The application of movement-detection sensors is crucial for understanding surface movement and tectonic activities. The development of modern sensors has been instrumental in earthquake monitoring, prediction, early warning, emergency commanding and communication, search and rescue, and life detection. There are numerous sensors currently being utilized in earthquake engineering and science. It is essential to review their mechanisms and working principles thoroughly. Hence, we have attempted to review the development and application of these sensors by classifying them based on the timeline of earthquakes, the physical or chemical mechanisms of sensors, and the location of sensor platforms. In this study, we analyzed available sensor platforms that have been widely used in recent years, with satellites and UAVs being among the most used. The findings of our study will be useful for future earthquake response and relief efforts, as well as research aimed at reducing earthquake disaster risks. An earthquake is one of the major natural hazards which destroys lives and properties; more than 522 major earthquakes have occurred in the 21st century, killing more than 430,000 people worldwide . Sa. Sa86]. Navigation and monitoring satellites can perform detection and early warning functions before earthquakes. The recent advancement  of real-Satellites provide historical and real-time images of the disaster area before and after the earthquake. Satellites also provide a unique synergistic view of the spatial scale and variable time of the disaster area. Earth-orbiting satellites complement traditional in situ measurements and ground-based sensor networks such as those for seismology, volcanology, geomorphology, and hydrology . SatelliThis review shows that there are benefits and limitations to earthquake sensors for decision making based on their model and applications . Base stThe application of earthquake sensors is very important for timely search and rescue operations in disaster scenarios. Earthquake sensors have been evolving in recent years and have been applied in different time and space scenarios. The development of frontier technologies such as the Internet of Things and Artificial Intelligence has provided unique opportunities in emergency situations. The current development status of seismic monitoring and rescue sensors is manifested in different aspects. The constant innovation in sensors technologies such as MEMS, DAS, UAV, satellite, and nanotechnology can enable to more effective detection and recording of seismic activity. Moreover, the use of big data and AI could help to achieve real-time data to share earthquake locations and destruction behavior with the public. This will enhance the capability of earthquake responders to provide early warning and rescue operations. Moreover, the new development of sensor networks could establish a stable communication network to achieve information transmission and real-time responses. The development of earthquake-related sensors is an ongoing process of innovation and expansion, with the continuous strengthening of scientific and technological progress, providing more efficient, intelligent, and comprehensive protection for earthquake rescue and relief. However, there is a strong need to strengthen the capabilities of earthquake sensors for timely prediction for effective disaster management. The integration of new innovative technology in earthquake prediction should be in place to provide comprehensive information sharing for effective disaster management in the future.


In critical care medicine, where there is a demanding career with a problematic work-life balance, mentoring is an important support tool to grow professionally, creating a network of support throughout the career. The mentoring process consists of evidence-based steps to guide critical care mentors and mentees and pair them with each other according to the correct selection and matching of participants.In order to focus on the active role of a young intensivist selected as a mentee at any level and to support their success in a mentoring relationship, the NEXT Committee of the European Society of Intensive Care Medicine (ESICM) developed 2012 a mentoring program.The critical steps of the mentoring program start from establishing a policy and program objectives, passing through the selection of participants, and matching with mentors up to the definition of the personal development plan supported by checklists, worksheets, and evaluation forms. The present manuscript provides key steps and tips for a good, essential based on our experience in the ESICM NEXT-Mentoring Program so that they guide for future mentoring programs conducted by other scientific societies. In addition, we discuss common challenges and how to avoid them.The online version contains supplementary material available at 10.1186/s44158-023-00116-4. Mentoring is an essential process and an exchange relationship to advance the careers and careers of the mentor and the mentee . FurtherIn order to focus on the active role of a young intensivist selected as a mentee at any level and to support their success inside a mentoring relationship, the NEXT Committee of the European Society of Intensive Care Medicine (ESICM) developed in 2012 a mentoring program. In 2020, we implemented the “NEXT-Mentoring program” to facilitate mentoring relationships between students and faculty mentors, who participated in a formal mentoring program that fosters early introduction to research and promotes academic careers. In the present manuscript, we will discuss key steps and tips for a good approach, essential based on our experience in the ESICM NEXT-Mentoring program, so that they are a guide for future mentoring programs conducted by other scientific societies. In addition, we discuss common challenges and how to avoid them.Critical care is a multi-professional community; teamwork is paramount in our daily practice. The diversity of skill sets, experience, and knowledge of the critical care team requires collaboration in the delivery of care, research, and professional development. In this setting, staff satisfaction, retention, and effective leadership can increase staff morale, decrease medical turnover rates, and improve patient care quality. Unfortunately, mentoring programs in critical care are built more for the nursing staff and less for the medical staff , particuRelative advantage—The perception of change among the groupCompatibility—The importance of values and past experiences of innovationSimplicity—The ease of understanding the proposed changeTrialability—The degree to which innovation can be testedObservability—More discernible results contribute to how comprehensively the innovation will be adopted (see Rogers 1).Nowadays, mentoring has evolved from the traditional dyad of a mentor and mentee to a more extensive network of collaborators based on cornerstone characteristics. The definition and elaboration of an innovative mentoring program in a critical area, as suggested by Everett Rogers, must be based on the following fundamental principles:In support of these principles, peering can be a significant tool for sharing skills and ideas among all groups: mentees share with mentors, and mentors share with other mentees and mentors . ParticuThe mentoring process is an evidence-based process used to help guide critical care mentors and mentees and pair them with each other according to a correct selection and matching of participants. Mentors and mentees are at the heart of the mentoring program. They do not enjoy meeting when they are not compatible with each other. The role of the ESICM NEXT in the mentoring program is to advertise the program, elicit participation, judiciously select mentees, contact mentors for each new mentee in the program, support the flow of the program, review program feedback and outcome metrics regularly to improve the program organization, and develop education workshops. The steps to build a mentoring program are described and explained below Fig. , partly The ESICM considers mentoring a key component of training, research experience, and career development. Therefore, ESICM’s policy is to support, endorse, and promote mentoring.Through the leadership and guidance of a robust research program, the ESICM NEXT-Mentoring Program aims to develop professional and successful individuals, guiding them on their career paths. Consequently, this mentoring program strives to establish, design, and facilitate positive, enduring, and mutually beneficial mentoring team relationships that allow mentees to plan, learn, collaborate, and grow in their clinical and research careers. The ESICM NEXT-Mentoring Program focuses on managing a productive academic career and nurturing and cultivating junior mentees to become the next generation of research leaders, encouraging professional development, and establishing effective and independent researchers. Ultimately, this program allows mentees to broaden their professional networking within the scientific community.Enhancing their research skills and productivityGuidance and enhancing their clinical skillsFacilitating their professional development in all aspectsSupporting multicultural and diverse workforcesThe specific objectives of the ESICM NEXT-Mentoring Program Fig.  are to eThe fulcrum of mentoring is represented by the mentees who are the program’s recipients and without devaluing a two-way relationship that can be of equal value for both mentees and mentors. For this reason, it is strongly recommended to select the mentees first, allowing the coordinator to assess the suitability of mentors in relation to the profiles and needs of the mentees. High levels of motivation and career needs are on the list of mentee selection criteria; However, this program is also for young talents eager to expand their quantitative research methods and practices. For this reason, an ESICM NEXT mentee should possess basic research and clinical knowledge, problem-solving and innovation skills, the ability to work independently, value research integrity and collaborative research, and good communication skills and interpersonal skills. During the assessment