Remote Assessment Research Articles

Clinician-Prioritized Measures to Use in a Remote Concussion Assessment: Delphi Study.

There is little guidance available, and no uniform assessment battery is used in either in-person or remote evaluations of people who are experiencing persistent physical symptoms post concussion. Selecting the most appropriate measures for both in-person and remote physical assessments is challenging because of the lack of expert consensus and guidance. This study used expert consensus processes to identify clinical measures currently used to assess 5 physical domains affected by concussion (neurological examination, cervical spine, vestibular, oculomotor, or effort) and determine the feasibility of applying the identified measures virtually. The Delphi approach was used. In the first round, experienced clinicians were surveyed regarding using measures in concussion assessment. In the second round, clinicians reviewed information regarding the psychometric properties of all measures identified in the first round by at least 15% (9/58) of participants. In the second round, experts rank-ordered the measures from most relevant to least relevant based on their clinical experience and documented psychometric properties. A working group of 4 expert clinicians then determined the feasibility of virtually administering the final set of measures. In total, 59 clinicians completed survey round 1 listing all measures they used to assess the physical domains affected by a concussion. The frequency counts of the 146 different measures identified were determined. Further, 33 clinicians completed the second-round survey and rank-ordered 22 measures that met the 15% cutoff criterion retained from round 1. Measures ranked first were coordination, range of motion, vestibular ocular motor screening, and smooth pursuits. These measures were feasible to administer virtually by the working group members; however, modifications for remote administration were recommended, such as adjusting the measurement method. Clinicians ranked assessment of coordination (finger-to-nose test and rapid alternating movement test), cervical spine range of motion, vestibular ocular motor screening, and smooth pursuits as the most relevant measures under their respective domains. Based on expert opinion, these clinical measures are considered feasible to administer for concussion physical examinations in the remote context, with modifications; however, the psychometric properties have yet to be explored. RR2-10.2196/40446.

Advancements in Telemedicine: Enhancing Public Health Outcomes through the Implementation of 5G Networks for Ultra Low Latency Communication

With the introduction of 5G networks, a new era emerges in telemedicine, dramatically improving public health outcomes with fewer telecommunications networks. The proliferation of 5G communications networks that enable seamless remote access, routine patient monitoring, and expedited treatment on mobile devices is the driving force behind improved patient care and public health risk variety detection and maintenance. High infrastructure costs, wide adoption, and data privacy and security Despite the compelling potential of 5G in telemedicine, some barriers to adoption have been proposed for Integrating Smart Automated Healthcare Analysis (I-SAHA), using artificial intelligence (AI) and machine learning (ML). Using these, I-SAHA can analyze health information as its peak rapidly and reliably, albeit with insights related to diagnosis by physicians and prognosis. In the context of telemedicine in a 5G application, this study investigates the performance of I-SAHA applications through an in-depth simulation analysis. Through its simulation, I-SAHA demonstrates that increased speed and accuracy in remote health assessment can lead to more dynamic, personalized health care. Additionally, 5G networks enable real-time transmission of vital health information to ensure prompt medical intervention with minimal intervention. The results show how telemedicine can benefit from 5G networks and how I-SAHA applications can improve healthcare. This approach has the potential to expand access to better health care by reducing existing barriers and improving public health outcomes through innovative research on telecommunications.

