Nursing professors and nurses validated it. They assessed the pertinence of content, clarity, and language of the video scenes. The Delphi Technique was used in this phase. After recording, three nursing professors, along with undergraduate nursing students from a public university, assessed the educational video. The professors first watched the video and suggested changes, and then the students watched the video after the changes were implemented.six rounds were needed for experts to validate the video script using the Delphi Technique. After the video recording, undergraduate students considered the video of easy understanding.the video script was composed of four topics and was validated by experts after six rounds. The video was assessed by the professors and nursing undergraduate students, who considered the topics and the video as a whole as apprehensible. This study is expected to contribute to professional training and improvement of the knowledge and skills of nursing students. Therefore, teaching tools that aid in the execution of this procedure are extremely important. Universities currently seek other tools to use in the teaching-learning process with students, since teaching based only on theoretical classes does not facilitate the retention of knowledge. Thus, various tools have been used, and videos are among them.Bed bathing is one of the procedures most frequently performed in clinical practice, but because its execution presents various steps, students often face difficulties performing it. Therefnowledge. Thus, (-). This tool can be used in undergraduate teaching, as well as to improve the knowledge of patients and family members who are supposed to perform a given procedure(-). Video can be used in various teaching settings, such as classrooms, simulation centers, distance learning, and can aid students in acquiring new skills and improve their learning process.A video can be an effective tool to be used during classes because it has various advantages, such as the fact it is a practical method, with a good cost-benefit profile, and low investment when compared to the large number of people it reaches. It also facilitates understanding of information as people are allowed to watch the scenes multiple times, as many times as necessary, and is well-accepted in the educational field-4. Throcedure-8. Vi. Video content allows for the demonstrations of clinical skills that undergraduate students are yet to experience, thus providing them an opportunity to enhance visual learning.Compared with written information, videos are more accessible in terms of language and communication and can be more cost-effective. Video . Another important step is assessing the video, which can be performed by experts and by the population who are supposed to use the video. In this context, studies developing and validating videos addressing nursing procedures are essential both for teaching and care delivery.There are various methods to develop a video but in general three steps are implemented: pre-production , production  and post-production (video editing and inclusion of audio). Anothehe video,11. I. Other studies report the efficacy of using videos, such as reducing the need to repeat lectures, and allowing to review and improve teaching methods; increase knowledge at the short-term; and improve practical and theoretical knowledge and performance in assessment tests(-).One study, the objective of which was to develop and validate an educational video on the dressing of central venous catheters without cuff, shows that this tool can contribute to nurses’ training and can be used to update human resources, even through distance learning, improving the quality of care delivery. Other dies,,-14 re methods; increaort-term; and imnt tests-14.From this perspective, nurses can develop and incorporate validated teaching technologies, such as videos, to assist educational practices. However, no studies developing and validating a video on bed bathing were found in the literature. This procedure has several steps and can lead to complications when not performed appropriately. Therefore, a video can promote patient safety, as students are allowed to practice several times while watching the video before actually providing patient care.In this sense, the following guiding question emerged: Do nurse specialists and undergraduate nursing students consider a literature-based video considered valid?In order to answer this question, the objective was to develop and validate a video on bed bathing directed to nursing professionals and students.11-12.This methodological study was conducted from July 2016 to January 2017. The video’s development and validation were performed according to the steps described by other authors: development and validation of the video script, recording, and video assessment.The video script, a storyboard, was based on the literature. Three professors from the Fundamental Nursing Program and four nurses with at least two years of hospital experience validated the video script, all of whom consented to participate and signed free and informed consent forms. Specialists teaching classes on the topic and/or providing care to patients who required bed baths were selected. The specialists were recruited through intentional non-probabilistic sampling on the Lattes Platform. Note that the Delphi Technique allows the number of experts to be directly determined by the phenomenon one intends to study, and there is no consensus in the literature on the ideal number of experts; studies validating video scripts have selected from five to nine specialists,,15., as well as the order of dialogues and images. An instrument containing all the topics addressed in the video that included a three-point Likert scale , used in previous studies, was adopted and sent via e-mail along with the video script to be analyzed. If nurses considered the script to be partially appropriate or totally inappropriate, they were asked to suggest pertinent changes. In order to be considered valid, there should be a 100% agreement regarding the video script among the specialists and achieve a mean score equal to 3 .The nurses assessed the pertinence of content, clarity, and language used by the characters of each of the video scenes, as wel adopted and sen. It is a method to collect opinions and criteria from a group of experts on a given topic by successively applying questionnaires, while information from previous phases is used in each phase to reach consensus among the participants. Comments from one round are collected, analyzed, and integrated into the next round to collect opinions from the experts. The advantages of using the Delphi method are: condensing different opinions and obtaining consensus among experts; the anonymous nature of the process, which prevents a single strong individual from dominating the process and influencing the group’s opinion; the process can be carried out via e-mail and does not require experts to physically meet, enabling members from different places to participate.The Delphi Technique was used in this phase of validation. This technique has been used to validate instruments and video scripts,,16. Iicipants. Commenticipate.The recording of this educational video was based on the validated script. The video was developed together with a team specializing in video development, which recorded the video scenes and the characters’ lines. It was recorded in a Skills and Simulation Center, where a scenario was created with a fictitious infirmary. Those who participated as part of the cast became familiar with the script before recording and editing. The video was composed of images, scenes, and descriptive phrases. The scenes were filmed repeated times by the Skills and Simulation Center at the Federal University of São Paulo until the content of the validated script was complete; ten hours of work were necessary to film all the scenes. The scenes that contained the patient’s phrases were filmed first because the actor (a nurse) performed these scenes first, and then the validated script was followed. The technique of the procedure was simulated by two nurses using a low-detail training manikin. Two Sony Nx5 camcorders were used. A professional with experience in voice-over recorded the narration of the video in a studio with an Audio-technica microphone and Tascam recorder, while the video was edited using Adobe Premiere CC Program. Three days were necessary to complete the editing, in order to include the content of the validated script, totaling ten hours. One re-edit was required at this point., was used for the students to assess understanding of the educational video as a whole and each of its parts. The minimum score was 1 (I did not understand anything), and the maximum was 5 (I understood it perfectly and have no doubts). In addition to the content, students were asked to assess the video for images and audio, the environment where it was filmed and the characters. The Wilcoxon Test was used to verify agreement among the students’ answers. Binomial distribution was used to calculate a 95% confidence interval for the proportion of maximum scores . The project was submitted to the Institutional Review Board, while data collection was initiated only after receiving approval (No. 1025890).Three professors from the Fundamental Nursing Program assessed the educational video for content and face validation and undergraduate nursing students from a public university in São Paulo, Brazil assessed it for face validation. Professors first watched the video and suggested changes. After these changes were implemented, the students watched the video. The population was composed of second-year nursing students who agreed to participate in the study. Sophomore students were selected because the theoretical classes addressing the topic of bed bathing are taught during the second year of the program. A five-point Likert scale, developed by the researchers and used in a previous study, was usThe video script was composed of four topics addressing the definition of bed bathing, the indications for this type of bath, steps , and related complications. After its development, the video script was validated by nurses ; six rounds were necessary to obtain a consensus among the experts. Note there were no specialists losses during the rounds, and no changes were requested regarding the definition of the procedure. Regarding the topic “definition”, three rounds were necessary to obtain a consensus among the experts. In round 1, the mean score of the content was 3.0; clarity was 2.71; order of dialogue was 3.00; and language was 2.29. In round 2, the mean score of content was 3.00; clarity was 3.00; and language was 2.57.The changes suggested by the nurses regarding the content can be viewed on An educational video on bed baths of 21 minutes and 21 seconds duration was developed addressing the following topics: definition (36 seconds), indication (21 seconds), procedure (17 minutes and 24 seconds), and complications (3 minutes).After the video was developed, three professors from the Fundamental Nursing Program assessed it and proposed small adjustments . The video was re-edited implement these changes and then the video was presented once more to the nurses; no further changes were suggested at that time.Afterwards, the video was assessed by the nursing undergraduate students, who scored the level of comprehension for each topic and the video as a whole. All scores were greater than 4  and the . Planning is essential to ensuring the success of the subsequent steps, and this study presents the development and validation of a storyboard, which portrays (lines and images) exactly what is addressed in the video, in addition to guiding the filming and avoiding the need to re-editing. The script was composed of four topics: definition, indication, procedure, and complications in order to address all the knowledge necessary to teach students and the population that will use this tool.Various steps that can be taken to develop a video, but the most frequently used are: planning or pre-production, filming or production, editing or post-production. Planni-editing,12. T. The experts were nursing professors from the Fundamental Nursing Program and professional nurses and the experience of judges on the topic was taken into account; both professionals had experience with this procedure (bed bath) in their professional routines. The choice of 100% inter-judge agreement was intended to lend greater rigor to the planning phase, though a mean of 75% consensus is generally used.The Delphi Technique was used to validate the script. Even though it has seldom been used for this specific purpose, it has been used to validate instruments and manuals through expert consensus. The exroutines. The chlly used.. We believe this result is due to the size of the script, which contained 18 pages, and the fact the experts did not communicate during the assessments, which might have hindered the clarification of potential divergences.Six rounds were necessary to validate the script, a number larger than that reported in the literature (two to three rounds). We bel. The information not to apply vigorous comforting massage on bone prominences and areas where pressure injuries are starting to appear was also included in the script, as guidelines concerning pressure injuries emphasize it. The objective of this information is to prevent and/or not worsen pressure injuries. Another suggestion