of applicants, it is also considered age, gender, and regional location, ensuring inclusivity.Each section of ESICM provides a list of mentor candidates which are selected based on their experience and contribution to society. These potential mentors are then contacted individually via email by the program coordinator, who explains the structure and responsibilities of the mentor but also of the mentee within the program. The coordinator guarantees the presence as a support to the future developing relationship. Both components of this report have responsibilities to consider, which will be further explored later.essential key points.One of the most challenging aspects of a program that can influence productivity is performing a good match . Particithe goals of individual mentees  [First of all, the coordinator of a mentoring program should know tention) . With a tention) . Identiftention) .profiles and criteria for matching mentors and mentees should be created in order to match them on the right skill traits and fill out rich profiles [Secondly, profiles .the type of matching for mentors and mentees [Self-matching — That consists in which mentees find their own mentors career based on interests and/or skills [r skills ; Shollenr skills , 28.Admin matching — In which the mentoring program coordinator creates matches on behalf of the participants [icipants Bulk matching — That allows to match a large pool of program participants at the same time (more than 200 participants) [cipants) Hybrid matching — This method of matching mentors and mentees requires you to use the questions asked for manual matching. From this, you will create a pool of mentors for the mentee to select from.Thirdly, it will be necessary to determine  mentees . To thisadmin matching mentors and mentees that is a manual matchmaking process performed based on the selected number of participants [The NEXT Mentoring is based on icipants  for a hiIn case of more than 10 mentees, software available can help pair mentors and mentees using advanced algorithms that automatically suggest the best match by analyzing the data in each participant’s profile in order to find the best mentoring matches. Online platforms facilitate the creation of mentoring networks that provide mentees with specific, accessible, and timely support .providing a guide for the couple is necessary [Fourthly, ecessary . UnfortuAt the first meeting, mentees should have a plan, predefined goals, and need . The perThe PDP-MA of the NEXT-Mentoring Program is organized as a form to be filled by the mentor and mentee with the following information: a section dedicated to identifying the personal goals of the mentee, the reason for applying for the NEXT-Mentoring Program, hopes for the career, and a list of other goals discussed with the mentor. Additionally, the document presents a section dedicated to the areas of interest of the mentee, including expectations regarding the main objectives of the NEXT-Mentoring Program: (1) teaching activity, (2) research activity, (3) personal development, (4) networking, and (5) other (if any) to be by a mentor.Each of these possible objectives requires information on 1) which are the goals, (2) uses of resources need of collaborators and time required to achieve goals, and (3) barriers to achieving new goals. In the PDP-MA, the frequency of meetings between mentor and mentee is defined, as well as the expectations for this mentoring relationship, while describing the expected responsibilities of both mentor and mentee. The complete form is available as Supplementary Material Table  which arThe mentee and mentor have specific responsibilities to ensure that the relationship is effective, and that objectives are met. Both mentee and mentor should follow semi-structured guidance that is created for the mentor to teach the mentee in particular skills, as well as to facilitate the growth of the mind by sharing resources and networks, challenging the mentee to overcome the comfort zone, and creating a safe learning environment, and for the mentee to facilitate their knowledge and progresses in lives and career. A checklist of the NEXT-Mentoring Program has been developed to clarify the responsibilities and goals of the mentor and mentee and is provided in Table Both mentors and mentees should take notes during the meeting to monitor the progress and follow up on agreed-upon action plans (activity report). The NEXT-Mentoring Program coordinator or collaborators will contact mentees and mentors every 6 months to receive feedback and support if necessary. Both mentor and mentee can contact the program manager for any help. At the end of the second year (and subsequent years) and/or at the end of the mentoring relationship, the mentee and mentor should provide a final review to the NEXT-Mentoring Program coordinator. In any case, mentors or mentees may reassess their relationship at any time during the mentoring program and decide to continue or discontinue. If a mentor–mentee pair chooses to stop, a discontinuation evaluation form should be filled out.The mentor should act as a facilitator, a guide, a supporter, and a supervisor by providing constructive criticism and feedback. These responsibilities are achieved by formalizing goals, objectives, and metrics of success with the mentee, meeting periodically to review progress and attainment of goals, providing feedback and encouragement on accomplishments, evaluating the mentee’s development during the program, and being assessed by the mentee, with an assessment of whether the mentor meets or exceeds expectations.The first responsibility of the mentee is to contact the assigned mentor to plan the activities. Additional tasks of the mentee include taking part in the mentor–mentee lunch meeting at ESICM-LIVES for two consecutive years, initiating contact and scheduling meetings with a mentor, preparing a specific agenda for each session, including career goals, and learning to evaluate the ideas and suggestions provided by the mentor.The goals that meet expectations will be evaluated by the mentor and assessed by the mentee using the NEXT-Mentoring worksheet during the mentoring program. All the main 4 objectives of the program  plus others, if any, will be evaluated for accomplishment and obstacles. The mentor and mentee will plan new strategies to overcome the barriers together  for the mentee and 32-item skills (8 open and 24 ranked questions) for the mentor. These sheets are developed to give feedback about the relationship, attitudes, and feelings about acquired competencies. They include questions about professional development, professional career development, skill development, personal communication, role model, mentorship program quality, partnership, personal growth as mentee and mentor, and relationship. The form uses a 5-point Likert scale for ranked questions to allow the mentee and mentor to express how much they agree or disagree with a particular statement. The Likert scale provides five possible answers to a statement or question that allows respondents to indicate their positive-to-negative strength of agreement or strength of feeling regarding the question or statement, rated as follows: 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, and 5 = strongly agree. The scale has a rank order, but the intervals between values cannot be presumed equal , 34. SupThe mentoring program can be very demanding and require dedication, but it has challenges. Firstly, the availability of mentors could be extremely limited by personal and work commitments that would not allow the mentor to follow the assigned mentee properly. Secondly, while on the one hand, the mentor can be excessively busy; on the other hand, very often, the mentee is afraid to express personal and career needs , 36. ThiThe introduction of the figure of coordinator in a mentoring program indeed allows for an accurate selection of mentors, a well-defined matching, and support if required in the mentor–mentee relationship without being invasive or insensitive.The selection of mentors must be accurate and directed not only towards the extreme technical experience in specific sectors but also above all availability, enthusiasm, emotional intelligence, active integrity in mentoring, active listening, and honest feedback.The mentee should be educated about the potential difficulties they may encounter while building the relationship with their mentor. Decline the relationship in the sign of reciprocity ensures that the interpersonal encounter does not remain confined to a purely utilitarian level or one of domination/overwhelm, but it should be directed and structured around the principles of respect and equality dignity .The first face-to-face meetings or a period of attendance carried out in the mentor’s office could be helpful at the beginning of the NEXT-Mentoring Program , 40, in The possible solutions to the problems above can be, in our opinion, the following:Although numerous studies have considered the potential role for mentoring, there are few dedicated mentoring programs for critical care trainees and young specialists and no formalized training opportunities for those wishing to act as mentors. Mentoring has a valuable role to play in enabling mentees to achieve their extensive potential, while developing leadership and interpersonal skills, and to become also potential future mentors.In the present manuscript, we described the planning and type of support we created for our mentoring program in ESICM NEXT, which can be a pocket guide for future mentoring programs conducted by other scientific societies. Although the mentoring program for a scientific society is an impactful strategy to develop and engage people, running an impactful program goes way beyond just matching people up. It takes effort, resources, time, and dedication. We hope that these suggested tips will likely improve the mentor and mentees’ communication and experience.Additional file 1: Supplementary Material Table 1. PDP-MA. Supplementary Material Table 2. NEXT-Mentoring worksheet. Supplementary Material Table 3. NEXT-Mentoring evaluation form mentee. Supplementary Material Table 4. NEXT-Mentoring evaluation form mentor.


