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Purpose: Comfort Measures Only (CMO) is a label commonly used in the USA that guides the care of a hospitalized patient who is likely to die. The CMO label has unclear and inconsistent meaning, calling to question the experiences and practices of hospital-basedalliative care providers. The purpose of this study was to understand the meaning of CMO as experienced by hospital-based palliative care providers., Methods: Using hermeneutic phenomenological research, we investigated eight palliative care experts' common experiences and shared practices of using CMO order sets in their hospital work settings. Data were collected through individual face-to-face interviews, and were analysed by an interpretive team., Results: Four related themes and one constitutive pattern of "Dealing with Dying" reflect the meaning of comfort-measures-only practices. The themes are: comfort care as morphine drip; enacting a traditional binary pattern of care: all or nothing; supporting patient and family at end of life vs. CMO; and evolving culture-a better way to care for the dying., Conclusion: Palliative care providers and non-palliative clinicians understood and practiced end of life care in sharply different ways with dying in hospital settings, raising new questions that analyse, modify and extend extant knowledge.

Prenatal exposure to the Zika virus (ZIKV) is associated with a significant risk of neurological impairment for infants. ZIKV serves as a cautionary model with significant parallels to the current coronavirus 2019 (COVID-19) pandemic. A limited literature search was performed to compare and contrast the clinical and psychosocial aspects of infection with ZIKV and COVID-19. There are significant parallels between ZIKV disease and COVID-19 in terms of limited diagnostic techniques, therapeutics, and prognostic uncertainties. Both infections are associated with a significant risk of adverse outcomes for either the pregnant individual or the fetus. Existing social and economic inequalities amplify the risk burden of ZIKV disease and COVID-19 in vulnerable communities. Although each pathogen has unique features, there are underlying common principles with regard to the recognition, communication, and mitigation of risk of infection. Misinformation spread by social media platforms has undermined public health efforts and patient adoption of recommended mitigation strategies. Health care providers can provide partnership, social support, and evidence-based information to enhance health-seeking behaviors, thereby minimizing the risks for pregnant and reproductive-aged persons., (© 2021 by the American College of Nurse-Midwives.)

Persistent fetal occiput posterior (OP) position is a topic of interest with implications for intrapartum management. Although studies report a low incidence of persistent OP position, anecdotal evidence suggests an increase in prevalence given changes in maternal demographics. Clinicians are often familiar with interventions such as position changes and the use of props and a rebozo to address persistent OP position in early labor; however, midwives remain uncomfortable with the techniques of digital and manual rotation. This article reviews current evidence and recommendations for the management of persistent OP position in the second stage of labor. Further research is needed to guide clinicians on the optimal timing and techniques for digital and manual rotation., (© 2020 by the American College of Nurse-Midwives.)

One thousand people die every day in India as a result of TB, a preventable and treatable disease, even though the Constitution of India, government schemes, and international law guarantee available, accessible, acceptable, quality health care. Failure to address the spread of TB and to provide quality treatment to all affected populations constitutes a public health and human rights emergency that demands action and accountability. As part of a broader strategy, health activists in India employ Public Interest Litigation (PIL) to hold the state accountable for rights violations and to demand new legislation, standards for patient care, accountability for under-spending, improvements in services at individual facilities, and access to government entitlements in marginalized communities. Taking inspiration from right to health PIL cases (PILs), lawyers in a New Delhi-based rights organization used desk research, fact-findings, and the Right To Information Act to build a TB PIL for the Delhi High Court, Sanjai Sharma v. NCT of Delhi and Others (2015). The case argues that inadequate implementation of government TB schemes violates the Constitutional rights to life, health, food, and equality. Although PILs face substantial challenges, this paper concludes that litigation can be a crucial advocacy and accountability tool for people living with TB and their allies., Competing Interests: Conflicts of Interest: None declared.