was to keep the call-light close to the patient after the bath, especially for the bedridden. One study emphasizes that not having devices to call the health staff is a risk factor for falls, which compromises the safety of patients. Various experts suggested, especially the nursing professionals, that the modified bed bath technique used for unconscious patients and those unable to raise their hips for placement of the bedpan, was included. The experts suggested that after washing the patient’s feet, intimate hygiene be performed without placing the bedpan under the patient’s hips and then change the water, washcloth, and gloves in order to wash the patient’s back, buttocks and anus. This same sequence has been suggested when other devices are used for the bed bath, such as disposable washcloths; however, it is recommended to use each washcloth on one body part and dispose of it afterwards, minimizing cross infection. Therefore, this modified technique was included, emphasizing changing the water, gloves, and washcloth after intimate hygiene.The main suggestions involving content were related to the procedure itself, such as keeping the bed rails up when positioning the patient in lateral decubitus; concomitantly cleaning the patient’s bed and furniture with a 70% alcohol; and removing the plastic protecting the venous access. These steps are essential to ensuring patient safety and reducing the risk of infection. Another suggestion was to initiate hygiene on the upper and lower limbs on the side as opposed to the professional who is bathing the patient. The reason is that another professional can simultaneously rinse and dry the patient. Even though this information is not emphasized in the literature, it was retained because it does not violate the basic principle of bed bathing, that of washing from the least to the most contaminated parts. The ininjuries. Anothepatients. Variounfection. Theref. The nurse who played the role of a patient recorded scenes related to orientation provided by the health worker and scenes of the technique that did not involve body exposure. The use of professionals who experience the procedure in their practice substantiates the technique and facilitates recording. The video’s final version, i.e., after editing, was 21 minutes and 21 seconds long. Studies suggest that a video should not last more than 10 to 20 minutes, in order to avoid hindering comprehension of content on the part of viewers and also due to the difficulty disseminating the material on the internet(-). In this case, however, parts of the video can be viewed separately, while the most extended topic is the description of the procedure, with 17 minutes and 24 seconds.The use of simulators prepares students for the real context of practice, helping them to develop practical skills and appropriate care delivery, along with patient privacy. The nuecording,12. Tternet-. In thi. Other suggestions included: raising the volume of the actors’ voices in order to make them more comprehensible, considering different environments would be used to transmit the video and also replacing the term pressure ulcer with pressure injury. The term “pressure ulcer” was recently changed to “pressure injury” because, according to the National Pressure Ulcer Advisory Panel - NPUAP, the expression pressure injury more accurately describes this type of injury, both in terms of intact and ulcerated skinAfter the editing, the video was first watched by professors, who had participated in the script validation, so that they could identify potential gaps; a few adjustments were suggested and then implemented. One professor suggested changing the order of one of the scenes and keeping hand washing after organizing the room. Hand washing should take place before and after contact with patients and material that is close to patients (objects and surfaces close to the patient), in order to avoid the transmission of microorganisms from one patient to professionals or other patients. Other . Additionally, the use of confused and incomprehensible language can cause fatigue and disperse viewers, potentially leading to the incorrect performance of a procedure.Agreement between experts and the target population on the video concept, clarity, order of dialogue and language, is fundamental to ensure understanding of what is presented and renders the video more attractive. The use of an incorrect concept and/or terms difficult to understand may lead to the inappropriate performance of a procedure and, consequently, compromise patient safety. Additirocedure.This study contributes to the advancement of knowledge in Fundamental Nursing and the acquisition of practical skills by students and nurses and to improve teaching practices both in the classroom and in simulation centers. Additionally, it can contribute as a guide for the production of videos in different areas of knowledge.The study’s limitation is related to the size of the script, which may have hindered the experts’ assessments.A video addressing bed bathing was developed and validated. The video was composed of four topics addressing the definition of bed bathing, the indications for this type of bath, steps to execute this procedure, and related complications. This study is expected to contribute to professional training and improvement of the knowledge and skills of nursing students.


Throwing speed was predicted (24–72%) with only one or two variables in each model. The selected variables were: BMI, arm span in U16 model and height U14 model, and the BMI, arm span and height are proved to be good predictors of TS in male handball players.The objectives of this study were: (i) to analyse anthropometric parameters and throwing speed from seven meters in amateur male handball players of different ages; (ii) to know the relationship between anthropometric parameters and throwing. One hundred seventy-six male handball players (16.5 ± 5.1 years old) participated in the study, classified according to their age: senior (n = 35), U18 (n = 30), U16 (n = 37), U14 (n = 50) and U12 (n = 24). All participants were evaluated by anthropometric measurements  and throwing speed from 7 m standing. A one-way analysis of variance with a Bonferroni post hoc test was used to establish the differences between teams. Pearson’s simple correlation coefficients were calculated between analyse anthropometric parameters and throwing speed. Multiple linear regression was used to predict the throwing speed. Only BMI was related with throwing speed in all age groups (0.506 > r < 0.813,  Throwing the ball into the opponent’s goal is one of the most important actions for the achievement of sporting success in handball . This teTraditionally, it has been estimated that throwing speed (TS) depends on different factors such as technique, temporal coordination of the different body segments, and power of both upper and lower body muscle groups . On the Hand size and fingers length, influence the most on throwing in handball ,15,16. TPrevious work have considered both throwing distances from 7 m ,22,23 anConsequently, the objectives of this study were: (i) to analyse anthropometric parameters and TS from seven meters in male handball players of different ages and, (ii) to know the relationship between anthropometric parameters and throwing speed.A descriptive study was developed to clarify the relationship between TS (dependent variable) and anthropometric parameters (independent variables) in amateur male handball players.One hundred seventy-six amateur male handball players participated in the study. Convenience sampling was by non-probability and non-random sampling. The participants were classified in function their age: senior , under-18 , under-16 , under-14  and under-12 . All the subjects had knowledge and training experience in handball and in the technical gesture of the throw: senior (15.5 ± 5.6 yr), under-18 , under-16 (7 ± 1.88 yr), under-14 (5.2 ± 1.80 yr) and under-12 (2.7 ± 1.45 yr).All participants were informed in detail about the research protocol and the basic characteristics of the study as well as the possible risks related to the test execution, and informed consent in accordance with the Declaration of Helsinki was signed by all of them prior to the start of the study. Where needed, parents or other surrogates provided permission for under-18 and younger players. The recruitment was done among different handball teams in Aragon Handball Club, Spain, belonging to the different categories studied in the present study. The present study has the approval of the Alcala University, Spain, ethics committee.2) were found for every participant using a weighing scale  provided with a precision stadiometer . All the measurements were taken with participants wearing only underwear. The anthropometric assessment followed the guidelines issued by the International Society for the Advancement of Kinanthropometry (ISAK) [All the participants executed the same protocol under the same circumstances and were guided by a researcher. The measurements of height (m), weight (kg), and BMI (kg/my (ISAK) . All meay (ISAK) . Arm spay (ISAK) . Hand spIn regards with the measurement of TS, a protocol of nine standing throws was set up using only the best result for analysis. First, a standardized warm-up established by the researchers and technical staff was performed, consisting of five min of low intensity running, three min of mobility exercises and two min of active stretching and ballistic exercises. Finally, warm-up focused on throwing was developed prior to participation. Throws were performed from the seven-meter line, allowing only one foot to be lifted and never stepping on the seven-meter line, simulating a penalty throw in handball , with a 2. TS was used as a dependent variable. The ranges of the variance inflation factor for all the independent variables were between 1.009 and 2.830, and they showed a small influence of collinearity. The Durbin-Watson statistic was calculated and showed that there was no autocorrelation in the residuals . The analysis was complemented by descriptive statistics, model fitting, estimation and confidence intervals. Relative reliability analysis was examined by the intragroup correlation coefficients (ICC). An ICC equal at or above 0.70 was considered acceptable [The basic descriptive statistics mean and standard deviation were calculated. All the variables satisfied the tests of homoskedasticity (Levene variance homogeneity test) and normality (Kolmogorov-Smirnov test) of their distributions. One way of variance (ANOVA) was used to compare means between age groups. As significant variable effects were determined (α = 0.05), Bonferroni post-hoc pairwise comparisons were executed to determine where the main effects occurred. The intragroup linear relationships between variables pair was examined using Pearson linear correlation. A multiple linear regression was carried out to obtain the β index stepwise selection. Correlations between arm span, hand span and BMI were found via Rceptable . The magceptable . The ES ceptable . Statistceptable ,35.p < 0.001) and U14-U12 (p < 0.001) groups.In the intergroup analysis (ANOVA analysis provided the differences between contiguous age groups . Regardianalysis  between A linear intragroup correlation  was perfThe multiple linear regression model used to predict the speed throw  the R2 vThe purpose of the study was to analyse anthropometric parameters and TS from seven meters in amateur male handball players of different ages, to know the relationship between anthropometric parameters and TS.According to the results obtained to compare age groups, can be seen how the anthropometric variables are more relevant in younger players and gradually lose their value based on their progression in the categories. Previous studies determined the anthropometric parameters at different ages ,18,36,37With respect to the differences between anthropometry and TS, differences between all age groups are shown. These data are consistent with studied the relationship between anthropometric parameters and age groups in male handball players from greater to lower involvement from the youngest to the oldest players, respectively , and femRegarding the relation for each variables  a large While interpreting the findings of the present study, some limitations need to be considered. First, the previous training experience was not considered, discarding, consequently, the likely contribution to the TS. Furthermore, the present protocol was performed by amateur handball players, thus, outcomes in elite handball players is unknown.The conclusions of this study are BMI, arm span and height are proved to be good predictors of TS in amateur male handball players. However, further studies need to be undertaken in this area in order to reach a greater consensus among researchers, especially to unify what would be the anthropometric variable that mostly influences on TS in handball. The findings reported here make sport scientists and coaches clearly distinguish the different variables influencing on TS at different ages and, therefore, they facilitate their work not only on throwing improvement, but also on the return-to-play process. Hence, given that the anthropometric parameters analyzed here are easy to assess, these might be evaluated by coaches systematically over the sport career of the players allowing to know, from a practical standpoint, their evolution and the influence of body morphology on throwing speed.


