A behavioral approach to annotating sleep in infants: Building on the classic framework.

In infants, monitoring and assessment of sleep can offer valuable insights into sleep problems and neuro-cognitive development. The gold standard for sleep measurements is polysomnography (PSG), but this is rather obtrusive, and unpractical in non-laboratory situations. Behavioral observations constitute a non-obtrusive, infant-friendly alternative. In the current methodological paper, we describe and validate a behavior-based framework for annotating infant sleep states. For development of the framework, we used existing sleep data from an in-home study with an unobtrusive test setup. Participants were 20 infants with a mean age of 180 days. Framework development was based on Prechtl's method. We added rules and guidelines based on discussions and consent among annotators. Key to using our framework is combining data from several modalities, for example, closely observing the frequency, type, and quality of movements, breaths, and sounds an infant makes, while taking the context into account. For a first validation of the framework, we set up a small study with 14 infants (mean age 171 days), in which they took their day-time nap in a laboratory setting. They were continuously monitored by means of PSG, as well as by the test setup from the in-home study. Recordings were annotated based both on PSG and our framework, and then compared. Data showed that for scoring wake vs. active sleep vs. quiet sleep the framework yields results comparable to PSG with a Cohen's Kappa agreement of ≥0.74. Future work with a larger cohort is necessary for further validating this framework, and with clinical populations for determining whether it can be generalized to these populations as well.

Visual saliency guided perceptual adaptive quantization based on HEVC intra-coding for planetary images.

Due to the limited storage space of spacecraft and downlink bandwidth in the data delivery during planetary exploration, an efficient way for image compression onboard is essential to reduce the volume of acquired data. Applicable for planetary images, this study proposes a perceptual adaptive quantization technique based on Convolutional Neural Network (CNN) and High Efficiency Video Coding (HEVC). This technique is used for bitrate reduction while maintaining the subjective visual quality. The proposed algorithm adaptively determines the Coding Tree Unit (CTU) level Quantization Parameter (QP) values in HEVC intra-coding using the high-level features extracted by CNN. A modified model based on the residual network is exploited to extract the saliency map for a given image automatically. Furthermore, based on the saliency map, a CTU level QP adjustment technique combining global saliency contrast and local saliency perception is exploited to realize a flexible and adaptive bit allocation. Several quantitative performance metrics that efficiently correlate with human perception are used for evaluating image quality. The experimental results reveal that the proposed algorithm achieves better visual quality along with a maximum of 7.17% reduction in the bitrate as compared to the standard HEVC coding.

Satisfaction with and reliability of in-hospital video-EEG monitoring systems in epilepsy diagnosis - A German multicenter experience.

OBJECTIVE: To analyze satisfaction with and reliability of video-electroencephalography-monitoring systems (VEMS) in epilepsy diagnostics. METHODS: A survey was conducted between December 2020 and January 2021 among German epilepsy centers using well-established customer satisfaction (CS) and quality assurance metrics. RESULTS: Among 16 participating centers, CS with VEMS was low, with only 13% of customers actively recommending their system. Only 50% of users were satisfied with the overall performance of their VEMS, and a low 18% were satisfied with the manufacturer's customer service. User interface, software stability, lack of regular updates, and missing customer-oriented improvements were reported as frequent problems jeopardizing diagnosis in approximately every 10th patient. The greatest potential for improvement was identified for software and hardware stability as well as customer service. CONCLUSION: Satisfaction with VEMS and their customer service was low, and diagnostics were regularly affected by software or hardware errors. Even if this can be partly explained by the technical complexity of VEMS, there is an urgent need for improvements with regard to the reliability and durability of system components as well as signal synchrony and data management. SIGNIFICANCE: This analysis highlights low consumer satisfaction of users with VEMS and uncovers frequent problems and potential for improvement.

Qualitative assessment of YouTube videos as a source of patient information for cochlear implant surgery.