Integrated Assessment of Disturbed Ecosystems Using Remote Sensing Technique

Introduction. Today, there is a need for a shared vision of restoration of disturbed ecosystems, which is defined as “the process of stopping and reversing degradation, leading to improved ecosystem services and restoration of biodiversity.”Problem Statement. The assessment and restoration of disturbed ecosystems has become especially relevant for the Ukrainian society now, as warfare has caused large-scale changes in environment and both short-term and long-term consequences for ecosystems in Ukraine.Purpose. Assessment of ecosystems disturbed as a result of warfare impact by remote sensing.Materials and Methods. Multispectral satellite imagery, ground truth data and ecosystems characteristics of study area have been used. Remotely sensed data processing, geospatial modelling, and mathematical statistics have been applied.Results. A warfare impact on the ecosystems of Ukraine has been overviewed. Possibility of using remote sensing methods have been considered; their advantages and disadvantages have been generalized. A demo example of the described technique for assessing the ecosystem conditions along the E40 highway on the west of Kyiv has been shown with the use of multi-time satellite imagery of very high resolution (0.5 m on the ground) between May 2020 and March 2022. The analysis of the obtained maps allows us to assess short-term changes in land cover: a decrease in the area of water bodies, coniferous and leafy plants, an increase in the open soil area. The ecosystem conditions map of the studied area enables identifying plots of high risk.Conclusions. Integrated remote assessment of the condition of disturbed ecosystems and geospatial analysis of corresponding risks are useful tools for the territory management. Remote sensing techniques are particularly important in the context of largescale warfare. In many cases, only remote sensing techniques can provide information on the condition of ecosystems that areinaccessible or dangerous for ground-based research. Currently, the proposed approach has been elaborated and tested over other territories, different ecosystems and other data sources. Completed and tested integral geo-information technology will be relevant for the post-war recovery of the territory of Ukraine. Further research should be focused on building a pool of quantitative models for probabilistic assessment of the risk of disruption of various ecosystems under diff erent conditions, as well as on obtaining an array of statistical data to increase the reliability of the resulting maps.

IoT - Toxic Gas Detection System in Sewage

The application of IoT and machine learning in gas detection systems for sewage offers an innovative approach to real-time gas detection and enhances environmental safety in industrial and urban environments. This system uses advanced technologies such as the Internet of Things (IoT), machine learning algorithms, and high-performance sensors like the MQ135 and the DHT11 to achieve the best results in the gas concentration measurement and collection. It identifies abnormalities and determines which emission control measures are most effective for specific release points and similar situations. The design of the device includes sensor nodes that are primarily responsible for data collection and a central microcontroller (MCU) that operates a machine learning algorithm for efficient anomaly detection and predictive maintenance. The system uses the IoT connection to regularly send data to cloud platform (Blynk), enabling real time monitoring of gas levels and environmental conditions. The system generates a visual image of the captured data that can be accessed online. Distinctive attributes like accurate gas detection, continuous monitoring, predictive maintenance, remote assessment, and comprehensive data visualization, all contribute to smart decision-making for environmental safety.

Telemedicine for Preoperative Assessment, Surgical Appointments, and Preoperative Education in Gynecological Day Surgery: An Prospective Observational Analysis.

This study investigates the differences in the cost, time, pre-operative education and patient satisfaction levels of patients requiring a second hysteroscopic surgery using a full-service model of remote preoperative assessment, surgical appointments, and preoperative education. Forty-one patients who were proficient in the use of telemedicine platforms, planned to undergo a second hysteroscopic surgery, and selected either telemedicine (N=21) or face-to-face (N=20) models for their preoperative assessments, surgical appointments, and preoperative education were included. The data were analyzed using the Mann-Whitney U-test and Fisher's exact test. No significant demographic differences were observed between patients who used telemedicine and those who did not. The telemedicine group demonstrated significantly lower median travel time (40 min vs 205 min, P < 0.01), time spent in hospital (60 min vs 155 min, P < 0.01), meal time (0 min vs 60 min, P < 0.01), and total time spent (108 min vs 415 min, P < 0.01). Similarly, the telemedicine group had significantly lower median travel expenses (40 yuan vs 300 yuan, P < 0.01) and meal expenses (0 yuan vs 135 yuan, P < 0.01), and overall, total expenses (255 yuan vs 837 yuan, P < 0.01). 95.2% of the telemedicine group completely understood the preoperative education, compared to 100% who completely understood in the face-to-face group (P = 1.00). All patients in the telemedicine group were very satisfied compared to 80% in the face-to-face group (P = 1.00). Telemedicine may be a feasible and advantageous method for preoperative assessment, surgical appointments, and preoperative education in gynecological day surgery. The application of telemedicine has demonstrated notable time and cost efficiency with high patient satisfaction levels. Future research should explore the full potential of telemedicine in this setting and for other surgical procedures.

Behind the screen: exploring the effects of home working on 999 telephone clinicians during the COVID-19 pandemic.