Background: Research on community (home or birth center) twin birth is scarce. This study evaluates outcomes of twin pregnancies entering care with a single community practitioner. Methods: This is a retrospective observational cohort study of 100 consecutive twin pregnancies planning community births during a 12-year period. Outcomes measured included mode of birth; birth weights; Apgar scores; ante-, intra-, and post-partum transports; perineal integrity; birth interval; blood loss; chorionicity; weight concordance; and other maternal or neonatal morbidity. Results: 31 women (31%) transferred to a hospital-based clinician prior to labor. Of the 69 pregnancies still under the obstetrician's care when labor began, 79.7% (n = 55) were Dichorionic Diamniotic and 21.3% (n = 14) were Monochorionic Diamniotic. The vaginal birth rate was 91.3% (n = 63): 77.3% for primips and functional primips (no previous vaginal births) and 97.9% for multips. Six mothers (8.7%) had in-labor cesareans (1 multip and 5 primips). Rates of vaginal birth did not vary significantly by chorionicity. There were 8 transports in labor (11.6%): 2 vaginal and 6 cesareans. Average gestational age was 39.0 weeks (range 35–42). Compared to primiparas, multiparas had less perineal trauma and higher rates of vaginal birth and spontaneous vaginal birth. One twin infant and one mother required postpartum hospital transport. Of the babies born in a community setting, there was no serious morbidity requiring hospital treatment. Conclusions: A community birth can lead to high rates of vaginal birth and good outcomes for both mothers and babies in properly selected twin pregnancies. Community twin birth with midwifery style care under specific protocol guidelines and with a skilled practitioner may be a reasonable choice for women wishing to avoid a cesarean section—especially when there is no option of a hospital vaginal birth. Training all practitioners in vaginal twin and breech birth skills remains an imperative. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear., Methods: Using a prospective mixed methods design, the study assessed patients' (n=10) perception of chronic heart failure symptoms and medication adherence. Patients completed guided interviews related to six concepts of meaning ascribed to medication use and four standardized measures of medication-related beliefs, behaviours, symptoms, and satisfaction., Results: This study suggests that patients' perception of meaning associated with medication taking was categorized as positive, negative, or absent. Symptom persistence influenced a majority of patient beliefs in the efficacy medicines, and patients with more positive meaningful associations with their medicines were more likely to remain adherent during the course of this study., Conclusions: Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.

Collaborative practice between obstetrician-gynecologists and certified nurse-midwives has been successful at the Family Beginnings obstetric unit at Group Health for at least three reasons. Each provider group is able to practice independently and thus give the kind of maternity and women's health care sought by the local community. The legal framework in Washington State supports a wide range of maternity care practices and includes a reasonable provider insurance scheme. The boundaries between different groups operating within distinct scopes of practice are well-defined and communicated. This allows providers to smoothly share or transfer clients from midwife to obstetrician and back as needed in each case. The success of the Family Beginnings model is demonstrated by a favorable comparison with national and Washington State metrics of delivery outcomes. Replicating the model elsewhere depends on building support for collaborative maternity care across the obstetric and midwifery professions in states where an appropriate legal framework exists, and in institutions where policies for credentialing nurse midwives are in place. Where these supports do not exist, all practitioners jointly advocating for more enlightened approaches is recommended.

Congenital Zika syndrome (CZS) is a major concern in India and highlights the multifaceted challenges posed by the Zika virus (ZIKV). The alarming increase in CZS cases in India, a condition that has serious effects on both public health and newborns, has raised concerns. This review highlights the importance of raising concern and awareness and taking preventive measures by studying the epidemiology, clinical symptoms, and potential long‐term consequences of CZS. The review also contributes to worldwide research and information sharing to improve the understanding and prevention of CZS. As India deals with the changing nature of CZS, this thorough review is an important tool for policymakers, health workers, and researchers to understand what is happening now, plan for what to do in the future, and work together as a team, using medical knowledge, community involvement, and study projects to protect newborns' health and reduce the public health impact of these syndromes. [ABSTRACT FROM AUTHOR]

