Real-time Sessions Research Articles

Language Learning Through Zoom

Attributable to the COVID pandemic, Zoom has become one of most widely used digital tools for online interaction. Schools and universities had to transition to wholly online teaching, and Zoom was one of the platforms used for real-time sessions. Therefore, it is necessary to investigate students' experiences of using tools like Zoom to see the positive and negative sides of videoconferencing for language learning. Students' and teachers' digital competence is an important factor that impacts online learning, and therefore students' experiences are analyzed in relation to the TPACK framework, which looks at teachers' digital competences and the intersections between their technological, pedagogical, and content knowledge (TPACK). It is found that especially the intersection between technological and pedagogical competences is sometimes lacking among teachers and is identified as the cause of a lot of negative experiences. Thus, the conclusion of this study is that such competences need to be developed by teachers.

Black Veterans Experiences with and Recommendations for Improving Weight-Related Health Care: A Photovoice Study

BackgroundNon-Hispanic Black or African American (hereafter Black) veterans lose less weight than other users of the Veterans Health Administration’s (VHA) weight management program (MOVE!), despite higher enrollment.ObjectiveTo understand factors that affect weight loss disparities between Black veterans and other veterans.DesignQualitative study using Photovoice methods.ParticipantsSelf-identified Black veterans in MOVE! across the USA (two women, seven men).ApproachWe conducted six virtual Photovoice sessions with Black veterans. Session one provided orientation to the goal of understanding factors that might affect weight loss disparities. Participants chose missions related to weight management and VHA care, bringing photos or other media (e.g., poems) to discuss during remaining sessions. Facilitators/participants identified themes related to each session in real time. Between and after sessions, facilitators/investigators conducted rapid qualitative analysis of transcripts/audio to group similar themes, identify illustrative quotes/photos/other media, and prepare dissemination products (e.g., this manuscript). Participants provided feedback on the manuscript during an additional session.Key ResultsThemes were identified across three categories: (1) Food in Our Lives and Health Care; (2) Body Image; and (3) Healthcare Bias and Discrimination. The emotional impact of food and the negative effects of bias and discrimination on health care quality and trust were especially salient. Participants provided recommendations for weight-related and general care. Notable recommendations included the need for VHA to hire and retain providers—especially Black providers—who understand and respect Black patients and are committed to delivering evidence-based, culturally sensitive care. In addition, weight management care should be tailored to individual patients’ diets and health beliefs and deemphasize body mass index.ConclusionsPhotovoice resulted in concrete targets that could reduce health disparities. Institutions should consider Photovoice and similar approaches to build trust with and incorporate input from marginalized communities. This approach requires sustained commitment from leaders to engage stakeholders and implement solutions.

Virtual Overseer for Examination Using Artificial Intelligence

The Virtual Overseer for Examination using AI is a proposed system that utilizes artificial intelligence (AI) to monitor and supervise online exams. The system aims to enhance the credibility and integrity of online exams by detecting and preventing cheating behaviors such as copying answers or using unauthorized materials. The proposed system utilizes computer vision and machine learning algorithms to analyze exam sessions in real time and flag suspicious behaviors for review by human proctors. The system also employs facial recognition technology to authenticate test-takers' identity and ensure that the right person is taking the exam. Overall, the Virtual Overseer for Examination using AI has the potential to revolutionize online education and assessment by providing a secure and reliable platform for conducting remote exams.

Wheelchair skills training for caregivers of manual wheelchair users: a randomized controlled trial comparing self-study and remote training

In this single-blind randomized controlled trial, we tested the hypotheses that, in comparison with control participants receiving only self-study materials (SS group), caregivers of manual wheelchair users who additionally receive remote training (RT group) have greater total Wheelchair Skills Test Questionnaire (WST-Q) performance and confidence scores post-training and at follow-up; and that self-study and remote training each individually lead to such gains. We studied 23 dyads of wheelchair users and their caregivers. Caregivers in the SS group received a handbook and videorecording. Those in the RT group also received up to four real-time (“synchronous”) sessions remotely. The WST-Q 5.1 was administered pre-training (T1), post-training (T2), and after a 3-month follow-up (T3). The mean total WST-Q scores of both groups rose slightly at each new assessment. For the T2-T1 and T3-T1 gains, there were no statistically significant differences between the groups for either WST-Q performance or WST-Q confidence. For performance, the T2-T1 gain was statistically significant for the RT group and the T3-T2 gain was statistically significant for the SS group. For both groups, the T3-T1 gains in performance were statistically significant with gains of 12.9% and 18.5% relative to baseline for the SS and RT groups. For confidence, only the T3-T1 gain for the SS group was statistically significant with a gain of 4.5% relative to baseline. Although less than the gains previously reported for in-person training, modest but important gains in total WST-Q performance scores can be achieved by self-study, with or without remote training. Registration Number NCT03856749.

