Integrated frequency-modulated optical parametric oscillator

Optical frequency combs have revolutionized precision measurement, time-keeping and molecular spectroscopy1-7. A substantial effort has developed around 'microcombs': integrating comb-generating technologies into compact photonic platforms5,7-9. Current approaches for generating these microcombs involve either the electro-optic10 or Kerr mechanisms11. Despite rapid progress, maintaining high efficiency and wide bandwidth remains challenging. Here we introduce a previously unknown class of microcomb-an integrated device that combines electro-optics and parametric amplification to yield a frequency-modulated optical parametric oscillator (FM-OPO). In contrast to the other solutions, it does not form pulses but maintains operational simplicity and highly efficient pump power use with an output resembling a frequency-modulated laser12. We outline the working principles of our device and demonstrate it by fabricating the complete optical system in thin-film lithium niobate. We measure pump-to-comb internal conversion efficiency exceeding 93% (34% out-coupled) over a nearly flat-top spectral distribution spanning about 200 modes (over 1 THz). Compared with an electro-optic comb, the cavity dispersion rather than loss determines the FM-OPO bandwidth, enabling broadband combs with a smaller radio-frequency modulation power. The FM-OPO microcomb offers robust operational dynamics, high efficiency and broad bandwidth, promising compact precision tools for metrology, spectroscopy, telecommunications, sensing and computing.

Does ICT influence carbon emissions in the context of universal connectivity: a global perspective?

The Connect 2030 initiative, launched by the International Telecommunication Union, is in alignment with the Sustainable Development Goals (SDGs) of the United Nations Agenda 2030. Its main objective is to achieve universal connectivity, a goal that is closely related to environmental issues. This topic currently receives attention from researchers and policymakers. Given these considerations, our study investigates the impact of information and communication technologies on carbon dioxide emissions for a panel of 84 countries spanning the years 2009 to 2020. Using principal component analysis, we construct an ICT index that encompasses international bandwidth, reflecting the universal connectivity, and participation in international data exchanges. The empirical analysis applies the pooled mean group-panel autoregressive distributive lag (PMG-ARDL) approach to estimate both the long-run and short-run coefficients of CO2 emissions' determinants. Our findings show that ICT and renewable energy mitigate CO2 emissions, unlike financial development, GDP, and non-renewable energy, which contribute significantly to emissions for the full sample. These outcomes suggest that promoting ICTs in general and international bandwidth in particular, as part of universal connectivity, improves the quality of the global environment.

Communication and coordination of care for people living with HIV: a qualitative study of the patient perspective

BACKGROUND

There is growing consensus that primary health care (PHC) providers have an important role in providing holistic, preventative care for people living with human immunodeficiency virus (PLHIV). In regional Australia, HIV care is primarily delivered through specialist services, thus adequate coordination and communication between specialist and PHC professionals is crucial. This study aimed to explore patient experiences of the coordination of care and health care professional communication for PLHIV in regional Australia.

METHODS

Semi-structured interviews with PLHIV in a regional area of Australia were conducted in March to April 2022. Interviews were conducted via video conferencing, face-to-face, or via telephone call. Interviews were audio-recorded and manually transcribed. Transcripts were coded inductively and thematic analysis was conducted to explore perspectives on communication and coordination.

RESULTS

Thirteen participants were interviewed. Most participants were male, aged 50-70, were diagnosed with HIV more than ten years ago, and had been living in regional Australia long-term. Through qualitative analysis, themes emerged in the following areas: (1) Patient perception of care coordination; (2) Patient understanding of modality of communication; (3) Positive attitudes towards communication between healthcare professionals; and (4) Concerns for information sharing between healthcare professionals. Many participants highlighted lack of clarity around care coordination as a key issue in their healthcare, with some citing themselves as the primary care coordinator. Participants identified that coordination and communication between PHC professionals and specialist services are essential in the delivery of their health care, but some were hesitant for this to occur. Hesitancy was entrenched in some patients' distrust of healthcare due to previous experiences of confidentiality breaches and stigma.

CONCLUSION

This study identifies the need for clarity in coordination between health care professionals to deliver safe and effective HIV care, which may occur through care plans. Patient support for communication between healthcare providers may be strengthened by ensuring trust in the people and systems involved. Eliminating stigma in healthcare as well as building more trustworthy electronic-based communication technologies are essential components to trust-building between PLHIV and healthcare systems.

A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults

Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.

Implementing and Enhancing Social and Economic Needs Screening at a Federally Qualified Health Center

BACKGROUND

Programs to screen for social and economic needs (SENs) are challenging to implement.

AIM

To describe implementation of an SEN screening program for patients obtaining care at a federally qualified health center (FQHC).

SETTING

Large Chicago-area FQHC where many patients are Hispanic/Latino and insured through Medicaid.

PROGRAM DESCRIPTION

In the program's phase 1 (beginning April 2020), a prescreening question asked about patients' interest in receiving community resources; staff then called interested patients. After several refinements (e.g., increased staffing, tailored reductions in screening frequency) to address challenges such as a large screening backlog, program phase 2 began in February 2021. In phase 2, a second prescreening question asked about patients' preferred modality to learn about community resources (text/email versus phone calls).

PROGRAM EVALUATION

During phase 1, 8925 of 29,861 patients (30%) expressed interest in community resources. Only 40% of interested patients were successfully contacted and screened. In phase 2, 5781 of 21,737 patients (27%) expressed interest in resources; 84% of interested patients were successfully contacted by either text/email (43%) or phone (41%).

DISCUSSION

Under one-third of patients obtaining care at an FQHC expressed interest in community resources for SENs. After program refinements, rates of follow-up with interested patients substantially increased.

