Video Link Research Articles

The Efficacy of Telehealth Versus In-Person Management Delivery in Adult Patients with Obesity.

The effectiveness of telehealth in managing obesity in Saudi patients is still under investigation. This study compared the effectiveness of telehealth and in-person obesity management programs for adults. This clinical trial involved 62 adults, 29 receiving in-person intervention at the clinic and 33 receiving telehealth via videoconference calls. Anthropometric measurements, biochemical parameters, and dietary and lifestyle habits were assessed at baseline and after 12 weeks. Patients have been educated about goal-setting, healthy eating behaviors, personalized meal plans, and increasing physical activity levels. It showed that 45% and 49% of the in-person and telehealth groups lost more than 5% of their initial body weight. Weight, % body fat, and waist circumference were significantly reduced in the in-person and telehealth groups (p < 0.001). No significant differences between the groups were found in the parameters mentioned above. Within-group analysis showed that light physical activity levels improved in both groups significantly (p < 0.001), and the moderate physical activity level improved significantly among the telehealth group (p < 0.039). No significant differences were observed between the groups regarding physical activity level, blood pressure measurement, and biochemical markers, except for the RBC blood level (p = 0.026). The telehealth group had significantly higher attendance rates for counseling sessions (97% vs. 75% for the in-person group, p < 0.01). Participants' dropout rates were higher for the in-person group 21%, compared to the telehealth group 13%. Telehealth participants' satisfaction regarding the benefits of the obesity management program in losing weight was higher at 87% compared to the in-person group at 76%. In conclusion, applying a telehealth obesity management program can support patients struggling with obesity who may have limited access to traditional healthcare services, while ensuring that telehealth care replicates the quality of in-person care.

Introducing online narrated video animations to facilitate patients' understanding of cardiac procedures in a high-volume tertiary centre

Abstract Introduction Discussions about the benefits and risks of invasive procedures, including their alternatives, are an integral part of certain patient consultations in Cardiology. However, patients absorb only a fraction of the information shared during a single encounter, often due to time constraints, leading to an incomplete understanding. Video animation tools were designed to better facilitate communication and consolidate patient (and family members) understanding in advance of their procedure. Purpose We are a high-volume tertiary cardiac centre, and we aimed to assess real-world patient feedback having introduced an online cardiac video animation tool into our organisation. Methods In July 2022, we obtained unlimited patient access to a digital tool that offers short, multi-language narrated video animations covering the breadth of cardiac procedures (cardiac intervention, electrophysiology, structural and cardiac surgery). It is accessible on any device, including a desktop, laptop, or mobile phone. Specifically, we purchased password protected access to 31 video animations in three local languages. Web-links and QR codes for each video animation were designed. These were shared with patients and family members during different stages of the patients’ journey through the hospital. We sampled qualitative feedback from a cohort of patients attending pre-assessment clinic, measured on our electronic patient record via a 3-point Likert scale. Results As illustrated in Figure 1, we adapted our patient pathway to integrate use of this resource in the patient journey by 1) notifying patients during their out-patient cardiologist consultation; 2) emailing video links integrated within an e-consent process; 3) introducing video links as QR codes in patient letters; 4) reminding patients during their nurse-led pre-assessment clinic; 5) via hospital poster advertisements; 6) and on the front page of the hospital website. Since its introduction 18 months ago, 20,607 animation views have occurred, with 90% watched to completion. The three most popular animations were "angiogram/angioplasty" (4135), atrial fibrillation ablation (1415), and TAVI (1243). From July 2022 to December 2023, 1,878 patients have attended our nurse led pre-assessment clinic, and we sampled qualitative feedback from about 20% (342 patients). As demonstrated in Figure 2, 84% of patients felt the procedural video animations were quite helpful/very helpful. The remaining 16% found it "not helpful", with anecdotal reasons being "inability to access the technology", "feeling already adequately informed", or "not wanting to know". Conclusion In our high-volume tertiary centre, online narrated video animations discussing cardiac procedures were successfully implemented into our patient pathway and deemed helpful by the majority of our patients.Fig1.Process map of the patient journeyFig2.Patients’ feedback regarding video