The COVID-19 pandemic has significantly stretched global healthcare provisions since its commencement in 2019. From the outset, ambulance services in the UK had to adapt and change their working practices to meet distancing requirements, to increase staff numbers and to ease the effects of staff becoming unavailable for work due to self-isolation and illness. One strategy was moving clinicians from emergency operation centres (EOCs) to working from home. Like many international services, UK ambulance services use paramedics and nurses to undertake telephone and video assessments of patients calling the 999 emergency services line in a model known as virtual care or remote clinical decision making. Virtual care is any interaction between a patient and a clinician or clinicians, occurring remotely via information technologies.Increasing evidence is becoming available to suggest that the pandemic caused harm to the well-being of healthcare workers, primarily due to the severe stress of regular exposure to death and human suffering. However, there remains a dearth of literature focusing on the well-being of remote and virtual clinicians, especially those who moved from working in EOCs to working at home during the COVID-19 pandemic. Therefore, this study reports the findings of a qualitative analysis of these effects from the clinician's perspective. The authors hope that the findings from this study will inform the operating, well-being and leadership practices of those delivering such services. A convenience sample of telephone nurses and paramedics from one UK ambulance service where home working had been implemented were contacted. Fifteen clinicians with recent home-working experience responded to the invitation to participate out of a possible 31 (48%). All participants had previously practised remote assessment from within an EOC. Semi-structured interviews took place via video-conferencing software and were recorded, transcribed and thematically analysed. An inductive approach was taken to generating codes, and both researchers separately read the transcripts before re-reading them, assigning initial themes and determining frequency. Five main themes were discovered, with further associated sub-themes. The main themes were: safety; financial implications; working relationships; home-working environment; and anxiety. Few studies explore remote clinicians' health and well-being. This study identified that home-working clinicians felt that there had been no detrimental impact on their health and well-being because of working from home during the initial phase of the COVID-19 pandemic. While some concerns were raised, these were mitigated through the support that clinicians received at home from family members, as well as from colleagues, some of whom had developed new working relationships. Financial implications appeared to have contributed to some concerns for participants initially, but these had been alleviated quickly despite requiring further exploration of the true financial impact of working from home.

Real Time Collaborative Code Editor

Abstract: The main goal of our project is to provide an online platform especially for group coding interviews. This platform provides a comprehensive environment for seamless communication between interviewers and candidates, with the goal of addressing the challenges faced during remote technical assessments. The creation ofa feature-rich web platform is the goal of our project. Thisincludes an adaptable rich text editor that enables coding in real time, a mechanism for instantaneous code evaluation via execution and compilation, integrated video conferencing for efficient communication, and the abilityto set up interview rooms to hold several interviews at once. We're designing a user intuitive interface using technology and strong programming frameworks. The main objectives of the platform are to ensure real time code execution and a seamless interview process. This is achieved by incorporating code compilation engines implementing editing tools and utilizing WebRTC for video conferencing. By creating a user-friendly and productive environment that benefits both interviewers and candidates, our platform seeks to expedite the remote technical interview process. This means reducing logistical obstacles, making thorough coding evaluations possible, and creating a positive interview environment.

Feasibility of Using Standardized Outcome Measures in the Remote Assessment of Patients with Chronic Stroke: A Case Series

Introduction: With the increase of telerehabilitation utilization worldwide after the COVID-19 pandemic, a review of the current literature shows a concurrent increase in telerehabilitation studies focusing on interventions and delivery models. There is a gap in research on valid and reliable tests and measures that can be used in the physical therapy examination of people with stroke via telerehabilitation. Current reports on psychometric properties of most standardized outcome measures are only applicable in an in-person setting and may not be directly applicable in a remote setting where various challenges contribute to the reliability of results. This report describes the feasibility of administering selected standardized outcome measures in the remote assessment of three patients with chronic stroke with different contexts. Methods: Three patients with chronic stroke underwent physical therapy examination and intervention sessions via telerehabilitation with varying contexts. Results: Various factors affected the results of the assessment including patient and caregiver’s (if present) ability to follow instructions, availability of material and spatial resources, and stability of internet connection. Strategies to improve reliability of assessment results can also be employed such as performing repeat trials, reviewing recordings for accuracy and confirmation, using highly visible markers, and confirming measurement accuracy on video. Discussion: Physical therapy outcome measures that can feasibly be administered remotely are the Timed Up and Go Test, the 10-Meter Walk Test, the 6-Minute Walk Test, the 5-Times Sit to Stand Test, and the Stroke Impact Scale. The Mini Balance Evaluation Systems Test could not be administered remotely as close to standard protocol as possible due to the difficulty of administering the reactive postural component with patient anxiety and safety considerations and materials required.