BACKGROUND: YouTube is increasingly used as a source of healthcare information. This study evaluated the quality of videos on YouTube about cochlear implants. METHODS: YouTube was searched using the phrase 'cochlear implant'. The first 60 results were screened by two independent reviewers. A modified Discern tool was used to evaluate the quality of each video. RESULTS: Forty-seven videos were analysed. The mean overall Discern score was 2.0 out of 5.0. Videos scored higher for describing positive elements such as the benefits of a cochlear implant (mean score of 3.4) and scored lower for negative elements such as the risks of cochlear implant surgery (mean score of 1.3). CONCLUSION: The quality of information regarding cochlear implant surgery on YouTube is highly variable. These results demonstrated a bias towards the positive attributes of cochlear implants, with little mention of the risks or uncertainty involved. Although videos may be useful as supplementary information, critical elements required to make an informed decision are lacking. This is of particular importance when patients are considering surgery.

The influence of the abundance and morphology of epileptiform discharges on diagnostic accuracy: How many spikes you need to spot in an EEG.

OBJECTIVE: The operational definition of interictal epileptiform discharges (IEDs) of the International Federation of Clinical Neurophysiology (IFCN) described six morphological criteria. Our objective was to assess the impact of pattern-repetition in the EEG-recording, on the diagnostic accuracy of using the IFCN criteria. For clinical implementation, specificity over 95% was set as target. METHODS: Interictal EEG-recordings of 20-minutes, containing sharp-transients, from 60 patients (30 with epilepsy and 30 with non-epileptic paroxysmal events) were evaluated by three experts, who first marked IEDs solely based on expert opinion, and then, independently from the first session evaluated the presence of the IFCN criteria for each sharp-transient. The gold standard was derived from long-term video-EEG recordings of the patients habitual paroxysmal episodes. RESULTS: Presence of at least one discharge fulfilling five criteria provided a specificity of 100% (sensitivity: 70%). For discharges fulfilling fewer criteria, a higher number of discharges was needed to keep the specificity over 95% (5 discharges, when only 3 criteria were fulfilled). A sequential combination of these sets of criteria and thresholds provided a specificity of 97% and sensitivity of 80%. CONCLUSIONS: Pattern-repetition and IED morphology influence diagnostic accuracy. SIGNIFICANCE: Systematic application of these criteria will improve quality of clinical EEG interpretation.

Comparison of Robotic Surgery Video Quality Between YouTube and Curated Sources Using GEARS Criteria.

OBJECTIVE: To compare the quality of robotic prostatectomy surgical videos on the popular website YouTube with more curated, professional sources using the Global Evaluative Assessment of Robotic Skills (GEARS) criteria. METHODS: A search was performed on YouTube for robotic prostatectomy. Results were sorted by views and the first ten that met inclusion criteria were selected for review. To represent curated sources five robotic prostatectomy videos were selected from the DaVinci Surgery Community (DVS) video repository and the AUA Surgical Video Library in order of publishing from present to past. Videos were edited to be deidentified. The videos were reviewed blindly in parallel and graded using the GEARS criteria. Concordance among reviewers was measured using Chronbach's alpha. Comparisons between groups were made using student t-test. RESULTS: There was a high level of reliability of overall GEARS scores between reviewers for each video (α = 0.843). There was no significant difference between overall GEARS scores between the YouTube videos (mean 24.8, SDEV 1.85) and the AUA group (mean 24.3, SDEV 6.18) (P = 0.78). YouTube videos scored higher than the DVS videos (mean 22.1, SDEV 2.34) (P 0.03). CONCLUSION: Despite concerns about the quality of surgical videos on YouTube for education, the most viewed surgical videos for robot assisted laparoscopic prostatectomy score as well or better than more curated sources using the GEARS criteria. This may represent selection via crowd sourcing of the best videos amongst a much larger overall quantity.

Guidance for using text, email, and video communication in practices devoted to reproductive medicine.

The prevalence and ease of electronic communication, specifically email through patient portals associated with electronic medical records or via traditional enterprise email clients (e.g., Outlook) and video, have resulted in increased use for rapid communication between practitioners and their patients. Concerns regarding patient privacy and compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) remain a barrier to routine incorporation of electronic communication into practice. Furthermore, capital investment, implementation, and maintenance costs may provide additional barriers. These long-standing concerns have been heightened and tested by the COVID-19 pandemic. Best-practice guidelines for the secure and safe use of electronic communication with reproductive care patients are provided.