Performing minor glaucoma interventions on the slit lamp

Background: Complications are frequently encountered after glaucoma surgeries, for which timely intervention is necessary. Many of these interventions, like bleb needling, tube repositioning, anterior chamber (AC) reformation, paracentesis, and hyphema drainage, are fairly simple, but can often be vision saving. However, waiting for operation theater availability for these minor procedures can be a risky decision. Hence, techniques for performing these procedures on a slit lamp should be part of every glaucoma surgeon’s armamentarium. Purpose: This video is meant to introduce the viewers to simple techniques for performing minor procedures, enabling management on a slit lamp. The need to know a simple yet effective way to perform these procedures cannot be overemphasized. Synopsis: This video demonstrates, in the specified order, techniques for AC paracentesis, AC reformation, Ahmed glaucoma valve tube repositioning, iris repositioning, bleb needling and hyphema drainage. Utmost aseptic precautions must be taken before performing these procedures on the slit lamp, especially in cases where the 26G needle enters AC. This includes the use of a sterile air filter, donning sterilized gloves, and using its sterile wrapper to place the 2 ml syringe being used. Use of betadine eye drops before the procedure and a week-long course of topical antibiotics after these procedures is recommended. Highlights: This video demonstrates simple techniques for performing useful procedures on the slit lamp, an effective tool for managing postoperative complications. Video link: https://youtu.be/35sOVm7rxEc

How universities can support Aboriginal and Torres Strait Islander peoples to achieve self-determination and improved wellbeing.

The right to self-determination is enshrined in international law, affirming Aboriginal people have the right to make decisions about matters that affect their lives, including meeting their social, political, cultural and economic needs. This paper explores the role of universities in supporting Aboriginal self-determination, including an examination of the importance of the social and cultural determinants of wellbeing and the impacts of assimilation on Aboriginal people’s ability to live in accord with cultural traditions. Insights into how universities can create more culturally appropriate learning environments are also reviewed with a particular focus on the fundamental differences between Western and Aboriginal culture, pedagogy, epistemology, ontology, and axiology. The paper suggests that by undertaking a process of truth telling, universities will be able to create improved learning and research environments for Aboriginal students and staff that better support self-determination. By doing this, universities will leverage their unique position of influence to create improved wellbeing for Aboriginal people and the nation as a whole. This is an invited article based on a HERDSA keynote address, which was presented at the 2024 conference held in Adelaide, 8-11 July. Dr Callaghan was also invited to provide a video introduction to the article. The video link may be found on the ASRHE journal site next to the link to the PDF.

The effect of assessor visibility on student stress and anxiety in emergency care simulation assessments

BackgroundSimulation assessment can result in anxiety for students. These assessments involve being observed by assessors, so there is a significant socio-evaluative stress component which may cause greater anxiety if assessors are visible to students during assessments. The aim of this study was to determine the effect of assessor visibility on biological and physiological markers of stress and levels of anxiety experienced by pre-hospital emergency care students in a simulation assessment environment.MethodsA paired comparison, pre-post test research design was used with two conditions; an assessor visible condition with simulation assessors visible to students in the room and an assessor not visible condition with assessors not in the room but connected via video link. With a sample of 29 emergency care students anxiety was measured with the State-Trait Anxiety Inventory and stress was measured with salivary cortisol and heart rate variability (HRV).ResultsDifferences in state anxiety scores, HRV variables and salivary cortisol suggested lower stress and anxiety in the assessor visible group. Only heart rate was significantly different between the groups (p = 0.016), with a higher heart rate in the assessor not visible group.ConclusionsGreater stress and anxiety may be experienced by students during emergency care simulation assessments when assessors are not visible to students.