Positive player's experiences greatly rely on a balanced gameplay where the game difficulty is related to player's skill. Towards this goal, the gameplay can be modulated to make it easier or harder. In this work, a modulating mechanism based on visual computing is explored. The main hypothesis is that simple visual modifications of some elements in the game can have a significant impact on the game experience. This concept, which is essentially unexplored in the literature, has been experimentally tested with a web-based cube puzzle game where participants played either the original game or the visually modified game. The analysis is based on players' behavior, performance, and replies to a questionnaire upon game completion. The results provide evidence on the effectiveness of visual computing on gameplay modulation. We believe the findings are relevant to game researchers and developers because they highlight how a core gameplay can be easily modified with relatively simple ingredients, at least for some game genres. Interestingly, the insights gained from this study also open the door to automate the game adaptation based on observed player's interaction. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty. Methods: The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women. Findings: When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult. Conclusions: The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly. [ABSTRACT FROM AUTHOR]

Extended reality (XR) technology combines physical reality with computer synthetic virtuality to deliver immersive experience to users. Virtual reality (VR) and augmented reality (AR) are two subdomains within XR with different immersion levels. Both of these have the potential to be combined with robot-assisted training protocols to maximize postural control improvement. In this study, we conducted a randomized control experiment with sixty-three healthy subjects to compare the effectiveness of robot-assisted posture training combined with VR or AR against robotic training alone. A robotic Trunk Support Trainer (TruST) was employed to deliver assistive force at the trunk as subjects moved beyond the stability limits during training. Our results showed that both VR and AR significantly enhanced the training outcomes of the TruST intervention. However, the VR group experienced higher simulator sickness compared to the AR group, suggesting that AR is better suited for sitting posture training in conjunction with TruST intervention. Our findings highlight the added value of XR to robot-assisted training and provide novel insights into the differences between AR and VR when integrated into a robotic training protocol. In addition, we developed a custom XR application that suited well for TruST intervention requirements. Our approach can be extended to other studies to develop novel XR-enhanced robotic training platforms. [ABSTRACT FROM AUTHOR]

Emotional arousal, an essential dimension of game users’ experience, plays a crucial role in determining whether a game is successful. Game users’ emotion arousal assessment (GUEA) is of great importance. However, GUEA often faces challenges, such as selecting emotion-inducing games, labeling emotional arousal, and improving accuracy. In this study, the scheme for verifying the effectiveness of emotion-induced games is proposed so that the selected games can induce the target emotions. In addition, the personalized arousal label generation method is developed to reduce the errors caused by individual differences among subjects. Furthermore, to improve the accuracy of GUEA, the Breath Rate Variability (BRV) signal is used as a GUEA indicator along with commonly used physiological signals. Comparative experiments on GUEA based on multimodal physiological signals are conducted. The experimental result shows that the accuracy of GUEA is improved by adding the BRV signal, up to 92%. [ABSTRACT FROM AUTHOR]

Risk factors associated with severe–critical COVID-19 (coronavirus disease 2019) are based on findings in the general population. Pregnant women are at increased risk of severe–critical infection, and few reports are based on these women. A multicentric case–control study was conducted at the Mexican Institute of Social Security, State of Mexico, during the COVID-19 pandemic. We included pregnant women who were consecutively admitted to respiratory care units and were followed until 30 days after the resolution of pregnancy. A total of 758 pregnant women with a positive RT-PCR test for SARS-CoV-2 were enrolled from June 2020 to July 2021. We defined groups using the World Health Organization Severity Classification; cases were pregnant women with severe–critical COVID-19 (n = 123), and controls were subjects with non-severe COVID-19 (n = 635). Data was gathered from clinical files. A multivariate logistic regression analysis was used to adjust odds ratios and their 95% confidence intervals of factors associated with severe–critical COVID-19. Risk factors associated with severe–critical COVID-19 in pregnancy were non-vaccination (OR 10.18), blood type other than O (OR 6.29), maternal age > 35 years (OR 5.76), history of chronic hypertension (OR 5.12), gestational age at infection ≥ 31 weeks (OR 3.28), and multiparity (OR 2.80). [ABSTRACT FROM AUTHOR]