Rural-Urban Differences in Telehealth Utilization and Delayed Care During the COVID-19 Pandemic

Purpose: Use of telehealth among older adults increased during the COVID-19 pandemic, but patterns and correlates of its use are poorly understood. The present study uses a representative sample of Medicare beneficiaries to examine rural-urban differences in telehealth utilization during the pandemic and to investigate the associations between the number and type of telehealth services utilized and delayed in-person care. Methods: The study sample (N = 3,257) came from Round 10 of the National Health and Aging Trends Study. Telehealth was measured in three modalities: phone calls, e-mails or portal messages, and video calls. Multivariable Poisson and logistic regressions were performed to test the study aims, adjusting for sociodemographic and health controls. Analytic weights and survey design factors were incorporated to generate population estimates. Findings: Results show that rurality is associated with lower rates (incidence rate ratio = 0.78, p < 0.001) and lower odds of telehealth use compared with urban older adults. Specifically, rural older adults were less likely to use e-mail or portal messages (adjusted odds ratio [AOR] = 0.43, p < 0.001) and video calls (AOR = 0.57, p = 0.004) to communicate with their usual health care provider. Use of any 2 forms of telehealth was associated with greatest increased odds of delayed in-person care among rural and urban populations during the pandemic. Conclusions: Future efforts are needed to expand the utilization of e-mail/portal messages and video call telehealth services among rural older adults. Telehealth may be an important mechanism to support care continuity during and beyond the COVID-19 pandemic for both urban and rural older adults when in-person modalities of care are not feasible.

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes

BACKGROUND

The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed.

OBJECTIVE

This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes.

METHODS

A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool.

RESULTS

Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload.

CONCLUSIONS

The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

Feasibility and acceptability of a remote, hands-free cognitive battery for adults with traumatic spinal cord injury

PURPOSE/OBJECTIVE

To evaluate the acceptability and feasibility of testing the cognitive abilities of adults with traumatic spinal cord injury (TSCI) via teleconference.

RESEARCH DESIGN

Data were collected prospectively at two study sites from 75 adults living with TSCI. Participants completed a series of self-report measures via an online survey platform, in addition to a brief battery of cognitive testing administered via audio-video teleconference. Modifications were made to select measures to allow for hands-free administration of all tasks.

RESULTS

Feasibility was demonstrated by a 97.4% completion rate among the 77 participants who began the cognitive testing and approximately normal distributions for nearly all cognitive testing variables examined. No ceiling or floor effects were observed across cognitive testing variables. Review of acceptability ratings indicated that participants found this approach to cognitive testing to be highly acceptable.

CONCLUSION/IMPLICATIONS

Our findings provide evidence for the feasibility and acceptability of administering cognitive testing via teleconference to adults living with TSCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Telemedicine: The Situation in Morocco

The Moroccan healthcare system is facing several challenges in ensuring equitable access to quality services and reducing or at least controlling their rising cost. Telemedicine can address these two needs by optimizing the use of existing human and material resources through telecommunications. Today, the gradual increase in the population's healthcare needs poses a major challenge to the Moroccan healthcare system, given the shortage of personnel in healthcare facilities and the persistent difficulties in accessing certain regions. In this regard, Morocco has established a regulatory framework defining the rules for the practice of telemedicine. Several initiatives have been launched, particularly in the public sector, aiming to cover 80% of medical deserts in Morocco by 2025.

Focus group in the development of concepts for a Nursing model: experience report

OBJECTIVE

To communicate the experience of developing concepts for the construction of a care model through focus groups.

METHODS

An experience report on the development of concepts through remote focus groups with members of a research group from a public university in southern Brazil.

RESULTS

Focus groups were developed in which homogeneity and heterogeneity criteria were observed among participants. In addition to the concepts of the nursing metaparadigm, the concepts of care and family-centered care were developed, relevant to the nursing care model in question.

FINAL CONSIDERATIONS

Despite the challenges of conducting remote focus groups, they were suitable for the collective construction of concepts for a nursing care model, allowing the interaction of participants from different locations.

Evaluating the impact of e-registration and mHealth on institutional delivery in hazard-prone areas of Bangladesh: A protocol for a non-randomized controlled cluster trial

Despite substantial progress, Bangladesh still has a high rate of maternal deaths owing to difficulties during pregnancy, delivery, and the postpartum period. Increasing facility delivery is mandatory to reach the goal of bringing down the MMR to <70 deaths/100,000 live births by 2030. In the era of digitalization, the introduction of e-registration and mHealth may aid the government in reaching this target. The southern part of Bangladesh is a hazard-prone area, where service uptake from institutions is low. This study aims to determine the effect of an e-registration tracking system and mHealth counseling on institutional deliveries to pregnant mothers in hazard-prone areas of southern Bangladesh. We will conduct an open-label, two-arm, non-randomized controlled cluster trial for six months and use three hazard-prone areas for intervention and another three hazard-prone areas for control. We will collect data at baseline and end-line of the study period using a structured questionnaire. We will enroll at least 268 pregnant mothers from the intervention and 268 pregnant mothers from the control areas after screening based on the inclusion and exclusion criteria. Pregnancy information will be obtained from the Family Welfare Assistant register. The respondents of the intervention arm will be registered in the e-Registration system, and receive voice call and text messages from the midwives to have their deliveries done in healthcare facilities. We will follow the participants until their delivery and exclude those respondents from the study who will have post-dated delivery, migrate out, lost to follow-up, or die during the study period. Random-intercept mixed-effect logistic regression will be performed to explain the relationship of e-registration and mHealth package with institutional delivery. Institutional delivery is still uncommon in Southern Bangladesh despite several interventions. Innovative approaches like e-registration and mHealth counseling may be helpful to bring women to health facilities. The findings from the study might enable the policy makers of Bangladesh to integrate the intervention package into the existing healthcare system. This experiment is registered in the open science framework. Clinical trial registration: Registration number: DOI 10.17605/OSF.IO/YZE5C) and https://www.clinicaltrials.gov/ (registration number: NCT05398978.

The Support, Educate, Empower personalized glaucoma coaching trial design

BACKGROUND

Glaucoma is a chronic disease that affects 3 million Americans. Glaucoma is most often asymptomatic until very late in its course when treatment is more difficult and extensive peripheral vision loss has already occurred. Taking daily medications can mitigate this vision loss, but at least half of people with glaucoma do not take their prescribed medications regularly. The purpose of this study is to improve glaucoma medication adherence among those with medically treated glaucoma and poor self-reported adherence using the Support, Educate, Empower personalized coaching program.

METHODS/DESIGN

This study is a two-site randomized controlled trial enrolling 230 participants with poor self-reported glaucoma medication adherence. The trial has two arms, an intervention arm and a control arm. Participants in the intervention arm receive personalized glaucoma education and motivational interviewing-based coaching over 6 months from a trained non-physician interventionist for three in-person sessions with between visit phone calls for check-ins where current adherence level is reported to participants. Participants also can elect to have visual, audio, text or automated phone call medication dose reminders. Participants in the control arm continue usual care with their physician and receive non-personalized glaucoma educational materials via mail in parallel to the three in-person coaching sessions to control for glaucoma knowledge content. All participants receive a medication adherence monitor. The primary outcome is the proportion of prescribed doses taken on schedule during the 6-month period. The secondary outcome is glaucoma related distress. The exploratory outcome is intraocular pressure.