Stakeholders’ perception: E-Learning initiatives in school education of Rajasthan state in the course of COVID-19

The COVID-19 pandemic led to increased adoption of e-learning in academic institutions, leading to the adoption of digital learning initiatives in Rajasthan. Projects-like SMILE, ‘Shikshadarshan - Educational T-DD Rajasthan’, ‘Shikshavani - Education via Radio’, ‘Hawamahal- Joyful Saturday program’, and ‘YouTube Rajiv Gandhi Career Portal’ were implemented. This study aimed to understand stakeholders’ perceptions of e-learning initiatives in Rajasthan and the global transformation of the education system. A descriptive survey conducted on 308 stakeholders from five government schools in Dungarpur district. The study reveals that 89% of students in Rajasthan state use smartphones for online classes, using WhatsApp video links, e-Raksha apps, YouTube, and open learning sources like Google. However, students often need help with language problems in content provided through e-learning initiatives, possibly due to the absence of their local language. Teachers are aware of e-learning initiatives but must be fully aware of them. Many teachers believe digital teaching-learning approaches make teaching plans and assessments more complex than face-to-face teaching. Parents and community members agree that their children can adopt e-learning comfortably, but 63% are unsatisfied with e-learning during COVID-19. Most participants agree that face-to-face teaching is better than e-learning and that the focus should be on face-to-face learning. The government should consider local languages for online videos and live programs. The department should include training programs for online learning resources in post-service education and teacher training to implement effective online education.

The Comparative Performance of Large Language Models on the Hand Surgery Self-Assessment Examination.

Generative artificial intelligence (AI) models have emerged as capable of producing human-like responses and have showcased their potential in general medical specialties. This study explores the performance of AI systems on the American Society for Surgery of the Hand (ASSH) Self-Assessment Exams (SAE). ChatGPT 4.0 and Bing AI were evaluated on a set of multiple-choice questions drawn from the ASSH SAE online question bank spanning 5 years (2019-2023). Each system was evaluated with 999 questions. Images and video links were inserted into question prompts to allow for complete AI interpretation. The performance of both systems was standardized using the May 2023 version of ChatGPT 4.0 and Microsoft Bing AI, both of which had web browsing and image capabilities. ChatGPT 4.0 scored an average of 66.5% on the ASSH questions. Bing AI scored higher, with an average of 75.3%. Bing AI outperformed ChatGPT 4.0 by an average of 8.8%. As a benchmark, a minimum passing score of 50% was required for continuing medical education credit. Both ChatGPT 4.0 and Bing AI had poorer performance on video-type and image-type questions on analysis of variance testing. Responses from both models contained elements from sources such as PubMed, Journal of Hand Surgery, and American Academy of Orthopedic Surgeons. ChatGPT 4.0 with browsing and Bing AI can both be anticipated to achieve passing scores on the ASSH SAE. Generative AI, with its ability to provide logical responses and literature citations, presents a convincing argument for use as an interactive learning aid and educational tool.

Advancements in UAV Path Planning: A Deep Reinforcement Learning Approach with Soft Actor-Critic for Enhanced Navigation

This paper tackles the intricate challenge of autonomous navigation for Unmanned Aerial Vehicles (UAVs) through dynamically changing environments. We focus on a sophisticated Deep Reinforcement Learning (DRL) approach using the Soft Actor-Critic (SAC) algorithm, optimized for UAV path planning within a continuous action space. This methodology leverages environmental image data to enhance the precision of flight maneuvers and effective obstacle avoidance. Our approach, validated through extensive simulations in Gazebo and field tests, demonstrates the algorithm’s efficacy in enabling UAVs to adeptly navigate obstacles using depth maps. The study further explores the robustness of the SAC algorithm by comparing it with traditional DRL methods, emphasizing its superior performance in real-world applications. This research contributes significantly to advancing UAV technology, particularly in autonomous motion planning, by integrating cutting-edge machine learning techniques. The video link is: https://www.youtube.com/watch?v=Nd_aMzejNXY .