3D Remote Assistance for NDT Inspections

In this work, we present a system architecture that is especially designed for remote ultrasound testing inspections (UT). The system itself is realized using a real-time session service and a web service based on a REST API (REST: Representational State Transfer; API: application programming interface). This web service is used to store data persistently, e.g., sample geometries, raw nondestructive testing (NDT) data and derived inspection results in a shared dataspace. In the current development state, the results consist of textures mapped onto the sample geometry. This approach allows us to display the UT results directly on the real sample using mixed reality technologies. We also implemented a feature to assist the inspector remotely by making use of the availability of this digital representation. Hence, it is necessary to share additional data like the current UT-signal, temporary position marks, user and device positions, etc. between the different participants. A real-time distribution of this highly dynamic data is required to create an effective assistance environment. Therefore, a separate session service is used. The inspection data generated in this temporary session can also be transferred to the afore mentioned dataspace to be saved persistently. The system features mixed reality visualization for the inspector and optionally a virtual reality or a 3D Desktop environment for one or more remote assistants.

Flexibility enhancement of multi-district DISCOs considering a trade-off between congestion and extractable reserve capacity from virtual energy storage systems

One of the fundamental concerns of distribution companies (DISCOs) is how to satisfy security requirements under uncertain conditions and real-time contingencies. To address this concern, it is vital to employ operational flexibility levers aimed at mitigating congestion and retaining optimal reserve capacity, particularly in critical feeders. Increased interaction between DISCOs and virtual energy storage systems (VESSs) offers an unparalleled opportunity to unlock the energy flexibility of distribution grids at the local level without increasing operational complexity. According to the state-of-the-art, models that tap the economic performance of VESSs while respecting the flexibility and security setpoints adopted by DISCOs in a distributed manner have remained scarce. This study goes beyond by developing a flexibility-oriented decision-making strategy as a single-leader multi-followers stochastic model; in which a multi-district DISCO involves the flexibility setpoints and congestion management strategy in the market participation plan of each VESS locally to enhance the energy flexibility of each district. In the upper level, DISCO aims to deal with stressful situations in real-time sessions by (i) determining the minimum reserve capacity requirements in each district to be provided by VESSs with respect to the existing uncertainty sources and the importance of each district, and (ii) alleviating the congestion in critical feeders to release the feeder capacity for deployment of the available reserve power promptly. In the lower level, each VESS makes optimal decisions on power and reserve bidding in day-ahead, reserve, and real-time markets that are affected by the flexibility services required by the DISCO. Inspired by the activity schedule of different users, it also examines how demand response programs can affect DISCO’s ability to unlock consumer-side flexibility in realizing congestion management strategies. The developed bi-level scheduling model is first reformulated as single-level mathematical program with equilibrium constraints (MPEC) by employing Karush–Kuhn–Tucker (KKT) optimality conditions and then linearized into a mixed-integer linear program (MILP). The proposed strategy is validated through extensive simulations conducted on the modified IEEE 33-bus test system consisting of three districts with different users. Furthermore, DIgSILENT PowerFactory is used to verify the feasibility of the proposed model under contingency cases and to provide insights for DISCOs to control multiple VESSs and capacity-correlated uncertainties.