Adaptation and development of the instruction manual for a videoconference-based Motor Assessment Scale: validity, reliability and measurement error of Tele-MAS

Purpose To develop an instruction manual to administer the Motor Assessment Scale (MAS) via videoconferencing (Tele-MAS), investigate its validity, reliability and measurement error. Materials and methods In-person assessment, conducted at the participant’s home, was compared to remote assessment conducted by rater A. Then, within two days, the rater B, repeat the remote assessment (n = 41). Part of the sample (n = 10) was assessed again within seven days by rater A to determine test-retest reliability. Concurrent validity, agreement of alternate forms (in-person x remote) for total score and reliability of individual items were analyzed using respectively the Pearson correlation coefficient, Bland-Altman plots and weighted Kappa (Kw). Interrater and test-retest reliability were analyzed by Intraclass Correlation Coefficient (ICC). Standard Error of Measurement (SEM) and Minimal detectable changes (MDC) were computed. Results The Tele-MAS instruction manual was developed. In-person MAS and Tele-MAS present a high positive correlation (r = 0.97). Bland-Altman plots showed adequate agreement (MD=-0.0 point). Most Individual items showed excellent reliability (Kw > 0.70). Tele-MAS showed excellent interrater (ICC(2,1)=0.92) and test-retest (ICC(3,1)=0.98) reliability. Tele-MAS presents a SEM = 3% and MDC = 8%. Conclusion The Tele-MAS is a valid and reliable global motor assessment scale to be applied in individuals after stroke.

Paradigm Shift in Sports Science: The IOT-Enhanced Agility-Pad for Athletic Performance Evaluation

This paper explores the development and implementation of an agility monitoring system, aiming to provide real-time assessment of an athlete's agility. The need for such technology to facilitate instant and remote agility assessment has become increasingly apparent in the field of sports science. Unfortunately, progress in this area has been relatively slow until the emergence of IoT (Internet of Things) technology, which presents a promising avenue for athlete agility monitoring through telemetering. The core of this innovative system consists of an agility pad and a real-time monitoring module, with communication facilitated by LabVIEW software. Our approach involves rigorous testing, including unit testing of the agility pad, which serves as an MQTT publisher, the server, which functions as an MQTT broker, and the monitoring module, acting as an MQTT subscriber. In addition to these technical aspects, this article showcases various outcomes of our research. These include the designs of two activity diagrams, a comprehensive conceptual framework for agility monitoring, the database structure, communication designs for the agility pad, a wiring schematic, a 3D model of the agility pad, and the corresponding wiring configuration. We have successfully constructed two sets of agility pads, each integrated with an MCU system (ESP8266) and a dedicated database architecture designed for agile monitoring. One significant achievement of our work is the identification of the optimal delay interval required on the agility pad to prevent data loss on the MQTT broker. Furthermore, we have effectively developed a mechanism for detecting and addressing abnormal data during each testing phase, which contributes to the robustness and reliability of the system. This paper not only highlights the innovative technology behind the IOT-Infused Agility-Pad but also underscores its potential to revolutionize the assessment of athletic performance, offering coaches and athletes real-time insights into agility progress.

Randomised controlled decentralised feasibility trial of a fixed low-dose combination antihypertensive drug strategy to attenuate cognitive decline in high-risk adults

ObjectivesThe Action To promote brain HEalth iN Adults study aimed to determine the feasibility and applicability of recruitment using home blood pressure (BP) monitoring, routine blood biochemistry and videoconference measures...

Use of a remote assessment pathway for diagnosis of carpal tunnel syndrome.

We undertook a retrospective cohort study of a remote carpal tunnel syndrome assessment pathway created in response to limitations caused by the COVID-19 pandemic. Between July 2020 and September 2021, 702 patients referred from primary care (general practice) were assessed in a nurse-led telephone clinic using the carpal tunnel questionnaire of Kamath and Stothard (2003). Depending on their questionnaire score, patients were referred either for nerve conduction studies or a consultant hand surgeon review for diagnosis and treatment planning. Questionnaire scores of 3 and above accurately predicted a likely diagnosis of carpal tunnel syndrome in 83% of patients, and a diagnosis was unlikely in 90% of those with a score below 3. The pathway resulted in an estimated cost savings of £24,436 (€28,862, US$30,945) in comparison with the pre-pandemic service. However, some limitations in the pathway may have impacted effective patient management and we suggest possible improvements.Level of evidence: III.

