; Ivanov, Matin; Cerón-Madrigal, José-Joaquín; Botía-González, María; Alcazar-Artero, Petronila-Mireia INTRODUCTION: Military personnel frequently act as first responders in complex tactical-medical scenarios where they must make critical decisions under pressure and coordinate with civilian emergency services. Traditional simulation methods have limitations in replicating the stress and cognitive load inherent to these contexts. Virtual reality (VR) allows the recreation of high-demand scenarios, enabling the assessment of decision-making under operational pressure. METHODS: A pre-post quasi-experimental study was conducted with 38 active-duty military personnel, who completed two VR scenarios: a mass casualty incident (MCI) and a tactical combat casualty care (TCCC) scenario, following a counterbalanced crossover design. The primary outcome was the accuracy of decision-making across two VR scenarios (MCI and TCCC). Secondary outcomes included physiological stress response through salivary biomarkers, neurophysiological metrics in a subsample and subjective experience assessed through a focus group. The analysis included descriptive statistics, paired t or non-parametric tests, linear mixed models for biomarkers and a qualitative thematic analysis. RESULTS: In the tactical scenario, participants showed a 76.7% accuracy rate, with variability in decisions under fire and airway prioritisation. In the MCI scenario, high accuracy was observed in triage items but errors occurred in more complex situations. Biomarkers showed moderate increases with no significance in univariate analyses but mixed models revealed effects of scenario type and exposure order. EEG metrics identified resilient, intermediate and vulnerable profiles, with signs of mental fatigue in high-demand phases. CONCLUSIONS: VR appears to be a useful tool for evaluating decision-making under pressure and for complementing training in tactical-medical scenarios, although this study does not provide direct evidence of improved learning outcomes. 2026-05-28T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/28144 Pharmacokinetic/Pharmacodynamic Modelling of Cefquinome in Lactating Sheep and Lactating Goats After Intravenous, Subcutaneous and Long-Acting Administrations Cárceles-Rodríguez, Carlos-Mario; Fernández-Varon, Emilio; Bernal-Alcaraz, Cristina; Cárceles-García, Carlos; Moron-Romero, Rocío; Díaz-Villamarin, Xando; Muñoz-Rascon, Pilar; Serrano-Rodríguez, Juan-Manuel The pharmacokinetics (PK) and pharmacokinetic-pharmacodynamic (PK/PD) relationships of cefquinome in small ruminants remain incompletely characterized, particularly for long-acting (LA) formulations. This study evaluated cefquinome disposition after intravenous (IV), subcutaneous (SC) and LA subcutaneous (SC-LA) administration in lactating sheep and goats using nonlinear mixed-effects models (NLMEs) and Monte Carlo (MC) simulations. Cefquinome exhibited low volumes of distribution (0.21-0.31 L/kg), with goats showing higher clearance and shorter terminal half-lives than sheep. The SC-LA formulation reduced the absorption rate constant and increased both the mean absorption time and terminal half-life by 4-6-fold, resulting in sustained systemic exposure over 48 h. PK/PD analysis showed higher PK/PD cut-off values for the LA formulation, with values of 0.125 ?g/mL for the fT > MIC index and 0.25 ?g/mL for the fAUC/MIC index, respectively, whereas IV and SC regimens achieved lower thresholds. MC simulations indicated that only the LA formulation achieved ? 90% probability of target attainment (PTA) values at MICs equivalent to tentative epidemiological cut-off values (TECOFF) for respiratory pathogens. Notably, fAUC/MIC provided a more informative descriptor of efficacy for the LA formulation. These findings highlight the advantage of LA formulations and demonstrate improved performance compared with conventional dosing regimens in sheep and goats. 2026-06-13T00:00:00Z https://sms.carm.es/ricsmur/handle/123456789/28032 Can immersive virtual reality assess hypothermia resuscitation decision-making? A cross-sectional study in a civil-military disaster management context López-López, Carmen-Amalia; Greif, Robert; Semeraro, Federico; Ocampo-Cervantes, Ana-Belén; Pons-Claramonte, Manuel; Nieto-Caballero, Sergio; Pardo-Ríos, Manuel; Martínez-Guillén-Martínez, Daniel; Sánchez-Gómez, Marina; Georgiev, Martin-Plamenov; Ivanov, Martin-Lyubomirov; López-Ferrandiz, Lucía OBJECTIVES: To evaluate the feasibility and acceptability of an immersive virtual reality (VR) scenario for assessing decision-making in accidental hypothermia resuscitation within a civil-military disaster-management exercise, and to explore neurophysiological signals as hypothesis-generating correlates of decision-making. DESIGN: Cross-sectional observational study. SETTING: A multinational civil-military disaster-management exercise in Bulgaria (September 2025). PARTICIPANTS: Convenience sample of first responders who completed the VR scenario and post-experience questionnaire (n=62; mean age 30.6 years (SD 7.8); 59/62 male (95.2%) and 3/62 female (4.8%); 43/62 civilian (69.4%) and 19/62 military (30.6%)). INTERVENTIONS: Participants completed an interactive 360° immersive VR scenario with multiple-choice decision points covering key steps in accidental hypothermia management. A subsample underwent exploratory neurophysiological monitoring (electroencephalogram (EEG)/ECG) during the scenario. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was decision accuracy across scenario decision points. Secondary outcomes included perceived usefulness, ease of use, presence and physical discomfort. Exploratory outcomes (subsample) included EEG-derived engagement index and frontal alpha asymmetry. RESULTS: Sixty-two participants completed the simulation. Perceived usefulness and ease of use reached the highest median score (7.0 (IQR 6-7.0)), with >95% agreement across items. Decision accuracy across decision points ranged from 37.5% to 85.7%, with lower accuracy in hypothermia-specific algorithm steps compared with general resuscitation actions. In a very small exploratory EEG/ECG subsample, illustrative case-level, event-locked individual traces suggested possible differences preceding incorrect responses (hypothesis-generating only). CONCLUSIONS: Immersive VR was feasible and well accepted for assessing hypothermia resuscitation decision-making in a civil-military exercise. Observed performance highlighted hypothermia-specific decision gaps. Controlled and longitudinal studies are needed to evaluate learning gain and training effectiveness. 2026-03-01T00:00:00Z