Sociodemographic and structural conditions have consequences for the labor market participation of young persons with disabilities (YPWD) in vocational rehabilitation (VR). As the type of program determines the labor market chances, we analyze the processes of selecting active labor market programs (ALMP) in VR. Which factors determine the allocation to (1) programs in general and (2) moreover, the allocation to specific programs?We conduct logistic (1) and multinomial regression (2) using register data of the German Federal Employment Agency. Besides variables on the micro level, we control for a wide range of structural and organizational influences. The sample comprises VR and employment biographies of 255,009 YPWD accepted to VR between 2010 and 2015. Program participation is restricted to start 180 days after VR acceptance.Sociodemographic factors, like age and the status before entering VR as well as the local apprenticeship market as a structural condition, highly influence the general allocation to ALMP. For the allocation to specific ALMP, sociodemographics  are highly relevant. Furthermore, structural conditions  and – to a lesser extent - re-organization processes at the FEA  are important determinants.(Automatic) paths into VR programs for especially persons with mental disabilities in sheltered workshop are clearly shown. Furthermore, it is somewhat questionable that YPWD participate more often in sheltered workshops in regions where sheltered work possibilities are more common, as well as where NEO was implemented locally; and participate more often in company-external vocational training where VR service providers are commissioned to a greater extent. Health conditions and labor market participation are bidirectionally related , 2. On tIn addition, research has shown that there are multiple scarring effects resulting from unemployment at the very beginning of the school-to-work-transition. Unemployment experiences in younger life lead to multiple restrictions in later life such as an increasing number of unemployment periods or lower wages , 8. If pBeing unemployed in younger life also causes greater mental health problems both in the short and long term . Cruces,Which factors on various levels determine the allocation to (1) programs in general and (2) moreover, the allocation to specific programs.In this paper, we focus on a vulnerable group: young persons with disabilities (YPWD) at their first transition into the labor market. Specifically, for disadvantaged young people with restricted health, this transition constitutes a critical point in their employment biography . To imprAt the beginning of VR, the YPWD – the rehabilitant – and the VR counsellor decide together on the choice of active labor market programs (ALMP). Since it is possible and common to allocate several programs during the VR process , we must select. We decided to look at the first program, as we assume that the first program refers to the overall VR strategy. Thus, if rehabilitants attend a prevocational training program as their first program, the counsellor very likely suspects a lack of vocational training maturity. A preparation phase is not necessary if the counsellor directly opts for vocational training. In our analysis, we consider that elements such as sociodemographic factors or the type of disability determine the probability of program participation.We additionally assume that external  structural conditions and institutions set a framework for activities, leading to differing allocation processes. We conduct multivariate logistic and multinomial regression analyses, using longitudinal administrative data from the German Federal Employment Agency (FEA) for cohorts of YPWD starting VR in 2010 through 2015.To analyze the support structures for YPWD alleviating their labor market transition, we consider the German vocational training system, as well as the specifics of the VR process for YPWD.Berufsschule] and usually lasts for two or three years. Trainees receive apprenticeship pay. Characteristically, vocational training occurs in an unsubsidized in-firm manner. In Germany, a vocational training degree is especially important for a stable and sustainable participation in the labor market , disability-specific vocational promotion centers [Berufsförderungswerke] or integrative companies  to the number of regular employees. By using this indicator, we assume that the higher the local share of a special labor market, the more people are allocated to those special VR programs.As structural factors, we include (a) the  markets . The typre-organization of the local employment agencies (of the FEA) in 2012, called NEO [Neuorganisation der Bundesagentur für Arbeit]. The aim of the FEA was a harmonization of political territorial  structures (administrative regions or districts) with organizational  territorial structures and a further development of internal organizational structures ) . It compBased on logistic regression, in the first step, we analyze general participation in ALMP after being officially accepted by the FEA as a vocational rehabilitant. In the second step, based on a multinomial regression for those participating in ALMP, we want to know which factors are associated with the allocation to specific programs.The data on program participation is right-censored until April 2016. In order to approach this censoring, we restrict the program allocation to be finished during the first 180 days after a person is accepted to VR. Thus, programs starting after 180 days after VR acceptance are counted as “no program participation”.Dependent Variables. The first main outcome is the general participation in programs. It includes participation in any ALMP during VR (yes (1) or no (0)). The second main outcome is the type of the first allocated program with the following categories: (a) (un)subsidized in-firm vocational training, (b) company-external vocational training, (c) general prevocational training program , (d) disability-specific prevocational training programs , (e) other prevocational training , (f) training in sheltered workshops and (e) other programs.Independent Variables. As described above, we consider different independent variables: sexage (at the beginning of VR), nationality (German vs. non-German), highest schooling degree , type of disability  and status before entering VR . Re-organization of the local employment agency (NEO) is a dummy variable. Year of entering VR ranges from 2010 to 2015, Regional structure of apprenticeship market contains ten categories. The variables Regional structure of subsidized vocational training, and local work possibilities on a special or second labor market for people with disabilities are dummy variables distinguishing local agencies that are above or below the German average.The characteristics of YPWD entering VR in 2015 are shown in Table Looking at the first dependent variable – the general participation in programs -, we find that every year 20 to 25% did not participate in any VR program during the first 180 days after VR acceptance. When we look at the second dependent variable - at the type of program -, we find that most of them participated in disability-specific prevocational training programs. These numbers slowly increased from 24% to 2010 to 32% in 2015. The second most frequent first program chosen were sheltered workshop programs (as a preparation for employment in sheltered workshops) with 22% in 2010 and 20% in 2015; about 13% of rehabilitants start directly with company-external vocational training . However, the model for the determination of the choice of specific programs has a high level of explanatory power (Pseudo R2 0.29). This shows that the selection of specific programs can be explained by the data at hand, whereas the general take-up of programs is determined by additional unobserved factors.We do not explain much variance in the general allocation process to ALMP  and conversion factors  hinder or promote YPWD in their capability to achieve (specific) programs. The results partly support our assumptions. We provide empirical evidence for the association between functionings as well as conversion factors and outcomes in order to explain general and primary allocation into VR programs. Specifically, we find that the general allocation to programs is mainly associated with sociodemographic factors – except for one conversion factor: the local apprenticeship market. When looking at the specific allocation to ALMP, sociodemographics are central determinants as well, but in addition, we find that some of the conversion factors – structural factors – play an important role as well.Hereinafter, the most influential and surprising results from above will be discussed. The status before entering VR is the most influential factor when it comes to the selection to any program: if people enter VR from other  programs, they most likely take up any program, as they already showed willingness to invest in their qualification; however, they take up programs less often if they were in school at the time of VR acceptance. However, this effect is due to the fact that we tackle the censoring of the data by restricting programs to begin during the first 180 days after VR acceptance. As we did not have that effect without this restriction, we might conclude that YPWD accepted for VR while still in school take longer than 180 days to start their first program. Furthermore, the local training market is relevant as a structural information: if competition among school graduates for training is higher and if YPWD live in rural regions with little industrial environment, the higher the probability to take up any program. This might be due to the circumstance that in these regions YPWD have less alternatives to VR.A decisive factor in the choice of program is education: persons without a schooling degree most often go into sheltered workshops, while YPWD with higher secondary schooling degree go directly into vocational training. Therefore a (higher) schooling degree serves as a sign for the ability to master (regular) vocational training and the lack of a degree makes sheltered environments as a last resort for inclusion necessary.Connected to this, the selection into ALMP is highly determined by the type of disability. As expected, persons with mental disabilities, frequently coming from special schools where the probability for (higher) educational degrees is lower , most ofStructural and organizational-specific conditions additionally influence the allocation processes to a certain extent. The year of entering VR has a significant influence; more recent cohorts have a higher probability of entering disability-specific and less often general prevocational training as well as sheltered workshops. Especially the former might reflect strategies in preventing later drop-outs, or a higher need of YPWD to receive disability-specific support during occupational orientation. Furthermore, this result and the results on the NEO variable support our assumption of a socialization period for the counsellors in the field of VR. Especially in the complex field of VR, the professional knowledge of the counsellors is crucial and should be trained as soon and as comprehensive as possible. The more time the counsellors have to become familiar with their new field of action (VR), the more their program allocation changes from general to disability-specific  ALMP, and YPWD are less often allocated to sheltered workshops. The latter can be considered a one-way ticket to the secondary labor market as well as an easy way for the VR counsellor to close a case.Finally, our results show that the selection into sheltered workshops is slightly more often observed in regions where work possibilities on a special labor market for PWD (like sheltered workshops) are above average. And the selection into company-external vocational training is higher in regions where subsidized vocational