Heart rate (HR) is extremely valuable in the study of complex behaviours and their physiological correlates in non-human primates. However, collecting this information is often challenging, involving either invasive implants or tedious behavioural training. In the present study, we implement a Eulerian video magnification (EVM) heart tracking method in the macaque monkey combined with wavelet transform. This is based on a measure of image to image fluctuations in skin reflectance due to changes in blood influx. We show a strong temporal coherence and amplitude match between EVM-based heart tracking and ground truth ECG, from both color (RGB) and infrared (IR) videos, in anesthetized macaques, to a level comparable to what can be achieved in humans. We further show that this method allows to identify consistent HR changes following the presentation of conspecific emotional voices or faces. EVM is used to extract HR in humans but has never been applied to non-human primates. Video photoplethysmography allows to extract awake macaques HR from RGB videos. In contrast, our method allows to extract awake macaques HR from both RGB and IR videos and is particularly resilient to the head motion that can be observed in awake behaving monkeys. Overall, we believe that this method can be generalized as a tool to track HR of the awake behaving monkey, for ethological, behavioural, neuroscience or welfare purposes. These include tracking changes in pupil diameter5, in skin conductance6, social blinks7, blink rates9, nose temperature10 and heart rate (HR)12. HR measure is of particular relevance in diverse cognitive contexts. For example, it has been shown that HR increases when monkeys watch videos with high affective content13 and during learning process15. In spite of this, very few methods currently allow to easily, reliably and non-invasively track HR in awake behaving untrained monkeys. The aim of the present study is to fill this methodological gap.Tracking variations in autonomous responses has proven to be invaluable in the study of complex behaviours and their physiological correlates in non-human primates17. It also involves placing a captor on the subject, usually on the fingers. For both these methods, signal quality can deteriorate in time, due to a displacement of the electrodes or the captor. In addition, when dealing with adult human subjects, this may introduce experimental biases due to the fact that subjects possibly becomes aware of the scope of the study. In young infants or animals, placing the captor or maintaining it all throughout the experiment may turn out to be challenging if not impossible. In monkeys, recording HR either involves ECG or PPG under sedation20 or implanting a telemetry device for HR measure during behaviour22. PPG recording or HR measures using captors embedded in a wearable jacket is also an option24. However, this requires intensive monkey training and might bias HR measures due to discomfort or stress.The classical tools already available on the market to extract heart rate, such as electrocardiograms (ECG) or pulse oximeters, require a direct contact of electrodes or captors with the skin. Indeed, ECG detects changes in voltage generated by the cardiac muscles and requires to place electrodes on a shaved skin. The pulse oximetry method measures oxygen saturation and pulsations of blood thanks to photoplethysmography (PPG). PPG consists in detecting luminosity variations of the skin that are directly related to changes in blood flow27. This method is based on the mechanical effect of blood ejection from the heart on hole body posture. More recently, methods allowing to extract HR at a distance from human subjects have been developed based on video image processing30. Imaging photoplethysmogram (iPPG), detects, as is the case for PPG, variation of skin light absorption/reflection properties33. Indeed, heartbeat induces blood flow in all the body including the face skin. This results in a change in the skin reflectance38. These changes in human skin reflectance can be tracked from webcam40 or smartphone41 video quality images associated with ICA signal processing techniques.Ballistocardiography has proven efficient in tracking human HR in open field situation, such as the home, analysing whole body movement using machine learning methods42 have successfully applied HR tracking in awake macaques in combination with discrete Fourier and wavelet transform based iPPG. While this study is of great interest, it falls short of two objectives that are useful to behavioural and experimental studies in non-human primates. First, Unakafov et al.42 do not address IR video-based hear rate estimation, although for example, a lot of neuroscience studies require video recording in light controlled environments. Second, they do not evaluate the sensitivity of their method in the awake behaving monkey and its ability to track subtle changes in heart rate, for example during the processing of emotional stimuli.These methods appear highly relevant to non-human primate research and welfare, as cognitive processes, emotional states or welfare indicators such as stress can only be inferred by indirect measures. However, one of the major challenges in this context is the fact that changes in skin reflectance are more difficult to detect in monkeys due to reduced glabrous facial skin surface. In spite of this limitation, Unakafov et al.30. A major advantage of this approach relative to iPPG is its resilience to subject motion29. We have further associated EVM video extraction with wavelet transformation based analyses, that has also been shown to be motion tolerant on poor quality human webcam video data43. In a first step, we show that EVM-based HR tracking has a high temporal coherence with ground truth ECG data, whether extracted from RGB video images or IR video images  and that EVM-based HR estimate is very close to ECG-based HR estimate. For both types of video quality, we show that temporal coherence between EVM-based heart tracking and ground truth ECG is not significantly different between humans and monkeys. Last, we describe the dependence of temporal coherence between EVM-based heart tracking and ground truth ECG on the localization of the specific facial region EVM is performed onto. In a second step, we apply EVM-based heart tracking to the awake monkey and we show that this measure allows to identify consistent HR changes following the presentation of conspecific emotional voices or faces. Overall, we believe that this method can be generalized as a tool to track HR of the awake behaving monkey, for ethological, behavioural or welfare purposes.Here, we present an alternative indirect HR tracking method in the monkey, using Eulerian Video Magnification (EVM)Macaca mulatta) participated at this study. They were aged between 9 and 17 years . The project was authorized by the French Ministry for Higher Education and Research (project no. 2016120910476056 and 2015090114042892) in agreement with the French implementation of European Directive 2010/63/UE. This authorization was based on the ethical evaluation by the local Committee on the Ethics of Experiments in Animals (C2EA) CELYNE registered at the national level as C2EA number 42 and the National Ethics of Experiments in Animals board of the French Ministry of Higher Education, Research and Innovation. In order to meet the ethical requirement of reduction, following the recommendation of the ethical committee, we describe our finding and perform our statistical tests in two monkeys.Three rhesus monkeys (Two human participants were included in this study and were covered by a broader project authorization (ID RCB 2018-A03438-47).Monkeys were lightly anesthetized with Zoletil  so as to avoid head movements. During the video and ECG acquisitions, monkeys were gently resting on their side, under constant physiological monitoring.During these sessions, monkeys were awake and sat in a sphinx position in a plastic monkey chair and head restrained to avoid movement. They faced a screen (1920 × 1200 pixels and a refresh rate of 60 Hz) placed 54 cm from their eyes on which stimuli were presented by an experimental control and stimulus delivery software (EventIDE). The auditory stimuli were displayed by a Sensimetrics S14 insert earphones and set up. Monkeys were required to fixate the centre of the screen all throughout the recording blocks. Eye fixation was controlled thanks to an Eyelink video eye tracker (EyeLink). Recording blocks consisted in 2 alternations of 16 s of fixation and 16 s of emotional stimuli presentation . In one type of recording blocks, fixations alternated with highly emotional auditory content (screams). In a second type of recording blocks, fixations alternated with highly emotional visual content (4° × 4° aggressive faces). In total, 54 fixation to scream transitions (30 for monkey T and 24 for monkey S), and 57 fixation to aggressive faces (30 for monkey T and 27 for monkey S) were collected. The auditory stimuli and part of the visual stimuli were recorded in Cayo Santiago, Puerto Rico and kindly produced by Marc Hauser. The other visual stimuli were created in our own lab.Electrocadiographic signal (ECG) was recorded thanks to a BiopacSystem. In humans, two electrodes were placed on the subject’s thoracic cage, on each side of the heart, while the reference electrode was placed on the abdomen, close to the stomach.In macaques, two electrodes were placed on the subject’s thoracic cage, on each side of the heart, while the reference electrode was placed close to the groin on a shaved skin. ECG signal was recorded at a frequency of 2 kHz, in order to have a well-defined QRS waveform.We used a USB camera with a variable framerate (maximum frame rate of 30 frames per second), and a spatial resolution of 640 × 480 pixels. The camera had two working modes depending of light intensity. At high light intensity level, the camera was a color (RGB) device. At low light intensity level, the camera was an infrared (IR) device.When comparing EVM-based HR tracking to ground truth ECG HR estimation in monkeys (monkey T and monkey Z), the animals were anesthetized and laying on their side. The video recording was targeted to the face. When comparing EVM-based HR tracking to ground truth ECG HR estimation in humans (subject H1 and H2), subjects were requested to gently and steadily gaze at the camera and video recording were targeted to the face. For each monkey and human subject, we collect ten minutes of videos in full light (RGB mode) or in the dark (IR mode).When analysing the effect of emotional