Patients utilize the internet as a pathway to acquire knowledge of specific diseases. However, there are limited oversight and review mechanisms to ensure the authenticity of online information. This study aimed to evaluate the quality of video-based resources used to obtain information about atrial fibrillation (AF).Multiple AF-specific keywords were used to perform a systematic search of YouTube. Two independent reviewers reviewed the top 50 results of each keyword search. To record data, the Journal of the American Medical Association (JAMA) score, modified DISCERN score, AF-specific score (AFSS), and essential score (Escore) were used. The Kruskal-Wallis test was used for intergroup comparisons.p < 0.05) than those submitted by publishers without a medical background. The video quality did not differ among those included in this study.A total of 74 videos that met the inclusion criteria were included in the analysis. In terms of video quality, 68% were poor, 19% were moderate, and 13% were exceptional. Videos submitted by publishers with a medical background were much less popular (Some videos on YouTube that are of real value are not as popular as those with low-quality content submitted by news agencies/media publishers. Furthermore, videos submitted by those with a medical background do not receive as much attention as others. It is important to acknowledge that video platforms should establish content and quality auditing mechanisms for videos. Furthermore, publishers should ensure that viewers receive accurate and complete knowledge and use more concise and accessible images or animations that are tailored to the audience. Atrial fibrillation (AF) is the most common clinical arrhythmia disorder. It affects approximately 33 million individuals worldwide  and has Traditional health education has included the detailed explanation of illnesses by physicians at the clinic, distribution of educational materials such as pamphlets, and displaying of posters detailing relevant diseases; however, the streaming of videos on the internet has gradually become a contemporary and important way for patients and the general public to gain knowledge about diseases. YouTube is becoming an important source of non peer-reviewed medical information because it allows easy access to information and has worldwide popularity . The 201This was an observational retrospective study. Using YouTube, we searched for the keywords “Atrial Fibrillation,” “AF,” and “AF+Management” on 13 September 2021, and recorded the URL, number of views, number of likes/dislikes, and number of comments/responses, which may change over time, of the videos. The video content and quality evaluations were completed within the following month.The keyword searches were performed by two authors using a cleared-cache web browser. They selected the top 50 results for each search term because patients who want to learn about AF , 10 are After a quick scan of the video during the first round of evaluation, the searcher checked whether the title and content of the video met the inclusion criteria. Finally, the two reviewers examined whether each of the videos met the standards. If there was a difference in opinion between the two reviewers, then it was resolved through consultation and re-examination. If no consensus was reached, then it was resolved by a third reviewer. The following data for each video were required: URL, video name, author qualification, upload date, video duration, number of views, numbers of likes, dislikes, comments, and author responses.Because there is no scale that can be used to evaluate the quality of information provided by videos about AF, we developed a new scoring system, the AF specific score (AFSS), based on the existing literature and expert guidelines. The AFSS was found to have good reliability and validity , 12 rel and the After the review, all videos were categorized into the following four groups according to whether the video publisher had a medical background: physicians group, medical facilities group, official accounts group, and news agencies/We media group . The scoThese scoring criteria can determine whether the knowledge provided by the videos was sufficient. Furthermore, the essential item veto system excluded some videos that had sufficient elements but simply comprised a patchwork of knowledge points with little actual learning value. Therefore, this study was able to evaluate the usefulness and usability of videos through two screening mechanisms.P < 0.05 was considered significant. Theoretically, video publishers with a medical background should produce high-quality videos that are more popular among viewers because of their authority and production values. During this study, we compared the video durations and numbers of views, likes, comments, and responses by grouping videos according to their publisher type and quality.All videos were categorized into the physicians, medical facilities, news agencies/We media, and official accounts groups  and rateA total of 150 videos were included in the analysis. Of these, 60 videos were excluded because they were duplicates, four videos were excluded because they included non-English language, one video was excluded because there was no audio, and 11 videos were excluded because they were not relevant to the topic. Finally, 74 videos were selected for analysis ; 16% of p = 0.065). Videos in the news agencies/We media group had the highest number of views  (p=0.003) and were mainly within 10 min in length. Only the number of likes was statistically different among groups . According to the video quality scores obtained using the Escore and the AFSS, there were a large number of low-quality videos with a duration of <10 min; furthermore, the number of views decreased as the running time increased (P = 0.003). After integrating these data, we assessed the relationship between video quality and popularity and found that there was still a significant difference between the low-quality videos and medium-quality and high-quality videos during this study (p = 0.043)  , 6. DuriThis study aimed to provide a better understanding of the quality of evidence provided by videos independently accessed by patients with AF using a large online media-sharing platform (YouTube). We found that lower-quality and less comprehensive videos about AF available on YouTube are more popular. Furthermore, we found no significant differences in the content quality and number of comments when comparing video publishers with and without a medical background.p < 0.05) and able to reflect the rigor and structural integrity of the data used by the video publishers. The quality of the video content did not differ among these four rating systems, which was consistent with the results of Radonjic et al., who evaluated video information about abdominal aortic aneurysms. Theoretically, videos produced by physicians and authoritative medical institutions should have better structural integrity, data rigor, and video quality than those published by others; however, previous studies have not reached this conclusion  and that the differences among the numbers of views, comments, and replies were too large. Loeb et al. evaluated videos about bladder cancer on YouTube and reported the lack of a corresponding association between the number of video likes and video ratings, suggesting that most viewers do not effectively identify the quality of the videos  varies based on the type of publisher. Gokcen et al. reported that YouTube videos of herniated disks presented by news agencies/We media and official accounts are usually designed to be more suitable for viewing by the general public . This hae videos . Similare videos . Howevere videos . This inWith the rapid development of information technology, contemporary internet streaming video sites are becoming one of the most important ways for patients and the general public to gain knowledge about diseases. Because of its worldwide popularity (approximately two billion hits per day) and easy access to information by 95% of the world, YouTube is a great source of non peer-reviewed medical information . HoweverAlthough this study simulated the search behaviors of patients independently looking for data, it had some potential limitations. First, we used search terms that may not fully include what the general public might use. We used only the top 50 search results on the YouTube website and excluded non-English videos. Videos from other online platforms were not analyzed; therefore, we may have missed some of the videos that should have been included in the analysis. Objective evaluation indicators, such as the number of views, number of likes, and number of comments on online video sites are dynamic and may subsequently change or affect the statistical results. Second, the scales used for this study, although developed based on authoritative guidelines and the literature, were not professionally vetted. Third, the video search performed during this study only simulated patient behavior and may have been inaccurate. The quality of all videos on YouTube was not fully analyzed; therefore, the overall quality of the videos was not fully reflected.With the advent of information technology, people can access knowledge from multiple sources. This is a double-edged sword that can be both beneficial and harmful. Large amounts of video content regarding AF are available on the internet. During this study, we found that some YouTube videos that are of real value are not as popular as ones with low-quality content submitted by publishers without a medical background and that videos submitted by individuals with a medical background do not receive as much attention as others. The reason for this may be that the video content is not presented in a way that appeals to the masses, and that the quality does not differ from that of other publishers. It is essential to acknowledge that video platforms should establish auditing mechanisms for content and quality. Publishers should ensure that viewers receive accurate and complete knowledge while providing more concise and accessible images or animations tailored to the audience.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.ZW and WL designed and revised the manuscript. CL, LB, and LJ performed data acquisition and statistical analysis. All authors have read and approved the final manuscript.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.