training is above average. This is interesting as it raises questions about whether the regional demand regulates the supply for vocational rehabilitants or whether it is the other way around.As a conclusion, we find certain predefined paths into different VR programs. Of course, capabilities as sociodemographic factors and conversion factors determine certain pathways. However, institutional and structural factors are also relevant in determining certain paths in non-inclusive environments, and that is at least questionable. Most rehabilitants need special support and many share a lack of vocational training maturity. For them, it might be the only way to achieve a vocational degree. However, that does not have to be true for all YPWD in VR. The type of disability does not necessarily reflect a reduced capability in employment activities or tasks. Therefore, an allocation into programs should depend mainly on the prerequisites of the individual person. Longstanding experience and a comprehensive training of the VR counsellor is crucial in this respect.There is a need for VR as a sociopolitical instrument to counteract excluding tendencies on the labor market and to constitute the basis for building self-esteem and self-reliance and leading to a self-determined life with sufficient income. But following predefined paths and organizational factors, and on local availabilities and demands, VR may lead to social exclusion for some as an unintended consequence.Avoiding this is not only important for the individual. The consequences for society must also be considered. Switching from an individual to a societal perspective shows that labor market participation is not only an individual value but is also important for labor market development in general. Current German labor market challenges include a rising average age of the overall population followed by shrinking labor force potential . Even la


Introduction: Orthopaedic Residency Directors advised against visiting subinternship rotations in the peak of the pandemic. To adapt, programs offered multiple virtual experiences. The purpose of this study was to evaluate programs and applicants perceptions regarding the value of virtual experiences during the 2020 to 2021 application cycle and their utility in future application cycles.Methods: A survey was disseminated to 31 residency programs gathering data about virtual experiences offered in this cycle. A second survey was disseminated to interns who have successfully matched at those programs to identify how interns think to have benefited from the experiences.Results: Twenty-eight programs completed the survey (90% response rate). One hundred eight new interns completed the survey (70% response rate). Virtual information sessions and resident socials were the highest attended . Interns and leadership agreed that virtual rotations provided students with a good understanding of program culture and what the programs offer educationally. Neither the leadership nor the interns would recommend replacing in-person aways with virtual experiences.Conclusion: Virtual experiences helped bridge the gap after away rotations were canceled. Alongside in-person aways, virtual experiences are likely to play a role in future cycles. However, virtual experiences remain incomparable to in-person away rotations and are not recommended as a replacement. There has been application inflation with 1,289 US medical school applicants for 868 positions in 2021, with less than 1% of available positions going unfilled over the past 30 years.2345 Orthopaedic surgery applicants are consistently among the top applicants for all medical and surgical specialties regarding class rank, United States Medical Licensing Examination (USLME) step 1 scores, Alpha Omega Alpha status, and research productivity.6 Given the competitiveness of matching into orthopaedic surgery, the visiting orthopaedic surgery rotation  remains one of the most important aspects of the application process.8 Cohn et al,9 in a survey of orthopaedic surgery program directors, found student subinternship performance to be the single most important factor in resident selection. With USMLE step 1 becoming pass/fail, it is thought that even more weight will be placed on the subinternship performance.9Orthopaedic surgery remains one of the most competitive and sought after medical or surgical residencies. In 2015, there were 1,062 applicants pursuing 703 residency spots, with graduates of US medical schools applying to an average of 70 of 161 residency programs.In the wake of the COVID-19 pandemic, the Council of Orthopaedic Residency Directors (CORD) advised against visiting subinternship rotations. Exceptions were made for students without a home orthopaedic surgery program (“orphan program”) or where an away rotation was a graduation requirement. These new recommendations raised notable concerns for applicants and program directors alike. Without in-person subinternship experiences, there was a fear that programs would be unable to adequately assess how applicants would integrate in their respective programs. Furthermore, there were concerns that applicants may not gain the benefits of away rotations, some of which include assessing the environment of a prospective program, establishing professional relationships, obtaining letters of recommendation, and furthering orthopaedic education, mentorship, as well as an opportunity to show one's work ethic or ability to work in a team. To adapt and abide by CORD's recommendations, many orthopaedic surgery programs offered virtual experiences. The goal was for these virtual experiences to ideally provide the same benefits to both applicants and programs afforded by in-person away rotations.The purpose of this study was to ascertain program leaderships' and applicants' perceptions about the value of the virtual experiences during the 2020 to 2021 application cycle and the utility of different virtual experiences in future application cycles.https://jhmi.co1.qualtrics.com/jfe/form/SV_8G4ogCmz7AxtLTg and https://qfreeaccountssjc1.az1.qualtrics.com/jfe/form/SV_aWxLaHsRdBlR9NY). A 10-question online survey was designed to target residency programs' leadership gathering data about virtual electives offered during the 2020 to 2021 application cycle at their programs. Leadership was surveyed about the selection process for applicants offered to participate in their virtual opportunities and how successful those different virtual opportunities were at portraying the different aspects of their program. A second eight-question survey was designed to target the interns of class of 2026 to identify the virtual opportunities they had participated in during their 2020 to 2021 application cycle. The surveys were piloted and reviewed by the study team, which included both faculty and residents. In an effort to increase the response rate, surveys were anonymous. In addition, respondents were allowed to freely response to further clarify or expand on any of their answers.Two surveys were built in the Qualtrics online platform  . Most of the respondents were program directors 21 PDs), but 6 associate PDs and one chairperson participated as well. During the 2020 to 2021 cycle, most programs did not allow any in-person away rotations for various reasons  either agreed or strongly agreed that the virtual experiences led to a good understanding of what their program had to offer educationally. Seventy-two percent (N = 8) agreed or strongly agreed, while 18% (N = 2) disagreed or strongly disagreed that these experiences allowed students to get a feel for the culture of their program. Seventy-two percent of the leaders (N = 8) agreed or strongly agreed that virtual experiences permitted applicants to get a feel of what their residents were like Table . ConversFor the intern survey, 108 of 156 interns took the survey (70% response rate with some incomplete responses). Seventy-four percent of the respondents were male, 24% female, and 2% other. Sixty-two percent of the interns surveyed were White, 9% Black or African American, 6% Hispanic/Latin or of other Spanish origin, 18% Asian, 2% Other, and 4% preferred not to respond . 62% of the interns also agreed/strongly agreed that the virtual rotations lacked the opportunity for them to demonstrate their strengths. Sixty percent of the interns (N = 60) felt that virtual experiences lacked the opportunity to form strong relationships with faculty and mentors. Opinions varied about the interns' insight into what the programs had to offer surgically . Fifty-two percent of the interns (N = 52) thought that virtual experiences allowed them to gain an understanding of the dynamic between the residents and the fellows. Almost an equal proportion of interns reported conflicts with the medical school responsibilities compared with those who denied conflicts (39% [N = 37] versus 41% [N = 39]). Finally, 70% of the interns [N = 68] would not recommend virtual experiences to replace in-person rotations in the future. Only 2% of the interns (N = 2) would prefer a virtual experience rather than an in-person away rotation, while 64% of the interns (N = 60) thought that they would have had better chances of matching at the program of their choice had they completed in-person away rotations this past cycle .Many of the interns shared a similar opinion with the leadership about virtual rotations allowing them a good understanding of what the programs had to offer educationally (76% [N = 75] agreed or strongly agreed), what the residents are like (63% [N = 62] agree or strongly agree), and what the culture of the program is (63% [N = 62] agreed or strongly agreed)  surveyed offered virtual information sessions, and 43% of the programs (N = 12) developed virtual curricula/rotations. These longitudinal experiences were quite variable lasting between 2 weeks and 6 months, half of which did not give students the opportunity to present or demonstrate orthopaedic knowledge (Table 3 surveye12 Similarly, we found variability in the types of virtual opportunities offered by programs and how students were offered and/or selected for participation. More work is needed to determine the optimal virtual experience. Optional experiences and informational meetings were found to be most helpful.For in-person away rotations, notable heterogeneity exists for both the selection of students and the organizational structure of the rotation.The strength of our study includes high response rates by both program leadership and applicants on a topic that remains important to the orthopaedic application cycle. This is especially true because the Coalition for Physician Accountability's work group on away rotations discusses the future of in-person away rotations. In-person away rotations may become even more critical as we transition into an era of pass/fail grading for the USLME step 1. Program leadership and interns felt that virtual experiences should not be used in place of in-person away rotations. Recall bias is always a concern with retrospective survey studies. Our response rate and demographic representation of respondents limit bias in our study. Finally, our survey was only disseminated among successfully matched applicants, and our study lacks data from unmatched applicants.Virtual opportunities allowed students to get a good sense about the prospective program's culture and educational structure. Virtual information sessions and virtual experiences where participation was optional were found to be most helpful. Applicants found that it was difficult to demonstrate their strengths to residency programs or form strong relationships with faculty and thought that they would have a better chance of matching had they been able to participate in in-person away rotations. There may be potential for hybrid experiences in the future; however, virtual opportunities remain incomparable with what in-person rotations had offered and are not recommended to substitute for them.