stimuli on EVM-based HR tracking, we recorded IR videos while monkeys T and S were performing the above described task.ECG and video time series were synchronized using the AcqKnowledge software. Specifically, the AcqKnowledge software was used to record the ECG signal and send start and stop synchronization triggers to the video recording system.In order to optimize HR extraction, the first processing step involves defining, in the recorded video a region of interest (ROI) to feed in the rest of the processing pipeline Fig. A. Becaus30 allows to magnify variations in frame to frame video information and can thus be used amongst other things to amplify skin colour variations due to blood circulation. It involves both a spatial and a temporal processing such that any variation in pixel properties through time and space is amplified. This can be modelled as follows: on a 1D signal, let I be the intensity of the signal at pixel x and sapling time t. The displacement function, δ(t), represents at a given time the distance of the pixel from its original position. Thus the intensity of the pixel of interest can be written ast = 0, the intensity of the pixel x takes the value:The Eulerian video magnification algorithm or EVMThe EVM process consists in adding an amplified displacement function to the original intensity signal of gain α. Considering that the signal is within the selected range of frequencies of an ideal band-pass filter, the intensity signal generated by the EVM is defined as:Outside the selected frequency range, the intensity signal is set to identity: Î = I. This results in the selective amplification of movement information in the 1D signal within the frequency range of interest. This procedure can be generalized to a 2D signal such as a video. The input video is decomposed into several spatial frequency bands. The same temporal filter is applied to all these bands. The most relevant spatial frequency band to the signal of interest  is amplified and the result of this amplification is added to the initial video signal. Amplification factor (α) and temporal filtering parameters are hand-optimized by the experimenters to maximize the identification of the signal of interest.https://people.csail.mit.edu/mrub/evm/), and run it on our ROI-cropped video, defining a spatial filtering by a Gaussian blur and a down sample, as well as a temporal filtering by a band pass filter matching the expected range of HR estimates (e.g. 90 to 200 bpm45). The output of this first EVM processing round is a video in which luminosity changes due to HR are enhanced  and realigned to stimulus event presentation (0 s time reference). Individual time series are baseline corrected ([− 13 − 3 s]) and mean + /− s.e. is computed in time. Pre ([− 13 − 3 s]) and post-stimulus ([3 13 s]) HR estimates are compared using a non-parametric Wilcoxon test.Macaca mulatta) participated at this study. They were aged between 9 and 17 years . The project was authorized by the French Ministry for Higher Education and Research (Project No. 2016120910476056 and 2015090114042892) in agreement with the French implementation of European Directive 2010/63/UE. This authorization was based on the ethical evaluation by the local Committee on the Ethics of Experiments in Animals (C2EA) CELYNE registered at the national level as C2EA number 42 and the National Ethics of Experiments in Animals board of the French Minsitry of Higher Education, Research and Innovation. All experiments on non-human primates were performed in accordance with relevant guidelines and regulations.Three rhesus monkeys (Two human participants were included in this study and were covered by a broader project authorization (ID RCB 2018-A03438-47). All individual data was anonymized. All human experiments were performed in accordance with relevant guidelines and regulations. All experimental protocols were approved by the CNRS (research institution acting as promotor) and the CPP-Sud-Est (acting as licensing committee). Informed consent was obtained from all participants.d was calculated by dividing the mean difference between HR before and after the stimulus by the global standard deviation during the run. When the Cohen's d is equal to 0.2, the effect is considered as small effect, 0.5 as medium and 0.8 and more as large.All statistical analyses are non-parametric Wilcoxon rank-sum tests that do not assume normally distributed data. This tests the hypothesis according to which the medians of two independent data distributions are close to each other. Such non-parametric statistical tests are usually considered as more stringent then parametric statistical tests. The effect size Cohen's In order to validate the EVM-based HR measure, we compared the inter-pulse signal estimated using the EVM approach Fig.  to groun30. Here, we confirm that HR can be estimated from human RGB . Overall, this is thus evidence for the fact that EVM can be used to provide a reliable non-invasive measure of HR estimation in the anesthetized preparation.Table During the EVM signal analysis, a ROI must be defined in order to optimize HR extraction. This ROI is usually placed in the most luminous part of the video, in order to record the luminosity variabilities as precisely as possible and thus have the best EVM-based HR estimation. see Fig. B. Althou48 or emotional processes13. A non-invasive HR tracking alternative thus needs to be able to track subtle changes in HR while monkeys are actively performing a task. Here, we required two monkeys to maintain eye fixation on a central cross for reward, while stimulating them with either monkey screams  and the aggressive monkey faces  induce a small but systematic change in HR. The onset of these systematic changes are of the order of a few seconds and are compatible with the reported latency of HR changes during emotional processing13.The main objective of this paper is to provide a non-invasive alternative to ECG and pulse oximeter HR tracking method for monkeys during typical behavioral tasks, with no behavioral training requirements. During such tasks, HR measures have been shown to co-vary with cognitive42. Importantly, and in contrast with this previous study, EVM-based HR estimates can be reliably obtained both from RGB and IR videos.Overall, we demonstrate that EVM combined with wavelet transform analyses allows to reliably extract HR estimates from both RGB and IR videos of both anesthetized and awake macaque monkeys. These HR estimates are directly comparable to ground truth ECG HR estimate, as they have the same temporal stability and show a high temporal coherence with these reference signals. These EVM-based HR estimates also show a higher similarity with ECG in monkeys than in human subjects  probably due to the fact that monkeys were under anaesthesia while human subjects were awake. Irrespective of anaesthesia and quite remarkably, coherence between EVM-based and ECG-based HR estimates tended to be higher when extracted from monkey videos than from humans. While this could still be due to improved stability of the face in the video stream in the anesthetized preparation, it still noteworthy, as human faces have more glabrous as well as a thinner skin, thus allowing for a better capture of superficial vascular changes. In any case, reporting this temporal coherence measure is crucial as it indicates that EVM-based HR estimation is sufficiently sensitive to track actual physiological variation of HR in time. These EVM-based HR estimates compare to those reported in a previous study extracting monkey HR from videos using imaging photoplethysmogram13. Reported HR changes can thus be specifically associated to stimulus emotional informational content rather than to visual stimulus presentation. This is an important point as local luminosity changes due to for example visual stimuli presentation have been shown to affect plethysmographic signals49 but not ambient light50. Indeed, HR has been shown to be modulated in a variety of tasks: emotional or valence tasks53, attentional tasks56 as well as learning tasks47. Tracking this physiological parameter non-invasively, is methodologically easier, brings no stress and thus improves animal welfare while experimenting, saves training time and minimizes possible measure biasing factors . In addition, HR measure has been shown to covary with pupil dilation, typically controlled by the autonomic nervous system57. Pupil dilation has been shown to vary as a function of reward58, surprise59, vigilance for social distractors60, arousal61 and systemic pharmacological neuromodulation5. Last, HR can be a crucial parameter to assess behaviour following a drug induction62 or a lesion15. Overall, this ability to track changes in HR measure in an experimental context, that we demonstrate here, is thus of major implications to behavioural, cognitive and neuroscience experiments in awake macaque monkeys. This method is less expensive and requires no training. It can thus now be recommended and implemented as a control measure in most such awake macaque experiments.Our present work addresses one crucial aspect of highest relevance to behavioural and cognitive studies in non-human primates, namely HR estimation in awake behaving monkeys. Here, using our EVM-based HR estimation method, we reproduce the observation that emotional sensory stimuli, whether it be auditory or visual, induce HR changes in monkeys63. This technique can be implemented to detect moving animals in open fields or working animals in less restrained environments than ours, provided a high-resolution fast frame rate camera is used. This would be an important add-on to our work as HR and HR variation in monkeys in their home cage, during their time in the experimental setup or in open zoo spaces is considered as a good health state and stress marker45. For example, Hassimoto et al.64 tracked the first 3 months of acclimation of rhesus monkeys in a new laboratory environment and they demonstrate a decrease of HR following this stressful period64.In order to improve HR detection from videos, a recent paper suggests to use neural networks to detect and enhance the ROI from which the signal is extractedIn summary, the method we describe here is an easy and reliable non-invasive alternative for HR estimation both in anesthetized and awake monkeys. It has several notable advantages. It is very easy to set up as it only requires a decent recording camera and a computer to implement the processing pipeline. It is stable over time and does not require any specific training from the animal due to its absence of body sensors. It