Sensing and remembering features in visual scenes are conditioned by visual attention and methods to guide it. This should be relevant in terms of product placement, which has become an important part of incorporating brands into different mass media formats with a commercial purpose. The approach can be challenging in 360° video, where an omnidirectional view enables consumers to choose different viewing perspectives, which may result in overlooking the brands. Accordingly, attention guidance methods should be applied. This study is the first to explore diegetic guidance methods as the only appropriate guiding method for an unobtrusive and unconscious nature of product placement. To test the effectiveness of three different diegetic guiding methods, a between-subject design was employed, where the participants were assigned randomly to one of four videos with the same scene but different guiding methods. The findings show and explain the discrepancy with studies on guiding attention in other contexts, as there were no significant differences between the guiding cues according to brand recall and brand recognition. The results also indicate a significant influence of brand familiarity on brand recall in 360° video. The article concludes by providing limitations, future research directions, and recommendations for audiovisual policy. Visual attention refers to sensing and interpreting relevant information and ignoring the rest by focusing on a certain aspect of the visual scene. It has had an increasing research interest across various fields throughout history , includiAs interrupted cognitive processes in advertising are not tolerated well by users , product360° video represents a promising, yet challenging format for placing brands , as consThis study focuses on the effectiveness of subtle diegetic guidance methods for enhancing placed brand memory in 360° video by examining the research question: Which diegetic guidance methods are the most effective for product placement in 360° video? The reasons for the appropriateness of exploring diegetic guiding in this context are threefold: (1) Diegetic guiding cues derive from the film`s theory, and are considered as a part of the scene ; (2) TheThis is the first study exploring the influence of diegetic guidance methods on product placement effectiveness in 360° video, and it is the first that addresses the issue of omnidirectional 360° view in terms of (over)looking the desired viewing perspective and placed brands. It is essential to explore the issue from the perspective of visual attention and guidance, as they can influence viewers’ memory and choices ,30. In aThis content is structured as follows. Sensations in the human eye are conditioned by a retina, comprised of a central fovea and a periphery . SensingCapturing and attracting viewers’ attention can generally be classified as bottom-up and top-down factors. The former refers to objects’ visual properties , while the latter represents a task or a goal that differs between individuals . Visual Guiding viewers’ attention in 360° video is similar to the real world. An omnidirectional view provides three degrees of freedom and an immersive viewing experience ,40, but Diegetic elements can be seen and heard by both viewer and the character and are part of the story. To capture and direct viewers’ attention, audiovisual and film producers can use different diegetic methods incorporated into the story world, such as moving protagonists and lights ,25. VisuProduct placement is an important form of advertising where directing visual attention can play a crucial role in detecting and recognizing placed brands. It differs from traditional advertising since commercial content and program content are not separated strictly . It can An integrative conceptual model has been developed for various factors influencing product placement outcomes . The latIn addition to the mentioned factors, technology-related variables can influence product placement effectiveness, where the impacts differ according to the technology condition , which iPrior studies explored the effectiveness of several methods for capturing and directing viewers’ attention in 360° video. Researchers ,25,52 coAnother study substantiated the positive influence of sound , moving objects, and lights on guiding viewers’ attention, where a beginning of a new scene turned out to be the most challenging . SimilarDespite prior studies exploring the cues for guiding viewers’ attention in 360° and virtual environments ,24,25,26From the marketing perspective, there is a need for research in this context, due to the omnidirectional nature of 360° video , where pH1. Respondents in the groups of diegetic guidance methods will have significantly higher (a) brand recall and (b) brand recognition scores than those in the control group.The research design consists of different stages, depicted in We used non-probability convenience sampling on users of the SurveyCircle platform, who were invited to watch a 360° video and fill in the questionnaire. Firstly, all the respondents answered the questions regarding control variables see . SecondlWe proposed a model of differences between diegetic guidance methods according to brand memory, namely, brand recall and brand recognition . In thisTo compare the effectiveness of different diegetic guidance methods, we have produced four 360° videos 90 s in length. The videos were produced with a monoscopic 360° camera in a controlled environment of a television studio. We did not apply any special editing methods, as they might have reduced the viewing experience . All theVideo 1 represents the content for the control group. It shows a protagonist, sitting on the couch and repairing the computer . He openVideo 3 (method: head pointing) depicts the protagonist, who is sitting on the couch and repairing the computer, while another character is sitting on the other side of the studio and watching him working . His heaVideo 4 (method: moving protagonist) shows the protagonist, who opens the studio door and goes past the camera to the other part of the scene . He grabUsers of the SurveyCircle platform could access the questionnaire comprising the relevant instructions and variables. Initially, they were not informed about the specific goals of the study, as this may have influenced the outcomes of being focused consciously on the placed brands . The stuA demographic part of the questionnaire asked participants about gender, age, and control variables—a device that will be used for watching the 360° video, and the experience of watching the 360° video. The latter was adapted from prior studies ,59 and cThe following section was programmed so that participants were assigned to one of four videos randomly (independent variables), and instructions were adapted to the device they had chosen for playing the video. In this light, they were informed to either click and drag (PC), move the device (smartphone/tablet), or move the head (HMD) to change the visual perspective.The next page included the dependent variables of brand recall and brand recognition that were adapted from prior studies ,60. Retun = 289), followed by Smartphone/Tablet (n = 69) and HMD (n = 3). The descriptive statistics of other ordinal control and dependent measures are reported in Three hundred and sixty respondents were assigned randomly to either video 1 (no cue), video 2 (sound), video 3 (head pointing), or video 4 (moving protagonist). The numbers of respondents per video were 88, 85, 95, and 93, respectively. Among the participants, 229 were females, 126 were males, and six identified as others. Participants were aged between 15 and 65 (average age = 27). The majority of respondents watched 360° video by means of a PC (p < 0.001). In turn, the non-parametric Chi-Square Test of Homogeneity was used, to determine whether there was a difference in product placement effectiveness between the three groups of guidance cues and the control group.The Shapiro-Wilk test was used to test the distribution of the variables of brand recognition and brand recall, which was essential for choosing an appropriate test for statistical analysis. The test showed that the distributions of brand recall and brand recognition were significantly different from a normal distribution (p = 0.887). Thus, H1(a) was not confirmed.The lowest percentage of brand recall was in video 3 (head pointing), while video 4 (moving protagonist) resulted in the highest percentage of brand recall . Despitep = 0.675), meaning that H1(b) was not supported.In terms of brand recognition, there were higher scores in all the groups. Video 1 (no cues) resulted in the lowest percentage of recognized brands, while video 4 (moving protagonist) again had the highest score . HoweverThe results mean that we have not proven the effectiveness of one diegetic guiding cue over the other according to brand recall and brand recognition. A binominal logistic regression was performed, to ascertain the effects of control variables—age, experience, gender, device, brand familiarity, and video type, on the likelihood that participants recall and recognize the brand. The important assumptions for conducting the test were met, namely, dichotomous dependent variables, more independent variables, independence of observations, more than 15 cases per independent variable, a linear relationship between the continuous  independent variables, and the logit transformation of the dependent variables, and no significant outliers.p = 0.175. Out of six independent variables, only brand familiarity added significantly to the model/prediction  = 13.949, 2(10) = 14.629, p = 0.146. None of the six predictor variables was statistically significant . On the other hand, more overt or non-diegetic guiding cues could likely result in higher brand memory, but exploring the latter would interfere with the concept of product placement concerning the unobtrusive brand placement  that shon = 360) for comparing four different categorical groups. However, the interpretation of the results derives from the assumption that all the participants watched the entire length of the 360° video. We suggest an experimental design with enforced internal validity and control for future studies, where fewer guiding methods should be applied due to possible smaller sample sizes. In addition, brand memory is not connected directly with visual attention. An eye-tracking methodology should be applied to explore the deviations between visual attention and brand memory [The questionnaire with the incorporated videos provided a sufficient sample size . It also stresses the importance of brand familiarity and provides important policy implications and future research directions regarding the guiding methods in relation to the technology condition, brand familiarity, and video type.