Positive cooking attitudes increased with income , especially among the <$20,000 and $30–39,000 income brackets. Cooking confidence increased post-intervention , with an interaction effect for food security status , with greater improvement for households with food insecurity. These findings provide evidence to program and policymakers that virtual nutrition and cooking education services for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) should continue to be supported beyond the pandemic as they reduce barriers to receiving program benefits, nutrition education, and may lead to reductions in household food insecurity.The present study examined if adapting the Cooking Matters (CM) curriculum to be used in an online format would improve participants’ shopping skills, attitudes toward cooking, and feelings of cooking confidence, similar to the traditionally offered method, which is conducted in person. Results from factor analyses indicated that the online CM program demonstrated construct and content reliability compared to in-person (Cronbach’s α ≥ 0.70). Repeated-measures ANOVA revealed a decrease in shopping skills overall (F = 5.91;  The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplementary foods, referrals to health care providers, health screenings, breastfeeding support, and nutrition education to low-income mothers and children ages 0–5 . The WICNutrition education is a unique aspect of the WIC program and is not a required part of any other nutrition assistance program in the United States .WIC’s nuTeaching kitchens have been shown to provide accessible nutrition education by reaching participants “where they are at” and re-acquainting them with their cultural heritage, foods, and healthful properties . NutritiCooking Matters (CM) is a national program developed by Share Our Strength, an organization dedicated to ending childhood hunger and poverty in the United States, to provide low-income caregivers with essential skills in shopping for and cooking healthy meals on a budget through hands-on cooking classes, grocery store tours, and digital media . AccordiParticipant recruitment occurred in collaboration with the Ventura County WIC program. Ventura County WIC staff informed their clients of the opportunity to participate in the Family Kitchen cooking education program through monthly mass text and email communications. WIC staff also spoke with eligible clients during regularly scheduled bi-monthly phone visit appointments. It offered the Family Kitchen cooking education program as an option for its clients to meet their nutrition education requirements for the month. Standardized scripts were created in English and Spanish for all recruitment efforts.https://familykitchenvc.info, accessed on 5 August 2023), where screening, consent, cooking education videos, and all surveys were located. In consultation with the WIC staff and directorship, it was recommended that the best way to reach clients would be through cell phone access. Thus, all Family Kitchen project content was set up and tested to work equally well on a mobile device and computer. Incentives for Family Kitchen program participation included fulfilling WIC’s nutrition education requirement for the month to receive WIC benefits. Written consent was obtained online and included a section for participants to fill in their name and WIC family ID number if they want to receive credit toward their WIC nutrition education requirement. The present study was approved by the California State University Northridge Institutional Review Board (IRB-FY21-174).Eligibility criteria included being a current Ventura County WIC participant, over 18 and English- or Spanish-speaking. Those interested in participating in the study were directed to the project website  and an introductory knife skills video. This additional module was developed by Family Kitchen members with the input and guidance of Ventura County WIC staff to ensure study participant safety while cooking in the kitchen with small children.The topics of the modules included “No More Mealtime Madness”, “Hack Your Snack”, “Drink to Your Health”, “The Family Kitchen”, and “Kids Say Yes to Fruits and Veggies”. In collaboration with the community partners at Ventura County WIC, recipes were adapted from the CM program to include culturally appropriate, WIC-approved foods for the study population. Given that the population in Ventura County is 44.5% Hispanic or Latino, the recipes that were created included foods traditionally consumed by this study population . Althoughttps://familykitchenvc.info/, accessed on 5 August 2023).The impact of the Family Kitchen program on participants’ healthy eating practices was measured using a prospective, mixed method, pre-post survey design. A screening form was developed to ensure that study inclusion and exclusion criteria were met. The screening, consent, and pre-survey were presented on the project website before participants could access any pre-recorded video content. All surveys and forms were available in English and Spanish and were self-administered online via Qualtrics at the study’s dedicated website . Food security status was measured using the validated United States Department of Agriculture (USDA) six-item short form Household Food Security Survey Module . Prevalence of food security was calculated based on the number of affirmative responses to the survey questions, indicating either “yes”, “often”, “sometimes”, “almost every month”, or “some months but not every month”. A score of 0–1 indicated high or marginal food security, 2–4 indicated low food security, and 5–6 indicated very low food security .Complete pre-and post-surveys in English and Spanish (N = 257) were analyzed using IBM SPSS Statistics software, version 17.0. Criteria for survey completion included missing no more than three survey questions. Frequencies were calculated for age, language, sex, education, income, race/ethnicity, and food security status. To test the first research objective  in an online/virtual setting compared to the standard in-person cooking education traditionally offered), exploratory factor analysis was conducted on the pre-and post-survey questions. Factor loadings of 0.50 or greater determined which factors on the CM scale grouped . Composite scores, an average of the test scores, were calculated for each variable assessed  to determine how well the items on the scale worked together to assess the variable of interest. Cronbach’s α was used to determine survey reliability .To test the second research objective, which was to understand if there was a relationship between participating in a pre-recorded online cooking education program and (1) improved shopping skills to purchase healthy foods on a budget, (2) improved attitudes toward cooking, and/or (3) increased feelings of confidence in cooking habits, change scores were calculated subtracting pre-survey assessment scores from post-survey assessment scores. Data were examined to determine if assumptions for parametric testing were met. Mixed-subjects Analysis of Variance (ANOVA) was used to assess changes from the pre-survey to the post-survey and to identify any relationships between-subjects variables and within-subjects variables. Between-subjects variables included: age, education, race/ethnicity, income, and food security status. The within-subjects variable was the intervention program. Each ANOVA test examined a different dependent variable . All tests analyzed the main effect of time, the main effect for that particular between-subjects variable, and the interaction effect of time and the between-subjects variable.p < 0.001). The racial/ethnic make-up of the sample was predominately Latinx, Mexican, and Hispanic (76.8%), followed by 13% White, 7.4% Asian, 2.8% American Indian or Alaska Native, 1.2% identifying as African-American or Black and the remaining 1.6% as “Other”. There were statistically significant differences between English- and Spanish speakers in terms of their race, with more English speakers identifying as Latinx, Mexican or Hispanic when compared to Spanish speakers . In terms of household income, 46.9% earned less than $20,000/year, 22.6% earned between $20,000–$29,999, 14.6% earned between $30,000–$39,999, 8.4% earned $40,000–$49,000, 3.3% earned $50,000–$59,000, and the remaining 4.2% earned $60,000 or more. For 36.7% of study participants, high school was their highest level of education. More than half (55%) of study participants reported experiencing high or marginal food security, 35% reported experiencing low food security, and 9.3% reported experiencing very low food security. There were no other statistically significant differences between English- and Spanish-speakers for the remaining demographic variables.p ≤ 0.05), which was consistent across age groups  and food security status  with a larger decrease among the FI. For the analyses that included education, income, or race, these between-subjects factors did not interact with the within-subjects factor . The estimated marginal means reveal that the 95% confidence intervals overlap for education, income, and race when tested individually against the outcome of interest shopping skills, indicating no differences between these variables.Results from the mixed-subjects ANOVA of the mean composite scores for shopping skills, attitudes toward cooking, cooking confidence, and nutrition facts label reading are shown in p ≤ 0.05). Specifically, those with incomes less than $20,000/year and those between $30–39,000/year reported the greatest improvements in attitudes. For the analyses that included education, income, or race, these between-subjects factors did not interact with the within-subjects factor . The estimated marginal means reveal that the 95% confidence intervals overlap for the intervention program, age, educational level, and race when tested individually against the outcome of interest attitudes toward cooking, indicating no differences between these variables.p < 0.001) regardless of the group variable under analysis and an interaction effect between time and food security status  with a larger increase in cooking confidence for the FI in comparison to the FS. No relationship was found for age, educational level, income, and race. The estimated marginal means reveal that the 95% confidence interval overlaps for age, income, educational level, and race when tested individually against the outcome of interest confidence in cooking skills, indicating no differences between these variables.p ≤ 0.001) and for those who were FI . There was no interaction between education, income, or race.Results from this study showed that the CM survey reliably measures the same constructs in an online format as it does in an in-person setting . These findings align with a previous study that found high internal consistency of CM surveys in an in-person setting . ReliabiThe mixed-subjects ANOVA