works in a classical behavioural task environment and is resilient to luminosity changes. Its major disadvantage lies in the fact that it doesn’t, as it stands, allow real-time tracking of HR or the tracking of HR in freely moving subjects. Once these two limitations are overcome, the method will be usable during veterinary or health visits whether under sedation or light anaesthesia, under minimal contention condition, or even in home cage or open field environments.66. By extension, we expect that this method can also be applied on young infants in neurodevelopment studies, where pulse oximetry HR tracking can turn out to be extremely challenging.The generalization of this method to experimental and ethology animal facilities can be considered as a contribution to animal welfare. During actual cognitive, behavioural or neuroscience experiments it can be considered as a refinement measure as well as a crucial physiological control parameter to include in the data analyses or in the framework of data sharing consortiaOverall, the non-invasive video-based HR extraction method described here generalizes to experimental situations that have not been addressed by previous studies. First, it successfully extracts non-human primate HR estimates both from RGB videos, as previously achieved by others, as well as from IR videos. Second, we show that this method is very robust to small head movements, successfully tracking HR in the awake behaving monkey. Third, we show that this method is sufficiently sensitive to track HR variations during the exposition of non-human primates to emotional visual and auditory stimuli. It thus represents a non-invasive low cost and easy to implement HR tracking method that can be used in multiple anesthetized and awake monkey behavioural, veterinary and experimental set-ups. Association with automated face detection algorithms is further expected to generalize this method to open-field situations, thus representing a real breakthrough in the study of monkey behaviour and well-being.


Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like.Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations.We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations , 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography , we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime).appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow , and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient  to simultaneously follow instructions and manipulate technology  to make it possible for the clinician to see and hear adequately.Patients had been selected by their clinician as A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link.RR2-10.2196/10913 There is a significant push from decision makers across the world to make better use of digital technologies, including video consultations -3. VirtuPublished research on video outpatient consultations has been summarized in several recent reviews -10. ThesMuch of this literature uses either experimental methods, classifying service models primarily by the technology used and secondarily by the task or clinical work supported by that technology, or questionnaires and semistructured interviews, typically with small samples, to assess feasibility and acceptability. There is limited evidence on costs . Patientends of the consultation. Ekberg et al [There has been limited research focused specifically on the dynamics of video-mediated interaction in health care consultations and the ways in which communication might be altered by the use of video. To date, only 8 studies have examined such interaction in video consultations, with only one analyzing video recordings at both rg et al ,43 lookerg et al -46 explorg et al -46. A prrg et al ,47. Stomrg et al  studied rg et al .There is a growing body of evidence outside of health care that highlights the ways in which video calling might alter interaction . Early sIn summary, although the evidence on video consultations indicates that they are feasible, safe, and effective in health care, the evidence on interaction in such consultations is limited. Only a handful of studies have considered the impact of the video medium on the microdynamics of interaction in medical consultations . The resWe studied interaction in video consultations in four clinics in two National Health Service (NHS) trusts (one acute and one community). The Qualitative Analysis of Remote Consultations (QuARC) study built on several years’ work by our team looking at the national-level context for video consultations, the organizational context supporting adoption and implementation, and microlevel interactions between patients and clinicians ,47,59. TAs set out in the QuARC study protocol , the aimOur research questions were as follows:What are the (often implicit or unspoken) communication strategies through which technology-mediated consultations for diabetes, cancer, and heart disease are successfully accomplished?How do patients and clinicians negotiate misunderstandings in technology-mediated consultations, and what strategies are more effective?What can we learn from a detailed linguistic analysis of real-life remote consultations to guide other clinicians and patients interested in or actively using Skype and other video platforms for medical consultations?We have previously published a detailed study protocol . This seA mixed methods design was used to study video consultations in 4 contrasting clinical settings  across 2 NHS trusts (Oxford and London). The study was informed by linguistic ethnography, which uses both linguistic and ethnographic approaches to understand how social and communicative processes operate in a range of settings and contexts, combining video and audio recordings of consultations, interviews, and observations from 2 previous studies  to examine in detail how patient-clinician interaction is shaped by use of Skype and FaceTime.This study was delivered by a core working group  and supported by an independent steering group with a lay chairperson and cross-sector stakeholder representation, including patients, NHS stakeholders, and national-level decision makers.Both studies from which data were drawn received ethical approval for a detailed analysis of video recordings of video consultations. VOCAL was approved by the National Research Ethics Service Committee London–City Road and Hampstead in December 2014 (14/LO/1883) and OQTS by the South Central–Berkshire Research Ethics Committee in September 2015 (15/SC/0553). All participating staff and patients in both studies gave their informed consent to be audio and video recorded during consultations and for the data to be used for research purposes.The study took place at 2 NHS trusts in London and Oxford, each of which explored the use of video consultation services. We collected data over 30 months . The data sources are summarized in Our dataset consisted of 37 video recordings of consultations  from theExclusion criteria were no 3G internet access at home, lack of familiarity with the technology, clinical inappropriateness , inability to give informed consent, and comorbidity preventing participation . In the diabetes clinic, which included a high proportion of limited English speakers, bilingual health advocates trained in the use of remote consulting were available, so limited English was not an exclusion criterion there. In the antenatal diabetes and cancer surgery clinics, those who were comfortable with a family member interpreter were included, but a remote interpreting service was not available. In the heart failure service, all participating patients were native English speakers.To enable comparison, we collected 28 audio recordings of matched face-to-face consultations . ParticiVideo consultations for the VOCAL study were recorded by a researcher (JW) using a small digital camcorder with a wide-angle lens. For the OTQS study, they were recorded by a researcher (CA/TG) using a small digital camcorder and a handheld iPad (Apple Inc). Face-to-face consultations were audio recorded using a digital Dictaphone. We captured clinician and patient interaction with the videoconferencing software using a commercially available screen-capture software tool (ACA Systems) to record screen images showing on each party’s computer screen as a video file. This was run directly from a USB memory stick.ends  or where a failure in the technology was addressed . For the fourth question, we built a collection of cases where the patient and clinician struggled with smooth turn-taking, and so had repeated overlapping talk and/or stopped talking. Silences and overlapping talk are common in all conversations ; hence, what participants say, how they say it , and accompanying nonverbal communication . Guided by the principles of sequence organization and turn design [In line with CA ,64, we tn design ,66, we tn design ,68, and trouble, such as potential misunderstandings, and grouped these into key challenges. At this point, we zoomed out to our contextual data with the aim of better understanding how and why such challenges occur  and how they are negotiated.Finally, once we had a solid appreciation of the patterns of communication across collections, we identified areas where there was Patients and their caregivers were key to the research. We set up a dedicated patient advisory group (PAG) in 2015 to enable patients to review documents and give feedback on their experiences and to incorporate patient feedback within the respective studies. We have since set up a standing group, Patients Active In Research on Digital health, who, along with the PAG, have reviewed emerging findings (including anonymized video clips) from the QuARC study and provided feedback on developing guidance on video consultations. Finally, we worked with a design company to co-design guidance and an accompanying animation that involved 2 workshops with a total of 50 members of the public, followed by a review of materials via email. This process was critical in developing both content and design of these outputs .We found that for this highly selective group of patients and clinicians, the use of video technology typically  enabled effective consultations that followed the conventional organization of a consultation . PatientClinicians managed to start consultations in the same way as a face-to-face consultation by asking, for instance, “How are you today?” and inviting patients to provide updates on their condition since the last consultation . PatientThe use of video calling  was a novel form of communication for many users , we identified 