Versatile Video Coding (VVC)/H.266, completed in 2020, provides half the bitrate of the previous video coding standard /H.265) while maintaining the same visual quality. The primary goal of VVC/H.266 is to achieve a compression capability that is noticeably better than that of HEVC/H.265, as well as the functionality to support a variety of applications with a single profile. Although VVC/H.266 has improved its coding performance by incorporating new advanced technologies with flexible partitioning, the increased encoding complexity has become a challenging issue in practical market usage. To address the complexity issue of VVC/H.266, significant efforts have been expended to develop practical methods for reducing the encoding and decoding processes of VVC/H.266. In this study, we provide an overview of the VVC/H.266 standard, and compared with previous video coding standards, examine a key challenge to VVC/H.266 coding. Furthermore, we survey and present recent technical advances in fast and low-complexity VVC/H.266, focusing on key technical areas. Many qualified media services have been provided owing to the advancements in multimedia technology, including content generation, data compression, large-data delivery, rendering technology, and real-time encoding/decoding technology. Based on such technologies, territory broadcasting, movies, on-demand videos, video-based conference calls, video-based mobile communications, video surveillance, real-time remote control, 3D videos, augmented reality videos, and virtual reality video services have generated significant interest among consumers .The popularity of media services is causing network bandwidth problems due to the delivery of various types of media that require a large amount of data for qualified services. A recent Cisco report claimed that video data account for roughly 80% of all Internet data traffic . This asHistorically, video coding has been essential to the growth of the media industry. Without the use of data compression technology in the development of digital media, a digital media transformation would be impossible. MPEG-1  was usedThe aforementioned video coding technologies are typically a result of collaboration between two well-known video standard organizations, the ITU-T Video Coding Experts Group (VCEG) and the ISO/IEC Moving Picture Experts Group (MPEG), used to meet the industry needs and consumer demands for a higher resolution, higher quality, and higher frame rate within the context of constrained intra-bandwidth structures. MPEG-2/H.262 was the first video coding standard jointly created by the VCEG and MPEG groups . Its goaFollowing the completion of HEVC/H.265, there have been calls for a new video coding standard enabling the support of realistic media requiring large numbers of data, such as 8K or higher resolutions, 360-degree virtual reality, screen contents, high dynamic range, a wide chromatic gamut, and adaptive streaming , as showVVC/H.266 effectively accomplished its goal by utilizing a variety of cutting-edge coding techniques for intra- and inter-prediction, transform, quantization, in-loop filtering, and entropy coding, together with flexible block partitioning. For similar objective and subjective video qualities, VVC/H.266 showed a considerably larger bitrate reduction than HEVC/H.265 . HoweverTo address the issue of the VVC/H.266 coding complexity, numerous studies on fast coding methods with low complexity have recently been conducted. In this study, we aim to provide a comprehensive review of the latest fast and low-complexity encoding methods for versatile video coding. The main contributions of this paper are as follows. (1) We conduct a brief review of the advancements of the VVC/H.266 standard over previous video coding standards. (2) We analyze and identify key challenges in video encoding based on VVC/H.266 coding. Finally, (3) we conduct a comprehensive survey of recent advances in fast and low-complexity video coding methods, which are classified into specific coding areas for low complexity.The remainder of this paper is organized as follows. The VVC/H.266 standard uses a block-based hybrid coding framework, which is similar to earlier video coding standards. To improve the coding performance, the VVC/H.266 standard employs novel coding tools with a flexible block partitioning method. As with all previous video coding standards, the VVC/H.266 standard employs intra-prediction to reduce the spatial redundancy, inter-prediction to reduce the temporal redundancy, transform coding of the residuals to further reduce the spatial statistical redundancy, and in-loop filters to enhance the quality of the reconstructed video. The VVC/H.266 standard specifically employs a multi-type tree (MTT) structure as quad-tree, binary, and/or tri-tree block partitions using a 1:2 to 1:8 ratio between the width and height of the block ,15. In cIntra-prediction is improved by increasing the number of directional angles from 35 to 93 to provide an accurate prediction using the new VVC/H.266 partitioning shapes . To incrTo enhance the coding performance by minimizing the temporal duplication between sequential frames, many inter-prediction tools have been adopted in the VVC/H.266 standard. According to whether motion data are shared across an entire block, newly adopted inter-prediction tools in VVC/H.266 can be typically divided into two groups. For instance, all block-based inter-prediction tools include history-based motion vector prediction , merge wA multiple transform selection (MTS) , sub-bloThe VVC/H.266 standard improved all coding components of the hybrid coding structure and incorporated advanced coding tools to achieve the challenge goal of improving the coding efficiency by 50% over the prior coding standard . Although these advancements have contributed to achieving the objectives of VVC/H.266, an increase in complexity was unavoidable, which needed to be resolved.During the official standard phase, JVET maintained a VVC/H.266 test model called VTM , which sT measurement: T = Ttest/Tanchor * 100%, where testT and anchorT represent the runtimes of the tested and anchor methods, respectively. A value of 100% indicates that there is no difference in runtime.According to Several recent efforts have been made to address the complexity of VVC/H.266. The majority of studies on fast and low-complexity coding of VVC/H.266 have focused on reducing the complexity of the block partitioning. Based on our search of recent papers on this topic, we identified that more than half are related to the fast method for block partitioning, as shown in This subsection describes the basic partitioning process used in VVC/H.266 encoding before reviewing the fast and low-complexity methods applied for partitioning. The block partitioning used in VVC/H.266 achieves a significant coding performance by allowing for a flexible block size. Such flexible partitioning can create adaptive CU partitions based on the video image characteristics using the newly introduced MTT. Nonetheless, the introduction of BT and TT significantly increases the encoding time. To determine the best-fitting CU block shape, an exhaustive evaluation of all possible QT, BT, and TT block shapes results in significantly more recursive calls to the coding tool functions than HEVC/H.265 using QT. The first approach is to investigate the split mode for an early split mode determination or to skip some of the split modes in the mode evaluation. At a given depth, five split modes were evaluated in the VVC/H.266 partitioning, i.e., HBT, VBT, HTT, VTT, and QT. With this approach, the partitioning process involves a reduced number of evaluations to determine the split mode by skipping unnecessary evaluations at a given depth. This approach saves a significant amount of encoding time by reducing computations in a skipped mode evaluation. The following studies were investigated from this perspective.Park et al.  proposedIn , Park etIn , Zhao etIn , Zhang eIn , SaldanhThe second approach is to determine the portioning depth at an early stage. In the VVC/H.266 partitioning process, all possible combinations of CU shapes are evaluated under the allowed depths of QT, BT, and TT. According to In , Zhang eIn , Zhang eZhang et al.  proposedFan et al.  proposedIn , Yang etIn , Tang etLiu et al.  proposedIn , Li et aIn , Chen etIn , Yea et Pan et al.  proposedThe method in this section uses texture or motion information to determine the early stage of depth during the CU encoding processing. Based on the observation that such information is strongly related to the determined partitions, the proposed methods apply novel algorithms developed to determine the optimal CU size and partitions at an early stage. As shown in Many tools have been adopted in VVC/H.266 to improve the coding performance for both intra- and inter-coding. Among the newly adopted and updated tools, several computations are required to determine the best modes or motion information. In this section, we look at studies that have been conducted to reduce the number of computations required by individual coding tools. Most studies reduce the number of RDO checks by reducing the modes or determining the best mode early in the process.Dong et al.  proposedIn , Tun et In , Park etTsang et al.  proposedPark et al.  proposedIn , Zhang eIn , Guan etIn , Fu et aIn , Choi etEfforts have been made to develop a low-complexity method for VVC/H.266 implementation. The transform module was primarily targeted for hardware implementation. The transform module is the most complex module used in a decoder implementation. In particular, in VVC/H.266, the use of MTS causes the decoder to become more complex by adding DST-VII and DCT-VIII with an increased transform size of up to 64 × 64.Kammoun et al.  proposedHamidouche et al.  proposedAdditional effort has been made to investigate low-complexity VVC/H.266 implementations in software (SW) implementations. Open-source SW-based codecs are widely used in the industry. Looking at the history of standard codecs, it is clear that the timely availability of SW-based codecs has influenced the success of standard codecs; therefore, VVC/H.266 SW-based codec development is regarded as extremely important.In , WieckowIn , WieckowIn , BrandenIn this study, we reviewed the VVC/H.266 standard against previous video coding standards and analyzed and identified key challenges in video encoding based on VVC/H.266 coding. Furthermore, we surveyed and presented recent technical advances in fast and low-complexity VVC/H.266, taking key technical areas into account. Although the latest video coding standard, VVC/H.266, achieved an improvement in coding performance of approximately 50% compared to HEVC/H.265 by incorporating new advanced technologies with flexible partitioning, the increased complexity of the encoding must be overcome before it can be made available on the market. To address the issue of VVC/H.266, significant effort has been made in developing methods for reducing the encoding/decoding of VVC/H.266. One of the attempted approaches is investigating the early CU depth and split mode decision methods during the partitioning process, which requires the majority of the VVC/H.266 encoding time. Texture analysis, statistical analysis, syntax correlation, and machine learning-based classification were used to estimate the CU depth and split mode. Some methods concentrate on increasing the speed of individual coding tools, whereas others have used practical hardware and software implementations. In conclusion, studies on fast and low-complexity VVC/H.266 algorithms are important and will lead to a promising direction for the success of this standard in academic and industrial communities.