Production and validation of educational technology on nursing care for syphilis prevention.

OBJECTIVES: Validate script and storyboard of a video for educational intervention on nursing care for the prevention and management of syphilis. METHODS: Methodological design study, with quantitative analysis approach. The content and appearance of the educational video script and storyboard was validated by a committee of experts on the subject and video. They were considered validated from the agreement of 78%, calculated by means of the Content Validity Index. RESULTS: There were suggestions, which were analyzed; and, where relevant, the script and storyboard were changed. The degree of agreement among the expert judges on the subject obtained a Content Validity Index (CVI) of 100%, while, with the technical experts in video, all the questions in the educational material obtained the percentage above the recommended minimum of 78%. CONCLUSION: The validated video is an important technological production and could be used in the context of health care.

YouTube: A good source for retrograde intrarenal surgery?

PURPOSE: To evaluate the quality of videos for retrograde intrarenal surgery (RIRS) on YouTube (Google, LLC) from the perspective of both patients and physicians. MATERIALS AND METHODS: All videos longer than 2 minutes returned by the YouTube search engine in response to the keyword search "retrograde intrarenal surgery" were included in this study. The quality of content was analyzed by using the validated Journal of the American Medical Association Benchmark Score (JAMAS) and the Global Quality Score (GQS). Two surgeons developed the RIRS Scoring System (RIRSSS) to evaluate the technical quality of the videos. A video power index (VPI) was used to score the popularity of the videos. RESULTS: A total of 63 videos with a median of 389 views were included in the present study. Forty-three videos (68.3%) were provided by health care professionals and 53 videos (84.1%) included technical aspects about RIRS. The median (interquartile range) GQS, JAMAS, RIRSSS, and VPI scores were 2 (1-3), 1 (1-2), 2 (1-5), and 0.41 (0.08-1.29), respectively. Videos with audio had significantly higher GQS and RIRSSS scores than did with videos with no audio (p<0.001, p=0.039, respectively). The GQS of videos providing general information about RIRS was higher, whereas RIRSSS scores were higher for videos detailing technical aspects (p=0.027, p=0.038, respectively). CONCLUSIONS: The quality of YouTube videos containing information about RIRS evaluated in this study was very low. It is necessary for health care organizations to prepare online materials and upload these materials to popular social media platforms to convey accurate information to patients.

Female genital cosmetic surgery (FGCS): Evaluation of YouTube videos.

OBJECTIVES: The purpose of our study is to evaluate the information available on YouTube regarding FGCS procedures in terms of content, accuracy, reliability and quality. METHODS: Videos were listed on YouTube on 01.10.2020 by searching the terms "plastic surgery for female genital", "vaginoplasty", "labiaplasty" and selecting their relevance from the filtering options. Among these listed videos, the 50 most watched videos were listed and recorded excluding commercials, repeating videos, those shorter than 60s and non-English ones. The videos were scored by two researchers using DISCERN and JAMA scales. The DISCERN scale varies between 0-75 points and according to the scores obtained from the scale, videos are classified as 63-75: (excellent); as 51-62: (good); as 39-50: (moderate) as 28- 38: poor and as <28 very poor. JAMA scale is a scale that evaluates the accuracy, usefulness and reliability of video sources between 0-4. Insufficient data on 1 point video source obtained from the scale, refers to. 2-3 (partially sufficient data) and 4: (completely sufficient data). RESULTS: The evaluation on DISCERN scores given to the videos revealed that the average DISCERN score of the first researcher was 45.65±13.271 and the average of the second researcher's DISCERN score was 44.65±14.235. The average of JAMA scores was 2.67±0.826 for the first researcher and 2.49±0.845 for the second researcher. Accordingly, a statistically significant linear relationship was found between DISCERN (r=0.812) scores and JAMA (r=0.622) scores by the researchers. CONCLUSION: We found that YouTube has the potential to provide patients with easy access to a large amount of information on FGCS, although almost all of the videos we included in the study were uploaded by health professionals, the overall quality of the content on the subject was moderate. We strongly suggest that any videos on health should be uploaded by experts and these videos should definitely be reviewed by a referee.

Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project.

INTRODUCTION: Advanced airway management is necessary in the prehospital environment and difficult airways occur more commonly in this setting. Failed intubation is closely associated with the most devastating complications of airway management. In an attempt to improve the safety and success of tracheal intubation, we implemented videolaryngoscopy (VL) as our first-line device for tracheal intubation within a UK prehospital emergency medicine (PHEM) setting. METHODS: An East of England physician-paramedic PHEM team adopted VL as first line for undertaking all prehospital advanced airway management. The study period was 2016-2020. Statistical process control charts were used to assess whether use of VL altered first-pass intubation success, frequency of intubation-related hypoxia and laryngeal inlet views. A survey was used to collect the team's views of VL introduction. RESULTS: 919 patients underwent advanced airway management during the study period. The introduction of VL did not improve first-pass intubation success, view of laryngeal inlet or intubation-associated hypoxia. VL improved situational awareness and opportunities for training but performed poorly in some environments. CONCLUSION: Despite the lack of objective improvement in care, subjective improvements meant that overall PHEM clinicians wanted to retain VL within their practice.

Do kinematic gait parameters help to discriminate between fallers and non-fallers with Parkinson's disease?

OBJECTIVE: Although a number of clinical factors have been linked to falls in Parkinson's disease (PD), the diagnostic value of gait parameters remains subject to debate. The objective of this retrospective study was to determine to what extent the combination of gait parameters with clinical characteristics can distinguish between fallers and non-fallers. METHODS: Using a video motion system, we recorded gait in 174 patients with PD. The patients' clinical characteristics (including motor status, cognitive status, disease duration, dopaminergic treatment and any history of falls or freezing of gait) were noted. The considered kinematic gait parameters included indices of gait bradykinesia and hypokinesia, asymmetry, variability, and foot clearance. After a parameters selection using an ANCOVA analysis, support vector machine algorithm was used to build classification models for distinguishing between fallers and non-fallers. Two models were built, the first included clinical data only while the second incorporated the selected gait parameters. RESULTS: The "clinical-only" model had an accuracy of 94% for distinguishing between fallers and non-fallers. The model incorporating additional gait parameters including stride time and foot clearance performed even better, with an accuracy of up to 97%. CONCLUSION: Although fallers differed significantly from non-fallers with regard to disease duration, motor impairment or dopaminergic treatment, the addition of gait parameters such as foot clearance or stride time to clinical variables increased the model's discriminant power. SIGNIFICANCE: This predictive model now needs to be validated in prospective cohorts.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND: This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery. METHODS: The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically. RESULTS: A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively). CONCLUSIONS: Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Assessing the Quality and Reliability of Patient Information Regarding First-Aid for Acute Burns on YouTube.

Given ever increasing ease of access to technology, the majority of adults first turn to the internet for medical advice. The world wide web is filled with user-generated content within multiple social media platforms that lack a governing body to validate the information's accuracy and reliability. The authors performed a qualitative review of first-aid burn resources available on YouTube using two validated scales: Modified Discern and Global Quality Scale. A search was conducted using the term "burn treatment" on September 18, 2019. Of 120 reviewed videos, 59 met their inclusion criteria. 36% (n = 21) of the speakers had formal medical training, with only 12% (n = 7) identified as burn care professionals. The mean views originating from nonmedical speakers (162,675) were more than eight times that originating from burn centers (14,975). The quality of the videos was compared by video source, speaker, and specialty. Burn centers had the highest Modified Discern and Global Quality Scale scores, 2.91 and 2.86, respectively (P < .05). Additionally, the authors were able to demonstrate that there was a statistically significant higher quality of videos when the speaker was a burn care professional or had formal medical training. Unfortunately, their review demonstrated that videos originating from hospital systems and burn centers made up a minority of the online media content. These results illustrate an opportunity for improvement by way of increased content creation to bolster the online presence of the burn community and provide patients with more accurate information.