analysis of changes in shopping skills from pre-survey to post-survey showed a statistically significant decrease in scores over time, no matter the age of participants. Additionally, higher-income participants demonstrated a larger decrease in shopping skills for healthy foods on a budget. One explanation for these findings may be that those earning higher incomes compare prices and incorporate budget-friendly meals less often than those living on a limited budget. Additionally, research has found that those with higher incomes spend more on food, especially ready-prepared meals and meals eaten outside of the home at restaurants, indicating that those with increased incomes may have as much of a need for shopping skills as those living on a more limited budget . ResultsFor attitudes toward cooking, participants with the highest income had the greatest increases in scores from pre-test to post-test. These results are consistent with previous research that found those with higher incomes are likely to have more kitchen equipment, more knowledge of how to utilize the cooking equipment and enjoy cooking meals more than those of lower socioeconomic status . In addiResults also revealed a statistically significant relationship between the intervention program and improvements in confidence in cooking healthy on a budget from pre-survey to post-survey. The food secure (FS) and FI experienced increased confidence in cooking healthy on a budget, with greater increases for those who were FI. These findings are supported by research by Pooler et al. , who fouThere are several limitations in this study. First, this study used a correlational design (pre-post design) comparing subjects to themselves from the pre-intervention to post-intervention. While results showed that there was an increase in cooking confidence, improved attitudes toward cooking, and the ability to read nutrition facts labels, it is not possible to discern if these results were due exclusively to the intervention implemented or if there were other reasons for these improvements due to the lack of a control group. Future studies assessing the impact of the CM program should employ a true experimental design to determine if there is a cause-and-effect relationship. However, the original purpose of this study was as a part of a larger national pilot study to understand if offering the CM curriculum in an online environment would be as effective as has been demonstrated in person. As such, the results provided indicate not only the reliability of the main constructs of the CM program but also point to the fact that there may be over time, improvements in these constructs are possible. There are few studies on the CM program and food assistance program recipients ,32, and Another limitation is that the study population only includes participants from the Ventura County (CA) WIC Program. Although WIC participants have some similar characteristics in terms of demographic information across the nation due to income eligibility criteria, the results of this study may not be generalizable to other WIC programs across the United States. The information in this study may be relevant for other programs that serve high proportions of Spanish speakers or whose program has a large proportion of Latino/a/Hispanic families.Finally, survey completion necessitated using a mobile device, tablet, or computer with stable internet access. Having internet access may have been a limiting factor for some WIC participants due to the costs associated with and/or accessibility in their region, especially during the COVID-19 pandemic. According to the United States Census Bureau, 94.5% of households in Ventura County have a computer, and 91.1% have a broadband internet subscription . HoweverOver the course of the COVID-19 pandemic, congress allocated 390 million dollars toward enhancing virtual services for WIC sites. There has been strong support among WIC participants for continued virtual services following the pandemic as these have reduced barriers to receiving benefits and nutrition education through WIC and are preferred by program participants ,14,24,34


With the inevitable technological boom enforced by the COVID-19 lockdowns and online emergency remote teaching practices, the prevalence of nomophobia (NMP) and smartphone addiction (SA) among adolescents has become a pressing issue, which has come under scrutiny. However, the impact of social media tools usage (SMTU) and digital gaming behavior (DGB) on these phenomena remains unclear since there is little research focusing on the complex interplay among these variables. Regarding this context, the present study aimed to explore the parallel mediating role of secondary school students’ SMTU and DGB in the relation between NMP and SA.In line with this aim, we employed a cross-sectional design with a critical case sampling strategy and collected data through an online survey from a total of 427 secondary school students in Istanbul in the 2021-2022 academic year. In order to test the parallel mediation model, we employed multiple linear regression models by utilizing PROCESS models with 5000 BC bootstrap samples and 95% CI.Results illustrated that there was an increase in the prevalence of NMP and SA during the COVID-19 home confinement as consistent with the previous research. The results also indicated that among the multiple mediators, the mediating role of SMTU was significant in the relation between NMP and SA. This means NMP has direct and indirect significant impact on SA through SMTU. However, the mediating role of DGB was found nonsignificant in this relationship. Our results are robust and hold key contributions to both theoria and praxis in educational psychology research realm by disentangling the complex underlying mechanism between NMP, SMTU, DGB, and SA. On the practical side, our results provide insightful implications for school boards and researchers in the development of effective interventions. Children, particularly school-age students, are susceptible to adopting new technologies into their daily lives . In conjunable to communicate, lose connectedness, unable to access information and give up convenience , or No Mobile Phone Phobia. NMP is a prevalent problem among younger generations and has become increasingly common more recently . The convenience . Althougvenience . With anvenience , NMP andvenience , SA and venience , DGB andvenience .In regard to pandemic conditions, home confinement and the curfews implemented during the COVID-19 pandemic and the resulting online participation of students in their classes have exacerbated students’ smartphone addiction . In a siIn view of these conflicting results existing in the literature, there is a need for exploration of the complex interplay between adolescents’ NMP and SA, SMTU and DGB as well as the underlying mechanism in this relation. Given this context, the present study aimed to investigate the mediating role of secondary school students’ SMTU and DGB in the relationship between NMP and SA. The study employed a cross-sectional design with a critical case sampling strategy and collected data through an online survey of 427 students in a secondary school in Istanbul during the 2021–2022 academic year. In order to test the parallel mediation model, multiple linear regression models with PROCESS macro using 5,000 bias-corrected bootstrap samples and 95% confidence intervals were used. The study’s findings present some invaluable implications for a better understanding of the role of SMTU and DGB in the relation between NMP and SA across secondary school students. More specifically, the present study holds key contributions to the existing literature in some respects. First, it discloses the complex interplay between the concepts of SMTU, DGB, NMP and SA. Additionally, it enables an increase in public awareness on digital media and the pandemic which have brought about behavioral disorders and technological addiction on secondary school students. The study adds to a better understanding of the mediating role of SMTU and DGB in the relation between NMP and SA. This study further highlights psychological implications of SMTU and DGB on psychosocial well-being and mental health. It also provides sociological implications of growing public concern about addictive SMTU and DGB. Additionally, the present study also provides some empirical originality regarding the critical case sampling since it is particularly useful in explaining phenomena of interest and it may provide unique insights into the relationship between NMP, SMTU, DGB, and SA among adolescents. Thus, we hypothesized a parallel multiple mediator model assuming that NMP impacts SA both directly and indirectly through SMTU and DGB across secondary school students in a context of COVID-19 home confinement.2.2.1.Social Cognitive Theory (SCT) provides an underpinning framework for Self-Regulation Theory (SRT). According to SCT individuals’ behavior is shaped by their cognitive processes, as well as the social and environmental contexts in which they live. SCT describes how individuals can use their cognitive processes to control their behavior and attain their lifelong goals . SRT wasSRT refers to the process of translating personal goals into action, which involves planning and adapting one’s thoughts, feelings, and behaviors to achieve desired outcomes . SRT can2.2.NMP is the anxiety and fear experienced by individuals when they are separated from or unable to use their mobile devices. It is increasingly prevalent as individuals get more reliant on their smartphones for social media and digital gaming. It is a real phenomenon which significantly impairs mental health and well-being causing symptoms of anxiety and depression . NMP hasSocial media tools have increasingly gained popularity amongst adolescents. Adolescents perceive social media as safe places to express themselves freely . ExcessiThe use of smartphones, while providing certain benefits, also brings about a number of associated problems. One such problem is the phenomenon of NMP, which can be defined as the fear of being without mobile phone contact. Research illustrates that excessive use of smartphones for SMTU and DGB has been linked to the development of NMP . The widGiven this context, previous research has attempted to explain the association between SA and NMP . In addiH1. NMP is positively associated with SA.H2.1. NMP is positively associated with SMTU.H2.2. NMP is positively associated with DGB.2.3.Smartphone addiction is characterized by compulsive smartphone use that disrupts individuals’ daily activities, such as their schooling and social interactions. Studies have shown that there is a positive correlation between the amount of time spent on smartphone use and the likelihood of developing smartphone addiction . ResearcAlthough DGB and SMTU differ in many aspects, the World Health Organization labels them as