To understand healthcare providers’ experiences with video recording of patient consultations.Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development.A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens.Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations.Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice. In this study, we focus on the experiences and circumstances of recording the videos when produced by the healthcare providers themselves. Given the rise in user-friendly technology that makes such methods even more accessible (Schwab-Cartas and Mitchell, The aim of this study was to understand healthcare providers’ experiences with video recording of patient consultations.This study is based on healthcare providers’ experiences with video recording of patient consultations, and these recordings were part of a cluster-controlled trial, which is referred to as main project.et al., et al., The main project examines if a given specific evidence-based patient education strategy used in cardiac rehabilitation would result in higher program completion rate and better self-management compared to another patient education strategy (Lynggaard Interpretive description was the chosen research methodology, to generate qualitative and practice-relevant knowledge inductively in the field Thorne, . InterprIn total, 12 healthcare providers were included based on a purposive sample strategy Thorne, . In totaet al., et al., et al., Can you tell me about your initial thoughts on participating in video recording consultations?’ and ‘How did you feel about being video-recorded during consultations?’. Second author moderated the focus-group interviews and the last author participated as assistant moderator, posing follow-up questions (Krueger and Casey, In-person focus group interviews were chosen to create an interactive context for shared discussions to understand the joint perspective among the healthcare providers (Krueger and Casey, et al., et al., TM. The second and the last author re-read and coded the data material based on an inductive analytic approach, creating the codes from the empirical data material.The focus-group interviews were transcribed verbatim and read by the author team who initially discussed first impressions and content of the material. Data were uploaded to NVivoInitial themes and general patterns were identified. Going back and forth to the raw data and using the study aim and symbolic interactionism Blumer,  as an inCategorical themes and relationships between them were identified. This stage included a critical appraisal of relationships within the data and relevant thematic options – moving from a descriptive analysis to an interpretive analysis through condensation of the material to capture the essence of the data – which yielded the categorical themes, representing the complex social actions and sense-making attached to the health providers’ experiences of recording videos.Memos of each theme – representing provisional understandings and meanings with representative citations – were conducted and co-authored by the first, second and last authors and discussed with the author team. At this stage, the data in Danish language were transformed into memos in English, and citations were directly translated into English with professional assistance.Main messages were extracted based on key insights within data. Illustrative quotes were provided, translated from Danish language. The presented quotes are without identification in order to anonymise the few participants.Data were analysed by drawing on the interpretative description methodology (Thorne Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process and logistics attached to healthcare providers’ video recordings of their own patient consultations and the personal investment attached to the video data. The concerns and challenges involved with video recording seemed to overall be offset by providing new insights for practice development in terms of individual and team-based performance connected to patient consultations.A lot is going on in this kind of conversation [in the initial patient consultation]. And the video recording was a new element, which we had to incorporate, but did not really have our hearts in… especially not in the beginning. Because it [the video] comes from outside. And I already thought that there were too many things going on in the consultations…and then, in comes this extra…extra ‘thing’. And how much time will this take? Will it distract our work and so on?Recording videos of patient consultations were referred to as a resource-demanding task by the healthcare providers, which caused concerns of compromising their primary work tasks. These concerns revolved around the workload of adding an extra task to daily clinical practice and whether it would impact the relation to the patient during consultations. A participant expressed concerns about adding video recordings as an extra element to the patient consultation.I was skeptical about this video recording… video recording myself … and the conversation I had with the patient… that it is a personal matter and when setting up a screen [the tablet] I feared that it did something… it was the screen I was skeptical of in the beginning.The citation touches upon concerns about core elements essential to the initial patient consultation as described by the healthcare providers: to establish a relationship with the patient, inform about the programme, clarify the patient’s needs and expectations of rehabilitation and goal setting for the intervention. The healthcare providers seemed to have a pre-understanding that the video format would conflict with their work of creating a confidential atmosphere during consultations. A participant shared initial concerns of how video recording could possibly affect the personal investment into the patient consultation.This citation indicates a general concern about the video recording causing limitations to establishment of a patient-healthcare provider relationship. An initial skepticism towards participating in recording videos seemed to be common among the healthcare providers, with some choosing not to take part in the process. In these situations, the manager appeared to have a central role to play supporting the healthcare providers who chose to take part in video recording by creating a safe environment to reflect and discuss any concerns and to find the best possible solutions in clinical practice.In the start-up phase of recording videos, practical and technical issues were experienced such as finding a quiet room with reliable internet connection, setting up the video equipment and tablets that inexplicably stopped recordings during the conversation. Further, tasks on recruiting patients and obtaining written informed consent were explained to cause organisational challenges.It was more important to embrace the person sitting in front of you, instead of fumbling half an hour with the IT. I think that we were all good at saying ‘never mind’, if somebody came out frustrated after a patient consultation because the recording did not work. It was just a video recording. After all, the patient is more important.It was, therefore, important for the participants that the management acknowledged that video recording demanded additional resources to not compromise the primary work tasks. Only one health centre allocated more time for the new tasks associated to video recording, which seemed to decrease distress among healthcare providers. The healthcare providers also explained that they felt very self-conscious in their first video recordings. Nevertheless, the participants explained how the video recordings gradually became an integrated part of and adjusted into daily clinical practice. Within the first weeks the healthcare providers became more familiar with the task and added their own procedures and techniques to perform video recordings of patient consultations. For instance, several healthcare providers reported that they modified the visible presence of the tablet and placed it on a chair beside the consultation desk. Others placed a piece of paper in front of the tablet screen to avoid seeing themselves while recording. Furthermore, the healthcare providers developed what they explained as a patient-first approach. A participant reflected upon the importance of not letting the recordings distract the patient consultations:The citation illustrate how healthcare providers’ initial concerns of compromising primary work tasks seemed to become manageable to them. The healthcare providers expressed to experience their motivation and ownership of the videos to increase concurrent to their enhanced engagement and personal investment in recording the videos.The reason why it [video recording] is intimidating, at least for me, is that this work [patient consultation] demands that I show my personality. It is not just about a professional skill – if I can do a squat properly. This [a patient consultation] is more than doing an exercise. This is about how I act as a person.During the process of recording videos, the healthcare providers explained to become aware that the video recordings not only captured their ways of practice and skills as a professional, but also exposed their individual personal skills. The healthcare providers expressed the significance of investing both professional and personal skills into the interaction with the patients during consultations. For instance, a participant explained how the experience connected to video recording of a patient consultation differs from exercising:Another concern, I think we had, was about…well, now that we have recorded these videos; ‘then who in the big, wide world, is sitting and watching these videos? … We knew they [the video recordings] should be analyzed and looked through. But still, what parameters are looked upon, and who is watching, and how many are sitting…five, ten people… looking at me, having this conversation [patient consultation]. And what are they keeping an eye on about my personality, apart from the topics of the project?The citation show how the video recordings could be perceived as exposing, because the consultations contained aspects beyond their professional competencies, which were to be evaluated by external researchers, unknown to them. The participants explained how they experienced being recorded on video to be a vulnerable position, by the thought of their personal skills potentially being an object for research. The healthcare providers shared to think about e.g. ‘what do they think of me?’, or ‘are they analyzing me or the method I use?’