Long block length rate-compatible low-density parity-compatible (LDPC) codes are designed to solve the problems of great variation of quantum channel noise and extremely low signal-to-noise ratio in continuous-variable quantum key distribution (CV-QKD). The existing rate-compatible methods for CV-QKD inevitably cost abundant hardware resources and waste secret key resources. In this paper, we propose a design rule of rate-compatible LDPC codes that can cover all potential SNRs with single check matrix. Based on this long block length LDPC code, we achieve high efficiency continuous-variable quantum key distribution information reconciliation with a reconciliation efficiency of 91.80% and we have higher hardware processing efficiency and lower frame error rate than other schemes. Our proposed LDPC code can obtain a high practical secret key rate and a long transmission distance in an extremely unstable channel. The cryptosystem based on computational complexity is being challenged by increasingly developed quantum computation. Quantum key distribution (QKD) ,2,3,4, bCurrently, there are mainly two types of QKD protocols, called discrete-variable QKD (DV-QKD)  and contR is the rate of key and K is given byDue to the imperfection of the quantum channel and potential eavesdropper Eve, the key strings held by Alice and Bob are not consistent, so that a procedure called post-processing is necessary to make them identical. The post-processing of CV-QKD mainly includes four steps: base vector comparison, parameter estimation, information reconciliation and privacy amplification. Information reconciliation is the most important part, whose performance has a direct correlation to the secret key rate. One of the major factors in information reconciliation is reconciliation efficiency nit time . IAB is The parameters mentioned above is related to the error correcting codes, among them low-density parity-compatible (LDPC) code is efficient for CV-QKD . The LDPHowever, quantum is easily influenced in the process of quantum signal preparation and transmission. To realize the free space QKD with satellite ,12, shipOne of the simplest rate-compatible methods for LDPC code is to operate on single-matrix using puncturing, shortening and extending. Furthermore, Gao proposed multi-matrix rate-compatible reconciliation where, in each iteration, multiple matrices produce more useful information to correct errors such that the iteration number falls and the convergence speed increases . HoweverIn this paper, we first obtain degree distribution with discrete density evolution and differential evolution algorithm. Then we use random construction, progressive edge growth (PEG) algorithm and rate compatible methods of extending and puncturing to construct a check matrix with a code length of 64,800. Finally, we extend the above LDPC code with quasi-cyclic extension to a code length of 648,000. The results show that the proposed codes have a reconciliation efficiency of 91.80%, higher hardware processing efficiency and lower FER than other schemes. Therefore, we can obtain a high practical secret key rate and a longer transmission distance in an extremely unstable channel with wide range of SNRs.The remainder of this paper is organized as follows. In In this section, we first briefly introduce the discrete density evolution and differential evolution, which are used to generate degree distribution. Then we introduce the constructions: random construction, PEG algorithm and QC-LDPC extension, with which we can construct the check matrix with the degree distribution ahead. We also introduce the rate compatible methods: puncturing and extending.Q and probability mass function S.We firstly define two functions: quantized function x; and x. The value range of decoded message is R isa and b are quantized messages.In which two-input operator The check node and variable node updating of discrete density evolution isl is the iteration number. The initial value ⨂ is discrete convolution and Finally, we calculate the error rate withl reaches the maximum number of iterations. Otherwise, we continue to update the check node and variable node.End the procedure when the Compared with continuous density evolution  and GausDiscrete density evolution is first proposed to obtain the noise threshold according to the degree distribution Stom first proposed the differential evolution algorithm in 1995 to solve the optimization problem . It usesn.Set channel noise threshold Randomly generate i, randomly choose four vectors from set of For each Calculate the corresponding error probability i, compare For each If the error probability corresponding to the best vector In this work, we use random construction, the PEG algorithm and QC extension for their good results in various situations.Various random constructions have been proposed based on the same core thought, that is, place non-zero elements in random unfilled positions in the check matrix without violating any set constraint. There are two constraint rules: one is that line Before introducing the PEG algorithm, we first introduce a common representation of LDPC codes—the Tanner diagram and several concepts. As shown in Determine the number of check node, variable node and the degree distribution of variable node.Randomly choose a variable node l, the set of check nodes adjacent to l. When l, connect the check node Take the variable node Repeat step (2) to add edges to the selected variable nodes until all of them are added.Repeat steps (1) to (3) to add edge for all other variable nodes.For the PEG algorithm, new edges are added to make the loop girth in the Tanner diagram corresponding to the check matrix as large as possible. As shown in QC-LDPC extension is uniquely determined by the dimension and shift times of the circulant matrix. Its quasi-cyclic characteristics make the process of coding and decoding more efficient. Compared with randomly constructed LDPC codes, QC-LDPC codes have lower error level and are more convenient for storage and hardware implementation. We multiply the corresponding positions of the base matrix Take lifting size of 3 as an example, the elements of the base matrix are 0 and 1, and the elements of the coefficient matrix are 1, 2 and 3. Then the matrix elements are replaced by the cyclic permutation matrices (CPMs). We replace 0 with zero matrices, 1 with Puncturing is a method that makes the code rate change from low to high. As shown in On the contrary, extending as shown in From the Equation  we can sWe first obtain the initial optimal degree distribution using discretize density evolution and differential evolution refer to From the initial optimal degree distribution, we find that the pairs of degree distribution are distributed nearby Algorithm 1: Obtaining the ultimate variable degree distribution with density evolution and differential evolutionInput:  Target error probability Output:  Error rate 1:fori = 1 to do2:    refer to 3:    calculate the error probability 4:if then    5:        6:end if    7:end for8:fordo9:    randomly choose four numbers 10:    11:    calculate the error probability 12:if then    13:        output 14:end if    15:if then    16:        17:end if    18:end forThrough the above operations, we obtain the degree, the maximum degree of the variable node, and the number of terms of the degree distribution polynomial. Ultimately, we calculate the optimal degree distribution for proposing our LDPC code with Algorithm 1.In order to maximize the use of limited key resources, we still need to fully consider the condition of rate lower than 0.1. Obviously, the secret key rate is low for the low mutual information With the degree distribution we obtained above, we construct a single matrix RC-LDPC code simultaneously with the random construction, the PEG algorithm, and QC-LDPC codes mentioned in The part A is a shared part for the rate from 0.1 to 1, which is constructed with at SNR∼3 , while rat SNR∼3 . TherefoR decreases every 0.05. For rate from 0.3 to 0.1, this number is 0.1. We use PEG algorithm to construct The part B is constructed with rest of degree distribution to realize the rate-compatible method of puncturing. In order to further improve the performance of our LDPC code, we construct the check matrix with the thought of puncturing. More specifically, we divide submatrix Multi-edge-type (MET)-LDPC codes are employed with low SNRs due to their good error-correcting performances, more amenable decoding complexity and also being able to be rate-compatible at low rates . Based oIn this section, we summarize the implementation results of the proposed LDPC codes over an unstable channel. Our purpose is to construct a RC-LDPC code with single matrix that can be adapt to the SNR from 0.01 to 15. We show the performance of reconciliation efficiency R reduces to a certain extent. When R is from 0.3 to 1, C decreases 0.1 to an integer multiple of 0.1. When R is from 0.01 to 0.3, C decreases 0.05 to an integer multiple of 0.05. In The reconciliation efficiency comes from n and the number of data blocks that have to be processed is m. Suppose the secret key rate that optical system can provide is M, the number of data blocks m is From Equation , the secn increases. Meanwhile, difference of hardware reconciliation efficiency between our proposed LDPC code and ATSC 3.0 LDPC code also increases.Because of the finite-size effects, the block length in the procedure of privacy amplification is at least resource ,27, so tFrame error rate is the rate that a data block failed to be decoded. It is mainly caused by two reasons: the defect of error correcting code and decoding algorithm; the unadaptable check matrix led by the changing of SNR. The FER caused by the defect of error correcting code and decoding algorithm can be reduced to r reason . TherefoN and has a lower performance reduction when the N increases. This comes from the fact that combined action of reconciliation efficiency Given the excess noise, efficiency of receiver’s detector and electronic noise at Bob’s side, we can calculate the practical secret key rate . Figure In this study, we design a rule of proposing a RC-LDPC code with single matrix for SNRs between 0.01 and 15 to solve the problems of great variation of quantum channel noise and extremely low SNR. First, we use the discretized density evolution algorithm and differential evolution to acquire good node degree distribution pairs of LDPC codes. Then, with construction methods including PEG algorithm, random construction, quasi-cyclic extension and rate-compatible methods including extending and puncturing, we proposed a convenient and efficient construction method for designing a RC-LDPC code. Considering the number of check matrix changing times led by the change of SNR, the result shows that we have a reconciliation efficiency of 91.80%, higher hardware processing efficiency and lower FER. It has a good performance especially in an extremely unstable channel.