Background: management of persistent occiput posterior position has always been controversial. Manual rotation by a delivery operator can reduce instrumental delivery and cesarean section. Aim: This study aims to determine the knowledge and experience of midwives and gynecologists about manual rotation of persistent occiput posterior position. Methods: This descriptive cross-sectional study was performed in 2022. The questionnaire link was sent to 300 participating midwives and gynecologists via WhatsApp Messenger. Two hundred sixty-two participants completed the questionnaire. Data analysis was performed using SPSS22 statistical software and descriptive statistics. Results: 189 people (73.3%) had limited information about this technique, and 240 (93%) had never performed it. If this technique is recognized as a safe intervention and is included in the national protocol, 239 people (92.6%) want to learn, and 212 (82.2%) are willing to do it. Conclusion: According to the results, the knowledge and skills of midwives and gynecologists need to be trained and improved for manual rotation of persistent occiput posterior position. [ABSTRACT FROM AUTHOR]

Background: Prenatal health promotion includes the provision of evidence-based information and practical skills to optimize maternal–fetal outcomes. Increasingly, prenatal education is delivered by both healthcare professionals and allied childbirth educators, in community- or hospital-based group classes, targeted outreach programs, and online modules. Objectives: To better understand how prenatal health promotion relates to a diverse urban community, we assessed the perspectives of Ottawa, Canada prenatal key informants. Design: This is a qualitative research with key informant interviews. Methods: Semi-structured interviews were conducted with 11 prenatal key informants, responsible for the design, delivery, or promotion of publicly available prenatal health services. Interviews explored concepts and delivery of prenatal health promotion, strategies to address existing and emerging prenatal topics, identification of barriers to prenatal health services, and recommendations. Results: Key informants recommended a lifespan approach to prenatal health promotion, with an emphasis on healthy behaviors, emotional health, labor and delivery, and postpartum/early parenting. Recognizing community health disparities, key informants used community outreach, and intersectoral collaborations for Indigenous and other at-risk communities to mitigate barriers to prenatal service uptake. Conclusions: Ottawa key informants conceptualized prenatal health promotion as inclusive, comprehensive, and as an extension of preconception, school-based sexual education. Respondents recommended the design and delivery of prenatal interventions as culturally safe and trauma informed, using online modalities to complement in-person activities. The experience and intersectoral networks of community-based prenatal health promotion programs represent potential capacity to address emergent public health risks to pregnancy, particularly among at-risk populations. Plain Language Summary: A broad and diverse community of professionals deliver prenatal education to help people have healthy babies. We interviewed Ottawa, Canada experts in prenatal care/education to learn about the design and delivery of reproductive health promotion. We found that Ottawa experts emphasized healthy behaviors beginning before conception and through pregnancy. Community outreach was identified as a successful strategy to promote prenatal education to marginalized groups. [ABSTRACT FROM AUTHOR]

The focal role of flow in promoting desirable outcomes in companies, such as increased employees’ well-being and performance, led scholars to study flow in the context of work. However, current measurement approaches which assess flow via self-report scales after task execution are limited due to obtrusiveness and a lack of real-time support. Hence, new measurement approaches must be created to overcome these limitations. In this article, we use cardiac features (heart rate variability; HRV) and a Random Forest classifier to distinguish high and low flow. Our results from a large-scale lab experiment with 158 participants and a field study with nine participants reveal, that with HRV features alone, flow-classifiers can be built with an accuracy of 68.5 percent (lab) and 70.6 percent (field). Our research contributes to the challenge of developing a less obtrusive, real-time measurement method of flow based on physiological features and to investigate flow from a physiological perspective. Our findings may serve as foundation for future work aiming to build physio-adaptive systems which can improve employee's performance. For instance, these systems could ensure that no notifications are forwarded to employees when they are ‘sensing’ flow. [ABSTRACT FROM AUTHOR]