Analysis of the YouTube videos on pelvic floor muscle exercise training in terms of their reliability and quality.

PURPOSE: The aim of this study was to evaluate the content, reliability and quality of YouTube videos related to pelvic floor muscle exercise training. METHOD: This study was carried out on the descriptive model in order to evaluate the content, reliability and quality of the videos on YouTube related to pelvic floor muscle exercise training. "Pelvic floor muscle exercise" was searched on YouTube in English in March 2020, and a total of 107 videos were watched. Quality Criteria for Consumer Health Information (DISCERN) survey was used to analyze the videos in terms of their reliabilities, and Global Quality Score (GQS) was used to evaluate their qualities. RESULTS: When the contents of 59 videos included in the study were examined, it was determined that 52 of them contained useful information and 7 of them contained misleading information. Comprehensiveness mean scores, DISCERN mean scores and GQS means of the useful videos were found to be statistically higher than that of the moderate and misleading videos (p < 0.05).When videos were analyzed according to the publishing sources, 84.62% (44/52) of the useful videos and 85.71% (6/7) of misleading video were observed to be published by independent health information websites. No statistically significant difference was found between the overall comprehensiveness mean scores, DISCERN mean scores, GQS means and the features of the videos according to their publishing sources. CONCLUSION: In this study, it was observed that the vast majority of YouTube videos on pelvic floor muscle exercise training were useful videos; the vast majority of these videos were published by independent health information websites and contained moderately safe, accurate and quality information.

Development and validation of a recommended checklist for assessment of surgical videos quality: the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool.

INTRODUCTION: There has been a constant increase in the number of published surgical videos with preference for open-access sources, but the proportion of videos undergoing peer-review prior to publication has markedly decreased, raising questions over quality of the educational content presented. The aim of this study was the development and validation of a standard framework for the appraisal of surgical videos submitted for presentation and publication, the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool. METHODS: An international committee identified items for inclusion in the LAP-VEGaS video assessment tool and finalised the marking score utilising Delphi methodology. The tool was finally validated by anonymous evaluation of selected videos by a group of validators not involved in the tool development. RESULTS: 9 items were included in the LAP-VEGaS video assessment tool, with every item scoring from 0 (item not presented in the video) to 2 (item extensively presented in the video), with a total marking score ranging from 0 to 18. The LAP-VEGaS video assessment tool resulted highly accurate in identifying and selecting videos for acceptance for conference presentation and publication, with high level of internal consistency and generalisability. CONCLUSIONS: We propose that peer review in adherence to the LAP-VEGaS video assessment tool could enhance the overall quality of published video outputs.

Reliability of Using the Proposed International Consensus Video Signs of Potential Concussion for National Rugby League Head Impact Events.

BACKGROUND: Consensus on the definition of extant video signs of concussion have recently been proposed by representatives of international sporting codes for global consistency across professional leagues. OBJECTIVE: To review the reliability of the proposed international consensus video signs of concussion in National Rugby League (NRL) head impact events (HIEs). METHODS: The video signs of concussion were coded for every HIE during the 2019 NRL season. Coding was conducted blinded to the concussion status. Frequency, sensitivity, specificity, and a receiver operating characteristic curve were calculated. RESULTS: There were 943 HIEs identified over the 2019 NRL season, of which 106 resulted in a diagnosed concussion. The most frequently observed video sign in concussed athletes was blank/vacant look (54%), which was also the most sensitive video sign (0.54, CI: 0.44-0.63), while the most specific was tonic posturing (0.99, CI: 0.99-1.00). In 43.4% of diagnosed concussions none of the 6 video signs were present. The 6 video signs demonstrated a "fair" ability to discriminate between concussion and nonconcussion HIEs (area under the curve = 0.76). CONCLUSION: International consensus agreement between collision sports for extant video signs of concussion and the definition of those extant video signs are clinically important. The selection of signs requires rigorous assessment to examine their predictive value across all sports and within individual sports, and to determine further video signs to compliment and improve the identification of possible concussion events within various sports. The current study demonstrated that, for NRL-related HIEs, the diagnostic accuracy of video signs varies.