Restrictive eating disorders such as anorexia nervosa and atypical anorexia nervosa typically result in development of protein energy malnutrition. In severe protein energy malnutrition, alterations occur in all organ function, metabolism, and endocrine systems. Electrolyte levels must be closely monitored, particularly after initiating refeeding to avoid the refeeding syndrome, a rare but potentially deadly complication of refeeding the malnourished patient –5. Anore2 is recognised as conferring severe malnutrition. In adolescents, a BMI < 70% median BMI (corresponding approximately to a BMI < 5th percentile) indicates severe malnutrition. The Society for Adolescent Health and Medicine (SAHM) has expanded the definition of severe malnutrition in adolescents and young adults to include not only a low BMI, but also includes those who have lost > 20% of body mass over a period of one year or > 10% body mass over six months, in recognition of the effect of weight suppression on severity of medical complications [Weight and BMI are the most commonly used terms to categorise the severity of malnutrition. In recent years, our understanding of severe malnutrition has evolved with the recognition that individuals with eating disorders can demonstrate the physical and psychological effects of malnutrition even at normal or above normal weights. A new diagnostic category in DSM-5 “Atypical Anorexia Nervosa” describes those individuals who have lost a significant amount of weight but whose weight is in the normal or above normal range . Weight 2, < 65% IBW) hospitalized on their medical stabilization unit [Gibson et al. describe the medical findings of 281 severely malnourished adult patients with extreme anorexia nervosa (BMI < 15 kg/mion unit . On admiIn an echocardiographic study of 124 severely malnourished adult patients with anorexia nervosa, Hanachi et al. [Taken together, these two studies demonstrate the high rates of medical complications in severe anorexia nervosa.The use of consensus-based guidelines has continued to inform assessment and refeeding practices in anorexia nervosa. This consensus-based approach –15, has Parker et al.  explore In this special edition, two papers examine the effect of macronutrient content on refeeding outcomes, an important yet understudied topic. Theoretically, a high carbohydrate load has been postulated to increase the risk of hypophosphatemia by stimulating an insulin surge and driving phosphorus and other electrolytes intracellularly . The preRefeeding outcomes with variation in macronutrient content were also assessed by Parker et al. . Their sBoth the Draffin and the Parker papers had small sample sizes and one studied oral refeeding while the other addressed enteral refeeding. More research of the optimal method and macronutrient content for refeeding is needed to better inform clinical practice.Taken together, the articles in this special edition of the journal demonstrate that severe malnutrition in restrictive eating disorders is associated with significant medical complications but also illustrates the importance of challenging existing consensus- based treatment recommendations regarding nutritional rehabilitation. The time has now come to replace existing refeeding guidelines with recommendations that are evidence-based.


Video game–based therapeutic interventions have demonstrated some effectiveness in decreasing the symptoms of attention deficit hyperactivity disorder (ADHD). Compared with more traditional strategies within the multimodal treatment of ADHD, video games have certain advantages such as being comfortable, flexible, and cost-efficient. However, establishing the most appropriate type(s) of video games that should be used for this treatment remains a matter of debate, including the commercial existing video games or serious video games that are specifically constructed to target specific disorders. This guide represents a starting point for developing serious video games aimed at treating ADHD. We summarize the key points that need to be addressed to generate an effective and motivating game-based treatment. Following recommendations from the literature to create game-based treatments, we describe the development stages of a serious video game for treating ADHD. Game design should consider the interests of future users; game mechanics should be based on cognitive exercises; and therapeutic mechanisms must include the control of difficulty, engagement, motivation, time constraints, and reinforcement. To elaborate upon this guide, we performed a narrative review focused on the use of video games for the treatment of ADHD, and were inspired by our own experience during the development of the game “The Secret Trail of Moon.” Attention deficit hyperactivity disorder (ADHD) is the most frequent neurodevelopmental disorder with a worldwide prevalence ranging between 4% and 8% . Core ADAccording to guidelines, the treatment of choice for ADHD is multimodal . Low adhAccording to the Interactive Software Federation Europe , there aThe aim of this Tutorial is to provide a basic guide for developers of serious video games targeting ADHD by considering the particularities  of this disorder. We offer a roadmap for companies, programmers, and researchers interested in this field. We take advantage of our own experience in developing the serious game “The Secret Trail of Moon” (TSTM) -23, a seVideo games offer intrinsic benefits that can be exploited for other purposes. Some studies stressed that video games could have beneficial cognitive effects on attention and visuospatial abilities in adults ; can impVideo games created with nongame objectives, which are known as “serious video games,” have been developed for different activities such as training, education, or evaluation in nonludic environments . SeriousVideo game–based therapeutic interventions have proven to be useful in health care environments. As previously mentioned, children with ADHD have low intrinsic motivation and poor internal language, which make it difficult for them to complete tasks, leading to procrastination. This low intrinsic motivation causes them to become bored earlier, relying more on an external stimulus or more engaging tasks . TherapeTaking into account the references on the creation of health-based games mentioned in the Introduction, we have adapted Kinross’  proposalThroughout the process, the collaboration of a multidisciplinary team is essential to balance clinical and technical components . Duncan In the video game industry, a preproduction phase is common. The idea starts by detecting an unmet need. The planning of a project is key to obtain a quality product that is developed within the estimated time and cost. In the case of game-based treatment, the team should stress the main treatment goal, which is based on the literature and the theoretical models chosen. Problem definition determines the final goal. In our example, TSTM  was baseThe idea stage is similar to the preproduction of a video game and refers to the process where a multidisciplinary team identifies the therapeutic goals of the video game. This stage provides a clear overview of what the team aims to achieve during the game-play experience and the first drafts of the game that will be developed in the next stage of the process. They should identify the targeted variables aligned with the therapeutic objectives and the strategies that will be followed to achieve the desired outcome. In the case of TSTM, developing these game mechanics involved hours of discussion within the team to find a balance between psychology and technology: the developers wanted a fun game, while the mental health professionals required internal validity of the game based on psychological constructs. The use of new technologies may enhance ecological validity through incorporating complexity, novelty, and diversity in the process of developing the video game . HoweverVirtual reality (VR) has been a major challenge in the development of TSTM. An example of this is the Kitsune game , which wIn this stage, the multidisciplinary team builds the game’s prototype, considering the game components highlighted by Kinross : game meSince video games intrinsically have a motivational design , a serioThe UCD methodology also allows for recording user performance; collecting this preliminary data with real users allows for closer adjustment to the patient’s needs. In the development of TSTM ,22, therThe initial TSTM design was modified following suggestions from patients with ADHD about esthetics, game difficulty, or rewards . The UCDTreatment with therapeutic video games may help to improve adherence to multimodal treatment in ADHD by bringing patients closer to treatment.The game’s theme is important in the design process, as player preferences may differ from one player to another. Games such as EndeavorRx  or Plan-A serious video game also has the following requirements: (1) easy to understand, (2) require a minimal cognitive load (baseline), and (3) gradual level of difficulty. The baseline can be designed as an in-game tutorial. It is important to ensure that the person has understood the task and how to perform it. All of these elements were examined in the previously mentioned usability study for TSTM . The afoSampayo-Vargas et al  stressedTo avoid boredom, game design components should be included in any serious video game related to objects, mechanics, dynamics, and emotions . “JuicinPeople with ADHD have limited self-perception and objectivity in task performance . TherefoAlthough video games are usually visually based, music and sounds are also fundamental elements that facilitate flow in video games alongside other elements. However, these elements should not be overwhelming, because people with ADHD are more likely to be distracted. Thus, audio-visual integration can be used to vary the intensity of emotional experience states . To faciPeople with ADHD present broad clinical and cognitive variability . AccordiDovis et al  suggesteAs previously discussed, people with ADHD may be more dependent on extrinsic motivation ,52. ChilResearch estimates that the average student's attention span is 10-20 minutes ; howeverConsequently, we have to reach a compromise between reinforcing the patient's attention beyond their own attention span and reducing gaming time to avoid addiction. Following the state of the art -17, treaKing et al  proposedSessions should last approximately 20-30 minutes depending on the patient’s age. We recommend dividing the session into a variety of tasks . Every 1According to Koster’s  definitiIn a serious video game, game mechanics are the main intervention components through which patients acquire metacognitive strategies and skills to improve their cognitive abilities . Game meAnalyzing the serious video games included in several recent reviews -17 led uMini games can be created by adapting a cognitive task using game-up and mapping techniques  or from Inattention is one of the core symptoms of ADHD . In tradLastly, one of the major criticisms of the use of serious video games is the lack of ecological validity ,40. ThusThe exploration stage of the IDEAL-Games framework  ensures In the video game TSTM, we used UCD methodology ,37 to foAssessment is critical to determine the effectiveness of a serious video game . AlthougAs mentioned above, studies sometimes present difficulties in demonstrating transfer and ecological validity. Although some studies demonstrated that playing video games for 16 hours already produce certain changes in the brain , it is eThis guide aims to provide a roadmap for video game developers and researchers to build a serious video game that is fun, motivating, and effective in treating ADHD, while avoiding addictive properties. Following the IDEAL-Games proposal  and suggThe use of video games for treating ADHD has many advantages: (1) it is cheap, comfortable, flexible, and cost-efficient ; (2) the use of novel platforms  may improve not only adherence but also the clinical effects if transferability is demonstrated; and (3) the incorporation of AI may offer more personalized treatments for each patient.Although serious video games promise to be an effective and interesting treatment platform, several limitations should be mentioned. For instance, serious video games must be tailored to the singularity of every patient . We must also consider the possibility of some conditions such as motor difficulties, visual impairments, dyslexia, or color blindness, among others that may compromise effectiveness, and introduce adaptations if necessary. In addition, patients may be unfamiliar with technological platforms. Accordingly, a gradual approach is recommended. Furthermore, technological platforms could have side effects . For exaWe hope that this guide assists the development of serious video games for ADHD. We stress the relevance of having a multidisciplinary team to balance clinical and technical skills . FurtherDespite the lack of studies comparing the effectiveness of commercial and serious video games on ADHD, we consider that serious video games have several advantages such as the specific design for symptoms and defective executive functions, although preventing the development of an addiction to the video game is essential.Finally, evidence-based video serious games could help to complement multimodal treatment. Currently, the diagnosis of ADHD is based on clinical criteria, objective tests, and the subjective view of caregivers and teachers. However, recent studies suggest that video games may also assist in improving ADHD diagnoses. Future actions such as incorporating new technologies  while using a serious video game may help to improve the current subjective diagnoses of ADHD.