Background and Aims: Single‐use electrocardiography (ECG) leads have been developed to reduce healthcare‐associated infection. This study compared the validity and reliability of short‐term heart rate variability (HRV) obtained from single‐use disposable ECG leads. Methods: Thirty healthy subjects (33 ± 10 years; 9 females) underwent 5‐min resting HRV assessments using disposable (single use) ECG cable and wire system (Kendall DL™ Cardinal Health) and a standard, reusable ECG leads (CardioExpress, Spacelabs Healthcare). Results: Intraclass correlation coefficient (ICC) with 95% confidence interval (CI) between disposable and reusable ECG leads was for the time domain [R‐R interval (ms); 0.99 (0.91, 1.00)], the root mean square of successive normal R‐R interval differences (RMSSD) (ms); 0.91 (0.76, 0.96), the SD of normal‐to‐normal R‐R intervals (SDNN) (ms); 0.91 (0.68, 0.97) and frequency domain [low‐frequency (LF) normalized units (nu); 0.90 (0.79, 0.95), high frequency (HF) nu; 0.91 (0.80, 0.96), LF power (ms2); 0.89 (0.62, 0.96), HF power (ms2); 0.90 (0.72, 0.96)] variables. The mean difference and upper and lower limits of agreement between disposable and reusable leads for time‐ and frequency‐domain variables were acceptable. Analysis of repeated measures using disposable leads demonstrated excellent reproducibility (ICC 95% CI) for R‐R interval (ms); 0.93 (0.85, 0.97), RMSSD (ms); 0.93 (0.85, 0.97), SDNN (ms); 0.88 (0.75, 0.95), LF power (ms2); 0.87 (0.72, 0.94), and HF power (ms2); 0.88 (0.73, 0.94) with coefficient of variation ranging from 2.2% to 5% (p > 0.37 for all variables). Conclusion: Single‐use Kendall DL™ ECG leads demonstrate a valid and reproducible tool for the assessment of HRV. [ABSTRACT FROM AUTHOR]

During active labor, a birthing person with cervical edema often has a dysfunctional or prolonged labor and, therefore, an increased risk for cesarean birth. Midwives seeking evidence on how to manage cervical edema when they are faced with this clinical situation will note a gap in the literature regarding the management of cervical edema that this report aims to fill. This case will discuss the use of intravenous diphenhydramine (Benadryl), the application of ice to the cervix, side‐lying release, epidural analgesia use, manual reduction of the cervix, and various positions to encourage reduction in cervical swelling. It is hoped these strategies will add to a midwife's clinical resources by providing ways to promote vaginal birth in the setting of cervical edema during labor. [ABSTRACT FROM AUTHOR]

Introduction: Effective collaboration between midwives and obstetricians on labor and birth units in hospitals has been shown to improve birth outcomes and quality of care. Guidelines for collaborative care in the United States exist; however, studies describing the actual lived experiences of midwives and obstetricians in collaborative practice are lacking. The goal of this study was to explore the experiences and perspectives of midwives and obstetricians working in collaborative practices on labor and birth units across the United States and to identify strategies that foster effective collaboration between them. Methods: We performed qualitative analyses of open‐ended comments obtained in an instrument validation survey assessing collaboration between midwives and obstetricians on labor and birth in the United States. Certified nurse‐midwives, certified midwives, attending general obstetricians, maternal‐fetal medicine attending physicians, and fellows across the United States were included in this study, herein called midwives and obstetricians. The final sample in the original validation survey included 232 midwives and 471 obstetricians (n = 703). Of these, 79 midwives and 132 obstetricians (n = 211) provided narrative comments on their perspectives and experiences with collaborative practice on labor and birth units in the United States. The narrative comments were analyzed using inductive techniques derived from grounded theory. Results: Four themes around how to foster effective collaboration were identified: (1) developing trust and respect, (2) promoting effective communication, (3) individual variability and need for clear guidelines, and (4) balancing autonomy. The midwives and obstetricians shared lived experiences that they perceived affected their work satisfaction and clinical outcomes in collaborative practices. Discussion: These findings hold potential to inform clinicians and health care leaders on ways to foster effective collaboration between midwives and obstetricians on labor and birth units. This in turn can improve quality of care for birthing persons, perinatal outcomes and clinician job satisfaction. [ABSTRACT FROM AUTHOR]