DISCUSSION

The personalized education and motivational-interviewing-based intervention that we are testing is comprehensive in that it addresses the wide range of barriers to adherence that people with glaucoma encounter. Leveraging a custom-built web-based application to generate the personalized content and the motivational-interviewing-based prompts to guide the coaching sessions will make this program both replicable and scalable and can be integrated into clinical care utilizing trained non-physician providers. Although this type of self-management support is not currently reimbursed for glaucoma as it is for diabetes, this trial could help shape future policy change should the intervention be found effective.

Effects of Recorded versus Live Teleconference Didactic Lectures on Medical Student Performance in the Surgery Clerkship

OBJECTIVE

Due to the COVID-19 pandemic, numerous institutions converted medical education didactics to electronic formats including both live teleconference didactics and recorded faculty lectures. This study aims to compare the effect of recorded versus live teleconference didactic lectures on medical student examination scores during the surgery clerkship.

DESIGN

Medical students completing the Surgery Clerkship received a weekly series of didactic lectures taught by faculty via a teleconference (2020-2021 academic year) or recorded format (2021-2022 academic year). Performance outcomes included weekly quizzes, National Board of Medical Examiners (NBME) Surgery Shelf Exam, and clerkship Objective Structured Clinical Examination (OSCE) scores.

SETTING

University of Miami Miller School of Medicine.

PARTICIPANTS

All second- (MS2) and third-year (MS3) medical students completing the Surgery Clerkship over two academic years (n = 312).

RESULTS

Students who received live teleconference lectures (n = 156) demonstrated higher average scores on weekly quizzes (89%) and the NBME shelf exam (76%) compared to those receiving recorded lectures (n = 156; 71% quiz, 70% shelf exam), both p < 0.001. There was a significant association with performance in the highest quartile (Q1) of weekly quiz scores and receiving live lectures (40% vs. recorded lectures 1%, p < 0.001). Comparing only MS3 students, mean weekly quiz scores and Q1 achievement were significantly higher (both p < 0.001) in the teleconference cohort with no significant difference in NBME shelf exam performance (p = 0.971). No difference in OSCE performance was observed between groups.

CONCLUSION

These results suggest that synchronous teleconferences may be more effective than recorded lectures for achieving institutional learning objectives on the surgery clerkship without any negative impact on NBME shelf exam or clinical evaluation parameters. This information should be used to inform future institutional clerkship design and educational initiatives.

Region Anomaly Detection via Spatial and Semantic Attributed Graph in Human Monitoring

This paper proposes a graph-based deep framework for detecting anomalous image regions in human monitoring. The most relevant previous methods, which adopt deep models to obtain salient regions with captions, focus on discovering anomalous single regions and anomalous region pairs. However, they cannot detect an anomaly involving more than two regions and have deficiencies in capturing interactions among humans and objects scattered in multiple regions. For instance, the region of a man making a phone call is normal when it is located close to a kitchen sink and a soap bottle, as they are in a resting area, but abnormal when close to a bookshelf and a notebook PC, as they are in a working area. To overcome this limitation, we propose a spatial and semantic attributed graph and develop a Spatial and Semantic Graph Auto-Encoder (SSGAE). Specifically, the proposed graph models the "context" of a region in an image by considering other regions with spatial relations, e.g., a man sitting on a chair is adjacent to a white desk, as well as other region captions with high semantic similarities, e.g., "a man in a kitchen" is semantically similar to "a white chair in the kitchen". In this way, a region and its context are represented by a node and its neighbors, respectively, in the spatial and semantic attributed graph. Subsequently, SSGAE is devised to reconstruct the proposed graph to detect abnormal nodes. Extensive experimental results indicate that the AUC scores of SSGAE improve from 0.79 to 0.83, 0.83 to 0.87, and 0.91 to 0.93 compared with the best baselines on three real-world datasets.

Shaping Communications: The Development of the National Telegraph Network in Ireland, 1850-70

Despite Ireland's centrality to transatlantic telegraphic communication and as an integral part of the United Kingdom, telegraphy on the island is often merely a footnote in the scholarship. Yet telegraphy had a significant impact in Ireland, accelerating internal and external communication times. This article provides the first comprehensive study of telegraphy's expansion, from its arrival in Ireland in the 1850s until the eve of nationalization in 1870. It shows how Ireland's geographical position as a telegraphic gateway to North America, the heavy integration of Ireland's economy into Britain after 1853, and the relationship between telegraphy and the rail network shaped Irish telegraphy in unique ways.

Comprehensive characterization and environmental implications of spent telecommunication printed circuit boards: Towards a cleaner and sustainable environment

The management and prevention of environmental risks associated with spent telecommunications printed circuit boards (STPCBs) is a concerning issue worldwide. Recycling might be proposed as a proper method to overcome this issue. Despite knowing that, choosing a sustainable method is challenging because of STPCBs complexity. This problem was overcome by analyzing STPCBs using different analytical methods and metal speciation. Understanding these data is essential in selection strategies to maximize selective recycling of metals and to minimize environmental impact. This research focused on characterizing STPCBs based on their structural, morphological, physiochemical, surface, and thermal properties. The accurate measurement of metal contents, indicating 187,900 mg kg^-1 Cu, 22,540 mg kg^-1 Pb, 1320 mg kg^-1 Ag, and 205 mg kg^-1 Au elements, plus other base metals, revealed a remarkable potential value in STPCBs. The results of structural analyses indicated that the powder has a crystalline structure and consists of Cu, Sn and Pb phases as well as different functional groups. In addition, after evaluating the zeta potential of the sample, the isoelectric pH of the sample was observed to be 5.6, which indicates that the powder particles have a negative surface in an environment with a pH higher than this value. Further, the metal speciation via sequential extraction procedure was performed, which showed that a unique harsh recycling strategy is required due to the stable structure of STPCBs. According to the results of this analysis, the global contamination factor (GCF) value was 83.48, which indicates STPCBs have a high degree of contamination. Leaching tests and environmental criteria were also conducted on this waste. The findings suggest that STPCBs needs pretreatments before landfilling to lower the concentration of toxic metals. Also, waste extraction test was the most aggressive procedure to assess mobility. Achieving this information is considered an essential step to choosing the most efficient recycling methods that minimize environmental impact while maximizing selective recycling of metals.