3 key challenges that  participants faced when doing video consultations: (1) establishing a connection and starting a video consultation, (2) dealing with disruption to conversational flow caused by technical issues with audio or video, and (3) conducting a physical examination via video. We describe each of these below, along with the communication strategies used to negotiate them. We present data extracts illustrating the analysis in the figures below  and exchange phone numbers and/or email addresses , lost passwords (n=2), or misunderstandings about which platform to use (n=1). The problem was typically resolved by one participant  calling the other by telephone, finding a solution, and then restarting the video connection.Before a video consultation can get started, steps must be taken at both gh et al  for furtOnce a connection was established, opening greetings at the start of a video consultation were critical, not only in prompting conversation but also in indicating that participants could see and hear one another. It was at this point when technological issues, such as limited audio, were acknowledged and addressed. When clinicians and patients were familiar with the technology and potential problems, openings ran smoothly, and problems were quickly resolved. However, when one or more participants were not familiar with the technology, this could quickly lead to confusion and delay .answer, the doctor appears on their screen  is not a greeting, but a means of testing if the patient and/or daughter can hear him—a practice that we found repeatedly when there was a problem with the connection and participants wanted to see if they could still hear each other. When the daughter is heard to have responded with hi (line 10), this provides evidence that they can hear, that the connection works, and that the problem is purely visual (as the nurse points out in line 12). The daughter moves to turn the camera on, the doctor confirms that they can now see, and the consultation begins. Unlike in a face-to-face consultation, it is only at this point that the doctor asks how are you, signaling the start of the clinical consultation and enabling the social rituals of being a doctor and being a patient to begin.In this example, the patient and clinician have already done the work of preopening, the patient has been invited to a video consultation, with Skype addresses and video appointment times confirmed to enable that to happen, and phone numbers confirmed ensuring an alternative means of communicating. Once a connection is established, the patient and clinician do not greet each other but instead query the connection and confirm at the patient’s end that they can see the doctor. Then, 2 periods of silence follow . During this time, the doctor is unsure what is happening: by ends  consultations in which participants experienced no problems with the audio or video. In the other 27 consultations, we identified 49 instances in which a breakdown in audio and/or video disrupted the conversational flow. In 25 of these consultations, we had recordings at both Such disruptions are significant as they not only disrupt conversational flow but also potentially impact the quality and outcome of consultations . We provBreakdowns in audio and/or video quality occurred at different times in video consultations and with variable duration and impact . At the Problems with the video connection at the start of consultations were typically the result of the patient or clinician not turning on their camera (8 cases). In 1 case, the clinician could not get the camera to work and, after just over 5 min, decided with the patient that they would proceed with an audio-only consultation.Problems during consultations were often  disruptive. We found 24 cases where there was a minor problem with the audio resulting in, for instance, soft or garbled talk . These lfrozen image of the patient, participants attempted to solve the problem initially and then agreed to make do. In the other 2 cases, the audio frequently suffered from noise or distortions. For 1 consultation, this led to repeated minor problems (n=13), with each party repeatedly unable to hear, and halting the consultation to seek clarification. In the other, a postoperative cancer consultation, there was distortion making it hard to hear, resulting in a misunderstanding about the medication dose. In the extract in repair space [In 4 consultations, the quality of the hardware or a slow internet connection caused persistent problems with audio (n=3) or video (n=1). In 2 cases, one with a low volume on the patient’s end, the other with a repeated ir space ,71.In this example, the clinician’s recommendation to change to a 25,000-unit strength capsule is indistinctly audible at the patient’s end, but the patient appears to mishear and to understand that the consultant wants her to start taking 5000-unit strength capsules (line 17). She indicates that she understands with “ah I see” (lines 13-14), but then points out that Creon is not available in 5000-unit strength (lines 16-17), revealing her misunderstanding. The clinician then has the opportunity to rectify the problem , but audWe found 2 cases in which the video was temporarily disrupted on one end of the consultation. In each case, the problem was quickly and automatically resolved .In 5 cases, the connection cut out completely: in 2, the connection was quickly and automatically restored, and in 3, participants had to reconnect themselves.Spoken conversation is characterized by a turn-taking system, a set of rules participants use to determine whose turn it is to talk. This system serves to minimize both silence and overlapping talk in a conversation, the principle being 1 speaker at a time . ResearcThe 151 cases of significant latency that we found were unevenly distributed across our dataset, with 67 instances in 21 consultations in which problems were resolved in less than 10 seconds and another 84 instances in only 4 consultations in which problems were not only more frequent but typically took longer to resolve. In 1 of the 4 consultations, there were 47 instances of latency.sorry or go on and/or repeating the last thing the other person said.Of the 151 cases of latency, 122 were quickly resolved with 1 participant dropping out  after 1 or 2 syllables of overlapping talk , and theinterruption is a result of latency. As can be seen from the nurse’s end (column 2), from her point of view, she does not begin to talk in the middle of the patient’s turn (line 16), but actually starts her turn before the patient (line 15). Due to the latency in the call, she cannot know that the patient has already begun talking again; similarly, the patient cannot realize that the nurse has begun to offer a solution to his presented problem. The result is overlapping talk. Both also deal with different problems: from the patient’s perspective, the nurse interrupts him; from the nurse’s perspective, it is the other way around. However, the latency means that neither of them can know this. Eventually, both then stop talking, and it takes a series of silences and repair sequences  before the patient can resume his narrative (line 22).Consider the example in go on (line 21), and the patient then resumes his talk as is usual when face-to-face but, because of latency in the connection, the nurse does not realize that the patient has resumed his talk. The nurse then repeats part of his talk (line 23) as an additional strategy to give him the turn, causing the patient to again stop talking (line 22) and confirm before definitively resuming his talk (line 26).In the 29 cases where latency caused disruptions to conversational flow, participants relied on the same communication strategies they use in face-to-face conversation to try to negotiate the problem. However, latency also caused problems when using these strategies. For example, in digital pressure) to produce an indentation (pitting) that is indicative of edema.Clinicians and patients are concerned about the appropriateness and safety of conducting physical examinations in a video consultation ,76. DataThese examinations appeared to be very straightforward when the clinician and patient were colocated. However, in the remote setting, the same physical examinations presented specific challenges: (1) adequate design of instructions to guide video examinations (nurses had to explain tasks using lay language and check that instructions were being followed), (2) accommodation of the patient’s desire for autonomy (on the part of nurses and relatives) in the light of opportunities for involvement in their own physical assessment, and (3) conducting a physical examination while simultaneously making it visible to the nurse . We have presented a detailed analysis of these challenges and the strategies used to attempt to overcome them in a separate paper .Heart failure patients tend to be elderly, and many have poor exercise tolerance, mobility problems, or comorbidities, making attendance at the clinic potentially difficult. For the 9 patients in our sample attending the consultation in person, physical examinations were all successfully conducted by the clinician with minimal assistance from attending carers. For the 7 consulting by video, all participants  had to employ novel communication strategies to collaboratively negotiate the challenges of achieving a satisfactory physical examination in the remote setting. Participants relied on a range of unspoken assumptions about the technology and their respective knowledge and understanding of medical procedures and the meaning of measurements. Clinicians and patients ran into unforeseen problems, either with the procedure  and/or the technical process . Although complex, in 5 consultations, these problems were resolved with patients and/or their relatives asking the clinician for feedback or instructions and working with them to successfully complete the examination.There were 2 consultations in which it was not possible to complete an attempted physical examination. In both instances, this was because the patient or relative was not able to hold the phone or tablet and test for edema at the same time. Take the example in The 86-year-old patient shown in Our study has shown that, at least for this group of patients and clinicians, interaction in the majority of video consultations is effective. Observation and recording of video consultations, combined with theoretical sensitivity to the ways in which technology mediates communication in clinical consultations, has enabled us to do the following. First, we have