Engineering Education in the Context of Digitalization and Transition to a Green Economy (SYNERGY 2022 Conference Results Review)

The article summarizes the results of the plenary session of the international network conference “Engineering education in the context of digitalization and transition to a green economy – SYNERGY-2022” held at the Nizhnekamsk Chemical Technology Institute of Kazan National Research Technological University from October 13 to 14, 2022. The forum was devoted to the training of engineers in the conditions of digitalization and the transition to a green economy. It brought together representatives of universities and industrial enterprises of Russia and abroad. Among the participants were representatives of national research universities and supporting universities of PJSC Gazprom, state authorities and industrial enterprises of Tatarstan. It was possible to observe the work of the plenary session in real time via the Internet in all the main universities of Gazprom. The organizers of the event were the Ministry of Science and Higher Education of the Russian Federation, the International Society for Engineering Pedagogy (IGIP), the Association of Engineering Education of Russia (AEER), as well as the Ministry of Industry and Trade of the Republic of Tatarstan and the Kazan National Research Technological University. Gazprom PJSC was the general sponsor. In total, the conference gathered more than 200 participants (120 online and 80 in person) from 15 universities in Russia, Germany and Kazakhstan. Representatives of 12 industrial enterprises spoke, 42 reports were made.

DMnet: A New Few-Shot Framework for Wind Turbine Surface Defect Detection

In the field of wind turbine surface defect detection, most existing defect detection algorithms have a single solution with poor generalization to the dilemma of insufficient defect samples and have unsatisfactory precision for small and concealed defects. Inspired by meta-learning ideology, we devised a cross-task training strategy. By exploring the common properties between tasks, the hypothesis space shrinks so that the needed sample size that satisfies a reliable empirical risk minimizer is reduced. To improve the training efficiency, a depth metric-based classification method is specially designed to find a sample-matching feature space with a good similarity measure by cosine distance. Additionally, a real-time feedback session is innovatively added to the model training loop, which performs information enhancement and filtering according to the task relevance. With dynamic activation mapping, it alleviates the information loss during traditional pooling operations, thus helping to avoid the missed detection of small-scale targets. Experimental results show that the proposed method has significantly improved the defect recognition ability under few-shot training conditions.

Investigating the effectiveness of an adapted professional development model in the adoption of school wellness initiatives

Objective: This study investigated the efficacy of a two-component professional development approach to improving school wellness in Pennsylvania secondary schools. Design: Circle of Wellness (CoW), a year-long, two-phase programme, involved providing Whole School, Whole Community, Whole Child (WSCC) workshops to Pennsylvania school staff and administrators, followed by personalised technical assistance to facilitate the implementation of wellness initiatives. Setting: The workshops were provided in-person, with follow-up technical assistance (e.g. phone calls, zoom meetings, real-time editing sessions via Google Drive) delivered remotely. Method: Workshops featured expert presentations, activity stations, and physical resources to meet all 10 components of the WSCC model. After workshop completion, research staff provided support to promote school staff adoption of a wellness action plan grounded in WSCC components. Participants then completed post-programme evaluations rating satisfaction and success with the implementation of their action plans. Results: In a final programme evaluation, 70% of the respondents reported bringing about healthy changes as a result of participating in the CoW programme ( n = 28). In addition, 100% of the school representatives reported that attending the workshop and participating in the programme were a worthwhile experience ( n = 40). Conclusion: Professional development opportunities such as the CoW, which includes follow-up guidance and resources, were well received by school staff, and the understanding gained through participation in such programmes contributed to the sustainability of wellness initiatives.

Regional Development: New Challenges for Engineering Education (SYNERGY-2021 Conference Results Review)

The article summarizes the results of the plenary session of the international network conference “Regional development: new challenges for engineering education – SYNERGY-2021”, held at Kazan National Research Technological University from October 19 to 20, 2021. The forum which brought together representatives of universities and industrial enterprises of Russia and abroad was devoted to the issue of training engineers for the petrochemical industry. Among the participants were representatives of international societies for engineering education, ten national research universities and seven supporting universities of PJSC Gazprom, state authorities and industrial enterprises of Tatarstan. It was possible to observe the work of the plenary session in real time via the Internet in all the supporting universities of Gazprom. The event was organized by the Ministry of Science and Higher Education of the Russian Federation, the International Society for Engineering Pedagogy (IGIP), the Association of Engineering Education of Russia (AIOR), as well as the Ministry of Industry and Trade of the Republic of Tatarstan and Kazan National Research Technological University. Gazprom PJSC became the general sponsor. In total, the conference gathered more than 450 participants (380 online and 85 in person) from 40 universities in Russia, the USA, Great Britain, Germany, Portugal, Finland, Poland, Kazakhstan, Belarus, Armenia, Latvia, and Estonia. Representatives of 7 industrial enterprises spoke, 77 reports were made.