examples of excessive screen time . RecentlH3.1. SMTU is positively associated with SA.H3.2. DGB is positively associated with SA.2.4.Social media has become an essential aspect of adolescents’ daily lives. The widespread usage of internet and social media among adolescents in OECD countries has reached on weekdays 2 hours after school while on weekends more than 3 hours per day . The incResearch studies have indicated increased DGB and addictive SMTU have been linked to adverse outcomes and perception of decreased well-being . There iMoreover, the phenomenon of NMP results in various symptoms including feelings of isolation or loneliness, depression, social anxiety disorder, obsessive compulsive disorder, and other psychological disorders . A previOur literature review reveals that most studies testing mediation models have focused on various factors such as internet addiction and psychological maltreatment, social media addiction, mental health, academic performance, FoMO, depression, PSU, SA, and internet gaming disorder . These rH4.1. SMTU mediates the relation between NMP and SA.H4.2. DGB mediates the relation between NMP and SA.3.3.1.The present study employed a cross-sectional design with a multiple mediator approach in order to test parallel multiple mediator role of SMTU and DGB in the relation between NMP and SA during the COVID-19 pandemic lockdowns. The hypothetical conceptual model was presented in 3.2.The present study employed a critical case sampling strategy to determine the study group. Critical case sampling is a purposive sampling technique that is particularly beneficial in exploratory research as well as research with limited resources. It is also useful in situations where a single case or a small number of cases can provide decisive insights into the phenomenon under scrutiny. Thus, in the present study the rationale for employing critical case sampling is that the phenomena under investigation are regarded as in line with “it exists everywhere if it is here; if it is not here, it does not exist anywhere” , p. 237.The critical case in this study is one of the most prestigious secondary schools in Türkiye. It offers an advanced level of education with tuition-free facilities and boarding possibilities. Its diverse student body is drawn from all around Türkiye. The academic and extracurricular activities provided by the school encourage students to become lifelong learners and develop self-regulating, creative and critical thinking skills that enable them to contribute to society in various areas. The academic program is trilingual  with a university preparatory curriculum, spanning 5 years, including 1 year of German preparatory and 4 years of secondary school. Since 2000, the school has offered the German Abitur diploma, which allows successful students to attend almost any German, Austrian, or Swiss university in almost any major, and is recognized by several member states of the EU. The students in this school have consistently scored some of the highest marks in both the Abitur and Turkish university examinations. The school has been a pioneer in education for over 130 years and is well known in Türkiye for its achievements. In recognition of its excellence, it has been awarded ‘The Seal of Academic Excellence’ as a German international school by the German government. Regarding its notable alumni roster, the school has produced a substantial number of distinguished officials, encompassing three former prime ministers as well as a considerable array of ministers and high-level executives, throughout its historical timeline. Thus, the students in this school are expected to have developed increased self-regulating skills which will help them avoid distractions and addictive behaviors such as NMP and SA. However, depleted self-regulation capacity across the students will increase the likelihood of addictive SMTU and DGB, as well as NMP and SA. Therefore, the sample drawn from this case is critical and expected to explain the phenomena under investigation, namely the mediating role of SMTU and DGB in NMP and SA, which can be attributed to a rich source of data. If the phenomena exist in this school, it exists every secondary school, which will raise extensive public concern and require immediate action by policy makers, school boards, parents and researchers.Prior to data collection, the participants were presented with an online informed consent that provided details on the research objectives, research team, data collection, data processing, and the measures in place to safeguard participant privacy. Additionally, prior to the commencement of the study, a letter of approval was granted by the Ethics Committee Review Board of the affiliated university. Therefore, the study was conducted in accordance with the guidelines outlined in the Declaration of Helsinki. All participants voluntarily completed the surveys, and no incentives were offered to encourage participation.3.3.The data were collected through (I) Personal Information Form, (II) Smartphone Addiction Scale (SAS-SV) developed by 3.3.1.The form was developed by the researchers. It included open-ended questions to gather some demographics such as age, gender, grade level, and some other questions to assess problematic use of social media tools and digital games played by students. The number of social media tools they use and digital games they play was coded and transferred into continuous variables to serve as multiple mediators in the mediation model.3.3.2.strongly disagree” to 6 = “strongly agree.” The internal consistency coefficient of Cronbach’s alpha was 0.87, indicating high reliability, and the test–retest reliability coefficient was estimated as 0.93. In this study, the items of the scale yielded a mean score of 2.69 and standard deviation of 1.02, with a high internal consistency coefficient of 0.86.The SAS-Short Version is a self-report scale comprising of 10 items rated on a 6-point Likert scale. It was developed by 3.3.3.strongly disagree) to 7 . These ratings are then summed to generate a total score, with higher scores indicating greater severity of NMP. Furthermore, the NMP-Q score can be interpreted in terms of the level of NMP exhibited, with scores ranging from 20 to 140. Specifically, a score of 20 corresponds to an absence of NMP, while scores between 21 and 59 indicate a mild level, scores between 60 and 99 indicate a moderate level, and scores of 100 or greater indicate a severe level of NMP (α) was estimated for each subscale as such not being able to communicate α = 0.92, losing connectedness α = 0.85, not being able to access information α = 0.84 and giving up convenience α = 0.75. Cronbach’s Alpha (α) coefficient for the scale total is α = 0.92, which indicates a high level of psychometric quality. The scale items were summed as M = 3.24, SD = 1.18, indicating a mild level NMP.The NMP-Q was developed by Yildirim and Correia in 2015. The scale consists of 20 items loaded on four dimensions. Each item is rated using a 7-point Likert scale that ranges from 1 (l of NMP . In the 3.3.4.n = 357) reported that they use YouTube (83%). In the second place, 324 use WhatsApp (76%), and finally 278 reported that they use Instagram (65%).In order to specify the participants’ SMTU frequency, the participants were invited to complete an open-ended question to identify their preferences about social media tools. Regarding the social media tools they use, the great majority of the participants  at all. Regarding the games they play, 104 reported that they play Minecraft (24%), in the second place, 84 play Counter Strike (20%), and finally 75 reported that they play Among Us (18%).3.4.In the present study, the procedures of parallel multiple mediators model were employed as suggested by p value <0.05 was considered statistically significant when the CI did not include zero . Pearson correlation coefficient was estimated to examine the associations among the key variables. A multiple linear regression model was utilized to explore the potential mediating roles of SMTU and DGB in the relationship between NMP and SA. To investigate the parallel multiple mediating effect, we used Hayes’s PROCESS macros version 4.1. A bias-corrected confidence interval (CI) of 95% was calculated based on 5,000 BC bootstrapping samples, and a ude zero .3.5.To assess whether there exists an inflation or deflation of the true correlation among observable variables, known as common method bias (CMB), in the current study, an exploratory factor analysis (EFA) was conducted following the recommendation of Harman’s single factor test . The ana4.The participants consisted of 427 secondary school students who were receiving online courses during the COVID-19 home confinement. The participants were 128 females (30%) and 299 males (70%). 38 (8.9%) of the participants were 14 years old, 90 (21.1%) were 15 years old, 184 (43.1%) were 16 years old, 67 (15.7%) were 17 years old, 45 (10.5%) were 18 years old and 3 (0.7%) were 19 years old. The average age was 15.93. Regarding the grade levels of the participants, 79 of the participants (18.5%) were in the preparatory class, 173 (40.5%) were at the 9th grade, 99 (23.2%) were at the 10th grade, 58 (13.6%) were at the 11th grade and finally 18 of them (4.2%) were at the 12th grade. The participants reported that 56 (13%) use only 1 social media tool, 100 (23%) use 2, 130 (30%) use 3, 96 (22%) use 4, 38 (9%) use 5 and 12 (3%) use 6 social media tools. The average SMTU was reportedly 2.99. On the other hand, the participants reported that 117 (27%) do not play any digital games. 