The mechanisms by which various pathogens cause congenital infections have been studied extensively, aiding in the understanding of the detrimental effects these infections can have on fetal/neonatal neurological development. Recent studies have focused on the gut-brain axis as pivotal in neurodevelopment, with congenital infections causing substantial disruptions. There remains controversy surrounding the purported sterility of the placenta as well as concerns regarding the effects of exposure to antibiotics used during pregnancy on neonatal microbiome development and how early exposure to microbes or antibiotics can shape the gut-brain axis. Long-term neurodevelopmental consequences, such as autism spectrum disorder, attention deficit hyperactivity disorder, and cerebral palsy, may be attributable, in part, to early life infection and changes in the immature gut microbiome. The goal of this review is thus to critically evaluate the current evidence related to early life infection affecting neurodevelopment through the gut-brain axis. [ABSTRACT FROM AUTHOR]

Background: Canadian public health agencies, both municipal/regional and provincial/territorial, are responsible for promoting population health during pregnancy and the early postnatal period. This study examines how these agencies use web-based and Facebook channels to communicate perinatal health promotion during the emergence of the COVID-19 pandemic. Methods: Perinatal health promotion content of websites and Facebook posts from a multijurisdictional and geographically diverse sample of government and non-governmental organizations (NGO) were evaluated using thematic content analysis in 2020. Results: Major Facebook perinatal health promotion themes included breastfeeding, infant care, labor/delivery, parenting support and healthy pregnancy. Facebook COVID-19-themed perinatal health promotion peaked in the second quarter of 2020. Websites emphasized COVID-19 transmission routes, disease severity and need for infection control during pregnancy/infant care, whereas Facebook posts focussed on changes to local health services including visitor restrictions. NGO perinatal health promotion reflected organizations' individual mandates. Conclusions: Canadian government use of Facebook to disseminate perinatal health promotion during the COVID-19 pandemic varied in terms of breadth of topics and frequency of posts. There were missed opportunities to nuance transmission/severity risks during pregnancy, thereby proactively countering the spread of misinformation. [ABSTRACT FROM AUTHOR]

Digital games are well known for holding players' attention and stopping them from being distracted by events around them. Being able to quantify how well games hold attention provides a behavioral foundation for measures of game engagement and a link to existing research on attention. We developed a new behavioral measure of how well games hold attention, based on players' post-game recognition of irrelevant distractors which are shown around the game. This is known as the Distractor Recognition Paradigm (DRP). In two studies we show that the DRP is an effective measure of how well self-paced games hold attention. We show that even simple self-paced games can hold players' attention completely and the consistency of attentional focus is moderated by game engagement. We compare the DRP to existing measures of both attention and engagement and consider how practical it is as a measure of game engagement. We find no evidence that eye tracking is a superior measure of attention to distractor recognition. We discuss existing research on attention and consider implications for areas such as motivation to play and serious games. [ABSTRACT FROM AUTHOR]

This study investigated the player experience, playful design factors, and player behaviors of real-life escape room games. A questionnaire survey, group interviews, and behavioral observation were conducted to gather players’ demographic information, game experience, social presence, game behaviors, and social interactions while playing a reallife escape room game. Results indicate that a player’s background and the theme of the escape room affect game performance and game experience. The playful design factors are sorted into five categories: story, clue, puzzle, mechanism, and interior design. The player behaviors include individual and team behaviors: searching, thinking, monitoring, physical activity, communication, information sharing, decision making, and cooperation. [ABSTRACT FROM AUTHOR]