A Symbols Based BCI Paradigm for Intelligent Home Control Using P300 Event-Related Potentials

Brain-Computer Interface (BCI) is a technique that allows the disabled to interact with a computer directly from their brain. P300 Event-Related Potentials (ERP) of the brain have widely been used in several applications of the BCIs such as character spelling, word typing, wheelchair control for the disabled, neurorehabilitation, and smart home control. Most of the work done for smart home control relies on an image flashing paradigm where six images are flashed randomly, and the users can select one of the images to control an object of interest. The shortcoming of such a scheme is that the users have only six commands available in a smart home to control. This article presents a symbol-based P300-BCI paradigm for controlling home appliances. The proposed paradigm comprises of a 12-symbols, from which users can choose one to represent their desired command in a smart home. The proposed paradigm allows users to control multiple home appliances from signals generated by the brain. The proposed paradigm also allows the users to make phone calls in a smart home environment. We put our smart home control system to the test with ten healthy volunteers, and the findings show that the proposed system can effectively operate home appliances through BCI. Using the random forest classifier, our participants had an average accuracy of 92.25 percent in controlling the home devices. As compared to the previous studies on the smart home control BCIs, the proposed paradigm gives the users more degree of freedom, and the users are not only able to control several home appliances but also have an option to dial a phone number and make a call inside the smart home. The proposed symbols-based smart home paradigm, along with the option of making a phone call, can effectively be used for controlling home through signals of the brain, as demonstrated by the results.

A novel customer churn prediction model for the telecommunication industry using data transformation methods and feature selection

Customer churn is one of the most critical issues faced by the telecommunication industry (TCI). Researchers and analysts leverage customer relationship management (CRM) data through the use of various machine learning models and data transformation methods to identify the customers who are likely to churn. While several studies have been conducted in the customer churn prediction (CCP) context in TCI, a review of performance of the various models stemming from these studies show a clear room for improvement. Therefore, to improve the accuracy of customer churn prediction in the telecommunication industry, we have investigated several machine learning models, as well as, data transformation methods. To optimize the prediction models, feature selection has been performed using univariate technique and the best hyperparameters have been selected using the grid search method. Subsequently, experiments have been conducted on several publicly available TCI datasets to assess the performance of our models in terms of the widely used evaluation metrics, such as AUC, precision, recall, and F-measure. Through a rigorous experimental study, we have demonstrated the benefit of applying data transformation methods as well as feature selection while training an optimized CCP model. Our proposed technique improved the prediction performance by up to 26.2% and 17% in terms of AUC and F-measure, respectively.

Removing False Targets for Cyclic Prefixed OFDM Sensing with Extended Ranging

Employing a cyclic prefixed OFDM (CP-OFDM) communication waveform for sensing has attracted extensive attention in vehicular integrated sensing and communications (ISAC). A unified sensing framework was developed recently, enabling CP-OFDM sensing to surpass the conventional limits imposed by underlying communications. However, a false target issue still remains unsolved. In this paper, we investigate and solve this issue. Specifically, we unveil that false targets are caused by periodic cyclic prefixes (CPs) in CP-OFDM waveforms. We also derive the relation between the locations of false and true targets, and other features, e.g., strength, of false targets. Moreover, we develop an effective solution to remove false targets. Simulations are provided to confirm the validity of our analysis and the effectiveness of the proposed solution. In particular, our design can reduce the false alarm rate caused by false targets by over 50% compared with the prior art.

Optical Polarization Division Multiplexing Transmission System Based on Simplified Twin-SSB Modulation

Optical twin-single sideband (Twin-SSB) modulation, due to the left sideband (LSB) and right sideband (RSB) signal carrying individual data, has become an attractive technique in fiber transmission because it satisfies the demand of the explosive increase in data traffic. This paper focuses on reducing the complexity of Twin-SSB system and further enhancing the spectral efficiency by proposing a polarization division multiplexing (PDM) Twin-SSB modulation scheme. LSB and RSB signals are extracted using de-mapping algorithm instead of optical bandpass filters (OBPFs) to reduce system complexity. To further improve spectral efficiency, PDM is employed to meet the polarization multiplexing transmission and achieve a higher transmission capacity. Based on the PDM Twin-SSB system, the LSB is 3-arr phase-shift-keying (3PSK) modulated, while RSB is quadrature phase-shift keying (QPSK) modulated. We simulated that the bit error ratio (BER) performance of LSB and RSB of X-polarization (X-Pol) and Y-polarization (Y-Pol) at 8-Gbaud, 10-Gbaud, 12-Gbaud, 14-Gbaud, and 16-Gbaud in the case of back-to-back (BTB) and 2 km standard single-mode fiber (SSMF) transmission. The simulation results verify the effectiveness and practical feasibility of the proposed PDM Twin-SSB scheme for future short-distance transmission owing to low cost, simplified structure, low algorithm complexity, and high data transmission capacity.

An Evaluation of the Quality of Environmental Impact Assessment Reports in the Mobile Telecommunications Infrastructure Sector: The Case of Plateau State in Nigeria

Environmental impact assessment reports meant for proposed development actions can be evaluated to reveal their quality and fitness for the purpose of environmental decision-making. Therefore, this study evaluated the quality and identified strengths and weaknesses in environmental impact assessment reports of telecommunications infrastructure proposed for Plateau State in Nigeria. To this end, 80 reports were evaluated using the modified version of the Lee and Colley review package. The results revealed the following points. In Review Area 1.0 (Description of the proposed telecommunications facilities) and Review Area 5.0 (Communication of results), the quality of environmental impact assessment reports was found to be generally satisfactory. However, the quality of all reports was considered 'very unsatisfactory' ('F') regarding their overall legal compliance with the requirements stipulated in the remaining three Review Areas, namely, Review Area 2.0 (Terrain susceptibility in the proposed project areas), Review Area 3.0 (Associated and potential environmental impacts), and Review Area 4.0 (Mitigation measures/alternatives). This 'F' rating was assigned to 65% (52/80) of reports regarding Review Area 3.0 because the information provided was 'very unsatisfactory'; important tasks were poorly carried out or not attempted at all. Moreover, in review areas such as Review Area 2.0 and Review Area 4.0, all reports in the evaluation were assigned an 'F' quality. Such an unsatisfactory quality rating is ascribable to the very unsatisfactory manner in which the reports were populated, especially as important task(s) were poorly performed or not attempted at all. Historically, only Review Area 1.0 and Review Area 5.0 indicated improvements in quality over time, whereas the remaining three review areas (Review Area 2.0, Review Area 3.0 and Review Area 4.0) did not improve. Based on the results obtained from the study, we recommend that there should be periodic reviews of environmental impact assessment reports by independent reviewers and environmental consultants should adhere to the sectoral guidelines for telecommunication infrastructure during the production of these reports. Moreover, in order to build technical capacity, more studies on report quality must be conducted in all sectors in Nigeria.