shown that when participants experience technical or operational issues in video consultations , they generally find a way to negotiate these, falling back on tried and tested rules of communication transferred from face-to-face situations. Familiarity with technology helps. Second, in a small proportion of consultations, technical interruptions before or during consultations may require workarounds such as using a standard telephone line to overcome lack of audio, and, in a few cases, it may threaten the quality of communication and clinical safety. Third, we have shown that in the minority of cases where significant latency occurs, clinicians and patients do not always hear the same thing at the same time. Finally, we have revealed that video consultations necessitate patients  to take an active role in understanding and manipulating the technology  and their surroundings . For those consultations involving a remote physical examination, this involves a complex process of giving and receiving instructions and ensuring visual presence.Careful analysis of verbal and nonverbal interaction, combined with a focus on social context, has enabled a robust understanding of the role played by language and social interaction in video consultations. Such detailed analysis takes time. Although we were fortunate to have data from 2 separate and fairly large qualitative studies, these comprised a relatively limited range of consultations in only 4 clinical conditions. Only 1 of these, heart failure, involved remote physical examinations.ends at every point.CA is an established methodological technique for studying social interaction that allowed us to systematically identify challenges and to then generate and analyze relevant collections across our dataset. This is a key strength of our study. When the original studies were designed, we did not set out to examine 1 of these challenges—latency. This meant that the dataset we analyzed did not allow us to determine the precise timings of all instances of latency. When selecting data to analyze the impact of latency on conversational flow we therefore focused on cases where both participants talked in overlap following a point where turn transition could have taken place  . Future Our dataset included video and audio recordings of consultations using Skype and FaceTime because these were the platforms being used at the time. Neither of these platforms was specifically designed for clinical consultations, and it may be that next-generation video consultation software  or more advanced peripheral technologies, such as noise-canceling microphones, may produce less in the way of breakdowns in conversations. We recommend that any future published studies of video interactions include details of the specific technologies used.To our knowledge, our study is one of the first to apply linguistic ethnographic approaches to the study of video-mediated consultations in health care. As such, it represents a significant addition to the existing literature, which has been dominated by trials and focused on issues of feasibility and acceptability and has also included some conventional CA without linguistic ethnography ,46. It eOur research confirms findings from our own and other studies that there are interactional differences between video and face-to-face consultations and potential for collaborative decision making via video ,48,49,78reciprocity of perspectives [Previous work has shown that speakers typically rely on what phenomenologists refer to as pectives , meaningpectives . Our stusuitable for a video consultation) [Our findings suggest that care is needed on the part of health care providers, commissioners, and policy makers in rolling out this new service model. Our own study and that of others has shown that video consultations appear to be largely safe and effective  ,9,83, foUntil recently, video consultations have tended to be an optional extra for many working in health services. The specter of COVID-19 has rapidly changed the landscape . CliniciBefore the COVID-19 pandemic, resources to support video consulting tended to be ad hoc and limited. In most cases, clinicians and patients were conducting video consultations without guidance for what works for which patients, clinical condition, or stage of diagnosis. That remains the case at the time of publication with, if anything, increased uncertainty about how video consultations can best be used as workflows are rapidly reorganized during the COVID-19 crisis. This lack of guidance means that clinicians and patients can run into unforeseen problems and communicative challenges that they may not know how to negotiate or easily resolve. Some problems potentially go unnoticed , which poses potential risks to the patient.Guided by the findings from this and previous studies and in collaboration with patients (see above), we have developed a suite of freely available resources for patients and clinicians .Questions remain about the extent of latency, its often subtle effects , and theThere have been significant advancements in technology in recent years, enabling both standalone platforms  and those dedicated to video consultations . Future studies should examine what, if any, technical and interactional benefits the latter bring, including improved peripherals  and use of companion devices .Video consultations are interactionally different from face-to-face consultations. The use of video technology has the potential to change the way in which patients and clinicians interact, particularly when problems with audio or video interrupt the usual flow of interaction or where a physical examination is required. The use of evidence-based guidance, combined with training and support, can help clinicians and patients to more quickly identify and work through technical problems and avoid the potential for significant misunderstanding. Such resources are likely to be essential if video consultations are to be delivered at scale.


Thymus regenerative therapy implementation is severely obstructed by the limited number and expansion capacity in vitro of tissue-specific thymic epithelial stem cells (TESC). Current solutions are mostly based on growth factors that can drive differentiation of pluripotent stem cells toward tissue-specific TESC. Target-specific small chemical compounds represent an alternative solution that could induce and support the clonal expansion of TESC and reversibly block their differentiation into mature cells. These compounds could be used both in the composition of culture media designed for TESC expansion in vitro, and in drugs development for thymic regeneration in vivo. It should allow reaching the ultimate objective - autologous thymic tissue regeneration in paediatric patients who had their thymus removed in the course of cardiac surgery. Thymus is an essential organ of the immune system since it is the main site of T lymphocyte production and the place of adaptive immunity regulation. The thymus significance for development and function of the immune system is the centre of hot discussions since the 1961, when thymus function was first discovered by Jacques Miller –7. AccorCurrent epidemiological data indicate that almost 1 in 100 children is born with a congenital heart defect , and theFoxn1 expression could be used to identify the human TEPC/TESC population(s)  for 2013–2017, the Scientific Centre of Excellence for Reproductive and Regenerative Medicine , Terry Fox Foundation and InnovaTRT project that was submitted for funding to the European Union’s Horizon 2020 Programme for 2019–2024 . The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.


Many people aged 40 years and above need near vision spectacles for reading and other essential daily tasks.As we grow older, the lens loses the ability to focus at close distances. Starting around the age of 40, near vision will slowly become worse, but distance vision will not be affected; this is known as presbyopia.People with presbyopia usually say that their near vision has slowly become worse.Distance and near vision charts with letters, Es or shapesPinhole A trial set of lenses or a selection of ready-made spectacles (RMS). Most people with presbyopia do not need spectacles with powers of less than +1.00 or more than +3.00. See Before prescribing spectacles for presbyopia, take a careful history (pp. 44–45) and carry out a comprehensive eye examination to make sure there is nothing else wrong with the person's eyes.If the presenting vision is 6/12 or worse in either eye, find out the cause of poor distance vision before prescribing spectacles for near vision.If the distance vision is 6/9 or better in each eye then one can proceed with checking near vision.The correct power of spectacles for presbyopia depends on the person's age, the distance at which they want to see for near work, and how well they can see.Find out the person's working distance; this is the distance at which they would like to do most of their near work see .Ask him or her to hold a near vision chart at the distance they do most near tasks. Around 40 cm is a comfortable distance for most people.Ask the person to hold the chart at the distance they want to see clearly (the desired working distance) with both eyes open. Ask them to read the smallest line or show the smallest shapes they can see clearly. Write this down as their near visual acuity .If the person already has spectacles for presbyopia, measure their near vision with these being worn. Write this down as ‘near visual acuity with spectacles'If the person is able to see N6 or better without any spectacles, they might not need spectacles for presbyopia. If they can see N6 or better with their old spectacles, they might not need new spectacles.Use the person's age as an idea for what power of near lens they may need. While the person wears spectacles with the selected power , give them the near chart again and ask them to hold it at the desired working distance . If the Ask the person to look at the smallest line they can see on the near chart with the near lenses, and then bring the chart closer until the letters become blurred. Hold one hand to mark the nearest distance , then asAsk the person again to hold the chart at their desired working distance. If the range is correct, the working distance should be in the middle of this range, for example at about 40 cm . This mePrescribe and give the reading spectacles.Ensure that the patient understands they are only for reading and not for seeing in the distance.Advise the patient that a good reading light will help to improve their near vision.