Biomimetic FeNi-MOF assisted intelligent theranostic hydrogels for pH identification and treatment of wounds

Wound healing poses a significant challenge because of prolonged treatment and compromised tissue regeneration caused by bacterial infections. Timely and efficient wound monitoring strategies are urgently needed to assess wound progression and healing in real time. To address this, we present an intelligent theranostic hydrogel system based on dual-site biomimetic FeNi metal–organic frameworks (MOFs) that enables intelligent wound pH monitoring and effective prevention of infection. Notably, the quasi-MOFs among the pristine bimetallic FeNi-MOFs and their derivatives demonstrate remarkable performance in mimicking superoxide dismutase (SOD), peroxidase (POD), and catalase (CAT) activities, along with exceptional stability. The synthesized MOF hydrogels act as wound dressings for monitoring wound status and promoting healing. By incorporating the quasi-MOF and a pH indicator (phenol red) into the hydrogel, the hybrid system allows accurate pH detection, reflecting dynamic wound conditions. Furthermore, visual changes captured by smartphones provide real-time signals for remote assessment of wound pH, facilitating precise antimicrobial therapy and on-demand pH monitoring. This multifunctional theranostic hydrogel represents a significant advancement in the development and optimization of MOF hydrogels, offering a platform for efficient wound healing and comprehensive wound assessment.

Are we ready to cure post-stroke cognitive impairment? Many key prerequisites can be achieved quickly and easily.

Post-stroke (PS) cognitive impairment (CI) is frequent and its devastating functional and vital consequences are well known. Despite recent guidelines, they are still largely neglected. A large number of recent studies have re-examined the epidemiology, diagnosis, imaging determinants and management of PSCI. The aim of this update is to determine whether these new data answer the questions that are essential to reducing PSCI, the unmet needs, and steps still to be taken. Literature review of stroke unit-era studies examining key steps in the management of PSCI: epidemiology and risk factors, diagnosis (cognitive profile and assessments), imaging determinants (quantitative measures, voxelwise localization, the disconnectome and associated Alzheimer's disease [AD]) and treatment (secondary prevention, symptomatic drugs, rehabilitation and noninvasive brain stimulation) of PSCI. (1) the prevalence of PSCI of approximately 50% is probably underestimated; (2) the sensitivity of screening tests should be improved to detect mild PSCI; (3) comprehensive assessment is now well-defined and should include apathy; (4) easily available factors can identify patients at high risk of PSCI; (5) key imaging determinants are the location and volume of the lesion and the resulting disconnection, associated AD and brain atrophy; WMH, ePVS, microhemorrhages, hemosiderosis, and cortical microinfarcts may contribute to cognitive impairment but are more likely to be markers of brain vulnerability or associated AD that reduce PS recovery; (6) remote and online assessment is a promising approach for selected patients; (7) secondary stroke prevention has not been proven to prevent PSCI; (8) symptomatic drugs are ineffective in treating PSCI and apathy; (9) in addition to cognitive rehabilitation, the benefits of training platforms and computerized training are yet to be documented; (10) the results and the magnitude of improvement of noninvasive brain stimulation, while very promising, need to be substantiated by large, high-quality, sham-controlled RCTs. These major advances pave the way for the reduction of PSCI. They include (1) the development of more sensitive screening tests applicable to all patients and (2) online remote assessment; crossvalidation of (3) clinical and (4) imaging factors to (5) identify patients at risk, as well as (6) factors that prompt a search for associated AD; (7) the inclusion of cognitive outcome as a secondary endpoint in acute and secondary stroke prevention trials; and (8) the validation of the benefit of noninvasive brain stimulation through high-quality, randomized, sham-controlled trials. Many of these objectives can be rapidly and easily attained.

Introducing a Simple Tool of Patient Self-Assessment of Wrist Range of Motion.