. Therefore, the healthcare providers gradually became much curious and reflected critically upon the research process. A participant explained how they in the team had experienced more questions to surface once the videos had been recorded:The citation illustrates the complexity inherent to videos as research data, as healthcare providers felt their personal skills were part of the external research evaluation. After having engaged in recording the videos of patient consultations the health providers experienced to no longer be in control of the video recordings and how they were interpreted. Although the purpose and methods of the main project and video recordings was presented to the healthcare providers prior to project start, some participants shared how they had experienced concerns of being personally evaluated without knowing the scale. To address the ambiguities connected to video recordings exposing professional and personal skills, the health providers discussed different ideas. For instance, the potentials of a closer collaboration with researchers, through involving the healthcare providers’ practice insights and tacit knowledge into the research analyses was suggested. Further the healthcare providers shared much curiosity regards the research analysis of the video recordings, wanting to be involved and gain feedback from their ‘expert’ point of view as well, to benefit from direct learning from a research perspective. Nevertheless, despite ambiguities of exposing professional and personal skills, the healthcare providers found the videos to provide a new learning approach for improvements in practice when used in a supervision setting.I think, that the video is a new dimension, which I thought was good to try, as a part of supervision. There is something about videos, which is revealing, but in a good way, I think. It is not meant in a negative sense. We do know that we can always join in on each other’s consultations, but we never do it. This [using the video recordings] does something else. It presents things more direct…something more…there are no layers on top. There are no assessments. It is kind of raw. Situations appear more naked – unfiltered.The video recordings of patient consultations appeared to add a new learning dimension to the work of health providers, by providing an avenue for looking at daily clinical practices and routines from outside. The task of producing video recordings of patient consultations forced the health providers to reflect upon own practices, which seemed to induce individual learning experiences. Besides the individual learning connected to recording own videos for research purposes, the video material was used in team supervision making team learning possible. A participant critically reflected upon the learning opportunities in sharing unfiltered material with colleagues.Some days are off days! So…I may have said it when recording ‘delete that s…’ … when I knew the performance would show a bad result if they [external researchers] used a motivational conversation scanner… the poor patient had just been loaded with information, because I was tired. Other times, I think best conversation ever… which is a pat on the shoulder!The citation illustrates the learning opportunities of using video recordings to share experiences for joint discussion on how to improve patient consultations. The healthcare providers expressed how they were dependent on professional guidance to create a ‘safe space’ for sharing vulnerable situations with colleagues and to facilitate the learning process. A participant explained how the recorded patient consultations necessarily reflected a natural variation in performance.I think there is great learning…or potentially great learning in watching oneself from the outside. How do you actually know…we all have an idea about how we think we act, and how we think the world perceives us, and how we want the world to perceive us. But here, we are given the opportunity to get a view on the matter/case, so to speak. So, I think that this has been really valuable, to me. And really exciting to see my colleagues’ video recordings in relation to how differently we approach the matter/case, and what we can learn from one another.This citation indicates that video recordings may give the healthcare providers the opportunity to gain insights in one’s strengths and weaknesses. Using video recording for supervision seemed to inspire discussions about how to also improve the team culture. For instance, to give constructive feedback, to be vulnerable, to gain insight into diversity in performance and to have scheduled meetings for working systematically with improving the local cardiac rehabilitation programme. A participant explained how the video recordings enabled new dimensions into daily practice.The citation supports that general experience among the healthcare providers retrospectively were, that the overall learning benefits from recording the videos and participating in supervision compensated for the extra effort and concerns connected to producing the videos.The results of this study add to the understanding of healthcare providers’ experiences with video recording of patient consultations. Conducting video recordings of patient consultations initially caused concerns among the healthcare providers of compromising daily clinical practices at the cardiac rehabilitation centres. Management support was important to succeed with video recordings. Furthermore, collaboration between healthcare providers and researchers appear as central to prevent healthcare providers’ distress of exposing professional and personal skills and support learning. Supervision using video recordings has potentials to add new learning dimensions and assist the process of mobilising knowledge into daily clinical practice and motivated overcoming the challenges of video recording.et al., et al., Confidence in using the video equipment and management support are important components to succeed conducting video recordings. In line with other studies, the healthcare providers found video recordings technically- and logistically challenging and time-consuming Halimaa, . Therefoet al., et al., et al., Besides the practicalities involved in video recording, the healthcare providers were initially concerned about whether the recordings would conflict with their work of creating a confidential atmosphere during consultations. In the literature, video recordings have been demonstrated to have little or no effect on patients’ and healthcare providers’ behaviour (Pringle and Stewart-Evans, et al., et al., et al., Continually dialogue and deliberation are important when researchers and healthcare providers collaborate on video recordings. Healthcare providers seemed concerned about their personal skills as research objective and being evaluated without knowing on which scale. This result may relate to the healthcare providers’ deficient knowledge of the project evaluation and ethics. The healthcare provider’s concerns may also indicate an insufficient level of information from the research team to the healthcare providers. The literature indicates that healthcare providers seem more likely to engage with a research project if they understand the benefits of the research and if it was personally meaningful and helpful to them (Williams et al., et al., et al., et al., The new learning dimension experiences through the reflective processes accompanying the recording of videos and through supervision seemed to be an important motivating factor to the healthcare providers because of the potential for personal and team-based improvements. Video-based feedback has been recognised to assist healthcare providers in tapping into the visual and auditory patient cues present in a consultation that are not available through text-based learning (Kamin The credibility of the study was sought enhanced through applying a systematic approach from planning and design, conducting the interviews and throughout the analysis by creating a study protocol before initiating the study Thorne, . Transpaet al. concept of information power our sample size was considered in alignment with the narrow research question and the specific nature of the phenomenon (Malterud et al., Our sample size may be considered a limitation. Although a bigger sample was sought for, it was not possible for all invited healthcare providers to participate due to high work pressure in the clinic, which seem a general weakness in clinical research. However, using Malterud The choice of focus group interviews showed to be appropriate for exploring, analysing and describing the research question. However, Thorne suggests triangulation of data sources as a means to increase credibility by which analytical standards and conclusions can be generated from the synthesised data Thorne, . Thus, aAt an institutional level, ethical considerations exist as well, regards the working environment for the healthcare providers. To some healthcare providers’ video recording one’s own performance in a patient consultation may be uncomfortable and cause distress and may ultimately influence job satisfaction. Therefore, an important implication for practice is management support and creating a safe environment for the healthcare providers to reflect and discuss any concerns, create the best possible solutions in practice and also support the choice of declining to participate in the task of video recording. The transferability of the results is considered relevant in health services other than cardiac rehabilitation, as similar experiences may appear in other contexts involving video recording of patient consultations.Video recordings by healthcare providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice. Management support was important to succeed with video recordings. Using video recordings as research data demands a high degree of involvement and clarification during the whole research process to create a trustful relation and a safe work environment for all involved parties. Supervision using self-produced videos was a motivation factor for video recording and overcome the challenges of recording. Supervision using video recordings may promote learning based on specific practice experiences and situations form healthcare providers own daily practice.


Forensic service-users (SU) are often transferred between units at short notice, with little information about their new ward and unaddressed concerns. The findings of our first Plan, Do, Study, Act (PDSA) quality improvement project exploring SU's transfer experiences from medium to low secure units during COVID-19 in East London. Whilst unsettling, it may also impact therapeutic progress due to difficulties in developing new relationships with clinicians and ward residents. Our second PDSA cycle explores SU concerns and identifies improvement recommendations.Five SUs consented to take part in the experience-based co-design approach. Remote semi-structured interviews explored experiences and suggestions for improvement. Audio transcriptions were thematically analysed to assess information provision, transfer expectations, new ward perceptions, available support and overall reflections.Recipients of a tour prior to moving felt most informed about the transfer and reported not requiring further information. Without the tour, some SUs were unaware of the name or type of their future ward. Therefore, SUs recommended everyone should have a tour prior to transfer, or where not possible a video tour. Two weeks was felt to be the ideal amount of notice prior to transfer and in the absence of this, weekly updates during ward round. Being able to talk to an SU who had recently moved to the new unit would be ideal, or in lieu of this a pre-recorded question and answer (Q&A) video.SUs were interested in the new ward policy regarding leave and mobile phone criteria. A recurring issue involved SUs being promised unescorted leave on the new ward, but this not taking place. Importance was also placed on the family being updated during the transfer and moving with a preferred staff member. Many SUs felt the process was smooth yet held concerns about forming new friendships. They felt their psychologist, primary nurse or ward manager were easiest to approach with concerns. On the transfer day, SUs benefitted from the encouragement and congratulations from the old team, however cited feeling rushed when moving.Implementing a pre-recorded tour with unit facility highlights and a recent SU transfer Q&A video would improve the transfer experience. Having clear policies regarding leave and mobile phone criteria prior to moving improves clarity. Our approach to include SUs in the transfer meeting with both the new and old wards ensures transparent expectations. We continue to monitor the success of these interventions on transfer experience through further PDSA cycles.