Measuring user engagement in interactive tasks can facilitate numerous applications toward optimizing user experience, ranging from eLearning to gaming. However, a significant challenge is the lack of non-contact engagement estimation methods that are robust in unconstrained environments. We present FaceEngage, a non-intrusive engagement estimator leveraging user facial recordings during actual gameplay in naturalistic conditions. Our contributions are three-fold. First, we show the potential of using front-facing videos as training data to build the engagement estimator. We compile FaceEngage Dataset with over 700 picture-in-picture, realisitic, and user-contributed YouTube gaming videos (i.e., with both full-screen game scenes and time-synchronized user facial recordings in subwindows). Second, we develop FaceEngage system, that captures relevant gamer facial features from front-facing recordings to infer task engagement. We implement two FaceEngage pipelines: an estimator trained on user facial motion features inspired by prior psychological works, and a deep learning-enabled estimator. Lastly, we conduct extensive experiments and conclude: (i) certain user facial motion cues (e.g., blink rates, head movements) are engagement-indicative; (ii) our deep learning-enabled FaceEngage pipeline can automatically extract more informative features, outperforming the facial motion feature-based pipeline; (iii) FaceEngage is robust to various video lengths, users/game genres and interpretable. Despite the challenging nature of realistic videos, FaceEngage attains the accuracy of 83.8 percent and leave-one-user-out precision of 79.9 percent, both of which are superior to our face motion-based model. [ABSTRACT FROM AUTHOR]

We examined relationships between general and specific anxiety symptoms and time perspective among adolescents and how these relationships varied by gender. Time perspective was conceptualized as a multidimensional construct and assessed with the following dimensions: time frequency, time attitudes, time orientation, and time relation. Multiple regression analyses indicated that participants (N = 771; Mage = 15.82, SD = 1.23; 54% female) with more anxiety (a) felt less positively about the present; (b) felt more negatively about the past, the present, and the future; and (c) thought the past was more important than the present and the future. Findings for specific anxiety subtypes were generally similar. Interactions between time perspective and gender indicated that more frequent thoughts about the past and the future may be associated with greater anxiety, especially for females. Results highlight the temporal qualities of anxiety and provide support for time perspective as a potential factor for understanding and supporting adolescents with anxiety. [ABSTRACT FROM AUTHOR]

Game jams are collaborative competitions where participants make games from scratch within a short period of time. Occasionally, these games aim to promote meaningful learning outcomes by embedding functional knowledge into entertaining and engaging gameplay. We wanted to understand if a game jam during a global pandemic could be used as an effective method to facilitate a collaborative, multidisciplinary team's ability to design, develop, and implement a serious game on a health-related topic (i.e., COVID-19). We examined the 2020 game jam hosted by the National Academy of Sciences to evaluate one method to organize a serious virtual game jam and provide a roadmap for implementation using qualitative and quantitative data collection methods to evaluate its efficacy. In addition to identifying best practices and lessons learned from our tools and processes, our results demonstrate that a virtual game jam can in fact be a powerful tool for creating a scientifically sound, population-level, big picture-thinking serious game used for health education, facilitate collaborative multidisciplinary teams and be a practical learning experience for game jammers. [ABSTRACT FROM AUTHOR]

This article investigated the impact of immersive virtual reality (VR) content, using 360-degree videos, in undergraduate education. To improve the delivery and reality of 360-degree VR content, we filmed the video in the third person so that the viewers could feel like they were in the environment where the lecture was conducted. To verify the educational effects, 33 university students participated in our experiment. We conducted pretest learning, using 360-degree videos, and posttest learning via conventional 2-D videos for statistical analysis. A paired t-test was used to compare the means of the pretest and the posttest. In addition, learning via 360-degree videos was assessed for its effectiveness through questionnaires consisting of five measurement elements—engagement, immersion, motivation, cognitive benefits, and perceived learning effectiveness—and comparing them to the existing 2-D video method, based on e-learning. From the results, we confirmed that the teaching material delivered through 360-degree VR content allows students to be more focused, immersed, and interested than 2-D learning modes. Furthermore, the high scores of cognitive and perceived learning elements imply that VR-based 360-degree educational content can encourage more active participation than traditional lectures and can improve the ability to analyze and organize study lessons. [ABSTRACT FROM AUTHOR]