Hand disorders can reduce wrist range of motion (ROM). The SARS-CoV-2 pandemic highlighted challenges in routine follow-up exams, making telemedicine a viable solution. This study evaluates the feasibility and accuracy of patient self-measured wrist ROM using a self-designed goniometer template. The template was designed to measure flexion/extension and radial/ulnar abduction movements. A cohort of 50 adults (25 males/25 females) participated in this prospective study. The exclusion criteria included wrist immobilization and ages outside of 18-65 years. Participants self-assessed their wrist ROM with the goniometer template. Measurements were independently performed by a student and a specialist using standard goniometry, as well as a resident using the self-designed goniometer. The results were blinded for unbiased analysis. Mean differences in ROM varied across movement directions, with minimal differences for ulnar abduction and more substantial deviations for radial abduction, extension and flexion. The patient-specialist comparison showed deviations below 5 degrees for flexion and ulnar abduction in 50% of cases. Telemedicine, expanded by the COVID-19 pandemic, offers significant potential for hand rehabilitation. Current methods of ROM assessment lack cost-effectiveness and simplicity. Our method, demonstrating comparable accuracy for most movements, provides a cost-effective, reliable alternative for remote ROM assessment, enhancing telemedicine practices in hand rehabilitation.

AROMHA Brain Health Test: A Remote Olfactory Assessment as a Screen for Cognitive Impairment.

Cost-effective, noninvasive screening methods for preclinical Alzheimer's disease (AD) and other neurocognitive disorders remain an unmet need. The olfactory neural circuits develop AD pathological changes prior to symptom onset. To probe these vulnerable circuits, we developed the digital remote AROMHA Brain Health Test (ABHT), an at-home odor identification, discrimination, memory, and intensity assessment. The ABHT was self-administered among cognitively normal (CN) English and Spanish speakers (n=127), participants with subjective cognitive complaints (SCC; n=34), and mild cognitive impairment (MCI; n=19). Self-administered tests took place remotely at home under unobserved (among interested CN participants) and observed modalities (CN, SCC, and MCI), as well as in-person with a research assistant present (CN, SCC, and MCI). Olfactory performance was similar across observed and unobserved remote self-administration and between English and Spanish speakers. Odor memory, identification, and discrimination scores decreased with age, and olfactory identification and discrimination were lower in the MCI group compared to CN and SCC groups, independent of age, sex, and education. The ABHT revealed age-related olfactory decline, and discriminated CN older adults from those with cognitive impairment. Replication of our results in other populations would support the use of the ABHT to identify and monitor individuals at risk for developing dementia.

Remote Neuropsychological Assessment: Forensics, Research, and Ethics

Remote Neuropsychological Assessment: Forensics, Research, and Ethics

Assessing Habitat Suitability: The Case of Black Rhino in the Ngorongoro Conservation Area

Efforts to identify suitable habitat for wildlife conservation are crucial for safeguarding biodiversity, facilitating management, and promoting sustainable coexistence between wildlife and communities. Our study focuses on identifying potential black rhino (Diceros bicornis) habitat within the Ngorongoro Conservation Area (NCA), Tanzania, across wet and dry seasons. To achieve this, we used remote sensing data with and without field data. We employed a comprehensive approach integrating Sentinel-2 and PlanetScope images, vegetation indices, and human activity data. We employed machine learning recursive feature elimination (RFE) and random forest (RF) algorithms to identify the most relevant features that contribute to habitat suitability prediction. Approximately 36% of the NCA is suitable for black rhinos throughout the year; however, there are seasonal shifts in habitat suitability. Anthropogenic factors increase land degradation and limit habitat suitability, but this depends on the season. This study found a higher influence of human-related factors during the wet season, with suitable habitat covering 53.6% of the NCA. In the dry season, browse availability decreases and rhinos are forced to become less selective of the areas where they move to fulfil their nutritional requirements, with anthropogenic pressures becoming less important. Furthermore, our study identified specific areas within the NCA that consistently offer suitable habitat across wet and dry seasons. These areas, situated between Olmoti and the Crater, exhibit minimal disturbance from human activities, presenting favourable conditions for rhinos. Although the Oldupai Gorge only has small suitable patches, it used to sustain a large population of rhinos in the 1960s. Land cover changes seem to have decreased the suitability of the Gorge. This study highlights the importance of combining field data with remotely sensed data. Remote sensing-based assessments rely on the importance of vegetation covers as a proxy for habitat and often overlook crucial field variables such as shelter or breeding locations. Overall, our study sheds light on the imperative of identifying suitable habitat for black rhinos within the NCA and underscores the urgency of intensified conservation efforts. Our findings underscore the need for adaptive conservation strategies to reverse land degradation and safeguard black rhino populations in this dynamic multiple land-use landscape as environmental and anthropogenic pressures evolve.