Past research indicates strong monetary motives for gambling often elevate an individual’s risk of experiencing symptoms of gambling disorder, with personal relative deprivation (PRD) and upward mobility (UM) identified as key factors in this relationship. Nevertheless, few studies have examined how financial motives, PRD, and UM might interact for people playing modern video games—many of which offer financial incentives to encourage participation. Due to the overlap between gambling and (video) gaming, evidence suggests disordered gambling and disordered gaming might also share similarities. Therefore, the present study explored whether PRD influences associations between playing video games for financial motives, symptoms of Internet gaming disorder (IGD), and UM in two samples: 797 college students (Study 1) and 179 adult gamers over 25 years old (Study 2). Results from Study 1 revealed more PRD predicted more IGD symptoms, with higher financial gaming motives mediating the relationship. In Study 2, PRD also predicted IGD severity, but only coping motives appeared to mediate the positive association between PRD and IGD severity. In both samples, perceived UM inversely moderated the effect of PRD on one’s financial or coping gaming motives. These findings suggest financial motives for video games might lead to more problematic forms of participation for younger adults and negative perceptions of PRD and UM might interact, similar to gambling, to elevate a gamer’s vulnerability for IGD.  Nowadays, video gaming and gambling are considered socially acceptable behaviors. In fact, not only are they acceptable, these pastimes are immensely popular. As a result, access to these forms of entertainment has skyrocketed in recent decades, often leaving policymakers and public health officials playing catch-up with the rapid advancements of these industries ,2. One mIn past samples of gamblers, a consistent pattern has emerged: stronger financial gambling motives are associated with greater gambling frequencies and gambling-related problems . An inteVideo gaming has been linked to recreational and problematic gambling for over three decades now ,19,20,21This raises the question: if this gaming–gambling relationship has been suggested for multiple decades, and the core features of these games are essentially the same as their predecessors, why is it that the APA and the World Health Organization (WHO) have only recently started to consider IGD as a potential medical diagnosis? Pathological gambling, after all, has been recognized as a mental disorder for more than four decades ,24. WhatOne significant change that has occurred in the video gaming world is the central role that money now plays. Even though the fundamentals of today’s electronic games have remained relatively unaltered over the years, the ways in which these design features are currently monetized have been reinvented completely. Depending on the specific video game title being played, virtual items obtained from modern in-game purchases , as well as other aspects of gameplay, can have a real monetary value linked to them. Typically, the rarer an item is in the virtual world, the more financial value it holds in the marketplace. For many video games, virtual items can be bought, sold, traded, and even wagered amongst players of all ages . These aBeyond money-making virtual items in modern gaming, though, it is also possible now to make life-changing money from simply playing video games. Despite this being a reality that 99.9% of players never see , the reInterestingly, both the APA and the WHO have yet to directly acknowledge the financial motives and risks that can be involved in problem video gaming. In fact, the APA’s Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5 ) even stClose et al.  analyzedrelative deprivation: the perception that, in comparison to similar others, one has less than they rightly deserve—often due to circumstances beyond their control ). This finding indicates the indirect relationship between PRD and IGD severity via financial gaming motives was significantly different for participants at each level of perceived UM. In particular, more PRD alone was not predictive of IGD severity via financial gaming motives if a participant reported high UM. It was solely when participants reported more PRD coupled with low and average levels of UM that this conditional effect was associated with more severe forms of IGD via financial motives, supporting our fourth hypothesis.The moderated mediation model revealed significant conditional effects of low and average levels of perceived UM on the association between PRD and financial gaming motives see , which sB = 0.06, 95% CI ). Nevertheless, gender was not predictive of IGD severity (p = 0.07). Further, more financial gaming motives were linked to less loneliness  and more positive urgency , but they were not significantly connected to personal income (p = 0.60), although less income did predict more symptoms of IGD . For the overall model, both negative urgency  and positive urgency  were strongly related to IGD severity, suggesting impulsivity related to these domains plays a critical role in problem gaming behaviors. In sum, this model explained 12.6% of the variance in IGD severity, based on its association with PRD and UM via financial gaming motives, F(7789) = 18.23, p < 0.001. Without coping gaming motives included as a mediator in this model, approximately 20% less variance in IGD severity was accounted for in this sample, which suggests coping motives are more predictive of current IGD symptoms.This moderated mediation model also had several significant associations with our covariates. For the relationship between PRD and financial gaming motives, males were indicated as being more likely to report these motives, as compared to females (SD = 1.65), and the average amount of money spent on in-game purchases in the previous month was USD 36.67 . Participants also estimated the total amount of money they had spent previously on a single video game’s in-game purchases . To facilitate their gameplay, participants reported using the following electronic gaming devices (multiple devices could be selected): 57% (n = 102) used a gaming console, 62.6% (n = 112) used a mobile device, and 60.3% (n = 108) used a PC. Gaming consoles were the only device significantly associated with IGD severity .For MTurk participants, the average time spent playing video games was 1.85 h per day . For these participants, 33.3% (n = 3) were Asian American and 66.7% (n = 6) were Caucasian American/White. An additional 18 participants (10%) reported three to four IGD symptoms and could be considered a subclinical group for IGD diagnosis. See Moreover, nine participants (5%) reported five or more symptoms of IGD; similar to the university participants, this group had a near-even gender distribution, with four females and five males (n = 17) sometimes, 2.2% (n = 4) often, and 0.6% (n = 1) almost always or always. Nineteen participants (10.6%) also reported playing video games to EARN money at the following frequencies: 7.3% (n = 13) sometimes and 3.4% (n = 6) often. Compared to university participants, these money motives for gaming were slightly higher for MTurk participants.In reference to the past 12 months, five participants (2.8% of entire sample or 11.6% of recent microtransaction spenders) reported experiencing problems from the money they spent on in-game purchases for video games, and three participants (1.7% of entire sample or 7% of recent microtransaction spenders) reported hiding their in-game spending from others. Furthermore, 22 participants (12.3%) reported playing video games to WIN money at the following frequencies: 9.5% , and coping gaming motives predicted IGD severity . Gender was a significant covariate for the association between PRD and coping motives, with females being more likely than males to feel relatively deprived and game for emotional coping . However, personal income and positive urgency were not significantly connected to either coping gaming motives or IGD severity. For the total effect model without coping motives, 19.7% of the variance in IGD severity was explained by PRD and the five covariates, F(6172) = 7.01, p < 0.001. Specifically, IGD severity had significant associations with both negative urgency  and loneliness , indicating higher levels of these constructs were related to more symptoms of IGD.In this mediation model, PRD predicted coping gaming motives (F(1170) = 5.24, ΔR2 = 2.4%, p = 0.02. These results suggest the positive association between PRD and coping gaming motives was strengthened when there was less perceived UM . This finding indicates the indirect relationship between PRD and IGD severity via coping gaming motives was significantly different for participants at each level of perceived UM. In particular, more PRD alone was not predictive of IGD severity via coping gaming motives if a participant reported high UM. It was solely when participants reported more PRD coupled with low and average levels of UM that this conditional effect was associated with more severe forms of IGD via coping motives. In Study 1, a similar effect was observed, but in college students, it was linked to financial gaming motives instead of coping motives. In sum, this model explained 27% of the variance in IGD severity, based on its association with PRD and UM via coping gaming motives, F(7171) = 9.02, p < 0.001.Moreover, a significant moderated mediation effect was found in this model  reported spending less time playing video games during the pandemic, 223 participants (28.0%) reported spending about the same amount of time, and 443 participants (55.6%) reported spending more time. For Study 2, 21 participants (11.7%) reported spending less time playing video games, 61 participants (34.1%) reported spending about the same amount of time, and 97 participants (49.2%) reported spending more time playing video games.Regarding the pandemic’s effect on the amount of money spent on video games, in Study 1, 280 participants (35.1%) reported spending less money on video games during the pandemic, 363 participants (45.5%) reported spending about the same amount of money, and 154 participants (19.3%) reported spending more money. In Study 2, 17 participants (9.5%) reported spending less money on video games during the pandemic, 133 participants (74.3%) reported spending about the same amount of money, and 29 participants (16.2%) reported spending more money. Based on these results, it appears that the COVID-19 pandemic in the U.S. elevated the amount of time spent on video games for approximately 50% of players and the amount of money spent for 16.2–19.3% of players.The short answer: yes. Consistent with previous research on the monetary aspects of modern video games ,41,42,43ageM = 41.87, SD = 10.16 vs. ageM = 20.30, SD = 4.54), the rate of participants’ problems related to in-game purchases equated to about one out of every nine spenders (11.6%) experiencing problems from their financial involvement in video games. These reported rates of financial problems could possibly explain why 7–25.6% of microtransaction purchasers reported concealing their video game spending from others.Yet, the amount a player spends is not necessarily indicative of that person experiencing problems from that behavior. Therefore, we asked participants directly if the money they spent on in-game purchases (within the last 12 months) had caused them problems. For college students (Study 1), roughly one out of every four spenders (24.7%) stated they experienced some difficulty from the loss of their money to video game microtransactions. Whereas for MTurk participants (Study 2), which was a much older demographic group , mos, mos83])In terms of gaming and gambling disorders specifically, ignoring the connections between different addictive disorders could increase the likelihood of their co-occurrence or potential substitution for one another. This possibility is supported by results from an extensive systematic review of the addiction literature , which eAlong with this study’s contributions to the theoretical conceptualizations of gaming and gambling disorders, to the best of our knowledge, this research was the first attempt to move PRD theory beyond the real world and into the context of online communities. In general, we saw a trend with younger participants who specified they were active in online communities appear more susceptible to reporting higher levels of PRD. This finding should prompt the general public—particularly users of social media—to critically evaluate the potential societal effects that can arise from online social interactions increasingly substituting for real-world ones. Unlike social comparisons conducted in-person, online comparisons offer a global reference group and can obscure details that are needed for accurate evaluations of others, as well as of ourselves. When this point is considered within the evolutionary setting that our brains developed , it seems reasonable that the human mind is perhaps