Risky health behaviors in childhood, including smoking, alcohol consumption, and having a poor diet, are the major sources of non-communicable diseases in adulthood. This study aimed to examine how parents affect children's risky health behaviors and whether intergenerational transmission differs based on socioeconomic status (SES).n = 5,946), alcohol consumption , and sugar-sweetened beverages (SSBs) consumption  were used as proxies for risky health behaviors in children. A binary choice model for panel data with a random-effect specification was employed to examine whether risky health behaviors can be transmitted from parents to their children. Subsequently, we conducted a seemingly unrelated estimation test (SUEST) to explore the differences in parental transmission between the different SES groups.Data were extracted from the 1991–2015 China Health and Nutrition Survey (CHNS). Smoking (We found strong intergenerational persistence of smoking, alcohol drinking, and SSBs drinking behaviors, except for the mothers' smoking behavior. Mothers had a greater influence on children's alcohol drinking and SSBs drinking behaviors than fathers both in urban and rural areas and in different SES groups. The intergenerational transmission of SSBs drinking behavior exhibited a decreasing trend with increasing SES for both urban and rural families. In urban areas, mothers' alcohol drinking behavior has a decreasing trend with increasing education level, occupation, and income; however, in rural areas, the influence of mothers' alcohol drinking behavior occurred in the same direction with increasing education level and occupation type. In rural areas, the influence of fathers' drinking and smoking behaviors on children appears to mostly increase with increasing SES. Meanwhile, the influence of such behaviors among urban fathers would decrease with increasing SES.Parents' behaviors and SES can influence the initiation of risky health behaviors in their offspring. Thus, to promote healthy behaviors, policymakers can introduce health education programs for parents, particularly for those living in rural areas and with a low SES. Risky health behaviors, such as smoking, drinking alcohol, and having a poor diet, are major potential causes of death –6 and arFamily is a key environment that influences children's behavior. As children's first teachers and socializing agents, parents' negative health behaviors can act as a bad model for their children –28. In aThere have already been many studies on the relationship between SES and children's risky health behaviors; however, whether SES differences affect the intergenerational transmission of unhealthy behaviors has not been sufficiently clarified. Previous studies have focused on parents' own behavior and the relationship between SES and parenting styles, which provide a reference for our own research proposition , 40–44. In the hope of adding up-to-date evidence to previous cross-sectional studies and using the longitudinal database from the China Health and Nutrition Survey (CHNS), this study aimed to examine how parents affect children's risky health behaviors. China, a developing country with rapid economic growth, is quite different from developed countries that have been studied earlier in this field , 33, 39.The primary database used in this study was the CHNS. The CHNS is an ongoing nationwide cohort project in China with 10 available waves from 1989 to 2015. These areas are representative and diverse in terms of a wide range of socioeconomic factors  and other related demographic, health, and nutritional factors. As only individuals aged between 20 and 45 years were surveyed in 1989, we excluded the baseline data, and only used data from 1991 to 2015 in the analysis, singling out smoking, alcohol drinking, and SSB drinking as proxies for risky health behaviors in children aged <18 years. We excluded samples with outliers and missing data, leaving 5,946 observations in the smoking group, 7,821 observations in the alcohol drinking group, and 3,537 observations in the SSBs drinking group. After matching the parent's ID with the child's ID, we obtained 24,573 observations in total: 4,609 observations in 1991, 4,140 in 1993, 3,577 in 1997, 3,312 in 2000, 1,972 in 2004, 1,583 in 2006, 1,424 in 2009, 1,782 in 2011, and 2,174 in 2015. Due to the existence of missing values in the dependent and control variables, we had to drop records containing missing values. Finally, we obtained 5,946 observations in the sample of children's smoking behavior, 7,821 observations in the sample of children's alcohol drinking behavior, and 3,537 observations in the sample of children's SSBs drinking behavior.The main dependent variables in this study were children's smoking, alcohol drinking, and SSB drinking behaviors. Smoking was assessed using the question, “Have you ever smoked?,” and was coded as 1 if the respondent answered “Yes.” Alcohol consumption was assessed based on the question, “Did you drink beer or any other alcoholic beverage?” and was coded as 1 if the respondent answered “Yes.” SSBs consumption was assessed based on the question, “Did you drink soft drinks or sugared fruit?” and coded as 1 if the respondent answered “Yes.” All risky health behaviors were answered by the respondents. We then linked answers from the parent questionnaires to those of their children.The independent variables were the risky parental health behaviors of these children, which were also assessed based on the three questions above. To analyze how risky health behaviors are transmitted from parents to their children, we also included parental SES variables, including educational attainment , household per capita income (RMB in 2015), and career type . Demographic variables, such as age (years) and sex , were also included. In addition, we controlled the area  and wave  effects. The variable of education was transformed into a dichotomous variable, with >6 years of education being classified as a high level of education, and ≤ 6 years of education being classified as a low level of education.t-tests for continuous variables were conducted, and p-values were reported.Data analyses were conducted using STATA/SE 14.0. Descriptive statistics for both parental and children's risky health behaviors, including smoking, alcohol use, and drinking SSBs, were reported as proportions, with corresponding chi-square tests to examine whether these behaviors were statistically significant for transmission from parents to their children. Parental SES and demographic variables were also estimated as proportions for categorical variables and means for continuous variables; chi-square tests for dichotomous variables and psmoking= 1.000, palcohol= 0.9043, pSSBs= 0.7745). Odds ratios (ORs) with their p-values are reported. The model is specified as follows:To investigate whether parental risky health behaviors could be transmitted and how these behaviors were transmitted, we adopted a binary choice model for panel data with random-effect specification after conducting the Hausman test  for regression in different subgroups, and drew a bar chart with confidence intervals. Regarding parental education level, we divided parents into low-level ( ≤ 6 years) and high-level (>6 years) education subgroups. Regarding income, those with an income equal to or lower than the average were included in the low-income subgroup, whereas those with an income higher than the average were included in the high-income subgroup. Finally, we divided occupations into manual labor and non-manual labor subgroups and then conducted a subgroup analysis. To test the differences in the coefficients The variables used in this study are displayed in The prevalence of smoking, alcohol consumption, and SSBs consumption in children was 4.37, 6.43, and 82.16%, respectively. Boys had significantly higher proportions of these three risky health behaviors than girls. Children who smoked and drank alcohol were significantly older than those who did not smoke and drink alcohol, while those drinking SSBs were significantly younger than those who did not drink SSBs.Both fathers and mothers of smoking children had higher smoking rates, while the difference in mothers' smoking rates between smoking and non-smoking children was not significant. Both fathers and mothers of children who drank alcohol had a significantly higher rate of alcohol consumption than those who did not drink alcohol. Similarly, among children who drank SSBs, both fathers and mothers had a significantly higher ratio of drinking SSBs than the fathers and mothers of children who did not drink SSBs.p < 0.01) than