This study compares cognitive and emotional responses to 360-degree vs. static (2D) videos in terms of visual attention, brand recognition, engagement of the prefrontal cortex, and emotions. Hypotheses are proposed based on the interactivity literature, cognitive overload, advertising response model and motivation, opportunity, and ability theoretical frameworks, and tested using neurophysiological tools: electroencephalography, eye-tracking, electrodermal activity, and facial coding. The results revealed that gaze view depends on ad content, visual attention paid being lower in 360-degree FMCG ads than in 2D ads. Brand logo recognition is lower in 360-degree ads than in 2D video ads. Overall, 360-degree ads for durable products increase positive emotions, which carries the risk of non-exposure to some of the ad content. In testing four ads for durable goods and fast-moving consumer goods (FMCG) this research explains the mechanism through which 360-degree video ads outperform standard versions. Online video ad spend is growing exponentially Zenith,  and the A 360-degree video is a monoscopic video viewed as one image directed to both eyes. It provides free and omnidirectional viewpoints from all the angles of a 360-degree radius under the control of the viewer. The use of 360-degree ads has highlighted two complementary features of research interest. First, the change from static to an interactive view provides a new customer experience. Due to its interactivity, the 360-degree video seems to provide a stronger connection than does traditional video with the human mind and increases users' immersive settings  the type of responses measured, that is, unconscious measures; (ii) the scope of the analysis is a continuous measure of the unconscious responses evoked by, and attention paid to, specific elements of ads.Based on the interactivity and cognitive overload literature, and on the motivation, opportunity, and ability theoretical frameworks, and the advertising response model (ARM), we compare the effects of existing dyads of 360-degree and standard video ads on consumers' emotions and cognition. The research goal is 2-fold. First, to measure the effectiveness of 360-degree video ads vs. standard format video ads based on visual attention paid to specific elements of the ads, such as the embedded brand logo, and the emotional connectivity developed between the consumer and the brand. Second, to analyze whether interactivity and users' control result in higher levels of engagement in the viewer's prefrontal cortex.Through this research we provide a theoretically grounded explanation for the persuasive power of 360-degree ads. The study contributes significantly to the knowledge of how consumers process interactive advertising. First, we explain the information processing of online video ads by assessing the influence of interactivity on the visual attention paid by the viewer to the ad, and on central (brand logo recognition) and peripheral information processing (emotions and asymmetry). Second, using unconscious measures, the present study is the first to explain the mechanism through which 360-degree video ads outperform standard versions.With its ability to give the user the control to manipulate his/her point of view, a 360-degree video provides two-way communication between the viewer and the message/interface and touches on a core concept in communication technology, that is, interactivity Macias, . The abiIn a 360-degree format, in contrast to the traditional video format where the point of view is determined by the creative director, and viewers are passive, viewers have a free and omnidirectional viewpoint which they can move arbitrarily through all the angles of a 360-degree radius. Thus, consumers have the freedom to explore ad content based on their interests, and are not restricted by the creator's or the director's choices, to “navigate” in real time through the video scenes  to process information are key factors in advertising content processing , their information processing might evolve over time from cognitive to emotional reactions, and from positive to negative encodings. Furthermore, Feng  found thGrounded in the ARM model, this study posits that 360-degrees video ads have superior advertising effectiveness in terms of affective responses to the ad , and that 2D ads are more effective in terms of the cognitive processing of the brand logo. In this section, we discuss the expected relationships among the model variables and propose a set of hypotheses. During 360-degree interactive ads the consumer has to focus his/her attention more and make higher cognitive processing effort than with traditional ads  recruited in the city where the laboratory is located. The participants were recruited by a professional market research company. The initial sample was reduced to 91 due to corruption in some of the acquired signals, that is, disconnection of a sensor during the test (3 subjects) and signals affected by artifacts (6 participants). The participants all had normal, or corrected-to–normal, vision and hearing. They were compensated for their participation with a gift card of 20. The study was approved by the ethical committee of the institutional review board of the university. Written informed consent was obtained from all subjects, in accordance with the Declaration of Helsinki.A 2 factor  X 2 (product type: FMCG vs. durable product) between-subjects experimental design was implemented. Car and beverage brand ads were chosen because of their popularity and because one is a durable product and one a FMCG. The criteria for selecting the ads were: (i) to find two official advertisements for each brand in the two different formats (360-degree and 2D) ; (ii) twBased on these criteria the following four brands were chosen: BMW, Honda, Nescafe, and Lipton. BMW has 6 times the sales of Honda in the market under study , an eye-open task (EO), and an eye-closed task (EC), each of which were 3 min long. Next, the participants' brain and eye movements were calibrated. ET was calibrated through 9 points that appeared on the monitor. When the calibration was excellent, or good, the participants were randomly assigned (to avoid bias in the data gathering) to one of the four scenarios depicted in After watching the videos the participants completed a short survey about their likeability for the ads , and their willingness to buy the product if money was available . https://imotions.com/guides/).Visual attention was analyzed using the Tobii Pro TX300 eye-tracking device. This records at 300 Hz and has a built-in 23-inch monitor. Following the recording of the gaze behavior, a speed-based fixation detection algorithm, with a threshold of 30 degrees/second, was used to identify the number of fixations and the average fixation time for each stimulus. To measure brand exposure, every second that the brand logo was shown in the advertisement was monitored through a dynamic AOI (area of interest) , and frontal asymmetry was calculated using the following formula:Electrical brain activity was recorded using the B-Alert X10 device . This records in nine channels, located in the frontal , central , and parietal—occipital areas , using the international location system 10-20. The recording was made at 256 Hz. First, data from each electrode were analyzed to identify corrupted channels using the fourth standardized moment (kurtosis). If a channel presented more than 10% of flat signal the electrode was classified as corrupted. The EEG baseline was removed and a bass pass filter between 0.5 and 40 Hz was applied. The signal was segmented into epochs of one second, and an intra-channel kurtosis level of each epoch was used to reject the epochs with high noise levels. To detect artifacts caused by eye movements, blinking, and muscular activation, independent component analysis (ICA)  via Matlab . The EDA was measured in micro-Siemens, the number of peaks and their amplitudes being identified during each stimulus. These measures are correlated with an increase in the subject's arousal caused by external stimuli  using the Emotient FACET library . To explore the differences between the subjects' responses, in both the 2D and 360-degree formats, we carried out an unrelated two-tailed t-test. The data analysis was performed using Matlab 2018b. To simultaneously compare the four ads a Bonferroni correction was applied, decreasing the threshold to consider a test significant to p < 0.0125.The Gaussianity of the data was checked using the Kolmogorov-Smirnov test , a higher number of fixations (p = 0.000), and more time spent (p = 0.013) viewing the brand, confirming H2. As expected, the visual attention paid to the brand logo is lower in the 360-degree video ads, because exposure to this specific element is influenced by the navigation paths adopted by the consumers. This finding is consistent with the MOA model and, more specifically, with the motivation and opportunity to process some parts of the ad. Furthermore, the areas viewed by the participants can be explained by the attention capture and transfer model  responses to advertisements, obtained from EEG, ET, FC, and EDA.The results showed significant differences in the visual attention paid, measured through ET, in the 360-degree vs. 2D ads. Indeed, the number of fixations and the time spent metrics were lower in the 360-degree videos than in the traditional, 2D videos. Therefore, 360-degree videos motivate viewers to watch specific parts of a video less than do 2D ads. This finding is consistent with the nature of 2D format ads. The 360-degree format allows viewers to look from multiple angles and, therefore, fixation can be dispersed, and the time spent on each stimulus will be lower. As previously stated, this conclusion is consistent with the MOA model and the top-down and bottom-up paths suggested by Pieters and Wedel . Thus, mAlthough it is well-recognized that audiences actively participate in the online video advertising process by going beyond the messages presented in the videos themselves, and draw conclusions about brands, this inference process has received little attention in studies into interactive video ads. The application of the ARM model to online video ads provides insights that help to explain how online video advertising is actually processed, and to identify the strengths and weaknesses of 360-degree videos in comparison to standard versions. Brand recognition, measured through brand logo exposure and fixation time, was higher in the 2D ads. In other words, the gaze view directed toward the brand logo was higher in the 2D format than in the 360-degree format. Lower visual attention values are related to the viewer's freedom to explore content based on his/her interests . However, previous consumer experience with the brand might also bias the results of the study. Furthermore, participant-related factors, such as involvement with the brand, and with the ad, might also have exerted some influence. Another limitation is that we did not directly compare the preferences of the participants for the study stimuli. In future studies we will use a preference-based filter to better control this aspect.Future research might expand in the following directions. First, the influence of content and executional factors, such as music and motion, might be considered. These executional factors might impact on emotions and cognitive workload. Second, the device used might have an impact. In this sense it would be interesting to analyze 360-degree videos viewed on mobile phones or on social media, and include cross-platform synergies, as suggested by Lim et al. . Future The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Local ethics committee of the Polytechnic University of Valencia. The patients/participants provided their written informed consent to participate in this study.JA-A has developed the intellectual concept and experimentation part of the paper. MA has done part of the writing and planning of the experiment. JM-M together with JG have helped to collect and analyze the data. CR has helped the writing of the article and contribution in the experimental test. EB together with JA-A has helped to conceptualize the tasks and methodology of the experiment. All authors contributed to the article and approved the submitted version.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.