Indoor optical fiber eavesdropping approach and its avoidance

The optical fiber network has become a worldwide infrastructure. In addition to the basic functions in telecommunication, its sensing ability has attracted more and more attention. In this paper, we discuss the risk of household fiber being used for eavesdropping and demonstrate its performance in the lab. Using a 3-meter tail fiber in front of the household optical modem, voices of normal human speech can be eavesdropped by a laser interferometer and recovered 1.1 km away. The detection distance limit and system noise are analyzed quantitatively. We also give some practical ways to prevent eavesdropping through household fiber.

A New Construction of 4q-QAM Golay Complementary Sequences

Quadrature amplitude modulation (QAM) constellation and Golay complementary sequences (GCSs) are usually applied in orthogonal frequency division multiplexing (OFDM) systems to obtain a higher data rate and a lower peak-to-mean envelope power ratio (PMEPR). In this paper, after a sufficient search of the literature, it was found that increasing the family size is an effective way to improve the data rate, and the family size is mainly determined by the number of offsets in the general structure of QAM GCSs. Under the guidance of this idea, we propose a new construction for 4q-QAM GCSs through generalized Boolean functions (GBFs) based on a new description of a 4q-QAM constellation, which aims to enlarge the family size of GCSs and obtain a low PMEPR. Furthermore, a previous construction of 4q-QAM GCSs presented by Li has been proved to be a special case of the new one, and the family size of new sequences is much larger than those previously mentioned, which means that there was a great improvement in the data rate. On the other hand, a previous construction of 16-QAM GCSs presented by Zeng is also a special case of the new one in this paper, when q=2. In the meantime, the proposed sequences have the same PMEPR upper bound as the previously mentioned sequences presented by Li when applied in OFDM systems, which increase the data rate without degrading the PMEPR performance. The theoretical analysis and simulation results show that the proposed new sequences can achieve a higher data rate and a low PMEPR.

Home Office, Health Behavior and Workplace Health Promotion of Employees in the Telecommunications Sector during the Pandemic

Our study aims to present the perception and experiences of employees at a large multinational telecommunications company in Hungary working in home offices, as well as their health behavior and the workplace health promotion during the SARS-CoV-2 COVID-19 outbreak. The sample consisted of the full sample of highly skilled employees at a large telecommunication multinational company (N = 46). Throughout the analysis, tests for homogeneity of variance were followed by a MANOVA test to compare the groups' means by gender, age, and job classification. The results clearly show that in the short term, workers' mental health did not deteriorate, they do not argue or fight more with their partners and are no more depressed or irritable than before. Workers are less likely to think of ways to be more effective at work than in a home office. Similarly, they do not think that employers have more expectations than before the pandemic. Our research shows the assumption about home workers being less efficient or less diligent in their daily work to be false. A supportive and flexible employer approach to health-conscious employees will be an essential aspect in the future.

Burnout among Telecommunication Sales Managers

(1) Background: Various investigations have confirmed that burnout prevails in intensive and demanding contemporary working environments. Most of these studies have analyzed the associations between emotional exhaustion and various work factors. We studied the gap in the literature by simultaneously considering the three commonly recognized dimensions of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) using a representative sample of telecommunication sales managers. (2) Methods: 849 survey respondents completed an anonymous questionnaire that included items representing psychosocial factors at work, lifestyle characteristics, and the Maslach Burnout inventory. The hierarchical regression analysis revealed the predictors of emotional exhaustion, depersonalization, and reduced personal accomplishment. (3) Results: job demands and witnessing bullying at the workplace were the most powerful predictors of emotional exhaustion, followed by self-rated health, night work, education, and physical inactivity. Witnessing bullying at the workplace, job control, self-rated health, and physical inactivity were the strongest predictors of depersonalization. Finally, direct experiences of negative acts at the workplace, job control, social support at work, bullying exposure duration, family crises, physical inactivity, smoking and alcohol, and body mass index were the most important predictors of reduced personal accomplishments. (4) Conclusions: the present study fills a gap in the research surrounding the three dimensions of burnout. The findings not only confirm that high job demands, low job control, and low social support at work contribute to burnout but also contribute to the novel understanding that workplace bullying plays an integral role.

The Conditions of Successful Telework: Exploring the Role of Telepressure

The purpose of this paper is to explore the causes of the inconsistent relationship between telework and work-life conflict, which has been reported in the research literature. We predicted that the qualitative aspects of telework, direction of work-life conflict, and telepressure would influence whether telework decreases work-life conflict. To test these predictions, data from a sample of 328 workers enrolled in the online subject recruitment platform, Prolific, were collected three times, with a one-month interval between each data collection. The analysis, based on these data, revealed that the qualitative aspects of telework had no impact on the relationship between telework and work-life conflict. In addition, telework was significantly related only to work-to-life conflict, but not life-to-work conflict. Finally, the moderating effect of telepressure was significant, such that the positive impact of telework on work-life conflict was found only for people reporting low telepressure. Based on the research findings, theoretical and practical implications were discussed.

Waveguide-Integrated PdSe2 Photodetector over a Broad Infrared Wavelength Range

Hybrid integration of van der Waals materials on a photonic platform enables diverse exploration of novel active functions and significant improvement in device performance for next-generation integrated photonic circuits, but developing waveguide-integrated photodetectors based on conventionally investigated transition metal dichalcogenide materials at the full optical telecommunication bands and mid-infrared range is still a challenge. Here, we integrate PdSe₂ with silicon waveguide for on-chip photodetection with a high responsivity from 1260 to 1565 nm, a low noise-equivalent power of 4.0 pW·Hz^-0.5, a 3-dB bandwidth of 1.5 GHz, and a measured data rate of 2.5 Gbit·s^-1. The achieved PdSe₂ photodetectors provide new insights to explore the integration of novel van der Waals materials with integrated photonic platforms and exhibit great potential for diverse applications over a broad infrared range of wavelengths, such as on-chip sensing and spectroscopy.