Transient ICD malfunctions during oncologic radiotherapy: a multi-centre, randomized, in-vitro study

Abstract Background Direct exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered potentially harmful, or even unsafe, by manufacturers and current recommendations. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and malfunctions may present during exposure. Purpose To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy RT, forty-three contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (ERI) were evaluated in a real-time in-vitro session in three different centres. Methods All ICDs had baseline interrogation. Single chamber devices were programmed to the VVI/40 mode and dual or triple chamber devices were programmed to the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still active. A centring computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2-, 5- or 10-Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was randomly assessed by an in-vivo dosimetry. During radiotherapy, the ICDs were observed in a real-time session using manufacturer specific programmer, and device function (pacing, sensing, programmed parameters, arrhythmia detections) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure. Results During radiotherapy course, almost all ICDs (93%) recorded major or minor transient electromagnetic interferences. On detail, sixteen ICDs (37.2%) reported atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. Twenty-four ICDs (55.8%) recorded non clinically relevant noise, and no detections were observed. Only three ICDs (7%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. Malfunctions occurred regardless of either 2-, 5- or 10-Gy photon beam exposure. Conclusions Transient electromagnetic interferences were observed in most of the contemporary ICDs during radiotherapy course, regardless of photon dose. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or ICD reprogramming to the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure. Funding Acknowledgement Type of funding source: None

How is telehealth being utilized in the context of rehabilitation for lower limb musculoskeletal disorders: a scoping review

Background Telehealth services may decrease costs, improve efficiency, and increase access for health care delivery. Telehealth has been used extensively in rehabilitation of various cardiopulmonary and neurological conditions with high clinical efficacy. However, there appears to be limited information regarding the provision of telehealth for managing musculoskeletal lower limb disorders and injuries. Objective To determine for which lower limb conditions telehealth has been used, and to describe the delivery mode and the content of that telehealth, when provided by physiotherapists. Design Scoping review. Methods A computerized search of Cochrane Library, PEDro, Medline, Scopus, SPORTDiscus, Web of Science, PubMed, and CINAHL was conducted up to the 5 April 2020. A search strategy was developed and adapted to each database. Studies were included if they investigated assessment or rehabilitation of a lower limb musculoskeletal disorder and utilized real-time telehealth physiotherapy sessions. We included primary studies, randomized controlled studies, nonrandomized clinical trials, and agreement studies. Results Ten studies were included in the review, categorized into two groups: assessment (five studies), and intervention or rehabilitation (five studies) via telehealth. Seven of those studies included patients who had undergone hip or knee arthroplasty. Nine studies utilized synchronous internet-based videoconferencing and one study used phone interviews as the method of delivering assessment or rehabilitation information. Conclusion Telehealth was used as a means of assessment of a variety of lower limb conditions, while rehabilitation via telehealth was limited to patients with hip or knee arthroplasty.

P1134Cardiac pacemakers and transient electromagnetic interferences during radiotherapy courses: a multicentre, real-time, in-vitro evaluation

Abstract Funding Acknowledgements None Background The effects of high dose oncologic radiotherapy (RT) on cardiac pacemakers (PMs), at even less than 6 MV power, are unpredictable, depending on multiple factors. Normal PM function may be impaired during direct exposure, due to electromagnetic interferences (EMIs). Potentially life-threatening malfunctions may occur, expecially in PM-dependent patients, and both manufacturers and guidelines discourage direct exposure. Purpose To evaluate transient EMI-related PM malfunctions during direct exposure to doses up to 10 Gy during radiotherapy course, 17 wireless-telemetry-enabled PMs with sufficient residual battery charge for the purpose of the study (at least 4 months to elective replacement indicator, E.R.I.) were evaluated in three different centres. Methods All PMs underwent baseline interrogation. Single chamber devices were programmed in the VVI/40 mode while dual or triple chamber devices were programmed in the DDD/40 mode. To avoid the "run-away" phenomenon during exposure rate-adaptive function was disabled. A centering computed tomography was performed to build the corresponding treatment plan and the PMs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a 6 MV linear accelerator in a homemade water phantom (600 Um/min). The effective dose received by the PMs was randomly assessed by an in-vivo dosimetry. During RT course, the devices were observed in a real-time session using manufacturer specific equipment, and PM function (pacing and sensing, programmed parameters) was recorder by a video camera in the bunker throughout the entire radiation exposure. Results During RT course, 13 PMs (76.5%) recorded not clinically relevant minor transient EMIs, and no atrial and/or ventricular oversensing nor base-rate-pacing inhibition were observed. Only 4 PMs (23.5%) reported neither transient malfunction nor minor EMIs, withstanding direct radiation exposure. Transient EMI-related malfunctions were observed regardless of either 2, 5 or 10 Gy exposure. Conclusions Minor, not clinically relevant EMI-related interferences were observed in most of the PMs during direct exposure. Nevertheless, to avoid potentially life-threatening PM malfunctions, magnet application on the PM pocket site or reprogramming are still suggested in PM-dependent (high risk) patients ongoing even low energy RT exposure.