simply unprepared to make thousands, if not millions, of social comparisons online without repercussions.Furthermore, this research has important clinical implications for medical professionals treating addictive disorders. If our results are a reasonable reflection of the overall IGD rates in the U.S. general population , clinicians should be encouraged to target adult clients’ beliefs related to PRD and examine how these beliefs can maintain someone’s financial and emotional coping motives for video gaming. Since both subjective and objective data suggest the U.S. has substantially less UM than many other developed nations , medicaFew studies, especially in the U.S., have investigated the financial motives and risks that are involved in today’s video games. Therefore, this research is at the forefront in attempting to discern the greater consequences of inserting opportunities for real money, gambling-related or not, into video games available to every child, teenager, and adult with a mobile device. This situation is especially concerning due to the lack of oversight involved in the video game industry’s implementation of gambling features ,88,89. UOverall, there were several limitations of this study that warrant acknowledgment. First, this research relied on self-reported cross-sectional data for all analyses, preventing our findings from fully addressing questions of causality between variables. Second, without a diagnostic determination being completed by a medical professional, we can only relay the number of IGD symptoms reported by participants and suggest whether there is a possibility of a medical diagnosis. Third, participants were recruited through convenience sampling to participate in the study’s survey and were not randomly sampled from the U.S. general population, which hinders us from identifying the true response rate of the survey and making more confident generalizations to the larger population. Although it is important to note that the survey’s recruitment description did not indicate the study was examining video gaming. Fourth, MTurk participants in Sample 2 could have been motivated to participate in the study for financial reward. Despite the study’s monetary compensation for MTurk workers being relatively low: USD 2.00, it is still possible that this payment incentivized participation in the survey that would have otherwise not occurred. Fifth, each question within the study’s survey required a response in order to minimize missing values in the datasets. This type of survey design could have prevented the identification of problematic questions or measures.Future studies should investigate problematic video game behaviors in the U.S. adult population longitudinally to better understand the directionality of associations between video game motives, different types of microtransactions, and IGD symptoms. It would also be beneficial to detail the course of disordered gaming over a significant temporal period to observe how different levels of involvement can occur at certain times in a player’s life. Additionally, the connection between disordered gaming and adverse childhood experiences (ACEs) has not yet been well documented. Previous research on childhood adversity and its relationship to later substance abuse has shown that for each ACE someone reports, it can double or even quadruple their likelihood of early substance abuse . Based oOn a related note, there appears to be a need for more neurobiological research on individuals with symptoms of IGD, as well as other behavior-based addictive disorders. While this study focused primarily on the psychosocial aspects of these variables, there is also consistent evidence demonstrating that a person’s biology plays a critical interactive role in the overall expression of addictive behaviors . Future The question is never “Why the addiction?” but “Why the pain?”—Gabor Maté  (p. 36)The prevalence of addiction we are seeing today, perhaps, speaks to a larger issue of how we have structured our modern society for the average person. More than ever before, we appear to be disconnecting from each other, as well as ourselves, which could at least explain some of the reasons why addiction appears to be finding its way into the lives of so many around us. Yet, until we decide to confront the fundamental components of our human culture as it now manifests, maybe the only option is to reduce the harms that can arise from the countless ways people cope with this current era. For video games, we could start by implementing more stringent age verification for games with unlimited spending limits or create greater transparency into the video gaming industry’s use of gambling mechanics in order to reduce the possibility of systematic consumer manipulation for corporate profits. Regardless of the path we pursue, though, it is becoming increasingly apparent that a radical shift is needed to address the existential threat that our contemporary ways of living have created for life on this planet.On a final note, if economic and social inequalities continue to widen as they have in recent decades , here is


GIBLIB (4.0). GIBLIB, 811 W 7Th Street, 13th Floor, Los Angeles, CA; https://www.giblib.com/; Contact for institutional pricing https://www.giblib.com/services/institutional-pricing; Individual pricing structure: Basic, Standard, and Premium plans. Compatible with PC, Mac, tablet, and mobile. GIBLIB, which sometimes refers to itself as the “Netflix of medical education,”  is an onCompany founders are CEO Brian Conyer and co-founder Jihye Shin . The chiThe target audience for GIBLIB is healthcare providers, trainees, and students. The experts featured in the resource primarily include physicians, but advanced practice providers, physical therapists, pharmacists, and others in healthcare roles are represented. The coverage includes a wide variety of specialties, making the content relevant to a broad health sciences audience.The videos can be used by practicing providers for their own learning and continuing education. Continuing Medical Education (CME) credit is available through the premium level individual subscription and may be an option for institutional subscribers. The content can be used by students and trainees to explore any topic or specialty of interest as well as a supplement to educational programs for these groups. Procedural videos  in particular can be used to supplement educational programs or to augment training in the instance of in-person learning disruptions such as those caused by the COVID-19 pandemic.Navigation in GIBLIB is easy and intuitive. Users can explore the content in several ways: search by keyword, browse by category, or view the catalog. Most aspects of the resource can be accessed seamlessly without registering for a personal account or logging in; institutional users do need to create an account and log in to make use of bookmarks, CME (if included), and playlists.From the main interface, a left sidebar provides navigation to “Home,” “Browse,” “Bookmarks,” “CME,” “Playlists,” “Catalog,” and “Tutorial” . The HomThe resource is designed to work on desktop, tablet, or phone, and all features are available on all devices with Chrome being the recommended browser. On a smaller laptop screen, the long lists of “Specialties” subtopics in “Browse” could not be viewed at once. With touchscreen or arrow keys, moving the list to access the remaining subtopics was possible but not intuitive. Similarly, on the reviewer's iPhone, the more granular levels of the “Specialties” were difficult to select and access. Navigating the video carousels on the main page was difficult on a laptop screen but worked seam-lessly on phone and tablet. Perfecting the ease of access across devices would make the resource more user friendly for faculty and students who would be likely to access the resource from a wide variety of devices.The video player controls are similar to those users are likely to have experienced on other streaming video platforms, including skip back 10 seconds, skip ahead 10 seconds, sharing options, playback rate, captions, picture-in-picture mode, full-screen mode, and playback quality levels. The captions are available in English, Spanish, Korean, and simplified Chinese, and they are powered by Google. As such, errors do occur and are similar to those seen in other software with automatic captioning or transcription features. The transcripts appear to be based on the captions, so errors may be found. However, the transcripts are fully searchable and allow users to skip ahead to a specific place in the video based on the text. Notes allow users to save any information learned from a video; notes created for a video can also be downloaded.As of this writing in January 2022, the resource contains nearly 4,500 videos. Of these, 75% of the videos are associated with Mayo Clinic; the remaining 25% of videos are affiliated with another 14 organizations, including Society for Thoracic Surgeons and Cleveland Clinic. New content is added regularly [Videos come in a variety of types. Procedural videos are primarily surgeries and include general, plastic and reconstructive, cardiothoracic, orthopaedic, and oral and maxillofacial surgery. Some surgery videos are 360 virtual reality (360VR). In these videos, the user sees a wider shot of the operating room and simultaneously a virtual screen showing a close view of the procedure itself . Users cOther video types are in the format of one-on-one conversations, interviews, conference presentations, discussions, or lectures, and cover a variety of topics. Some present a featured speaker talking about a particular area of expertise which may run anywhere from a few minutes to a halfhour or more. Many of the lecture and conference presentation videos provide the audio of the speaker and show a slide deck. On occasion a slide deck may have blanks, which occurs when content is removed due to copyright restrictions .The metadata for each video provides a brief description of the content, the name of the expert, the affiliated institution, filming date, and publication date. A beneficial addition would be a short list of objectives accomplished by the video enabling medical educators to determine whether a particular video might be appropriate for an educational purpose. This would help educators determine whether to invest their time in watching the video prior to assigning it to trainees or students. Another feature not currently available would be an option for creating a citation for any video and then exporting the citation to a reference management software allowing students and faculty to incorporate the material into lectures or class assignments easily. Even a suggested format for citing any video in the FAQ section would be of use.In the “Browse” section of the navigation sidebar, “Specialties” currently includes 36 content areas  with many of these content areas including subspecialties. The amount of content for each specialty varies; for example, many more videos are available for “Surgery” and “Internal Medicine” than for “Dermatology” and “Emergency Medicine.” Users can also browse by “Conferences,” which contain a variety of videos, such as recordings of a COVID-19 Live Webinar Series from Mayo Clinic. However, this section appears to be in development because at the time of this writing some of the collections have no content assigned. Another browsing option is “Courses” which provides predefined collections of videos about a specific topic. Some examples include GIBLIB and Cedars Sinai Present: Topics in Gender Dysphoria (3 videos), Opioids (9 videos), or Care of the Older Adult (15 videos). Users can also browse by specific “Organizations,” “Experts,” or “Hot Topics.”Institutional pricing is customized according to the size of the organization. Institutions should contact GIBLIB for further details.Free trials lasting 4 days are available for any user. Individual subscription plans include the basic plan at $20/month , the standard plan at $60/month , and the premium plan (includes CME) at $83/month for one year. The premium plan can also be purchased for 2 years ($1500 one-time payment) or 3 years ($1800 one-time payment). A discount of 50% is available on individual subscriptions for residents and students.Though many health sciences resources provide some video content, the exclusive focus on videos as well as the depth and breadth of topics available make GIBLIB a unique and excellent medical education resource for faculty, trainees, and students. The resource will meet many individual users own learning goals within their specialty but also provides them with options to explore topics outside of their specific discipline. The platform has great potential as a resource that faculty can use in supporting the curriculum of a number of health sciences educational disciplines. The ease of use on all devices will allow users to watch content on whatever platform they prefer, and the options for bookmarking and creating playlists allows users to prioritize, customize, and manage their learning.