children who had a non-smoking father. While the intergenerational transmission of fathers' smoking behavior was observed among rural children, the intergenerational transmission effect was even more pronounced among urban children; smoking fathers increased the probability of children smoking by 2,506% (p = 0.034). Considering the unreliability of the small sample size on mothers' smoking, maternal smoking transmission is not reported here.The results of the logistic regression for intergenerational transmission of risky parental health behaviors in Chinese children are presented in p < 0.01) in the total sample, 119.4% (p = 0.01) in the urban sample, and 52.6% (p = 0.012) in the rural sample. Mother's alcohol consumption increased the possibility of alcohol consumption by 257.4% (p < 0.01) in the total sample, 214.7% (p < 0.01) in the urban sample, and 239.5% (p < 0.01) in the rural sample.Similarly, to smoking fathers, fathers who drank alcohol increased the possibility of alcohol drinking in their children by 71.5% (p < 0.01) than children whose fathers did not drink SSBs. Indeed, SSBs drinking could increase the likelihood of children consuming SSBs by 259.2% (p < 0.01). A similar intergenerational transmission of this behavior was observed in both urban and rural children. Gender plays an important role in the intergenerational transmission of risky health behaviors. Boys were ~8,316, 353.3, and 25.1% more likely to smoke, drink alcohol, and drink SSBs, respectively, than girls. Furthermore, age also plays an important role in the intergenerational transmission of smoking and alcohol consumption. Similar effects were observed in both urban and rural children.Likewise, in the total sample, children whose fathers drank SSBs were ~161.2% more likely to drink SSBs  and alcohol drinking ; however, the OR of SSBs drinking dropped from 5.302 to 2.393, in the low education vs. the high education group, respectively. From low education level to high education level, the OR of the mother's alcohol drinking behavior decreased from 3.545 to 3.509, and the OR of maternal SSBs drinking decreased from 5.090 to 2.972, with insignificant differences in coefficients between the maternal low education and high education groups.The higher the father's education level, the more significant the intergenerational transmission of smoking , alcohol drinking , and SSBs drinking  than fathers in the non-manual labor group. Non-manual labor mothers showed significantly fewer intergenerational transmission effects of alcohol drinking  and SSBs drinking .Fathers in the manual labor group had a more significant intergenerational transmission of smoking . In contrast, the transmission effect of fathers' wine drinking behavior became stronger  as income increased. Both mother's alcohol drinking behavior  and SSBs drinking behavior  decreased from the low-income to the high-income group.With an increase in income, fathers' intergenerational transmission effect of smoking and SSBs consumption became weaker and insignificant  and alcohol drinking  increased, but the OR of fathers' SSBs drinking behavior dropped from 3.294 to 2.339. The OR of highly educated mothers' alcohol drinking behavior increased from 2.542 to 5.354, and that of maternal SSBs drinking reduced from 5.408 to 3.403, with significant coefficient differences  than mothers in the low-education group.With the rise in paternal education level, intergenerational transmission of fathers' smoking  than in fathers in manual labor jobs. Meanwhile, –labored fathers were less connected with children's alcohol drinking  and SSBs drinking . Furthermore, mothers in non-manual labor jobs showed significantly lower effects on children's alcohol drinking  and SSBs drinking  than mothers in manual labor jobs.Smoking in fathers in non-manual labor jobs had a stronger effect on children's formation of this behavior , with a similar effect being observed for fathers' wine drinking behavior . On the contrary, the influence of fathers' SSBs drinking behavior on their children's behavior went through a process of weakening as income increased , and the coefficient difference was significant . Both mother's alcohol drinking behavior  and SSBs drinking behavior  decreased from the low-income to the high-income group (pssbsofSUEST = 0.0007), whereas other subgroups did not.With an increase in income, the father's intergenerational transmission effect of smoking became stronger  risky health behaviors had significant intergenerational transmission effects; (2) the intergenerational transmission of mothers' alcohol consumption and SSBs drinking behavior was greater than that of fathers; and (3) the influence of SES on intergenerational transmission in urban areas was different from that of rural children. For addictive behaviors, such as alcohol drinking and smoking, intergenerational transmission mostly exhibited a decreasing trend with increasing SES in urban families but increased with increasing SES for rural families. However, the influence of parental SSBs drinking behaviors showed a consistent decreasing trend with increasing SES for both urban and rural families.This study showed that, consistent with many previous findings –50, 62, Importantly, differences between paternal and maternal influences were also observed. Contrary to many previous studies , 65, 66,The role of parental SES in the intergenerational transmission of risky health behaviors in urban and rural children was not exactly the same. In general, there was a significant decrease in the intergenerational transmission of SSBs drinking behavior with increasing SES: the risky health behavior transmission effect of high-SES parents was weaker than that of low-SES parents, and SUEST showed that only the education level of fathers in rural areas had no significant differences between groups, while only fathers' income level had significant differences between groups in urban areas. We also noted that the intergenerational transmission effect of urban mothers' drinking behavior tended to decrease when all three SES variables increased, but rural mothers' alcohol drinking behavior had a similar changing trend with the rise in education level and occupational class. However, SUEST showed that only the education levels of mothers in rural areas differed significantly between the subgroups. A similar situation occurred among fathers: rural fathers' risky health behaviors mainly appeared to show a similar changing trend with SES, while urban fathers' smoking had a reverse changing trend with the rise in occupational type and income. However, SUEST showed that there were significant inter-subgroup differences in the occupation types of fathers in urban areas, but there were no significant differences between the other subgroups.This reflected that SES had a dual influence on the intergenerational transmission of risky parental health behavior. On the one hand, higher SES means better family capital and better parenting style, which will prevent the formation of children's unhealthy behaviors and reduce the transmission of these behaviors from their parents , 67–71. On the contrary, however, higher SES can mean that parents will devote more time to their own careers to cope with higher workloads , more ofWe observed that parents played an important role in the development of risky health behaviors in children. Risky parental health behaviors set a bad example for their children and tempt children to imitate their parents' behaviors. It is worth noting that urban areas, especially urban mothers, mostly reflected the positive effects of SES, whereas fathers, especially those in rural areas, reflected adverse effects. This suggests that we should pay more attention to fathers' behaviors and awareness of health education in rural areas and invest in the rearing of their children. In addition to persuading children to drop these behaviors, more attention should be paid to reducing intergenerational transmission.The original contributions presented in the study are included in the article/Data for this study was from the China Health and Nutrition Survey (CHNS). CHNS was approved by the Institutional Review Committees of the University of North Carolina at Chapel Hill and the National Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention.ZY and JL conceptualized and designed the study, participated in explaining the data, and writing and revising the manuscript. ZY analyzed the data. WQ helped to revise the manuscript. All authors approved the final version of the paper and have directly accessed and verified the underlying data reported in the manuscript.