Performance of an all-links MIMO-OSTBC mixed underlay cognitive RF/FSO system

This paper presents a new model, to the best of our knowledge, of a mixed underlay cognitive radio frequency (RF)/free space optical (FSO) system in which both RF and FSO links consider multiple-input multiple-output (MIMO) orthogonal space-time block coding (OSTBC). In a dual-hop decode-and-forward configuration, the underlay cognitive radio network RF and FSO links experience κ-μ and Γ-Γ fading, respectively. For the above system model, a closed expression for the outage probability of the mixed underlay cognitive RF/FSO system with MIMO-OSTBC is derived, and the simulation results are verified using the Monte Carlo method. The results show that considering MIMO-OSTBC in all links of the mixed underlay cognitive RF/FSO system can effectively improve the communication performance of the mixed system and alleviate the degradation in the communication quality caused by the atmospheric turbulence. The communication performance of the MIMO-OSTBC mixed underlay cognitive RF/FSO system is further improved by changing the key parameters, such as peak transmit power, fading parameters, the number of secondary user transmit antennas and relay receive antennas, and relative speed of the primary user.

A construction heuristic for the capacitated Steiner tree problem

Many real-life problems boil down to a variant of the Minimum Steiner Tree Problem (STP). In telecommunications, Fiber-To-The-Home (FTTH) houses are clustered so they can be connected with fiber as cost-efficiently as possible. The cost calculation of a fiber installment can be formulated as a capacitated STP. Often, STP variants are solved with integer linear programs, which provide excellent solutions, though the running time costs increase quickly with graph size. Some geographical areas require graphs of over 20000 nodes—typically unattainable for integer linear programs. This paper presents an alternative approach. It extends the shortest path heuristic for the STP to a new heuristic that can construct solutions for the capacitated STP: the Capacitated Shortest Path Heuristic (CSPH). It is straightforward to implement, allowing many extensions. In experiments on realistic telecommunications datasets, CSPH finds solutions on average in time O(|V|²), quadratic in the number of nodes, making it possible to solve 50000 node graphs in under a minute.

Clinical Significance of Prehospital Telecommunication Defined as the Critical Stroke Call Pathway in Acute Ischemic Stroke Requiring Intra-Arterial Recanalization Therapy

BACKGROUND AND PURPOSE

To reduce the door-to-puncture time, which is a prognostic factor for the clinical outcome after intra-arterial recanalization therapy, we established a prehospital telecommunication strategy between neurointerventionalists and emergency medical technicians, namely, the critical stroke call pathway. We retrospectively evaluated the clinical significance of the critical stroke call pathway by comparing the door-to-puncture time and clinical outcome of the critical stroke call pathway with those of the routine stroke pathway.

MATERIALS AND METHODS

From January 2018 to June 2020, one hundred seventy-one patients with anterior circulation occlusion who underwent arterial recanalization therapy via the emergency department were included in this study. Patients were divided into the critical stroke call pathway group (n = 75, 43.9%) and the routine stroke pathway group (n = 96, 56.1%).

RESULTS

The critical stroke call pathway group exhibited a shorter door-to-puncture time than the routine stroke pathway group (median, 87 minutes; interquartile range, 63-107 minutes; P < .001). On multivariable analysis, a good clinical outcome (3-month mRS, 0-2) was independently associated with a shorter door-to-puncture time (adjusted OR, 0.998; adjusted 95% CI, 0.996-1.000; P = .027). In patients with an NIHSS score on admission of ≤11, an excellent clinical outcome (3-month mRS, 0-1) was more frequently achieved in the critical stroke call pathway group than in the routine stroke pathway group (22/33, 66.7%, versus 21/48, 43.8%; P = .042).

CONCLUSIONS

In our study, compared with the routine stroke pathway, the critical stroke call pathway remarkably reduced the door-to-puncture time for arterial recanalization therapy, with better clinical outcomes, especially in patients with a relatively good clinical status.

Towards equitable scheduling of global health teleconferences: a spatial exploration of the world's population and health by time zone

OBJECTIVES

To examine the world's population, development, and health by condensed Coordinated Universal Time (UTC) offset to support a normative position on how to most defensibly schedule global health teleconferences with the primary goal of advancing equitable regard for participants by health condition.

DESIGN

Spatial exploration examined through the lens of equitable regard for participants.

SETTING

The Earth.

PARTICIPANTS

The global population.

MAIN OUTCOME MEASURES

Global population, countries, Human Development Index (HDI), and health measured in total and disease-specific disability-adjusted life years (DALYs) per 100 000 per year by UTC offset. Strengths and weaknesses of scheduling teleconferences accordingly to alternative approaches.

RESULTS

The UTC offset with the largest population of approximately 1 724 million persons occurred in UTC+5, largest country count of approximately 40 countries in UTC+1, and the lowest median HDI of 0.527 occurred in UTC0. The highest median total DALYs per 100 000 per year of 41 873 occurred in UTC+11, highest median HIV/AIDS DALYs per 100 000 per year of 941 in UTC0, and highest median typhoid and paratyphoid fevers DALYs per 100 000 per year of 279 occurred in UTC+5. Hypothetical teleconference scheduling scenarios generated temporal distances of up to 11 hours to UTC offsets representing the most countries and greatest number of DALYs per 100 000 per year. Teleconference scheduling based on egoism was considered to be problematic, and contractualism as unrealistically demanding. Utilitarianism resulted in the risk of systematically disadvantaging small, temporally remote groups. Egalitarianism offered equality, but prioritarianism offered the possibility of addressing health inequities.

CONCLUSIONS

Global health teleconferences may generate great temporal distances between participants compromising representative participation, as well as the well-being of attendees. Our spatial exploration of the world's population and health by UTC offset may be used to support a normative position on scheduling global health teleconferences that enhance progress towards health equity.