139 (32%) play at least one game, 80 (19%) two games, 53 (12%) three games, 18 (4%) 4 games, 25 (6%) 5 or more games. The average game play count was reportedly 1.55.4.1.Prior to investigating the multiple mediator role of SMTU and DGB, the means, standard deviations, Skewness-Kurtosis values, and correlation coefficients for key variables were estimated and presented in r = 0.216, p < 0.01) and SA . Additionally, SMTU positively correlated with DGB  and SA . However, DGB was not significantly associated with other key variables. The skewness and Kurtosis values were found to be in the range of ±1.5, which ensured the normality assumptions ]. Thus, H1 in our study was supported. Then, the mediating role of SMTU and DGB in the relationship between secondary school students’ NMP and SA was tested by employing BC bootstrapping with 5,000 samples. As a second step, the relationship between NMP and SMTU (a1 path) was tested. The a1 path was found to be positive and significant , supporting the second assumption and H2.1. Third, the relationship between NMP and DGB (a2 path) was tested. The a2 path was found to be negative and not significant , not supporting the third assumption and H2.2. Next, the relationship between SMTU and SA was tested (b1 path), which was found to be positive and significant . This also supported the fourth assumption and H3.1. Later, the relationship between DGB and SA was tested (b2 path), which was found to be positive but not significant . This finding did not support the fifth assumption and H3.2. The results also indicated that NMP has a significant indirect effect on the SA through SMTU. Thus, the mediating role of the SMTU was found to be positive and significant, supporting the sixth assumption and H4.1. However, the findings demonstrated that NMP did not have a significant effect on SA through DGB. Thus, the mediating role of DGB was found to be nonsignificant, not supporting the seventh assumption and H4.2. Additionally, the direct effect of NMP on SA (c’ path) became weaker but still significant in the presence of the mediator variable SMTU . This is an indicator of SMTU playing a partial mediating role. As a conclusion, SMTU partially mediated the relationship between NMP and SA. The results of the mediation analysis were introduced in There are two classifications of multiple mediator models. If the mediators are connected in a causal sequence, then it is called as the serial multiple mediator model. Alternatively, they are only associated with each other without causing any causal influence, it is called as the parallel multiple mediator model. Based on this distinction, a parallel multiple mediator model assumes that antecedent variable mediator . Given t5.Adolescents are increasingly affected by the developments in digital technologies, which has become more prominent with the outbreak of the COVID-19 pandemic. The pandemic enforced some infection control measures such as home confinement and lockdowns, leading adolescents to spend more time at home and rely heavily on ICT tools, which caused adverse psychological and behavioral effects . In partTo our knowledge, the present study is the first to explore the relationship between NMP and SA amidst the COVID-19 home confinement and the parallel mediating role of DGB and SMTU in this relation. Our findings revealed that NMP is positive predictor of SA and SMTU. However, no significant associations were found between NMP and DGB. SMTU is positively correlated with SA, and contrary to assumptions, no significant associations were found between DGB and SA. As for the mediating roles, SMTU partially mediates the relation between NMP and SA, however the mediating role of DGB on NMP and SA is not significant. Details about the findings were presented in the following sections.5.1.b = 0.541, t = 16.512, p < 0.001 [0.4768 /0.6057]). This finding is concurrent with some previous research findings, indicating that during lockdowns smartphone use and NMP increased dramatically  ]. This finding mostly overlapped with the previous research in the literature in that adolescents mostly use social media and play digital games through smartphones, which makes them vulnerable to addictive behavior and this might cause NMP amongst them  . This finding mostly concurred with the literature. Overuse of the internet, reliance on smartphones, and addictive use of SMTU and digital games are prevalent among adolescents. This situation can make adolescents more vulnerable to SA (This study found a significant positive association between SMTU and SA (H3.1 supported) . Thus, this finding was not congruent with the literature. Research illustrated that smartphones are regarded as the most important digital gaming and social media tools amongst adolescents . Contrary to assumptions and previous research findings, the study disclosed that there was no significant associations between DGB and SA (b2 path) ). This means adolescents’ level of NMP and SA was partially influenced by SMTU. We can conclude from the findings that SMTU is a significant positive predictor of NMP and SA on adolescents. Thus, adolescents who exhibit excessive SMTU are more likely to experience NMP and SA. Given the significant negative effects of NMP and SA on adolescents’ well-being, it is notable to pay some heed to SMTU and its potential negative impacts on mental health. Thus, it is crucial to draw attention to the issue of SMTU as a factor that could potentially lead to adverse outcomes for adolescents. The negative effects of addictive SMTU have raised concerns among adolescents and others, including mental distress, depression, sleep disruption, and insomnia . Additionally, the direct effect of NMP on SA (c’ path) became weaker in the presence of the mediator variable SMTU . Although most of the findings of current study were consistent with existing literature it was surprising to some extent that there was no direct effect of NMP on SA in the presence of DGB. Adolescents level of NMP and SA was not influenced by DGB. This can be an indicator of that adolescents’ performing excessive DGB does not lead to NMP and SA. We can conclude from the above findings that DGB is not a significant predictor of SA in adolescents. This result can be attributable to the special characteristics of the participants because they are the students who got the highest score of 500 and ranked in the 0.01 percentile according to the 2021 Nationwide Central Placement Exam. As they have a high academic orientation and achievement motivation, they can simply self-regulate their own addictive tendencies or employ digital gaming as a coping strategy to mitigate the negative impacts of COVID-19 lockdowns. Therefore, further research is needed to explore the potential mediating role of DGB in the relationship between NMP and SA, especially with diverse sample groups. This would not only help to confirm the current research findings but also provide a better understanding of the conflicting results in the literature regarding the positive or and negative outcomes of DGB. In addition, such studies could help to identify potential intervention strategies for addressing the addictive digital gaming and SA as well as their associated negative impacts on mental health.As a conclusion, the COVID-19 pandemic and resulting home confinements and lockdowns have led to an increase in excessive technology use among secondary school students. This has raised some concerns regarding NMP, DGB, SMTU, SA, and associated behavioral disorders and technological addiction. The present study documented some empirical evidence indicating the links between NMP and SA, NMP and SMTU, SMTU and SA across secondary school students. Surprisingly, no significant associations were found between NMP and DGB or between DGB and SA. Furthermore, the study proved the partial mediating role of SMTU in the relation between NMP and SA. However, no mediation was found for DGB. The study contributes to a better understanding of the complex interplay among NMP, SA, DGB, and SMTU as well as their prevalence during COVID-19 home confinement. The study provided some implications and recommendations for parents, teachers, schools, and adolescents to address the negative impacts of NMP, SA, DGB, and SMTU.6.The contribution of this research has a bilateral impact on research community both theoretical and practical sides. Regarding theoretical contributions, previous research has focused on the study of the associations between NMP and SA, NMP and DGB, NMP and SMTU and so forth. However, the present study provides some empirical evidence to explain the complex interplay between these variables in addition to highlighting the parallel mediating role of SMTU and DGB in the relation between NMP and SA. More specifically, our results are robust and contribute to a better understanding of underlying complex mechanism in this relation. Regarding practical contributions, it helps public understanding of addictive SMTU, DGB, NMP and SA during the COVID-19 pandemic which have brought about behavioral disorders and technological addiction across secondary school students. More specifically, the implications of our findings are significant for school administrators, teachers, and researchers, as they highlight the need for the development of effective intervention programs and classroom guidance initiatives aimed at assisting students who struggle with NMP and SA. These programs could be devised to address the underlying causes of smartphone addiction and nomophobia, promote healthy digital behaviors, and provide support for affected students. By implementing such programs, school systems and educational institutions can play an active role in promoting the mental health and well-being of their students, while also enhancing academic performance and fostering a positive learning environment.In addition to its key contributions, the present study provides some practical implications for society, as it sheds light on the psychological and sociological effects of social media and digital gaming on the psychosocial well-being and mental health of adolescents. The study also raises awareness about the growing public concern regarding addictive SMTU. Interestingly, our findings revealed that unlike SMTU, DGB was not significantly associated with NMP and SA. These results provide parsimonious support for previous studies highlighting the potential benefits of digital gaming . By incrDespite its several contributions, a few limitations of the study are inherent and should be acknowledged. First, the sample is restricted to Turkish adolescents studying in one of the most prestigious secondary schools with a highest 0.01 percentile according to the Nationwide Central Placement Exam results. Thus, critical case sampling employed in the present study calls for some caution regarding the generalizability of the results to other populations. Second, the study utilized a cross-sectional design, and relied on self-reported data, which could introduce common method bias (CMB). Therefore, there is a possibility of CMB in this study although we have tested for and no CMB was traced, it is still possible that the relationships between variables may have been over or underestimated. Thus, it was not possible to establish causal relationships between the variables under investigation. These biases are bound to exist and cannot be avoided in survey designs.Overall, the current research presented valuable empirical support for the previous research studies and contributed a better understanding of the interplay between NMP, SMTU, DGB, and SA. Still, there is a need for more research studies to provide a clearer picture of the phenomena under scrutiny. Therefore, future research may use longitudinal designs to further test the mediation model and reduce the potential for biases. Furthermore, future research should include larger and more diverse samples from various schools and cities and also can employ qualitative or mixed method research design to gain a more comprehensive understanding of the complex interplay among the variables.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Hitit University Non-Interventional Studies Ethical Board. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.