High-quality essential newborn care (ENC) can improve newborn health and reduce preventable newborn mortality. The World Health Organization recommends specific ENC interventions. Video recordings have potential as a tool for assessment of clinical care also in low and middle-income countries.To use video observations of healthy newborns to describe ENC practices in a low-income setting and compare actual clinical practice with WHO recommendations.This is a cross-sectional observational study. Video records of neonatal interventions to 324 healthy newborns were assessed. They were obtained at baseline of a pre-post intervention study during a 10-week study period in Pemba, Tanzania. Data also included postnatal structured questionnaires. Eight ENC interventions and quality indicators were defined as per the WHO recommendations. Descriptive statistics were used to summarize ENC practices and maternal and neonatal characteristics.None of the newborns received all eight recommended ENC interventions. The median duration of separation from the mother was 25 minutes and 15 seconds (ranging from 22 seconds to 3 hours and 36 minutes), 51% of the newborns received proper thermal care during the separation. Twenty-one percent had sufficient umbilical cord care, 8% were stimulated for breathing, 69% were observed at least once by healthcare staff and 9% did undergo suctioning. None of the newborns received antibiotic ointments or vitamin K.Video recording of healthy newborns was feasible. The study identified omission of key ENC practices including proper thermal care, skin-to-skin contact and establishment of breastfeeding within the first hour of life, vitamin K administration as well as application of unnecessary practices such as excessive suctioning of breathing newborns. The rate of neonatal mortality decreased by 51% between 1990 and 2017 . PrioritThe World Health Organization (WHO) recommends essential newborn care (ENC) interventions to secure an early diagnosis and prevent illness in newborns . A key rExisting research has primarily focused on newborns with low birthweight or illness . There iThis cross-sectional observational study drew on data obtained during the baseline period of a pre-post intervention ‘Newborn Emergency Outcome study’  in Pemba, Tanzania with the aim of reducing neonatal mortality. Motion-triggered video cameras mounted on top of resuscitation tables in the delivery room of each district hospital were used to collect data presented in this paper during a 10-week period from 13 September 2019 to 22 November 2019. The Strengthening the Reporting of Observational studies in Epidemiology checklist was used to apply the methodology used in the current study.Pemba has a population of about 400,000 and four district hospitals . This stHealthy newborns delivered at Chake Chake District Hospital during the 10-week study period and their mothers were eligible for participation. Newborns undergoing neonatal resuscitation or showing danger signs were included in a different analysis, and these data will be presented elsewhere. Prior to the delivery the participants provided written consent to participate in the study. Women in the maternity and delivery wards were enrolled as soon as possible after admission; until the expulsion phase of the second stage of labour. Women in an obstetric emergency or with late presentation was not approached. After delivery consent could be obtained for the postnatal questionnaire. Research assistants asked the women for informed consent to video record the post-delivery care of their newborns and to complete a postnatal questionnaire, which was completed in cooperation with them. The research assistants were present in the maternity and delivery wards 24 hours a day to enrol women in the study, obtain their consent and complete the postnatal questionnaire. The health worker in charge of each birth, assisted by a research assistant, also completed a postnatal questionnaire as soon as possible after the delivery. Prior to the beginning of the study period the healthcare workers provided their consent to participate.A motion-triggered camera  was used to record the videos; it was installed on top of the resuscitation table and recorded all instances of newborns being placed on the table. The newborn was placed on the resuscitation table immediate after the health worker cut the umbilical cord and before active management of third stage of labour. A research assistant would cover the camera if any woman, who did not provide consent, was in the delivery room since the table was shared. Only newborns, the resuscitation table with surrounding floor and the hands and feet of the healthcare provider were in the field of vision to ensure the confidentiality of staff. The parents, obstetric procedures and caregivers faces where not visible. The research assistant placed each individually assigned identification card on the resuscitation table prior to or after placement of the newborn. The videos contained time stamps and identification numbers. The identification number was applied to each woman and her newborn until discharge. The recorded videos were stored on an encrypted micro-SD card in the camera, and the data were uploaded to a secure database that could only be assessed by the international PI with an encryption code and key. All videos are deleted after the final analyses from the study. The video recordings were only for research purposes and only the international study team had access to the video recordings to ensure the individual health workers’ anonymity. The postnatal questionnaires and data on the participants’ sociodemographic, obstetric, delivery and neonatal characteristics were collected and directly entered into Lenovo® (version 7) tablets using secure data collection software (i.e. RedCap® version 5.12.1). Birthweight was cross matched with the data from the hospital registers owing to inconsistencies for a small number of observations.Eight WHO essential newborn care interventions were observed on the video recordings. For each ENC indicator corresponding actions in video recordings i.e. video indicators and their subcategories, were defined by a team comprising two doctors specialized in paediatrics and a paediatric resident  5]. Som. Som5]. t-test was performed. Video indicators regarding suctioning, stimulation and administration of vitamin K and antibiotic eye ointment were afterwards compared with the postnatal questionnaires to account for findings possibly not captured on video.The video recordings were analysed according to the ENC video indicators defined in During the study period, 676 deliveries took place at Chake Chake District Hospital. Sixteen newborns died, 19 newborns were excluded owing to the need for neonatal resuscitation, and 317 newborns did not have video recordings. Of the 676 deliveries, 547 (81%) newborns had a postnatal questionnaire completed. Ultimately, 324 healthy newborns were eligible for inclusion in the ENC video analysis . Three hThe median maternal age of the participants was 26 years (IQR of 22–30 years); 18% of the pregnant women were aged ≤ 20 years. Most women were married (97%) and housewives (82%). As a minimum, three quarters of the women (77%) had finished secondary school. Median parity on admission was 3 (IQR of 2–5); 25% of the women were primigravida. Only 47% of them could provide an estimated gestational age; there were no reports of gestational age of < 37 weeks. There were no newborns with birthweight of < 1,500 g; 11% had a birthweight of < 2,500 g. The mean birthweight was 3.2 kg (standard deviation = 0.47 kg). The participants’ socioeconomic, obstetric and delivery characteristics are depicted in p = > 0.700).The eight defined ENC indicators and their subcategories were used to analyse each video of the newborns . Of the Ninety-nine newborns (31%) were not evaluated for colour or breathing by the healthcare staff at the resuscitation table; 101 newborns (31%) were assessed once, and 124 newborns (38%) were checked more than once. Of the 37 newborns who were clinically examined, 30 (9%) were examined once and 7 (2%) twice or more. Two newborns (1%) were assessed using a stethoscope. Sixty-eight newborns (21%) had their cord checked for bleeding, and an extra cord clamp was applied 15 times (5%). Bleeding was not observed from the cord in any cases, and extra cord clamps were used to shorten the umbilical cord. None of the newborns received the intramuscular administration of vitamin K, and one newborn was administered antibiotic eye ointment. This corresponds to the findings in the postnatal questionnaires, with no reports of vitamin K or antibiotic eye ointments administration.The time spent on the resuscitation table  was used as a surrogate marker for the duration of separation from their mothers. Thirty-one newborns (10%) spent more than one hour on the resuscitation table; therefore, they did not meet the recommendation of breastfeeding within an hour of being born. One newborn who was delivered by Caesarean section was fed by cup while on the resuscitation table and spent 30 minutes separated from its mother. No other newborns were fed while on the resuscitation table.None of the newborns received all eight ENC interventions . Less thVideo recordings were feasible and a useful objective tool to evaluate clinical ENC practices in Pemba, Tanzania. The data showed that none of the newborns received the recommended ENC interventions adequately . The stuThe findings of the current study are in line with other cross-sectional studies on ENC practices in Ghana , SomaliaThe use of video recordings in the current study was a major strength. It allowed for a less intrusive way of observation, the generation of less biased data, and it enabled the establishment of a timeline for each newborn for more accurate description of ENC practices. Specifically, indicators like thermal care, routine suctioning, time separated from the mother and observation of the newborns were optimal for video observations, since these were captured within the frame, were subjected to very few or no assumptions, and could not have been performed out of view. Direct observations of delivery care are considered to be the gold standard in low-income settings and to be more reliable than medical record reviews, health staff interviews and patient interviews . The HawWe had several ethical considerations in using video recordings in a delivery room and the consent process thereof. It could be argued that obtaining consent from a woman while she is in labour  involves ethical considerations as she may not be in the right state of mind to take in information and provide valid consent. The video inclusion rate (51%) could be affected by the timing of consent, since the consent was obtained during a vulnerable state and that women with late presentation or in an obstetric emergency was not approached. The inclusion rate for the postnatal questionnaire was 81%. The gap between the inclusion rates could be due to the timing of consent since consent for the postnatal questionnaire could be obtained post-delivery. Furthermore, newborns who might have had video consent had no video recording because they were not placed on the resuscitation table after delivery  or were placed on the resuscitation table together with a newborn without consent and consequently covering of the camera. To improve inclusion rates in future research different placements/tables for newborns with and without consent is recommended.The most recent (2014–15) service provision assessment report in Tanzania reported better compliance with ENC practices compared to the findings of the current study. Routine care practices, such as early skin-to-skin contact, early initiation of breastfeeding and wrapping newborns, were in place in 90% of the evaluated health facilities . HoweverIt has been estimated that compliance with newborn care practices immediately after birth prevents 10% of all neonatal mortality . A largeThe recommendation of early initiation of breastfeeding is supported by the findings of several studies . GloballOur findings identify educational and contextual factors contributing to challenges in provision of quality of ENC. There is consensus that ENC training for healthcare staff improves practices and compliance ,15,33. AThe current study demonstrated that ENC compliance was inadequate in this setting at a district hospital in Pemba. An implication for future research is the need to investigate barriers in provision of essential low-cost practices in low-income settings and to consider the impact of possible contextual factors in this regard, such as a scarcity of supplies, a lack of human resources, local cultural practices, and religion. In addition, determining health staff knowledge of the importance of adequate ENC practices should be undertaken.To the best of our knowledge, this study is the first to have used video recordings to assess the compliance and quality of ENC practices for healthy newborns. Previous studies have used video recordings to analyse newborn resuscitation scenarios. Given the obvious disparity more studies should be conducted using video recordings to evaluate ENC practices to validate methodologies. Video recordings may be feasible and acceptable in LMIC, however further research is needed of using video recording for quality improvement.The current study demonstrated using video observations of ENC practices that none of the included newborns received all the recommended ENC interventions. Further research is needed in barriers to provision of essential newborn care in a low resource setting.