910Noise-related malfunctions in modern ICDs during oncologic radiotherapy: a multicentre, real-time, in-vitro observation

Abstract Funding Acknowledgements None Background Direct photon exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered not recommended, or even unsafe, by manufacturers and guidelines. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and electromagnetic interferences (EMIs) may present during exposure. Purpose To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy radiotherapy, 36 contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (E.R.I.) were evaluated in a realtime in-vitro session. Methods All ICDs had baseline interrogation. Single chamber devices were programmed in the VVI/40 mode and dual or triple chamber devices were programmed in the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still working. A centering computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was randomly assessed by an in-vivo dosimetry. During radiotherapy course, the devices were observed in a real-time session using manufacturer specific programmer, and ICD function (pacing, sensing, programmed parameters, detection) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure. Results During radiotherapy course, almost all ICDs (90.9%) recorded major or minor transient EMIs. On detail, 16 ICDs (44.4%) reported EMI-related atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. 16 ICDs (44.4%) recorded not clinically relevant minor EMIs, and no detections were observed. Only 4 ICDs (11.2%) reported neither transient malfunction nor minor EMIs, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. EMI-related malfunctions occurred regardless of either 2, 5 or 10 Gy photon beam exposure. Conclusions Transient EMIs were observed in most of the contemporary ICDs. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or reprogramming in the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure.

Engineering Education: Transformation for Industry 4.0 (SYNERGY 2019 Conference Results Review)

The article summarizes the results of the plenary session of the international conference «Engineering education: transformation problems for industry 4.0 SYNERGY-2019», held at the Kazan National Research Technological University from 4 to 5 September 2019. Forum which brought together representatives of universities and industrial enterprises of Russia and abroad, was devoted to the training of engineers of the petrochemical industry. Among its delegates were representatives of international societies for engineering education, five national research universities and nine supporting universities of PC «Gazprom», state authorities and industrial enterprises of Tatarstan. It was possible to observe the work of the plenary session in real time on the Internet in all the supporting universities of Gazprom. The event was organized by the Ministry of Science and Higher Education of the Russian Federation, the International Society for Engineering Pedagogy IGIP, the National Fund of Training of Staff (NFTS), the Association of Engineering Education of Russia (AEER) as well as the Ministry of Industry and Trade of Tatarstan and the Kazan National Research Technological University. The General sponsor was the Public Joint Company «Gazprom». The conference gathered 155 participants from 15 universities of Russia, Kazakhstan and Estonia. Representatives of 11 industrial enterprises spoke, 55 reports made presentations.

2410Oncologic radiotherapy-induced implantable cardioverter-defibrillator malfunctions: a real-time, in-vitro evaluation