Early action by bystanders is particularly important for the survival of individuals in need of emergency care, especially those experiencing a cardiac arrest or an airway obstruction. However, only a few bystanders are willing to perform cardiopulmonary resuscitation. The use of a live video during emergency calls appears to have a positive effect on the number of cardiopulmonary resuscitations performed by bystanders.The objective of this study is to propose and evaluate the relevance of a living lab methodology involving video calls in simulated life-threatening emergency situations.The first study aimed at analyzing the process of dealing with out-of-hospital cardiac arrest at a dispatch center and identifying the needs of the dispatchers. The second study is a pretest of a living lab. The third study focuses on a living lab in which 16 situations of cardiac arrest and airway obstruction are simulated. The simulation includes both a live video and transmission of a video demonstration of emergency procedures. The measures focus on 3 areas: the impact of video tools, development of collaboration within the community, and evaluation of the method.The results of the first study show that dispatchers have an interest in visualizing the scene with live video and in broadcasting a live demonstration video when possible. The initial results also show that collaboration within the community is enhanced by the shared simulation and debriefing experiences, clarifying regulation procedures, and improving communication. Finally, an iterative development based on the lessons learned, expectations, and constraints of each previous study promotes the existence of a living lab that aims to determine the place of live video tools in the sequence of care performed by dispatchers.Living labs offer the opportunity to grasp previously undetected insights and refine the use of the applications while potentially developing a sense of community among the stakeholders.DERR1-10.2196/40699 The care provided in life-threatening emergencies is constantly evolving, partly because of the technological advances that are leading to changes in health care and further improvements in the way dispatchers respond to and handle emergency calls. Current health recommendations emphasize that all available resources, both human and technological, should be used to achieve better outcomes in terms of patient care . For insSeveral elements can affect a bystander’s willingness to intervene. A study showed that in terms of performing CPR, the fear of hurting the patient is the first barrier (reported by 63.1% of the respondents for older adults and 50.9% for children), followed by a perceived lack of appropriate skills (13.4% for older adults and 23.4% for children) and fear of parental blame (5.2%) in cases involving child CPR . NumerouThe use of live videos is an emerging trend in handling emergency calls. Live videos can be used to assess the condition of the patient or the context and thus provide feedback to the dispatcher, allowing them to have better visibility of the situation. Indeed, there seems to be a discrepancy between the reality of the situation in the field and what the dispatcher perceives when receiving only audio information ,29. LiveThe living lab is a method developed in the 1990s at the Massachusetts Institute of Technology, which aims to provide a meeting place for all the stakeholders involved in a situation to test a technological innovation ,39. ThisThe objective is to propose and evaluate the relevance of a living lab methodology in simulated life-threatening emergency call situations where live video tools are introduced into the call sequence with the aim of developing skills, trust, and collaboration among all emergency chain stakeholders .The 2 objects of this study are apps that allow video feedback (Urgentime) and video demonstration of rescue actions (SARA) during vital emergencies for cardiac arrest and FBAO. The emphasis lies on 1 main research question  and 2 secondary QRs (QR2 and QR3):QR1 focuses on the practitioner: does the inclusion of videos have an influence on the early treatment of a patient by a bystander in the context of an emergency call?QR2 focuses on the community: does the shared workshop have an influence on the building of a common frame of reference among stakeholders?QR3 focuses on the method: does the living lab methodology adapt to the needs and constraints of the stakeholders during the process?The emergency medical communication center (EMCC) of the Geneva region (emergency number 144) in Switzerland is part of the University Hospitals of Geneva (HUG). In 2021, this center responded to 115,000 emergency calls from the entire region of Geneva . Paramedics (50% of the team) or certified nurses (the other 50%) take calls, assess situations and patients, dispatch ambulances and other rescue teams, and assist callers in performing rescue procedures. Geneva’s emergency medical system is a 2-tier (or 3-tier) system, with the paramedic ambulance as the first tier and an emergency physician as the second tier. The third level consists of a senior specialist physician. In addition to these professional teams, the center can dispatch volunteer first responders for OHCAs or choking situations. A “Save a Life” first responder community was created in 2019, which currently consists of 1500 people, who are notified by an alarm app (Momentum [DOS Group]). Sending instant notification to these first responders is extremely simple (with the push of a button) in the computerized aid dispatch system used by the dispatchers. These first responders usually arrive between 2 and 4 minutes before a paramedic ambulance.The videos used during the experimentation come from SARA, an app developed by The Paris Fire Brigade in 2017. It consists of a smartphone or web application and a back office for the dispatch center. Dispatchers can transmit 1 of the 8 videos demonstrating life-saving techniques CPR and Heimlich maneuver, etc to the bystander. The first aid applications allow acting on the situation only when the volunteer arrives at the site, whereas SARA videos launch an initial relay of information with the calling witness. As the living lab is a living project that evolves based on the needs of the end users , choosing a flexible and diversified application was important and appealing to us.InstantView is a web application that allows the dispatcher to see the patient and the environment through the caller’s smartphone camera. The dispatcher sends a URL via SMS text message, and when the caller selects this link, the smartphone camera is activated. If the bystander has called the EMCC with the same phone as the one the link was sent to, there is no interruption in the audio communication. The video stream is simply added via data exchange . Once the connection is established, the InstantView platform can also allow for documents or demonstration videos to be broadcasted on the smartphone that is connected directly to the EMCC’s dispatcher. In light of this innovative context, this is a mixed methods study, which is divided into 3 parts, the first being a comprehension study, followed by 2 experiments (a pretest and living lab). The sequence of the steps is outlined in In the first study, there were 5 participants: 2 (40%) dispatchers, 1 (20%) dispatch coordinator, 1 (20%) assistant dispatcher, and 1 (20%) physician. Our objective was to obtain an overall view of the stakeholders at the center. We solicited the individuals currently working in the dispatch center and interviewed them on a volunteer basis. For the second study, we recruited 23 participants: 6 (26%) citizens, 2 (9%) dispatchers, 5 (22%) first responders, and 10 (43%) paramedics, distributed as shown in The citizens were solicited via the Geneva Association of Partner Patients, which is a network of former hospital patients who have registered as volunteers to participate in studies conducted at the HUG. There were no exclusion criteria in this study. The regulators were the volunteer regulators working on that day. As this study was planned within the context of the National Heart Day, jointly organized by the HUG, the ambulance service, and the Save a Life Association, we previously solicited first responders and ambulance attendants to participate in the simulations if they were interested. Concerning the third study, the distribution of participants was planned as shown in For the exploratory study, we constructed a semistructured interview guide that allowed us to collect the following information:Description of the current procedure of a cardiac arrest call Perceived benefits of and barriers to using an app to send emergency actions Dispatcher needs We conducted 5 interviews .During the pretest, 1 scenario was tested: “You find a 60-year-old unconscious man in Chaumettes Park. You call 144 and follow the instructions the dispatcher gives you.” The dispatcher assesses the patient via audio communication. The patient turns out to be in cardiac arrest and the dispatcher sends the relevant demonstration video via SARA. The dispatcher then asks the participants to perform CPR on the mannequin until the paramedics arrive (8 minutes in the Geneva region). Save-a-Life first responders join the participant around the 6-minute mark.The living lab tests 2 scenarios:“You find a 60-year-old unconscious man. You call 144 and follow the instructions the dispatcher gives you.” A live video feed allows for the assessment of the patient (Urgentime). Once the dispatcher diagnoses the patient as having a cardiac arrest, he sends the SARA recorded video demonstration of CPR. Participants start to perform CPR on the mannequin until the arrival of the ambulance (8 minutes in the Geneva region). Save-a-Life first responders join the participant around the 6-minute mark. Overall, 8 situations are performed with 1 participant and 8 with 2 participants.“You encounter a panicked person with an infant who appears to be choking. You call 144 and follow the instructions the dispatcher gives you.” A live video feed allows for the assessment of the patient (Urgentime). The dispatcher determines that the infant is experiencing sudden airway obstruction. The dispatcher sends the recorded video demonstration of the Mofenson maneuver. The participants are invited to perform the maneuver until the child cries (responsive mannequin) or until the situation deteriorates into cardiac arrest (2 out of 8 situations). Overall, 8 situations are performed with 1 participant and 8 with 2 participants.All simulations were filmed and recorded in an audio format.Collective elicitation interviews were conducted after each simulation with the respective participants (for approximately 24 minutes). Elicitation interviews  are an iWe built an interview guide that allowed us to collect the following details:Feelings related to the use of the applications: benefits, constraints, and perceived helping elements Subjective contributions of the method: perceived contributions in terms of learning, understanding of the course of an action, and feeling of community Throughout the construction process of the living lab, an artist follows the preparatory meetings between researchers and stakeholders and collects information on how the living lab evolves based on the results of the preliminary experiment. They contribute to the added value by proposing to photograph a particularly crucial scenes coconstructed with the participants during the living lab.First, we transcribed all the audio recordings (interviews and debriefings), which allowed us to obtain a corpus for our studies 1, 2, and 3. In the filmed sequences (studies 2 and 3), we also recorded the times from the moment the dispatcher picked up the phone, including the recognition of the cardiac arrest, implementation of the emergency procedures, transmission of the video, and reception of the video. We then compared our data with those from the literature. We also noted the number of times the applications were not successful. We then categorized the different simulations into action sequences  to compare the situations among them in terms of actions carried out (observations) and feelings (debriefings). Second, we performed a thematic analysis using ATLAS.ti  on our corpus. Thematic analysis is a method that “consists of systematically identifying, grouping and, subsidiarily, examining the discourse of the themes addressed in a corpus”  by categWe provided a document to all the participants explaining that we were collecting data  as part of the research and that these data would be used only to analyze the process and as support for scientific presentations. At the beginning of the session, all the participants were asked to read and then sign the consent forms or indicate their opposition before the experiment. The analysis and presentation of the data and their results are anonymized (participants are identified using a coding system). The compensation offered was 1 hour of free training in first aid and emergency procedures by certified professionals. Each participant signed a General Data Protection Regulation consent form, providing permission for audio and video recording and the use of