FP6.7 - Assessing knowledge and effective utilisation of incentive spirometer across surgical floor

Abstract Aim to assess the level of knowledge of healthcare workers providing incentive spirometer and instruction provided to patient. Methods Snapshot audit between 25&amp;28/05/23 assessing the knowledge and practice using two for patient and staff questionnaires. Inclusions criteria were all adult patients in surgical wards, all healthcare staff. Exclusion criteria were patients who did not receive a spirometer and patients or staff who were not willing to participate in the study. Results 75% of staff provided incentive spirometers, 84% of them never received formal education or training in the use of incentive spirometer. Only one staff member (1.85%) answered all the questions correctly. 83% of patients were not given the correct instructions and approximately 16% were instructed to exhale. Implemented Changes A video created with e-link; explaining the use of incentive spirometer. Training of medical and nursing staff by presenting the project in our local departmental meeting, the results and poster emailed to health professionals. A new patient leaflet was created containing clear instructions, the video link, and a table to record their usage. Random sampling showed significant improvement. The Second cycle will be conducted at beginning of the new year and the results will be presented at the conference Conclusion The lack of training led to incorrect instructions being given to patients. This could lead to false reassurance to the senior medical staff, by assuming that patients are using spirometers correctly which could delay recovery and discharge. Simple training has resulted in significant increase in knowledge and correct use of a spirometer. Checking the staff knowledge is recommended, especially in common daily practice

Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: an internal pilot study of a cohort randomised controlled approach

BackgroundPersistent pain is a frequent cause of sick leave and work disability in Norway. A return-to-work intervention featuring supported work placements, developed in the UK, demonstrated feasibility, and a return-to-work rate of 20% within 6 months was observed in the sample. We sought to adapt the intervention for delivery in Norway and to confirm feasibility prior to a full-scale trial.MethodsIn this internal pilot, we used a pragmatic cohort randomised controlled approach with national recruitment in Norway. We recruited people who were unemployed (for at least 1 month), having persistent pain (for at least 3 months), aged between 18 and 64, and wanting to return to work. We initially recruited people to an observational cohort study of the impact of being unemployed with persistent pain. After baseline measurement, we randomly sub-sampled participants to whom we offered the intervention, which featured individual case management and support, work-familiarisation sessions, and the offer of a 6-week part-time unpaid work placement. We assessed recruitment rates (aiming to recruit 66, and sub-sample 17 within 6 months); optimal recruitment pathways; intervention acceptance rates; the feasibility of data collection; using video links for work-familiarisation sessions and remote case manager support.ResultsThe pilot ran from June to November 2022. Of 168 people expressing interest, 94 consented. Recruitment posts on Facebook yielded the most ‘expressions of interest’ (66%, n = 111). After screening for eligibility, we included 55 participants. Of these, 19 were randomised to be offered the intervention. Of these, less than half (n = 8) consented to intervention participation. Remote case manager and work-familiarisation sessions appeared feasible. Following a delay in identifying placements, three participants received offers of work placements, with one starting and completing during the pilot period. Data collection methods were feasible, and no adverse events were reported.ConclusionsRecruitment and logistical processes, such as remote management by video link, are feasible. However, delivery of the intervention is challenging. In particular, sourcing placements and the time required for identifying appropriate placements was more challenging than anticipated. A full-scale trial is feasible but will require improvements to the placement identification processes.Trial registrationISRCTN85437524 (Referring to the ReISE trial, of which this internal pilot was a part), Registered 31 of May 2022 https://doi.org/10.1186/ISRCTN85437524Trial fundingNorwegian Research Council.

블랜디드 러닝 수업을 적용한 칼림바 합주 수업지도 방안 연구: 메타버스 플랫폼 ‘ZEP’을 중심으로

The purpose of this study is to design a Kalimba ensemble teaching plan based on the direction and digital application of the 2022 revised curriculum, and to suggest ways to effectively fulfill the goals of the 2022 revised curriculum in the school setting. The theoretical backgrounds of the Kalimba and the Metaverse were gathered through a review of academic papers and dissertations. The performance domain of the 2022 revised music curriculum was analyzed to design a teaching plan and explore practical methods for implementing a digital-instrument integrated class, as intended by the revised curriculum. The digital elements and music performance classes emphasized in the 2022 revised curriculum were fused so that students could experience the basics of new technologies. To create a student-led participatory class, a virtual reality space and study score were produced directly, enabling students to engage in creative and self-directed learning. To complement this, this study creates a virtual reality space using the Metaverse platform "ZEP" and provides online video and ensemble performance forms using the video link connection function of "ZEP" to foster basic digital literacy and improve music performance. It is hoped that research on instrumental teaching methods using digital media will be further expanded so that students can recognize the sensibility and value of music.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes

BackgroundThe Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE).MethodsEligible participants are between 21 and 80 years of age diagnosed with moderately controlled T2D (HbA1c: 6.0 to 8.0%) and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: (1) Personalized, (2) Standardized, or (3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrient targets to meet Mediterranean diet guidelines, in addition to 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same educational content as those in the UCC arm, following the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, in addition to real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app.DiscussionThe DiaTeleMed Study aims to address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level.Trial registrationClinicalTrials.gov NCT05046886. Registered on September 16, 2021.