Posterior fossa arteriovenous malformations (AVMs) in pregnant patients can present unique considerations for surgical treatment, including positioning to minimize pressure on the fetus, minimization of radiation exposure, and ethical considerations regarding emergency surgery. This video outlines surgical treatment of a ruptured tonsillar/vermian AVM performed in a staged fashion after emergent suboccipital craniotomy with posterior fossa decompression in the setting of a life-threatening infratentorial hemorrhage. Later, bilateral cerebellomedullary fissure dissection, exposure and dissection of the tela choroidea and inferior medullary velum, and disconnection of arterial feeders from the posterior inferior cerebellar artery (PICA) allowed resection of this AVM occupying the roof of the fourth ventricle.This study was approved by the UCSF Human Research Protection Program IRB no. 18-26938.https://youtu.be/rTYUGanopUEThe video can be found here:  This case will demonstrate resection of a tonsillar AVM in a pregnant woman in this ruptured posterior fossa AVM.0:28 Clinical History. This patient presented 18 weeks pregnant with loss of consciousness, and she was GCS of 3 with nonreactive pupils.0:37 Preoperative Imaging. An EVD was placed given the hydrocephalus and IVH, and her brainstem reflexes improved, as did her pupillary response. At that time, she was taken emergently for a posterior fossa decompression.0:49 Continuation of Clinical History. At the time of the posterior fossa decompression, she became unstable again, and she required defibrillation prior to turning her prone. Sinus rhythm was restored. However, she then became unstable during the craniectomy, and only a craniectomy and dural opening was performed, but no evacuation of the hematoma nor resection of the AVM given her instability. The case was stopped, and she was taken to the ICU. It was not felt that she would recover at that time given the cardiac instability; however, she did improve.1:22 Continuation of Preoperative Imaging. This is her CTA at the time of presentation showing the AVM in the fourth ventricle. We can see [yellow arrow at 1:27] on the coronal CTA the draining vein coursing superiorly and to the right along the superior aspect of the AVM nidus, and it is also at the anterior aspect of the AVM nidus adjacent to the middle cerebellar peduncle on the right. We can see bilateral PICA supply from the left [yellow arrow at 1:45] and the right [yellow arrow at 1:47] PICA vessels from the telovelotonsillar segments, and we can see the AVM nidus [dashed yellow circle at 1:51] sitting here in the roof of the fourth ventricle on both the coronal and the sagittal [dashed yellow circle at 1:56] CTAs. And again, finally here, we can see this draining vein [yellow arrow at 1:59] at the anterior aspect of the nidus going superiorly, and it’s on the right side. She did improve and was following commands at 1 week.2:09 Patient Positioning. She was then taken; here is her positioning in stage 2. She was taken back to the OR and placed in the lateral decubitus position. You can see the closure from the prior approach, or stage 1. She was placed in this position to avoid pressure on the fetus in the prone position, and the case was performed—stage 2 was performed—for the purpose of resecting the AVM.2:29 Demonstration of Initial Exposure After Opening Dura. Here’s the view from the microscope during the time of surgery. We are opening, and you can see that there is scar and bipolar cautery over the surface of the cerebellum at the time of the last procedure. Again, we are opening the dura. The dura had not been completely closed from the previous procedure. We are just opening more dura along the upper cervical spinal cord to allow for access and visualization of the PICA vessels. The inferior aspect is to the right of the screen; again, she is in the lateral position, and to the left of the screen is the left PICA, where we are cutting the arachnoid. We can see the left PICA underneath the cauterized tonsil.3:10 Demonstration of Bilateral Telovelar Approach to Devascularize the AVM Nidus. So, this approach—because the AVM is in bilateral tonsils and has supply from bilateral telovelotonsillar segments of PICA—will require bilateral opening of the telovelar approach on both left and right. Here is the left-sided opening of the tela choroidea of the fourth ventricle. We can see the left PICA running in that telovelotonsillar segment. The feeders to this AVM, again, are from that telovelotonsillar segment of PICA, so we will basically skeletonize both of those segments of PICA to devascularize the AVM, and also, we will come across the superior aspect of the AVM through the inferior vermis to get all the way around the AVM. So, this is coming through the inferior vermis and, again, we will carefully cauterize. Here is an AVM clip that is needed to clip a friable perforator vessel coming through the brainstem to this AVM, which does not often respond to cautery. Additional cautery along the left side of the telovelotonsillar segment of PICA, and now we are seeing more of the right side. Here is devascalarization of feeders from the right PICA now. And then we will go around this AVM on all sides. The inferior side has already been created by the space—the foramen magnum or cisterna magna—so there is no supply from the inferior aspect of the AVM. Here we can see the draining vein [yellow arrow at 4:42] at the superior and right anterior aspect of the AVM nidus, and it will be the last pedicle of attachment of this AVM before it is removed. And we will continue to cauterize and skeletonize now the right PICA. And this is exposure of the telovelar approach on the right. And we will cauterize any remaining feeders coming through the middle cerebellar peduncle, which is seen just deep to the bipolar there (5:13)—the inferior, posterior aspect of the middle cerebellar peduncle. Again, telovelar exposure on the right. This is bipolar cautery and cutting of the last attachment of this AVM, and then it is removed.5:28 Demonstration of Relevant Anatomy After AVM Resection. And now that the AVM has been removed, we can see at the inferior aspect of the screen here [yellow arrow at 5:33], we can see the upper cervical spinal cord. We can see the dura open over the cervical spine [yellow arrow at 5:38]. This is at the level of the foramen magnum [dashed yellow line at 5:41]; we can see the PICAs coming up into their telovelotonsillar segment [yellow arrow at 5:44] in the cerebellomedullary fissure. Both tonsils [shaded yellow ovals at 5:48] have been resected, and what happens when both tonsils involve this AVM and are removed with the AVM  is now the roof of the fourth ventricle has been removed. We can see the entire fourth ventricle, facial colliculi [yellow arrow at 6:05], and then all the way up to the cerebral aqueduct [yellow arrow at 6:08]. So now, we are seeing the entirety of the fourth ventricle after the roof has been removed, which harbored this AVM. We can see the bone that is remaining over the inion [yellow arrow at 6:16] here—this is superior—and so we really get a nice view of the fourth ventricle.ng.6:22 Postoperative Imagi We know that this AVM has been removed. There is no breakthrough bleeding. The vein has been taken at the top of the exposure. We did not perform an angiogram given this patient was pregnant, and we had postoperative CTA, which we will see here (6:33), which shows resection of this AVM. The patient did have a delayed angiogram at a later time.6:40 Clinical Course. She had a prolonged postoperative course and remained in the hospital with monitoring of fetal heart tones, which remained excellent. She was in the hospital for many weeks but eventually was discharged to rehab, where she continued to recover. She had poor PO intake at first, but she did not get a PEG tube and eventually regained the ability to take PO intake. Her tracheostomy had been removed prior to delivery. She delivered a healthy baby boy approximately 4.5 months later, and at 6 months’ follow-up, she was essentially neurologically intact, with some gait ataxia but otherwise walking independently. She has since made a full recovery.7:15 Conclusion. So, this case illustrates a posterior fossa AVM in a pregnant patient who underwent two stages. The first stage was a decompression, followed by the second stage after she showed some improvement following the decompression. The second stage was resection of the AVM and the tonsil, and she ultimately went on, 4.5 months after the surgery, to have a healthy baby boy through a normal vaginal delivery and has since made a full recovery. Thank you.Primary surgeon: Abla. Assistant surgeon: Raper, Raygor, Rutledge. Editing and drafting the video and abstract: Abla, Raper, Raygor, Dubnicoff. Critically revising the work: Abla, Raper, Raygor, Rutledge. Reviewed submitted version of the work: Abla, Raper, Raygor, Rutledge. Approved the final version of the work on behalf of all authors: Abla. Supervision: Abla.