the recordings for research purposes.In this section, we present the results of the first 2 phases and elaborate on the results expected from the living lab.According to the physician who participated in our study, approximately 2 cardiac arrests occur each day in Geneva, 33% of which are in public areas . With cardiac arrest being first priority, the dispatcher has 90 seconds to send resources from the moment the telephone call starts. An automated cardiac arrest procedure appears when the dispatcher completes gathering the information related to the patient’s condition, which is done according to a specific process. Currently, dispatchers can assess the patient via a video feed (Urgentime) or an audio phone call. First, they must obtain the patient’s location and then assess their state of consciousness and breathing. If the patient is unconscious and if there is a breathing anomaly (or not), the dispatcher sends an ambulance as first priority, then sends a first responder via the Save-a-Life button, and helps the bystander perform CPR.It appeared throughout the interviews that asking the bystander to perform CPR is a difficult task for the dispatchers. They described witnesses who were not always willing to come close to the patient during the assessment phase, “even to put their hand on the stomach [to check for breathing].” They specified that the bystander often does not perform CPR because they do not want to take responsibility for the action, and they are frightened.When asked about the use of SARA videos, the dispatchers expressed that they would need the videos to be integrated directly into the computer-aided dispatch system to avoid going to a separate computer for the video. They also raised concerns about the target population of the application; individuals having a cardiac arrest and older adults are more likely to be at home. Nevertheless, they believed that the CPR video offered a benefit and could be an asset in motivating some hesitant witnesses. Dispatchers also expressed a need to be able to receive video feedback to “keep the connection with the caller.” They could gain more insight into the bystander’s actions: “you can see the CPR being performed and guide it further” and identify potential mistakes in the execution of CPR. “We think people understand and at the end of the day, what is done in reality may not look so good.”The dispatchers recognized the cardiac arrests in 1 minute and 9 seconds, 1 minute and 32 seconds, 1 minute and 21 seconds, 2 minute and 51 seconds, and 1 minute and 56 seconds after picking up the call. The video was described as “useful,” “a good input,” and “stimulating” by 83% (5/6) of the participants. Overall, they identified 2 advantages of using a video during CPR: a better posture and more accurate performance of CPR. The participants also valued having a sound that signaled each compression to perform. Thus, it was easier for them to follow the right chest compression rhythm compared with if they were alone. It aided the participants to synchronize with the video and follow the “right rhythm.”Early feedback shows that the video had a reassuring effect on the participants emotionally affected by the situation: “emotionally it is quite strong, we imagine the person lying down.” As the dispatchers hinted during the exploratory study, the video does help initiate a massage in cases of hesitation by the witness. It also seems to reassure the bystander regarding the gestures they perform: “I was glad that I could have a link, to be able to see it, it made me feel secure.” Finally, the video provides comfort through words of support: “I felt more like I was getting good support, even encouragement to keep doing well.” The dispatchers also found that sending the video was reassuring: “the fact that they are watching, they are going to correct themselves and for us it is reassuring.” They also sensed more “serene” and “reassured” witnesses on the phone. However, in the subsequent interview with the dispatchers, they actually described being “falsely reassured” because they were ultimately unsure whether CPR was being performed or not, and the fact that they were sending the video prevented them from providing voice guidance over the phone. The simulations also allowed all the stakeholders within the survival chain to interact and collaborate. In contrast to what appears in the literature, professionals  did not consider the witness to be an obstacle but rather an additional resource to accomplish an essential act. A first respondent told us, “I have other skills; I will let the bystander do the massage.” The bystander can also maintain the link established with the emergency services “By the time the ambulance arrives, you start to get tired and being able to have someone who has a contact with the professionals, even psychologically, helps.” The bystander is, therefore, an additional resource that enables a more optimal distribution of the tasks carried out . However, both the first responder and the dispatcher must have confidence in the bystander to delegate. The first respondent obtains this trust based on whether the witness appears to be active, calm, and focused. As for the dispatchers, confidence is based on the witness’s ability to understand and respond. The simulation also led some participants to gain a better understanding of the regulation process. This could help prevent frustration in the future. For example, 5% (2/10) of the participants did not understand why they should not act immediately. The joint debriefing gave the dispatchers the opportunity to explain this process.One of the first obstacles to consider are technical difficulties, as they increase the response time. When fully functional, as in simulation 1, the app enabled cardiac massage to begin within 3 minutes and 15 seconds. However, dispatchers stated that they were unsure whether they saved any time compared with audio guidance. In addition, as the application is still at the prototype stage, its stability is uncertain, and the transmission of video is not always optimal in terms of time or quality. We also chose to give all the participants the same “standardized” cell phone to avoid any differences in participants’ personal phones. However, this led to 2 problems: the difficulty in handling a new phone in an emergency and a very low output sound. Dealing with a phone that was not their own was described as an additional challenge, and even stressful, as the participants were not always able to identify where the speaker was located and where to go to get the SMS text message to open the video or web application on the phone loaned for the test. In a real emergency situation, it can be more complex to perform these simple gestures on one’s own phone; we can assume that the fact that they were given a new phone accentuated these confusing effects. Sound-related problems further negatively affected the handling of the patient. The participants also reported experiencing trouble hearing the instructions given by the dispatcher. As a result, the dispatcher sometimes had to repeat the instructions several times, and in some cases, the participants were unable to understand the action to be performed . These elements led to a deterioration of the relationship between the dispatcher and the participant, as they prevented a proper establishment of communication. This can result in a feeling of isolation on both sides.The expected results for the practitioner are oriented toward a better handling of the patient by the bystander, both in terms of time and performance of the emergency procedures. For this purpose, a comparison will be made between OHCA and FBAO control situations  and simulations to understand whether the video saves time during the assessment of the patient’s condition (Urgentime) and the execution of first aid actions (SARA). A comparison of 1-witness situations with 2-witness situations will also be carried out to determine the most appropriate context for using videos. Therefore, we expect the situation to be easier to manage when there are 2 witnesses (one holding the phone and the other performing first aid). In addition, we will evaluate whether the use of live video and demonstration video can reassure the witness and possibly convince them if they are hesitant to perform emergency actions. Finally, we will evaluate whether the use of 2 functionalities (live video and demonstration video) leads to cognitive overload for the dispatcher.As in the preliminary study, we expect that the shared experiences  would allow both populations to exchange and learn to collaborate. We expect effects in terms of knowledge transfer, mainly a better understanding of emergency procedures among the participants, and that enhancing communication (with videos) lead to better and faster trust building among the stakeholders. Analyzing the debriefings and the construction of the restaging process provide insights into the key elements for the participants as well as clues for future living lab–focused activities.As in the previous study, the stakeholders will review and analyze the challenges encountered to facilitate the replication of the living lab tool kit in other emergency dispatch centers. In addition, they will assess the direct benefits (expected) and the secondary benefits .We collected results in 3 areas: practitioner, community development and method insights. The first area provided us subjective elements for understanding the effects of the inclusion of a video on the early treatment of a patient by a bystander. We were interested in understanding the effects on the experience of the different stakeholders, in particular, on the dispatchers. The second area focused on gathering evidence on whether the simulation developed a sense of community and collaboration among the participants. Finally, the third highlighted the contributions of the living lab methodology in terms of learning and confrontation with reality.Regarding the use of applications, the main results involve the identification of the dispatcher’s feelings when using an application to help with emergency procedures. Indeed, they expressed that they felt substituted by the application because it took precedence over them, allowing them to neither follow the patient’s treatment nor realize that there was a need to restart the guidance on the cardiac massage when there was a technical failure. From a community perspective, we found that all the stakeholders were willing to work together and that there was no reluctance on the part of dispatchers, paramedics, or first responders to work together. Citizens are seen as members of the chain of survival. Regarding the methodological aspect, we found that the approach is flexible and allows for the adaptation of scenarios according to new inputs from the previous steps. Consequently, we were able to integrate the needs of the regulators (feedback) and address the identified constraints. At this stage, the main results concern the fact that the simulation allows us to apprehend difficulties beyond those addressed; it allows us to identify the constraints of internal procedures or the effect of having 3 different tools simultaneously. This advantage is a result of the inclusion of all the stakeholders to ensure that the simulation resembles the reality as closely as possible. It could not have been detected in simulations with a single citizen and a dummy.The dispatchers expressed a strong interest in using a video feedback app to gain visibility of the situation and of CPR guidance, which is consistent with the literature reviewed ,29. SincThe main strength of these studies is the adoption of a perspective that allows the comprehension of emotions and subjective evaluation of the impact of the applications and of the methods used among the various stakeholders. This perspective makes it possible to document aspects that were not previously addressed. In particular, it allowed us to discover that the use of applications provoked uncertainty in the dispatcher, an aspect that had not been detected in the simulations in the other studies mentioned in the literature. The integration of all the actors of the survival chain can potentially have a concrete effect on the real care provided in Geneva, as it enables the community to gain a better understanding of each other and to collaborate more efficiently. The aims of our studies are to not only evaluate an application in technical terms but also use the experiments as a pathway to work on the development of collaboration.The main limitation of this study is that the pretest was conducted in the context of National Heart Day, so the citizen volunteers were all sensitive to the issue, and none of them refused to perform cardiac massage. Moreover, the fact that it was only the dispatchers who wanted to participate biased the results because we could not know the possible resistance to using this application. Finally, to achieve broader community development, ongoing sessions of a regular living lab is required with various communities; however, this process is costly in terms of time and investment from all the stakeholders, making it difficult to implemented to be on a large scale.


Data on the relationship between take-home video and the time to first ambulation remains scant. Here, we aimed to investigate whether viewed take-home video during pre-hospitalization is independently associated with the time to first ambulation in postoperative patients with inguinal hernia repair under general anesthesia.t-tests or Mann-Whitney U-tests was used to compare the means of two groups (viewed take-home video and non-viewed take-home video). Chi-square test was used to compare the rates between the two groups. We used a linear regression model to see if there was a difference between exposure and outcome variable. Both models were used to observe the effect size of the exposed variable. Subgroup analysis was employed to assess the impact of various factors.We retrospectively reviewed and analyzed the relationship between viewed take-home video and the time to first ambulation between September 2020 and October 2021.The independent P = 0.004). In addition, the linear regression analysis of the relationship between viewed video and length of stay showed that β = −2.10 . Similarly, subgroup analysis yielded similar results for the viewed video group patients compared to those in the non-viewed video group.This study included a total of 120 patients with inguinal hernia repair under general anesthesia following day surgery. The average age of the participants in the two groups was 43.16 and 44.83 years, respectively, and about 82.5% of the patients were male. Our fully adjusted linear regression results showed that individuals in the viewed video group were associated with a decreased time to first ambulation (h) after adjusting for confounders (β = −0.50, 95%CI: −0.83, −0.17; Taken together, our findings demonstrated that viewed video could shorten the time to first ambulation, which in turn reduce the length of stay in postoperative patients under general anesthesia. AlthougAn expert consensus on standard process of ambulatory surgery for inguinal hernia states that health education can reduce the psychological stress response caused by surgical operations to patients, shorten the hospital stay, save medical expenses, and relieve patient anxiety and postoperative pain . Health via a multidisciplinary team (MDT), adopted the theoretical frame for knowledge, attitude, and practice (KAP), and used the first ambulation system of recovery skills covered in post anesthesia discharge scoring system (PADSS), does not only shorten the time to first ambulation, reduce the length of hospital stay and early recovery, but also improves the efficiency of nurses, and provides a reference for the medical staff to guide the time to first ambulation.Inguinal hernia is a common and frequently occurring condition in surgery, and performance of inguinal hernia day surgery has considerable socio-economic value . The useThis retrospective study was conducted from September 2020 to October 2021 in a tertiary hospital named Shenzhen Sixth People's Hospital. When making the appointment for patients' operation at 3–5 days before surgery, medical staff at the day surgery management center conducted face-to-face perioperative care education as well as all patients were given the same educational brochure and QR code of take-home video for perioperative early recovery knowledge and skills instruction. During the pre-hospitalization period, patients could choose to read the health booklet or view the take-home video by scanning the QR code. For patients who chose to view the video, and at the end of the video, they had to fill in their name, the day of the proposed surgery and click “watched” to end the video, then the completed information was automatically sent to the Questionnaire Star .All anesthesia and surgeries (laparoscopy) were performed by the same anesthesiologist and specialist doctor. The mode of anesthesia included general anesthesia  combined with preoperative nerve block (quadratus lumborum block). In addition, postoperative pain was relieved using diclofenac sodium which was orally administrated for 5 consecutive days.Data on patients diagnosed with inguinal hernia was obtained from the day surgery care unit of the Shenzhen Nanshan Sixth People's Hospital, Shenzhen, China. The identities of participants were concealed to safeguard the patients' privacy. Besides, the information was abstracted from the electronic data acquisition system. Since this study was conducted retrospectively, ethical approval was waived by the local Ethics Committee of the Shenzhen Nanshan Sixth People's Hospital, and all the procedures were part of the routine care.In this study, since data collection was retrospective, we included only a specific team by setting nadir criteria in order to avoid the possible influence of different teams on the results.n = 63) and non-viewed take-home video (n = 57) groups   and thosThe independent variable  was viewed take-home video, which was recorded by a MDT who wrote the script and role played. In addition, the contents of the take-home video were formulated based on the guidelines and clinical practices  and the The outcome variable (continuous variable) was obtained following the previously published guidelines and studies , 15, 16.Demographic variables, patients' satisfaction , self-rat-tests  or Mann-Whitney U-tests (skewed distribution) were used to compare the means of two groups, Chi-square test was used to compare the rates between the two groups. Furthermore, given that the outcome variables were continuous, we used a linear regression model to see if there was a difference in time to first ambulation and length of stay in the viewed take-home video group compared to the non-viewed take-home video group, and what the difference was, and reported the effect values β and their confidence intervals.The independent variable for this study was whether viewed take-home video or not . The primary outcome variables were the time to first ambulation as well as length of stay. Therefore, we first observed the distribution of baseline data of participants was whether statistically different between the viewed take-home video and non-viewed take-home video groups. Among them, the independent To control for confounders, we used a multivariable model. To observe whether the effect values were stable, we presented both the fully-adjusted model with the unadjusted model and after controlling for confounders. To assess whether the effect values can be applied to different populations, we used indicators such as gender as stratified variables to observe whether the trend of effect values and credible intervals of exposure variables and outcome variables were stable at different stratification.All statistical analyses were done using Empower Stats (version 3.4.3). Packages used: ggplot, car, caret and corrplot.p-values were ≥ 0.05). However, the viewed video group had significant differences in the time to first ambulation, length of stay, patient satisfaction, SAS, and time to first dietary .We analyzed the baseline characteristics of the selected patients as shown in We then used covariates as the stratification variables to assess the trend of effect sizes in the time to first ambulation and length of stay . The eff2, <18.5 kg/m2), satisfaction (≥95 score), SAS (<50 score), and pain scores (<4 score) with respect to the interactions of the time to first ambulation and the length of stay. Besides, the interactions between gender  and the time to first ambulation were statistically significant . The effects of BMI (≤ 30 kg/m2), patients' satisfaction (≥95 score), SAS (<50 score), and pain scores (<4 score) on the time to first ambulation were 25.2 min , 25.8min , 25.8 min , and 20.4 min , respectively. In addition, the effects of BMI (<18.5 kg/m2), patients' satisfaction (≥95 score), SAS (<50 score), and pain scores (<4 score) on the hospital stay were 148.8 min ,125.4min , 113.4 min , and 96 min  minutes, respectively.The analysis showed that there were significant differences in patients' BMI  and 95% confidence intervals as shown in Of all the exposure factors, only viewed take-home video had a statistically significant difference in the effect of the two outcome variables. Of these, the male exposure factor, only had a statistically significant effect on the time to first ambulation (the outcome variable). No statistical tests were performed due to small female sample size.P = 0.005) and 99.6 min , respectively. In model II, the fully-adjusted linear regression analysis showed that individuals in the viewed video group were associated with a decreased time to first ambulation after adjustment for confounders . In addition, the relationships with viewed video and length of stay were analyzed and showed a β = −2.10 .In the unadjusted model (Model I), the effect of viewed video on the time to first ambulation and length of stay was decreased by 23.4 min  and 32.4 min , respectively.In the two models (I and II), the effect of the male on the time to first ambulation was decreased by 28.8 min  before moving, evaluate the occurrence of complications such as vital signs, blood glucose, pain, SAS and wound, dizziness, nausea, vomiting, and spontaneous micturition. Besides, singing the trilogy shows that there is no dizziness holding per position 30-s by the position is changed in sequence . In clinical practice, through the timely assessments by the nurses coupled with the patients' cooperation, our analysis showed that the time to first ambulation, length of stay, and the time to first dietary of the viewed take-home video group were lower compared to the no-view take-home video group. Because the skills of first ambulation after surgery in the take-home video included the contents of entries in PADSS and ≥9 points , our patBecause the patients' payment method was a packaged charge for medical insurance, there was no statistical difference in the hospital costs for the two groups of patients.To better analyze the impact of take-home video on the time to first ambulation and length of stay, we used a linear regression model, adjusted for potential confounding factors, to perform sensitivity analyses. Linear regression indicated that differences of viewed take-home video and male were statistically significant when controlling for age, BMI, education level, SAS, patient satisfaction, pain score, time to first dietary . Of thes2 was a reduction of 2.48 h . Data from the Mudumbai et al. study showed that overweight patients feared exercise and avoided physical activity .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.