A Self-Adapting, Pixelized Planar Antenna Design for Infrared Frequencies

Infrared antennas with reconfigurable characteristics offer several advantages in the medical, military, telecommunication and energy harvesting areas, while their design and implementation is a particularly challenging task for the researchers. This paper proposes a pixel antenna, designed for mid-infrared frequencies with a bandwidth more than 25 THz, consisting of 3 × 3 square metallic planar patches. Bolometer-based switches are placed between the adjacent pixels in order to obtain the adaptable characteristics, optimized for the incoming infrared radiation. The incident wave from a certain direction will heat up the bolometers. Consequently, the conductivity of these bolometers (PTC) will be decreased, and as a result they can be considered to turn to OFF state. The simulation results suggest that the proposed structure can steer the antenna pattern toward the direction of the incident radiation in an adaptable manner, thereby considerably increasing the antenna gain. The gain of the antenna can be increased up to 2 dB with respect to the reference one, which makes it a promising structure for various applications.

Possibilities and challenges in digital personal identification using teledentistry based on integration of telecommunication and dental information: a narrative review

Personal identification using dental evidence is decisive in the case of unidentified bodies because dental features, including decayed, missing and filled teeth, are unique to every individual. This review explored the possibilities and problems associated with personal identification through digital methods by the integration of telecommunications and dentistry, also known as teledentistry. Establishment of a global, objective personal identification method using dental evidence through teledentistry is desirable. However, the review reports that there are various problems that need to be resolved first, in aspects such as changes in dentition over time, technology, individual privacy and ethics. It is suggested that solving such problems and constructing a worldwide dental database for personal identification from dental images, using teledentistry, as part of social services, is a new challenge for researchers in forensic odontology and dentistry.

A Random Subcarrier-Selection Method Based on Index Modulation for Secure Transmission

Recently, a frequency diverse array (FDA) has been employed in an orthogonal frequency division multiplexing (OFDM) transmitter to achieve secure wireless communication without mathematical encryption. However, an insecure coupling effect arises if the frequency increments are linearly assigned to all antenna elements. To solve this problem, random subcarrier-selection methods are proposed; however, the challenge lies in the random selection of subcarriers. Inspired by the randomness of index modulation (IM), this paper proposes a low complexity random subcarrier-selection method based on index modulation (RSCS-IM). Specifically, this work conducted analysis on the spectral efficiency (SE) of our system and the computational complexity of RSCS-IM, which works out a closed-form expression of the BER performance of a desired position and validates the theoretical outcomes through simulation.

A 500-km Cascaded White Rabbit Link for High-Performance Frequency Dissemination

We perform experiments exploring the use of white rabbit precision time protocol (WR-PTP) for time and frequency dissemination over long-distance optical fiber links. We use unidirectional links, to ensure compatibility with active telecommunication networks, and White Rabbit equipment with modifications for improved performance. Using fiber spools, we realize a 500 km, four-span cascaded white rabbit link. We show short term fractional frequency stability of 2×10^-12 , averaging down to 2×10^-15 at one day of integration time, with no frequency shift within the statistical uncertainty. We demonstrate the impact of increasing the White Rabbit SoftPLL bandwidth and the PTP message rate. We show evidence of the effect of thermal fluctuations acting on the fiber, and finally discuss the limitations of the achieved performance. We show comparisons with experimental data acquired with commercial good quality global positioning system (GPS) receivers and show that the medium- and long- term stability and accuracy are more than one order of magnitude better with a WR-PTP link.

Psychological trauma and depression in recovered COVID-19 patients: a telecommunication based observational study

INTRODUCTION

Coronavirus disease 2019 (COVID-19) is adversely affecting the mental health of patients infected with the virus and the psychological impact on recovered COVID-19 patients is unclear.

OBJECTIVES

The study aimed to assess posttraumatic stress disorder (PTSD) and depression among COVID-19 patients after recovery from the disease.

METHODS

This cross-sectional study was conducted from November 9, 2020, to December 23, 2020. The study used a telemedicine model to enroll recovered COVID-19 patients from a database of patients provided by the health authorities. The National Stressful Events Survey PTSD Short Scale (NSESSS) for adults was used to assess PTSD symptoms and the Patient Health Questionnaire (PHQ-9) was used to assess depression.

RESULTS

The study enrolled 503 recovered COVID-19 patients with a mean age of 41.90 years. The majority were asymptomatic (64.6%), while 21.5% had had moderate to severe forms of the disease. Prevalence rates of PTSD symptoms and depression were 56.9 and 29% respectively. COVID-19 patients with severe forms of the disease were significantly more affected by PTSD symptoms (vs. mild, odds ratio [OR] = 18.7, 95%confidence interval [CI] 9.9-35.5) and depression (vs. mild, OR = 19.8, 95% CI 9.9-39.5). Similarly, patients who required oxygen or ventilator support reported significantly higher rates of PTSD symptoms (vs. managed at home, OR = 17.4, 95% CI 8.3-36.4) and depression (vs. managed at home, OR = 22.0, 95% CI 10.1-47.7).

CONCLUSION

This study reports that recovered COVID-19 patients suffered from a significant amount of depression and experienced significant PTSD symptoms. It will help with addressing a major psychological concern among the recovered subjects.

Customer churn prediction for telecommunication industry: A Malaysian Case Study

Background: Customer churn is a term that refers to the rate at which customers leave the business. Churn could be due to various factors, including switching to a competitor, cancelling their subscription because of poor customer service, or discontinuing all contact with a brand due to insufficient touchpoints. Long-term relationships with customers are more effective than trying to attract new customers. A rise of 5% in customer satisfaction is followed by a 95% increase in sales. By analysing past behaviour, companies can anticipate future revenue. This article will look at which variables in the Net Promoter Score (NPS) dataset influence customer churn in Malaysia's telecommunications industry.  The aim of This study was to identify the factors behind customer churn and propose a churn prediction framework currently lacking in the telecommunications industry.   Methods: This study applied data mining techniques to the NPS dataset from a Malaysian telecommunications company in September 2019 and September 2020, analysing 7776 records with 30 fields to determine which variables were significant for the churn prediction model. We developed a propensity for customer churn using the Logistic Regression, Linear Discriminant Analysis, K-Nearest Neighbours Classifier, Classification and Regression Trees (CART), Gaussian Naïve Bayes, and Support Vector Machine using 33 variables.   Results: Customer churn is elevated for customers with a low NPS. However, an immediate helpdesk can act as a neutral party to ensure that the customer needs are met and to determine an employee's ability to obtain customer satisfaction.   Conclusions: It can be concluded that CART has the most accurate churn prediction (98%). However, the research is prohibited from accessing personal customer information under Malaysia's data protection policy. Results are expected for other businesses to measure potential customer churn using NPS scores to gather customer feedback.

