Innovating Online Otolaryngology: The Development of the ENT Content Engagement and Quality Index for Audiovisual Material.

Introduction The advent of social media platforms, notably TikTok, has significantly transformed the landscape of health information dissemination, offering both opportunities and challenges for public health communication. This study focuses on TikTok's influence on sinus health information, addressing the dual challenge of widespread engagement and the risk of misinformation in otolaryngology, or ENT (ear-nose-throat), information online. We introduce the ENT Content Engagement and Quality Index (ENT-CEQI), a pioneering tool designed to assess the quality and engagement of ENT-related content on TikTok, aiming to improve public understanding of sinus health. Materials and methods Our methodology involved a systematic analysis of sinus health-related content on TikTok. We collected data on the top 100 most popular videos using the hashtag #sinus at two different points in time, analyzing engagement metrics and content quality. The ENT-CEQI was developed to evaluate content, incorporating both quantitative engagement metrics (views, likes, comments, shares, favorites) and qualitative assessments (accuracy, clarity, relevance, practicality, engagement). The study employed statistical analyses, including trend analysis, correlation analysis, principal component analysis (PCA), KMeans clustering, regression analysis, and the Kruskal-Wallis test, to understand the dynamics of content engagement and quality. Results Initial findings revealed significant disparities in engagement metrics and quality scores among different content creator categories, with physician-generated content showing the highest engagement and quality. The trend analysis indicated shifts in content popularity and quality over time, with a notable increase in views and likes for private company content. The PCA and clustering analyses identified distinct content clusters, offering insights into viewer engagement patterns. Regression analysis and the Kruskal-Wallis test, however, did not find significant predictors (p-value: 0.3916) of content quality or differences in likes across content types, suggesting complex factors influencing content engagement and quality perception. Discussion The study highlights TikTok's potential and pitfalls in disseminating sinus health information. The introduction of the ENT-CEQI represents a major step toward enhancing the evaluation of health content on social media, emphasizing the importance of accuracy, clarity, and relevance in public health communication. The analysis underscores the complexity of social media engagement and the need for robust tools to assess content quality. It also points to the critical role of healthcare professionals in engaging with the public through social media to combat misinformation. Conclusions TikTok serves as a potent platform for sinus health education, capable of reaching wide and diverse audiences. The ENT-CEQI emerges as a vital tool for assessing the quality and engagement of ENT-related content, guiding content creators toward producing more reliable and informative content. This study contributes to the understanding of social media's role in health communication, advocating for the strategic use of innovative tools such as the ENT-CEQI to enhance public health outcomes through improved online health education and misinformation management.

Audiovisual integration of rhythm in musicians and dancers.

Music training is associated with better beat processing in the auditory modality. However, it is unknown how rhythmic training that emphasizes visual rhythms, such as dance training, might affect beat processing, nor whether training effects in general are modality specific. Here we examined how music and dance training interacted with modality during audiovisual integration and synchronization to auditory and visual isochronous sequences. In two experiments, musicians, dancers, and controls completed an audiovisual integration task and an audiovisual target-distractor synchronization task using dynamic visual stimuli (a bouncing figure). The groups performed similarly on the audiovisual integration tasks (Experiments 1 and 2). However, in the finger-tapping synchronization task (Experiment 1), musicians were more influenced by auditory distractors when synchronizing to visual sequences, while dancers were more influenced by visual distractors when synchronizing to auditory sequences. When participants synchronized with whole-body movements instead of finger-tapping (Experiment 2), all groups were more influenced by the visual distractor than the auditory distractor. Taken together, this study highlights how training is associated with audiovisual processing, and how different types of visual rhythmic stimuli and different movements alter beat perception and production outcome measures. Implications for the modality appropriateness hypothesis are discussed.

Speech perception: Auditory and visual cue integration in children with and without phonological disorder in voiceless fricatives.

The literature reports contradictory results regarding the influence of visual cues on speech perception tasks in children with phonological disorder (PD). This study aimed to compare the performance of children with (n = 15) and without PD (n = 15) in audiovisual perception task in voiceless fricatives. Assuming that PD could be associated with an inability to integrate phonological information from two sensory sources, we presumed that children with PD would present difficulties in integrating auditory and visual cues compared to typical children. A syllable identification task was conducted. The stimuli were presented according to four conditions: auditory-only (AO); visual-only (VO); audiovisual congruent (AV+); and audiovisual incongruent (AV-). The percentages of correct answers and the respective reaction times in the AO, VO, and AV+ conditions were considered for the analysis. The correct percentage of auditory stimuli was considered for the AV- condition, as well as the percentage of perceptual preference: auditory, visual, and/or illusion (McGurk effect), with the respective reaction time. In comparing the four conditions, children with PD presented a lower number of correct answers and longer reaction time than children with typical development, mainly for the VO. Both groups showed a preference for auditory stimuli for the AV- condition. However, children with PD showed higher percentages for visual perceptual preference and the McGurk effect than typical children. The superiority of typical children over PD children in auditory-visual speech perception depends on type of stimuli and condition of presentation.

Precise timing of audiovisual stimulation conquers chemobrain.

In a recent study, Kim et al. utilized gamma entrainment using sensory stimuli (GENUS) to rescue cognitive impairment and glial dysregulation associated with cisplatin and methotrexate chemotherapy, specifically when applied both throughout and after chemotherapy administration. GENUS provides a time-dependent, non-invasive method for treating chemobrain, with broader implications for resolving neurodegenerative neuroinflammation.

Effects of sensory overstimulation in postpartum rats.

Research in rodents has shown that exposure to excessive early life audiovisual stimulation leads to altered anxiety-like behaviors and cognitive deficits. Since this period of stimulation typically begins prior to weaning, newborn rodents receive sensory overstimulation (SOS) as a litter within their home cage while the dam is present. However, the effects of SOS during the postpartum period remain unexplored. To this end, we adapted an SOS paradigm for use in rats and exposed rat dams and their litters from postpartum days (PD) 10-23. Maternal observations were conducted to determine whether SOS produced changes in positive and/or negative maternal behaviors. Next, we assessed changes in anxiety-like behavior and cognition by testing dams in the elevated zero maze, open field, and novel object recognition tests. To assess potential effects on HPA-axis function, levels of the stress hormone corticosterone (CORT) were measured approximately 1-week after the cessation of SOS exposure. Our results indicate increased nursing and licking in SOS dams compared to controls, although SOS dams also exhibited significant increases in pup dragging. Moreover, SOS dams exhibited reduced self-care behaviors and nest-building compared to control dams. No differences were found for anxiety-like behaviors, object recognition memory, or CORT levels. This study is the first to assess the impact of postpartum SOS exposure in rat dams. Our findings suggest an SOS-induced enhancement in positive caregiving, but limited impact in all other measures.

Psychological and physiological effects of soundscapes: A systematic review.

The aim of this systematic review was to conduct a comprehensive and rigorous investigation of both psychological and physiological responses to, and audio-visual interactions with, soundscapes to present an overview of the current status and to provide suggestions for future research. Our literature search focused on empirical and quantitative studies of journal articles and gray literature in English and Chinese. This systematic review excluded literature related to pure music, religious sounds, humanistic sounds, historical sounds, medical research, and differences in materials used. The Joanna Briggs Institute's Checklist for Randomized Controlled Trials was used to assess the risk of bias in the included studies. Twenty-five studies were included, involving 1950 participants. The major findings of this systematic review were that: (1) there were significant associations between the psychological and physiological responses; (2) the audio-visual interaction affected the psychological and physiological responses; and (3) because of the high risk of bias of the included studies, interpretation of their findings should be cautious. Nevertheless, given that this systematic review has a higher level of evidence than a single study and the synthesized evidence identified in this review is aligned with the results of other studies, the studies reviewed herein together provide consistent evidence. Replications are important in empirical research to build trustworthy results. Future research should focus on the psychological responses of pleasantness, preference, tranquility, the eight semantic dimensions (ISO 12913-2:2018), and the 11 pairs of adjectives describing the soundscape (Ba et al., 2023) and the physiological responses of heart rate variability and salivary, and follow the CONSORT guidelines to improve the research quality. An integration of sensory modalities, environmental factors, contextual indicators, temporal data, demographic variables, socio-cultural factors, and psychological and physiological responses may provide deeper insights into how people experience and understand the acoustic environment in context.

Macaque claustrum, pulvinar and putative dorsolateral amygdala support the cross-modal association of social audio-visual stimuli based on meaning.

Social communication draws on several cognitive functions such as perception, emotion recognition and attention. The association of audio-visual information is essential to the processing of species-specific communication signals. In this study, we use functional magnetic resonance imaging in order to identify the subcortical areas involved in the cross-modal association of visual and auditory information based on their common social meaning. We identified three subcortical regions involved in audio-visual processing of species-specific communicative signals: the dorsolateral amygdala, the claustrum and the pulvinar. These regions responded to visual, auditory congruent and audio-visual stimulations. However, none of them was significantly activated when the auditory stimuli were semantically incongruent with the visual context, thus showing an influence of visual context on auditory processing. For example, positive vocalization (coos) activated the three subcortical regions when presented in the context of positive facial expression (lipsmacks) but not when presented in the context of negative facial expression (aggressive faces). In addition, the medial pulvinar and the amygdala presented multisensory integration such that audiovisual stimuli resulted in activations that were significantly higher than those observed for the highest unimodal response. Last, the pulvinar responded in a task-dependent manner, along a specific spatial sensory gradient. We propose that the dorsolateral amygdala, the claustrum and the pulvinar belong to a multisensory network that modulates the perception of visual socioemotional information and vocalizations as a function of the relevance of the stimuli in the social context. SIGNIFICANCE STATEMENT: Understanding and correctly associating socioemotional information across sensory modalities, such that happy faces predict laughter and escape scenes predict screams, is essential when living in complex social groups. With the use of functional magnetic imaging in the awake macaque, we identify three subcortical structures-dorsolateral amygdala, claustrum and pulvinar-that only respond to auditory information that matches the ongoing visual socioemotional context, such as hearing positively valenced coo calls and seeing positively valenced mutual grooming monkeys. We additionally describe task-dependent activations in the pulvinar, organizing along a specific spatial sensory gradient, supporting its role as a network regulator.

Perception of visual and audiovisual trajectories toward and away from the body in the first postnatal year.

Perceiving motion in depth is important in everyday life, especially motion in relation to the body. Visual and auditory cues inform us about motion in space when presented in isolation from each other, but the most comprehensive information is obtained through the combination of both of these cues. We traced the development of infants' ability to discriminate between visual motion trajectories across peripersonal space and to match these with auditory cues specifying the same peripersonal motion. We measured 5-month-old (n = 20) and 9-month-old (n = 20) infants' visual preferences for visual motion toward or away from their body (presented simultaneously and side by side) across three conditions: (a) visual displays presented alone, (b) paired with a sound increasing in intensity, and (c) paired with a sound decreasing in intensity. Both groups preferred approaching motion in the visual-only condition. When the visual displays were paired with a sound increasing in intensity, neither group showed a visual preference. When a sound decreasing in intensity was played instead, the 5-month-olds preferred the receding (spatiotemporally congruent) visual stimulus, whereas the 9-month-olds preferred the approaching (spatiotemporally incongruent) visual stimulus. We speculate that in the approaching sound condition, the behavioral salience of the sound could have led infants to focus on the auditory information alone, in order to prepare a motor response, and to neglect the visual stimuli. In the receding sound condition, instead, the difference in response patterns in the two groups may have been driven by infants' emerging motor abilities and their developing predictive processing mechanisms supporting and influencing each other.

Capturing differences in perception and aesthetic judgment of live or medially presented music: development of a self-report instrument.

Nowadays there are multiple ways to perceive music, from attending concerts (live) to listening to recorded music through headphones (medial). In between there are many mixed modes, such as playback performances. In empirical music research, this plurality of performance forms has so far found little recognition. Until now no measuring instrument has existed that could adequately capture the differences in perception and aesthetic judgment. The purpose of our empirical investigation was to capture all dimensions relevant to such an assessment. Using 3D-simulations and dynamic binaural synthesis, various live and medial situations were simulated. A qualitative survey was conducted at the Department of Audio Communication of the Technical University of Berlin (TU Berlin). With the help of the repertory grid technique, a data pool of approximately 400 attribute pairs was created and individual rating data were collected. Our first study served to create a semantic differential. In a second study, this semantic differential was evaluated. The development of the semantic differential was carried out by first using a mixed-method approach to qualitative analysis according to grounded theory. Thereafter, a principal component analysis reduced the attribute pairs to 67 items in four components. The semantic differential consists of items concerning acoustic, visual and audio-visual interaction as well as items with an overarching assessment of the stimuli. The evaluation study, comprising 45 participants (23 male and 22 female, M = 42.56 years, SD = 17.16) who rated 12 stimuli each, reduced the items to 61 and resulted in 18 subscales and nine single items. Because the survey used simulations, the social component may be underrepresented. Nevertheless, the questionnaire we created enables the evaluation of music performances (especially for classical concerts) in a new scope, thus opening many opportunities for further research. For example, in a live concert context, we observed not only that seating position influences the judgment of sound quality but also that visual elements influence immersion and felt affect. In the future, the differential could be reviewed for a larger stimulus pool, extended or used modularly for different research questions.

Differences in audiovisual temporal processing in autistic adults are specific to simultaneity judgments.

Research has shown that children on the autism spectrum and adults with high levels of autistic traits are less sensitive to audiovisual asynchrony compared to their neurotypical peers. However, this evidence has been limited to simultaneity judgments (SJ) which require participants to consider the timing of two cues together. Given evidence of partly divergent perceptual and neural mechanisms involved in making temporal order judgments (TOJ) and SJ, and given that SJ require a more global type of processing which may be impaired in autistic individuals, here we ask whether the observed differences in audiovisual temporal processing are task and stimulus specific. We examined the ability to detect audiovisual asynchrony in a group of 26 autistic adult males and a group of age and IQ-matched neurotypical males. Participants were presented with beep-flash, point-light drumming, and face-voice displays with varying degrees of asynchrony and asked to make SJ and TOJ. The results indicated that autistic participants were less able to detect audiovisual asynchrony compared to the control group, but this effect was specific to SJ and more complex social stimuli (e.g., face-voice) with stronger semantic correspondence between the cues, requiring a more global type of processing. This indicates that audiovisual temporal processing is not generally different in autistic individuals and that a similar level of performance could be achieved by using a more local type of processing, thus informing multisensory integration theory as well as multisensory training aimed to aid perceptual abilities in this population.

Evaluation of parental anxiety following three methods of pre-anesthesia counseling: Video, brochure and verbal communication.

BACKGROUND: The purpose of this study is to provide comprehensive and efficient pre-anesthesia counseling (PAC) utilizing audiovisual aids and to examine their effect on parental anxiety. METHODS: For this prospective, controlled study, 174 parents were recruited and randomized into three groups of 58 (Group A: video, Group B: brochure, and Group C: verbal). During pre-anesthesia counseling, the parent was provided with a detailed explanation of preoperative preparation, fasting instructions, transport to the operating room, induction, the emergence of anesthesia, and nursing in the post-anesthesia care unit based on their assigned group. We evaluated parental anxiety using Spielberger's State-Trait Anxiety Inventory before and after the pre-anesthesia counseling. RESULTS: The results of our study show a statistically significant difference in the final mean STAI scores among the three groups (Group A: 34.69 ± 5.31, Group B: 36.34 ± 8.59, and Group C: 43.59 ± 3.39; p < .001). When compared to the brochure and verbal groups, the parents in the video group have the greatest difference in mean baseline and final Spielberger's State-Trait Anxiety Inventory scores (12.207 ± 5.291, p .001). CONCLUSION: The results of our study suggest that pre-anesthesia counseling by video or a brochure before the day of surgery is associated with a higher reduction in parental anxiety when compared to verbal communication.

Audiovisual speech asynchrony asymmetrically modulates neural binding.

Previous psychophysical and neurophysiological studies in young healthy adults have provided evidence that audiovisual speech integration occurs with a large degree of temporal tolerance around true simultaneity. To further determine whether audiovisual speech asynchrony modulates auditory cortical processing and neural binding in young healthy adults, N1/P2 auditory evoked responses were compared using an additive model during a syllable categorization task, without or with an audiovisual asynchrony ranging from 240 ms visual lead to 240 ms auditory lead. Consistent with previous psychophysical findings, the observed results converge in favor of an asymmetric temporal integration window. Three main findings were observed: 1) predictive temporal and phonetic cues from pre-phonatory visual movements before the acoustic onset appeared essential for neural binding to occur, 2) audiovisual synchrony, with visual pre-phonatory movements predictive of the onset of the acoustic signal, was a prerequisite for N1 latency facilitation, and 3) P2 amplitude suppression and latency facilitation occurred even when visual pre-phonatory movements were not predictive of the acoustic onset but the syllable to come. Taken together, these findings help further clarify how audiovisual speech integration partly operates through two stages of visually-based temporal and phonetic predictions.

The value of audiovisual sexual stimulation with virtual reality in diagnosing erectile dysfunction.

Background: The traditional audiovisual sexual stimulation (AVSS) test may experience limitations including low erectile response rate and lack of unified diagnostic criteria. Aim: We aimed to explore the clinical value of AVSS with virtual reality (VR-AVSS) test in assessing erectile function and diagnosing erectile dysfunction (ED). Methods: Participants 18 to 60 years of age were screened for analysis in 3 clinical centers from June 2020 to March 2022. Demographic data, 5-item International Index of Erectile Function (IIEF-5), erectile hardness score (EHS), and self-reported symptom questions were collected. The ED patients and control patients were confirmed according to the IIEF-5 and EHS. All subjects watched a 60-minute erotic video by VR device during RigiScan recording. The parameters including tip average rigidity, tip effective erectile duration (duration of rigidity ≥60%, tip effective erectile duration), base average rigidity, and base effective erectile duration were evaluated. Outcomes: The main outcome of interest was the application of VR immersion technology to improve the traditional AVSS test. Results: A total of 301 ED cases and 100 eligible control patients were included for final analysis. Compared with control patients, ED cases had significantly lower IIEF-5 scores, EHS, positive response rate, and erectile rigidity and duration. The positive response rate of ED and control patients were 75.5% and 90.9%, respectively. The cutoff points of tip average rigidity, tip effective erectile duration, base average rigidity, and base effective erectile duration were 40.5% (sensitivity: 77.6%, specificity: 70.2%; P < .001), 4.75 minutes (sensitivity: 75.9%, specificity: 75.4%; P < .001), 48.5% (sensitivity: 77.6%, specificity: 75.1%; P < .001), and 7.75 minutes (sensitivity: 79.3%, specificity: 75.7%; P < .001). Clinical Implications: The technological superiority of VR will enable the VR-AVSS immersion test to be a more accurate detection than traditional AVSS modes. Strengths and Limitations: Our study applied VR immersion technology to establish the standard operation procedure for the AVSS test, which could effectively reduce the interference of adverse factors and minimize the detecting errors. However, the test data only included positive response subjects, so the true erectile status of men with a negative response to the AVSS test cannot be obtained. Conclusions: The VR-AVSS test can effectively improve the diagnostic accuracy of ED. The average rigidity and effective erectile duration were the optimal diagnostic parameters for excluding ED.

Monolingual and bilingual infants' attention to talking faces: evidence from eye-tracking and Bayesian modeling.

Introduction: A substantial amount of research from the last two decades suggests that infants' attention to the eyes and mouth regions of talking faces could be a supporting mechanism by which they acquire their native(s) language(s). Importantly, attentional strategies seem to be sensitive to three types of constraints: the properties of the stimulus, the infants' attentional control skills (which improve with age and brain maturation) and their previous linguistic and non-linguistic knowledge. The goal of the present paper is to present a probabilistic model to simulate infants' visual attention control to talking faces as a function of their language learning environment (monolingual vs. bilingual), attention maturation (i.e., age) and their increasing knowledge concerning the task at stake (detecting and learning to anticipate information displayed in the eyes or the mouth region of the speaker). Methods: To test the model, we first considered experimental eye-tracking data from monolingual and bilingual infants (aged between 12 and 18 months; in part already published) exploring a face speaking in their native language. In each of these conditions, we compared the proportion of total looking time on each of the two areas of interest (eyes vs. mouth of the speaker). Results: In line with previous studies, our experimental results show a strong bias for the mouth (over the eyes) region of the speaker, regardless of age. Furthermore, monolingual and bilingual infants appear to have different developmental trajectories, which is consistent with and extends previous results observed in the first year. Comparison of model simulations with experimental data shows that the model successfully captures patterns of visuo-attentional orientation through the three parameters that effectively modulate the simulated visuo-attentional behavior. Discussion: We interpret parameter values, and find that they adequately reflect evolution of strength and speed of anticipatory learning; we further discuss their descriptive and explanatory power.

Awareness of Child Abuse and Neglect: A Prospective Interventional Study among Schoolteachers from Andhra Pradesh.

AIM: To assess the awareness of schoolteachers from Andhra Pradesh towards child abuse and neglect (CAN) through pre- and post-educational intervention (audiovisual aid) questionnaires. MATERIALS AND METHODS: A cross-sectional study was conducted with 300 schoolteachers using a 12-item questionnaire that was created using the standard focus group discussion method. Baseline awareness of CAN was assessed using the questionnaire. Subsequently, all the schoolteachers were educated regarding the various types of CAN and the process of reporting CAN using an audiovisual aid. The same questionnaire was re-administered to all the teachers immediately after the intervention and after three months. The data were statistically analyzed using Fisher's exact test to compare the frequency and distribution of responses among the study participants at various intervals. RESULTS: A statistically significant difference (p value < 0.05) was observed in the awareness of the schoolteachers regarding CAN compared to the baseline and immediately after the intervention. However, there was no statistically significant difference (p value > 0.05) between immediately after the intervention and three months. CONCLUSION: There is a need to have awareness among schoolteachers concerning CAN. However, after education through audiovisual aids, teachers' awareness of CAN has been improved.

A longitudinal causal graph analysis investigating modifiable risk factors and obesity in a European cohort of children and adolescents.

Childhood obesity is a complex disorder that appears to be influenced by an interacting system of many factors. Taking this complexity into account, we aim to investigate the causal structure underlying childhood obesity. Our focus is on identifying potential early, direct or indirect, causes of obesity which may be promising targets for prevention strategies. Using a causal discovery algorithm, we estimate a cohort causal graph (CCG) over the life course from childhood to adolescence. We adapt a popular method, the so-called PC-algorithm, to deal with missing values by multiple imputation, with mixed discrete and continuous variables, and that takes background knowledge such as the time-structure of cohort data into account. The algorithm is then applied to learn the causal structure among 51 variables including obesity, early life factors, diet, lifestyle, insulin resistance, puberty stage and cultural background of 5112 children from the European IDEFICS/I.Family cohort across three waves (2007-2014). The robustness of the learned causal structure is addressed in a series of alternative and sensitivity analyses; in particular, we use bootstrap resamples to assess the stability of aspects of the learned CCG. Our results suggest some but only indirect possible causal paths from early modifiable risk factors, such as audio-visual media consumption and physical activity, to obesity (measured by age- and sex-adjusted BMI z-scores) 6 years later.

Comparison of the effects of using feedback devices for training or simulated cardiopulmonary arrest.

BACKGROUND: High-quality chest compression is essential for successful cardiac arrest resuscitation. High-quality cardiopulmonary resuscitation (CPR) can effectively improve the survival rate of patients with cardiopulmonary arrest. However, bystanders untrained in cardiopulmonary resuscitation may provide inadequate chest compressions. Previous studies have shown that the use of feedback devices in training alone or in simulated cardiopulmonary arrest alone can improve cardiopulmonary resuscitation. This study aims to determine whether using an audiovisual feedback (AVF) device during CPR training or a simulated cardiopulmonary arrest (CA) scenario would be more effective in improving the quality of chest compressions (CC). METHODS: We use a prospective, randomized, 2 × 2 factorial design trial. A total of 160 participants from Wuhan University and senior clinical medicine undergraduates who had not participated in any CPR training before and had no actual CPR experience are recruited. Each participant is randomized to 1 of 4 permutations, including AVF device vs. no AVF device during CPR training and AVF device vs. no AVF device during simulated CA. Main outcomes and measures are the depth, the percentage of CCs with correct depth (5-6 cm), the rate of CCs, and the percentage of CCs with the correct rate (100-120 cpm). RESULTS: The use of the AVF device during simulated CA resulted in improved CC quality. In CA without AVF device, the average compression depth and the percentage of adequate depth with AVF device are 5.1 cm, 5.0 cm and 55.5%, 56.3%, respectively, which are higher than those without AVF device (4.5 cm, 4.7 cm and 32.8%, 33.6%). (p = 0.011, p = 0.000, both < 0.05).Compared with CA without AVF device, the average compression rate and the percentage of adequate rate with AVF device are 112.3 cpm, 111.2 cpm and 79.4%, 83.1%, respectively. The average compression rate and the percentage of adequate rate without using the AVF device are 112.4 cpm, 110.3 cpm and 71.5%, 68.5%, respectively. (p = 0.567 > 0.05, p = 0.017 < 0.05)Although the average compression rate in group D is slightly lower than that in group C, the percentage of suitable frequency with the feedback device is still higher than that without AVF device. CONCLUSION: Using a feedback device during simulated cardiopulmonary arrest is more effective in improving cardiopulmonary resuscitation than during training.

"Leo&Giulia standing for public health": an animated series to promote the values of public health among school-aged children. Best practices and field-trial protocol.

Background: The "Leo&Giulia standing for public health" project is an innovative digital health education model targeting primary school children. The project, developed during the COVID-19 pandemic, aims to educate primary school-aged children about public health issues through an animated cartoon series. It highlights the importance of early-life health promotion and the potential role of educational settings in shaping health behaviours. Study design: A 2-year school-based cluster-randomized controlled community trial will be conducted among 8-10-year-old pupils in the province of Pavia, Northern Italy. Methods: The intervention group will receive an educational programme via a new episode of "Leo&Giulia" animated series, focusing on smoking prevention. The study will assess changes in knowledge, attitudes towards smoking, and communication about smoking risks among peers and parents. The trial involves baseline and follow-up assessments through questionnaires targeting both children and parents. Results (expected): We assume that children in the intervention group will demonstrate increased knowledge and awareness of smoking-related health risks and develop negative attitudes towards tobacco use compared to the control group. Enhanced communication about tobacco harms among peers and between children and parents, as well as increased parental involvement in anti-smoking socialization practices, are expected secondary outcomes. Discussion and Conclusions: "Leo&Giulia" integrates health education into the school curriculum, leveraging the appeal of animated content to engage children in public health topics. The project is expected to contribute to the field of health education by demonstrating the effectiveness of digital health interventions in childhood, foreseeing potential long-term impacts on health behaviors and in shaping future public health strategies.