Climate change advocacy and cancer clinical trial organisations

BackgroundClimate change is a threat to human health; equally health care is a threat to climate change as it accounts for 4% of greenhouse gas emissions and 30% of the world’s electronically stored data. 350,000 international trials are registered on ClinicalTrials.gov with ~27·5 million tonnes of emissions (equivalent to half of annual Danish emissions).MethodsIn September 2023 climate awareness among cancer clinical trial organisations was assessed via a web-based scoping exercise.ResultsSeventy-five organisations were identified of whom 46 had search tools on their websites. Eight out of 46 clinical trial groups had at least one parameter of commitment to climate change, and 38 organisations had none. Of 46 websites, 5 had climate change position statements or policies, 4 had a committee or task force, 1 provided patient education resources for climate change via video link, 7 included green initiative advice and 8 had publications addressing climate change. Only 5 were listed as members of Climate Change Consortiums.ConclusionsBased on website assessment climate advocacy among cancer clinical trial organisations is low, and efforts to encourage climate engagement are needed.

Doughnut capsulorhexis: Pioneering advancements in cataract surgery to sidestep Argentinian flag sign

Background: For a successful capsulorhexis, it is crucial to use controlled centripetal and tangential vector forces in the rhexis border to counteract the centrifugal forces of the zonular component. Unfortunately, in hypermature cataracts, these maneuvers do not prove successful due to the raised intralenticular pressure, leading to an Argentinian flag sign. Among several techniques, this method of doughnut capsulorhexis is one such technique to perform successful capsulorhexis in cases with high intralenticular pressure. Purpose: In this video, we highlight this new method of capsulorhexis to prevent undue capsule-related complications in hypermature cataracts, as this plays a crucial role in successful surgical outcomes. Synopsis: The lens capsule usually experiences centrifugal vector forces exerted by the zonules, but in hypermature cataract cases, there is an additional factor of raised intralenticular pressure. In such cases, the attempts to make a 5 mm capsulorhexis might lead to the propagation of the rhexis to the periphery due to the combined mechanism of the two vector forces. Therefore, the technique of performing a smaller 2 to 3 mm rhexis is performed. This reduces the centrifugal force involved and prevents undue extension of the rhexis. Following this, decompression of the capsular bag is performed by aspirating the liquefied cortex using a bimanual irrigation and aspiration cannula, followed by controlled extension of the rhexis using a cystitome, which is performed for a successful surgical outcome. The second knick is made parallel to the first rhexis,1 mm away from the rhexis border, and a flap is raised. The rhexis can either be completed using a cystitome or a microrhexis forceps. Highlights: This technique does not require any additional instrumentation or training. It can be performed using the cystitome and microrhexis forceps. Surgeons of all calibers can efficiently perform it. This series of videos shows the successful outcome of continuous curvilinear capsulorhexis using the Doughnut method. Video Link: https://youtu.be/x0dTklOaMqg

Longstanding iris foreign body to treat or not to treat!

A 61 year female presented with whitish discolouration of left eye noticed few days ago with a forgotten history of trauma 28 years ago for which a consultation was made and was asked for review with orbital x-ray, which was not done as she was asymptomatic. On examination, her best corrected visual acuity was 6/6 both eyes. Examination of right eye was unremarkable except for early lens changes, while left eye showed a nebular corneal opacity, suggesting entry wound. A brown coloured foreign body was seen stuck to iris surface temporally, measuring 4*3mm with degenerative changes over it and exposing underlying pigment epithelium with focal cataract. Rest of anterior segment, gonioscopy and fundus examination were normal. A thorough search for other intraocular foreign bodies (IOFBs) was made, revealing no other IOFBs. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) demonstrated foreign body limited to iris surface, while orbital x-ray showed no evidence of metallic foreign body and electroretinogram (ERG) showed mildly decreased amplitude of b-wave. Plan for foreign body removal with cataract surgery was made as per patient’s request for cosmesis, and was retrieved through viscoexpression after a failed attempt to remove it through magnetic forceps thereby confirming its non-metallic nature. Special care was taken during capsulorhexis to not damage the intact capsule. Rest of cataract surgery was performed as usual and anterior chamber wash was done to flush all the debris. Post operative picture shows an area of partial and full thickness iris defect while maintaining a good visual acuity. The debate for removal of longstanding, well encapsulated, inert foreign body over iris without functional impairment depends on multiple factors.[1,2] Which in our case was due to the patient’s demand for cosmesis. Video link: https://youtu.be/pC3ZRoqxB8o

App-Based Addiction Prevention at German Vocational Schools: Implementation and Reach for a Cluster-Randomized Controlled Trial

This article examines the implementation, participation rates, and potential determinants of participation in the digital addiction prevention program “ready4life.” A two-arm cluster-randomized trial recruited German vocational students via class-based strategies. Intervention group received 16 weeks of in-app coaching; the control group received health behavior information, with coaching offered after 12 months. Potential determinants of participation were analyzed based on class and individual characteristics. Out of 525 contacted schools, 35 participated, enrolling 376 classes. Implementation during the pandemic required flexible adjustments, with 49.7% of introductions conducted in person, 43.1% digitally via online streaming, and 7.2% received a video link via email. Despite challenges, 72.3% of the vocational students downloaded the app, and 46.7% gave informed consent. Participation rates were highest among (associate) professionals, vocational grammar school classes, classes introduced by females, younger individuals, members of the project team, and classes introduced face-to-face. Female gender, lower social competencies, lifetime cannabis use, higher problematic internet use, and higher perceived stress were associated with higher individual participation. The study highlights the importance of proactive outreach and personalized interventions for addiction prevention programs in vocational schools. While reached students aligned with the aims of the app, tailored recruitment strategies could enhance engagement among under-represented groups. The trial was registered in the German Clinical Trials Register (DRKS): DRKS00022328; registration date 09.10.2020.

CURE: A Hierarchical Framework for Multi-Robot Autonomous Exploration Inspired by Centroids of Unknown Regions

In this paper, a novel multi-robot autonomous exploration approach CURE is proposed based on dynamic Voronoi diagrams and centroids of unknown connected regions. Compared with existing approaches, the novelty of this work is twofold: 1) Dynamic Voronoi diagram is used for partition of the space being explored to improve the efficiency of multi-robot exploration, and then a new parameter-insensitive utility function is elaborately designed to evaluate the information of centroids, which helps guide the robot to explore unknown regions. 2) A hierarchical framework consisting of global and local exploration windows for detecting centroids is designed, wherein the global exploration window is activated to find centroids to guide the robot exploration when there are no centroids in any one local exploration window. We validate the feasibility and exploration efficiency of the proposed approach in various complex simulation scenarios and challenging real-world tasks. All test results show that the exploration time consumption and path cost are reduced by up to 50.7% and 34.4%, respectively, compared with an advanced RRT-based multi-robot exploration approach. (Supplementary video link: https://youtu.be/P5jXKlGQOec) <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —This paper is motivated by the efficient multi-robot autonomous exploration problem. In some applications such as target search and disaster rescue, the information about the environment is totally unknown to the robots, and thus they are required to explore unknown environments autonomously. In this case, it is necessary to improve the efficiency of multi-robot exploration due to the time limitation of the task and the battery capacity. In this paper, a hierarchical framework is proposed to improve the efficiency of multi-robot autonomous exploration. Each robot only needs to explore the Voronoi partition it is responsible for and is guided to the unknown region by the centroid detected in the global and local exploration windows. Overall, the proposed approach can dramatically reduce the exploration time and path cost.