Abstract Background Direct exposure of implantable cardioverter-defibrillators (ICDs) during radiotherapy is still considered not recommended, or even unsafe, by manufacturers and guidelines. The effects of photon beams on ICDs are unpredictable, depending on multiple factors, and malfunctions may occur during exposure. Purpose To evaluate transient ICD malfunctions by direct exposure to doses up to 10 Gy during low-energy radiotherapy, 33 contemporary wireless-enabled ICDs, with at least 4 months to elective replacement indicator (E.R.I.) were evaluated in a realtime in-vitro session. Methods All ICDs had baseline interrogation. Single chamber ICDs were programmed in the VVI/40 mode and dual or triple chamber ICDs were programmed in the DDD/40 mode. Rate response function and antitachycardia therapies were disabled, with the ventricular tachycardia (VT)/ventricular fibrillation (VF) detection windows still active. A centering computed tomography was performed to build the corresponding treatment plan and the ICDs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the ICDs was assessed by an in-vivo dosimetry. During radiotherapy, the devices were observed in a real-time session using manufacturer specific programmer, and ICD function (pacing, sensing, programmed parameters, detection) was recorder by the video camera in the bunker throughout the entire photon exposure. All ICDs had an interrogation session immediately after exposure. Results During radiotherapy course, almost all ICDs (90.9%) recorded major or minor transient electromagnetic interferences. On detail, 13 ICDs (39.4%) reported atrial and/or ventricular oversensing, with base-rate-pacing inhibition and VT/VF detection. 16 ICDs (48.5%) recorded non clinically relevant noise, and no detections were observed. Only 4 ICDs (12.1%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. At immediate post-exposure interrogation, the ICDs that recorded major real-time malfunctions had VT/VF detections stored in the device memory. In none of the ICDs spontaneous changes in parameter settings were reported. Malfunctions occurred regardless of either 2, 5 or 10 Gy photon beam exposure. Conclusions Transient electromagnetic interferences were observed in most of the contemporary ICDs during radiotherapy course, regardeless of photon dose. To avoid potentially life-threatening ICD malfunctions such as pacing inhibition or inappropriate shock delivery, magnet application on the pocket site or reprogramming devices in the asynchronous mode are still suggested in ICD patients ongoing even low energy radiotherapy exposure. Acknowledgement/Funding None

P6553Contemporary pacemakers and oncologic radiotherapy courses: a real-time, wireless-enabled observation

Abstract Background The effects of high dose oncologic radiotherapy on cardiac pacemakers (PMs), at even less than 6MV power, are unpredictable, depending on multiple factors. Normal PM function may be impaired during photon exposure, with potentially life-threatening consequences in PM-dependent patients, and, unlike in magnetic resonance imaging setting, both manufacturer statements and guidelines discourage direct exposure. Purpose To evaluate transient PM malfunctions by direct exposure to doses up to 10 Gy during radiotherapy course, actually not recommended or considered even unsafe, 17 wireless-telemetry-enabled PMs obtained after upgrade or extraction of the system, with sufficient residual battery charge for the purpose of the study (at least 1 year to elective replacement indicator, E.R.I.) were evaluated in a real-time in-vitro session. Methods All PMs underwent baseline interrogation. Single chamber devices were programmed in VVI/40 mode while dual or triple chamber devices were programmed in DDD/40 mode. Rate adaptive function was disabled to avoid the “run-away” phenomenon during exposure. A centering computed tomography was performed to build the corresponding treatment plan and the PMs were blinded randomized to receive either 2, 5 or 10 Gy exposure by a low photon-energy linear accelerator (6MV) in a homemade water phantom (600 MU/min). The effective dose received by the PMs was assessed by an in-vivo dosimetry. During radiotherapy course, the devices were observed in a real-time session using manufacturer specific equipment, and PM function (pacing and sensing, programmed parameters) was recorder by a videocamera in the bunker before (5 minutes), throughout, and after (5 minutes) the entire radiation exposure. Results During radiotherapy course, non of the PMs reported spontaneous changes in parameter settings. 13 PMs (76.5%) recorded non clinically relevant minor transient electromagnetic sensing interferences. No atrial and/or ventricular oversensing nor base-rate-pacing inhibition were observed. Only 4 PMs (23.5%) reported neither transient malfunction nor minor noise, withstanding direct radiation exposure. Transient oversensing-related malfunctions were observed regardless of either 2, 5 or 10 Gy exposure. Conclusions Minor, non clinically relevant electromagnetic sensing interferences were observed in most of the PMs during direct exposure. Nevertheless, to avoid potentially life-threatening PM malfunctions, magnet application on the PM pocket site or reprogramming in the asynchronous mode are still suggested in PM-dependent patients ongoing even low energy radiotherapy exposure. Acknowledgement/Funding None

LARPA: A learning automata‐based resource provisioning approach for massively multiplayer online games in cloud environments

SummaryNowadays, with the development of communication systems, massively multiplayer online games (MMOGs) have become very popular. In these games, the players all over the world dynamically interact with each other by sending play actions such as shootings, movements, or chatting in the form of MMOG sessions in real time through a large‐scale distributed environment. Leveraging affordable cloud computing to host such services is a widely investigated issue. It is because the arrival rate of players to the game environment has to make fluctuations, and the players expect services to be always available with an acceptable quality of service (QoS), especially in terms of the response time. Therefore, the dynamic provisioning of resources in order to deal with fluctuating demands due to variability in the arrival rate of players of the MMOG services is highly recommended. In this paper, we propose a learning‐based resource provisioning approach for MMOG services that is based on the combination of the autonomic computing paradigm and learning automata (LA). The remarkable performance of the proposed approach in terms of response time, cost, and allocated virtual machines (VMs) is assessed through simulation and comparison with the existing approaches.

Procuring Spontaneous Session-Level Resource Guarantees for Real-Time Applications: An Auction Approach

Real-time multimedia applications, such as interactive gaming, live video streaming, and augmented reality, have strict latency and bitrate requirements. However, unpredictable network conditions, such as congestion and link quality, can severely degrade the quality of experience (QoE). While buffer-based mitigations cannot be applied to real-time applications due to their immediate resource needs, recent innovations in network slicing have demonstrated the feasibility of dedicating specified amounts of network resources to individual sessions in the radio access network. Encouraged by this, we propose to reserve network resources for multimedia sessions in real time according to their declared needs, thereby providing ad hoc session-level performance guarantees . Through Wi-Fi experiments and trace-driven LTE simulations, we show that such session-level resource provisioning is robust to real-time channel fluctuations and congestion externalities over the lifetime of a session. This approach, however, raises challenges: how can the network ensure that users are honest about their resource needs and optimally allocate its limited resources to users under uncertainty in future sessions’ resource needs ? We derive a novel multi-unit combinatorial auction (MUCA) model with a unique structure that can be exploited for fast winner determination, and yet incentivize truthful bidding, properties not simultaneously achieved in a generic MUCA but essential to making real-time session guarantees. Furthermore, since dynamic bidding in real time is challenging for end-users who are budget-constrained, we develop a reinforcement learning-based utility-maximizing strategy to distribute their budget across sessions and show that it yields high user utility.

ELECTRONIC MEDIA AND ITS APPLICATIONS IN PSYCHOTHERAPY: METHODS AND A GERIATRIC CASE STUDY

Introduction A growing body of literature indicates that clinically significant behavior markers can be extracted from mobile and communication data. However, it remains less clear whether and how such data can be incorporated into the care process, and whether they may actually have an impact in psychotherapy. Here, we describe the methodology of a novel study that assesses the feasibility and impact of incorporating data from patients’ electronic media (e.g. email, text messaging, social media) into therapy. We describe this study design, as well as our protocol for an adaptive approach anchored around privacy and patient control of data, as well as the technological infrastructure required for real-time signal extraction from passive data, and communication to clinicians. Methods We developed a protocol for initial study phase - an open trial designed to implement a process for accessing patient's electronic media, incorporating natural language processing and behavior measurement, as well as patient feedback. We also developed a process for identifying appropriate outcome measures and developing a clinician dashboard to incorporate these data into the patient's session in real time. We selected the geriatric clinic at McLean Hospital as the primary study site. Finally, we implemented the protocol as an N=1 study focused on how text messaging content impacts psychotherapy in a 77-year-old man with depression and anxiety. Results Preparatory surveys for study launch indicated that clinicians are already incorporating electronic media into psychotherapy, with text messaging and email content noted to be more valuable than social media. Among older adults, text messaging and actual phone calls may be primary markers for digital phenotyping. Relevant outcome measures include the working alliance (measured by the Working Alliance Inventory-Short Revised (WAI-SR) and the Ratings of Emotional Attitudes to Client by Therapist (REACT), and changes in subjects’ depression and anxiety symptoms (measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7). Conclusions Our initial findings from the process of study launch indicate that behavior around electronic media (i.e. how frequently a person may use or interact with electronic media) may be a more accessible metric for psychiatric symptoms. The process of accessing content from electronic communications raises complex questions around privacy, including those around third parties that may be communicating with patients. However, patients increasingly recognized that data from their digital lives can enhance the quality of care. Our initial feasibility study with a 77-year-old man illustrated the importance of incorporating patient feedback into study design and procedure. Our feasibility study also indicates that patients may be more willing to share private electronic media directly with physicians, rather than unrelated third parties. This research was funded by This work is supported by the Once Upon a Time Foundation