A Remote Oral Self-Care Behaviors Assessment System in Vulnerable Populations: Usability and Feasibility Study.

Preventative self-care can reduce dental disease that disproportionately burdens vulnerable populations. Personalized digital oral self-care behavioral interventions offer a promising solution. However, the success of these digital interventions depends on toothbrushing data collection e-platforms attuned to the needs and preferences of vulnerable communities. The aim of this study is to assess the usability and feasibility of the Remote Oral Behaviors Assessment System (ROBAS), which has been adapted to address the unique requirements of socioeconomically disadvantaged minority individuals. A cohort of 53 community-clinic participants, including 31 (58%) Latino and 22 (42%) Black individuals with no prior experience using electric toothbrushes, were recruited to use ROBAS, with planned assessments at baseline, 2 months, and 4 months. Beyond evaluating ROBAS's technical performance, extensive feedback was gathered to gauge users' experiences, viewpoints, and overall contentment. The System Usability Scale (SUS) served as a primary metric for assessing user satisfaction and acceptability. ROBAS exhibited largely reliable and consistent data-gathering capabilities. SUS scores (mean 75.6, SD 14.5) reflected participant contentment within a range of values for other commonly used digital devices and technologies. Among participants who answered questions about willingness to pay for ROBAS, 97% (30/31) indicated that they were willing to pay for ROBAS either as a one-time payment or as a subscription-based service. Additionally, 87.5% of participants expressed that they would endorse it to acquaintances. Most participants expressed no reservations about privacy; among those who expressed privacy concerns (n=20, 50%), the concerns included exposure of information (n=18, 45%), monitoring of brushing habits (n=12, 30%), and collection of information (n=14, 35%), although these concerns did not significantly correlate with specific participant traits. In qualitative terms, users valued ROBAS's ability to monitor brushing habits but called for refinements, especially in Wi-Fi and application connectivity. Recommendations for system improvements encompassed enhanced app functionality, individualized coaching, more comprehensive brushing data, and the addition of flossing activity tracking. The research highlights ROBAS's promise as a digital platform for unobtrusively tracking daily oral self-care activities in marginalized communities. The system proved to be both feasible, as evidenced by its stable and accurate data capture of brushing behaviors, and user-friendly, as reflected by strong SUS scores and positive user feedback. Influential factors for its uptake included ease of learning and operation, and the feedback provided.

Remote pulmonary pathology diagnosis using a handheld device for acquiring lung sounds at the mouth: a proof of concept study

IntroductionObtaining relevant information about respiratory conditions is a unique challenge in the rapidly growing field of telehealth. While auscultation using a stethoscope remains the first-line method in primary care, it is not a practical solution in a home setting, as it requires the presence of both a skilled caregiver and experienced interpreter online. We conducted a proofofconcept study of a simple selfcheck thermometer-like device (OmnySense®), which acquires auscultatory data through a microphone in the head of the device.ObjectivesTo have a concept of proof that home handled simplified device can asure a remote opion in telemedicine enhancing prompt and ease way to diagnose lung pathologies.MethodsWe assessed the agreement between subjective evaluations of lung sounds using the device and those using a digital stethoscope for the presence of crackles and/or wheezes. A total of 385 recordings from 13 patients admitted to the internal department were blindly, individually, and randomly assessed by three experienced physicians. The intra-modality agreement for crackles between evaluators was moderate for both the device and the stethoscope, with kappa statistics of 0.44 and 0.6 for the device and stethoscope, respectively, for the detection of wheezing and 0.46 and 0.4, respectively, for the crackles. The intermodality agreement was moderate for wheezes, with a kappa of 0.53, and was substantial for crackles, with a kappa of 0.71. Comparing the ability of crackles to diagnose pulmonary findings by imaging showed comparable sensitivity and specificity for both modalities.ConclusionsOur findings suggest that the diagnostic performance of OmnySense’s selfoperating device is similar to that of physician interpretation of digital stethoscope recordings; thus, OmnySense has the potential to become a useful tool in the remote assessment of respiratory conditions and pathologies.