The notion of patient rights encompasses the obligations of the state and healthcare providers to respect the dignity, autonomy and equality of care-seeking individuals in healthcare processes. Functional patient grievance redressal systems are key to ensuring that the rights of individuals seeking healthcare are protected. We critically examined the published literature from high-income and upper-middle-income countries to establish an analytical framework on grievance redressal for patient rights violations in health facilities. We then used lawsuits on patient rights violations from the Supreme Court of India to analyse the relevance of the developed framework to the Indian context. With market perspectives pervading the health sector, there is an increasing trend of adopting a consumerist approach to protecting patient rights. In this line, avenues for grievance redressal for patient rights violations are gaining traction. Some of the methods and instruments for patient rights implementation include charters, ombudsmen, tribunals, health professional councils, separating rules for redressal and professional liability in patient rights violations, blame-free reporting systems, direct community monitoring and the court system. The grievance redressal mechanisms for patient rights violations in health facilities showcase multilevel governance arrangements with overlapping decision-making units at the national and subnational levels. The privileged position of medical professionals in multilevel governance arrangements for grievance redressal puts care-seeking individuals at a disadvantaged position during dispute resolution processes. Inclusion of external structures in health services and the healthcare profession and laypersons in the grievance redressal processes is heavily contested. Normatively speaking, a patient grievance redressal system should be accessible, impartial and independent in its function, possess the required competence, have adequate authority, seek continuous quality improvement, offer feedback to the health system and be comprehensive and integrated within the larger healthcare regulatory architecture. [ABSTRACT FROM AUTHOR]

Research has shown that time perspective changes across the lifespan and recent studies have reported significant and meaningful associations between time perspective scores and scores on a range of mental, and physical health outcomes. In the present study, we examined the relationship between Time Attitudes (the affective dimension of time perspective) and mental well-being, as well as psychological and somatic symptoms in late adolescents, in a range of adjusted and unadjusted analyses. Participants were final year High school students (N = 3479 [40.9% Male]) in Northern Ireland. In line with a developing literature, time attitudes were operationalized through person-centred analyses: Cluster analysis yielded profiles, or time attitude categories, based on a six-factor index of attitudes toward the past, the present, and the future. Results supported those previously reported for younger adolescents, showing that higher mental-wellbeing, and both lower psychological and somatic symptomatology, were associated with membership of a Positive time attitudes profile. Further, these well-being constructs were positively associated with being male and reporting higher emotional self-efficacy. These results reported herein are in keeping with explanatory role of time attitudes in health and well-being outcomes among younger, and now older adolescents. We suggest that the next step in the investigation of time attitudes is to examine the extent (if at all) to which intervening with adolescents can nudge them towards a more positive appraisal of past, present, and future. [ABSTRACT FROM AUTHOR]

Why do so many people struggle with their medicines despite decades of research on medicines taking? Research into how people experience medicines in their everyday life remains scarce with the majority of research in this area of focusing on whether or not people take their medicines as prescribed. Hence, this study used a phenomenological hermeneutical qualitative design to gain a deeper understanding of individuals' perspectives on the lived experience of medicine-taking. Findings from this study highlight five main themes where participants experience medicines as: 1) life-saving and indispensable, 2) normal and a daily routine, 3) confusing and concerning, 4) unsuitable without adjustment, and 5) intrusive and unwelcome. These results can be the basis for mutually agreed prescribing through a co-creative approach that aims at enhancing open and honest dialogues between patients and healthcare professionals in partnership about medicines. [ABSTRACT FROM AUTHOR]