Enhancing physical fitness through Crossfit for 15-16-year-old high school students

Background and Study Aim. CrossFit represents a high-intensity functional training that has recently gained popularity among the youth. At the same time, restrictions imposed by military actions require different approaches to organizing CrossFit sessions. The most acceptable solution in such a situation is online education and training. The purpose of this study was to investigate the impact of CrossFit sessions within the framework of remote physical education on the physical fitness indicators of high school students. Materials and Methods. The study involved 27 students (aged 15-16 years) from a 10th-grade class at a school located in a war conflict zone (Kharkiv, Ukraine). The group consisted of 11 boys and 16 girls. Due to the military conflict and corresponding restrictions, physical education was conducted remotely. Physical education classes were held three times a week, lasting 45 minutes each. The structure of the lesson included 30 minutes of synchronous online work with the teacher and 15 minutes for independent task completion. Tests aimed at measuring strength, endurance, flexibility, and speed were used to assess the impact of CrossFit programs on physical fitness. Data were collected at the beginning and end of the experiment. The experiment was conducted over 8 weeks. Testing was carried out at home by students under the control and guidance of the teacher via video link during the first three lessons. Results. The test results confirm improvement in all indicators. The boys increased their plank hold duration from 48 seconds to 53 seconds, and the girls from 46 seconds to 52 seconds. In the squat series, an increase in indicators was noted: for boys from 21 to 25 in the third series. Girls also showed significant improvement across all squat series. The boys' speed-strength indicators improved from 43 cm to 46 cm. Girls demonstrated improvement in performing "Burpees" within 60 seconds, increasing the number of repetitions from 8 to 12. Conclusions. The study results indicate that CrossFit effectively enhances the physical fitness of high school students. However, the improvement in girls occurs to a slightly lesser extent compared to boys. This may be due to the initial level of physical fitness and individual physiological characteristics.

Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study: study protocol for a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes.

The Diabetes Telemedicine Mediterranean Diet (DiaTeleMed) Study is a fully remote randomized clinical trial evaluating personalized dietary management in individuals with type 2 diabetes (T2D). The study aims to test the efficacy of a personalized behavioral approach for dietary management of moderately-controlled T2D, versus a standardized behavioral intervention that uses one-size-fits-all dietary recommendations, versus a usual care control (UCC). The primary outcome will compare the impact of each intervention on the mean amplitude of glycemic excursions (MAGE). Eligible participants are between 21 to 80 years of age diagnosed with moderately-controlled T2D (HbA1c: 6.0-8.0%), and managed on lifestyle alone or lifestyle plus metformin. Participants must be willing and able to attend virtual counseling sessions and log meals into a dietary tracking smartphone application (DayTwo), and wear a continuous glucose monitor (CGM) for up to 12 days. Participants are randomized with equal allocation (n = 255, n = 85 per arm) to one of three arms: 1) Personalized, 2) Standardized, or 3) UCC. Measurements occur at 0 (baseline), 3, and 6 months. All participants receive isocaloric energy and macronutrients targets to meet Mediterranean diet guidelines plus 14 intervention contacts over 6 months (4 weekly then 10 biweekly) to cover diabetes self-management education. The first 4 UCC intervention contacts are delivered via synchronous videoconferences followed by educational video links. Participants in Standardized receive the same education content as UCC on the same schedule. However, all intervention contacts are conducted via synchronous videoconferences, paired with Social Cognitive Theory (SCT)-based behavioral counseling, plus dietary self-monitoring of planned meals using a mobile app that provides real-time feedback on calories and macronutrients. Participants in the Personalized arm receive all elements of the Standardized intervention, plus real-time feedback on predicted post-prandial glycemic response (PPGR) to meals and snacks logged into the mobile app. The DiaTeleMed study will address an important gap in the current landscape of precision nutrition by determining the contributions of behavioral counseling and personalized nutrition recommendations on glycemic control in individuals with T2D. The fully remote methodology of the study allows for scalability and innovative delivery of personalized dietary recommendations at a population level. The DiaTeleMed Study is registered with ClinicalTrials.gov (Identifier: NCT05046886).

P442 Do video conference calls contribute to increased gender equity among caregivers of children with a chronic disease?

P442 Do video conference calls contribute to increased gender equity among caregivers of children with a chronic disease?