Nurses' perspectives of taking care of patients with Coronavirus disease 2019: A phenomenological study

The pandemic of Coronavirus disease 2019 (COVID-19) has brought significant pressure on nurses globally as they are the frontline of care. This study aimed to explore the experiences and challenges of nurses who worked with hospitalised patients with COVID-19. In this qualitative study, a purposive sample of 14 nurses participated in in-depth telephone interviews. Data were analysed using Colaizzi’s phenomenological method. Five key themes emerged: (1) physical and psychological distress of nurses, (2) willingness to work, (3) the essential role of support mechanisms, (4) educational and informational needs of nurses and (5) the role of modern technology in COVID-19 care. Although the provision of care led to physical and psychological distress among nurses, with their commitment and professional obligation, it is a new experience that leads to personal satisfaction. Guilty feeling related to inefficiency of care, witnessing the suffering of patients, discomfort associated with wearing personal protective equipment (PPE), work-related issues (e.g., long hour shifts), negative impact to the family and rejection by others are the leading distress factors. Religious beliefs, including keeping trust in good and bad merits, have become a strong coping mechanism. Addressing distress among nurses is essential. The reported learning needs of nurses included skills related to donning and doffing PPE, skills in performing nursing procedures and breaking bad news. Nurse managers need to pay special attention to expanding training opportunities as well as support mechanisms, for example, welfare, appreciations and counselling services for nurses. Modern technology, particularly robots and telecommunication, can perform an essential role in COVID-19 care. The establishment of timely policies and strategies to protect health workers during a national disaster like COVID-19 is needed.

Telecommunication Facilities, Key Support for Data Management and Data Sharing by a Biological Mobile Laboratory Deployed to Counter Emerging Biological Threats and Improve Public Health Crisis Preparedness

In the case of rapid outbreaks of infectious diseases in remote locations, the lack of real-time information from the field and rapid spread of misinformation can be a major issue. To improve situational awareness and decision-making at all levels of operational deployment, there is an urgent need for accurate, reliable, and timely results from patients from the affected area. This requires a robust and fast channel of communication connecting first responders on-site, crisis managers, decision-makers, and the institutions involved in the survey of the crisis at national, regional, and international levels. This has been the rationale sustaining the development of advanced communication tools in the Biological Light Fieldable Laboratory for Emergencies (B-LiFE). The benefit of terrestrial (TETRA, LTE, 5G, and Wi-Fi-Fi) and SatCom communications is illustrated through a series of missions and exercises conducted in the previous five years. These tools were used by B-LiFE operators to provide accurate, comprehensive, timely, and relevant information and services in real time. The focus of this article is to discuss the development and benefits of the integration of multi-mission, multi-user nomadic, rapidly deployable telecommunication nodes for emergency uses (TEN) in the capacity of B-LiFE. Providing reliable communication channels through TEN enables the development and use of an ICT toolbox called MIML_LIMS (multi-institution, multi-mission, multi-laboratory LIMS), a tool which is mandatory for efficient and secure data management and data sharing by a mobile laboratory.

Remote training for combat medics during the COVID-19 era: lessons learnt for future crises?

BACKGROUND

In response to COVID-19, the UK government ordered strict social distancing measures. The UK Armed Forces followed these to protect the force and ensure readiness to respond to various tasking requests. Clinical training has adapted to ensure geographically dispersed medical personnel are trained while social distancing is maintained. This study aimed to evaluate remote training for Combat Medical Technicians, Medical Assistants and Royal Air Force Medics (CMTs/MAs/RAFMs) during the COVID-19 pandemic and the views of trainers on how this should be delivered now and in the future.

METHODS

A mixed quantitative and qualitative survey study was conducted to determine the experiences of a sample of Defence Medical Services personnel with remote training during the COVID-19 pandemic. Medical and nursing officers involved in teaching CMTs/MAs/RAFMs were eligible to participate.

RESULTS

There were 52 survey respondents. 78% delivered remote training to CMTs/MAs/RAFMs, predominantly using teleconferencing and small-group webinars. 70% of respondents report CMTs/MAs/RAFMs received more training during the COVID-19 pandemic than before. 94% of respondents felt webinar-based remote training should continue after COVID-19. The perceived benefits of webinar-based training included reduced travel time, more training continuity and greater clinical development of learners.

CONCLUSIONS

The challenge of continuing education of medical personnel while maintaining readiness for deployment and adhering to the Government's social distancing measures was perceived to have been met within our study sample. This suggests that such an approach, along with clear training objectives and teleconferencing, may enable personnel to deliver high-quality training in an innovative and secure way.

Does a learner-centered approach using teleconference improve medical students' psychological safety and self-explanation in clinical reasoning conferences? a crossover study

During clinical reasoning case conferences, a learner-centered approach using teleconferencing can create a psychologically safe environment and help learners speak up. This study aims to measure the psychological safety of students who are supposed to self-explain their clinical reasoning to conference participants. This crossover study compared the effects of two clinical reasoning case conference methods on medical students’ psychological safety. The study population comprised 4^th-5^th year medical students participating in a two-week general medicine clinical clerkship rotation, from September 2019 to February 2020. They participated in both a learner-centered approach teleconference and a traditional, live-style conference. Teleconferences were conducted in a separate room, with only a group of students and one facilitator. Participants in group 1 received a learner-centered teleconference in the first week and a traditional, live-style conference in the second week. Participants assigned to group 2 received a traditional, live-style conference in the first week and a learner-centered approach teleconference in the second week. After each conference, Edmondson’s Psychological Safety Scale was used to assess the students’ psychological safety. We also counted the number of students who self-explained their clinical reasoning processes during each conference. Of the 38 students, 34 completed the study. Six out of the seven psychological safety items were significantly higher in the learner-centered approach teleconferences (p<0.01). Twenty-nine (85.3%) students performed self-explanation in the teleconference compared to ten (29.4%) in the live conference (p<0.01). A learner-centered approach teleconference could improve psychological safety in novice learners and increase the frequency of their self-explanation, helping educators better assess their understanding. Based on these results, a learner-centered teleconference approach has the potential to be a method for teaching clinical reasoning to medical students.

Technologic optimization of a virtual disease focused panel during the COVID pandemic and beyond

Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity.