Growing research has found that exposing patients to forest landscapes through technology improves their health. However, studies on the effects of nature therapy sessions on particularly vulnerable groups that require frequent regular treatment such as patients of chronic kidney disease (CKD) is lacking. This study aims to understand the effects of watching panoramic videos of forest walks through virtual reality (VR) headsets on patients. We also examine the effects of the frequency of virtual exposure to forests on the physiological and psychological parameters of patients undergoing dialysis. Twenty-four dialysis patients with a mean age of 65.11 year underwent a virtual nature intervention over the course of 3 weeks. The intervention consists of 3 numbers of 6-min 360-degree nature videos delivered using VR headsets. We measured heart rate variability (HRV) and heart rate (HR) using continuous electrocardiographic (ECG) monitoring and assessed their emotional states using a questionnaire survey and in-depth interviews. The results showed that the initial 6 min of watching of the panoramic videos through VR headsets resulted in significantly reduced HR and sympathetic nerve activity and increased positive emotional responses. However, repeated VR exposure did not further improve the physiological health of the respondents. Considering these results, the use of VR headsets to watch 6-min nature videos indoors can be used to enhance the positive psychological responses among dialysis and bed-ridden patients. As this study is preliminary, future random controlled trials are needed to compare and determine the best dose, content, and delivery methods of such an intervention. Chronic kidney disease (CKD) is one of the top global public health concerns affecting about 50 million people . StudiesPatients with CKD are among the most vulnerable for psychological distress and depression . The paiPsychological intervention such as exposure to nature can help relieve chronic patients of anxiety and other negative emotions . The theThe effects of actual nature could be replaced with simulated nature indoors . There iAmong the studies that discussed the psycho-physiological effects of nature by using VR devices , 50, theTo assess the effect of watching 360-degree nature videos on physiological and psychological parameters of dialysis patients, a clinical trial experiment was conducted in the spring of 2021 in the dialysis rooms of Fu Jen Catholic University Hospital, New Taipei City, Taiwan. We focused on hemodialysis patients, as a high percentage of them are afflicted with psychological distress and anxiety and depressive disorders . ConsideFollowing the research protocols from related studies , 53, we Related studies have shown that nature exposure can have psychological benefits on health  and thatDialysis patients usually suffer from both physiological and psychological health problems. Dialysis treatments are usually very repetitive, dull, and slow, leading to patients feeling a sense of emptiness. Oftentimes, patients do not know how to fill that time. In addition, they have to endure physical discomfort during the treatment that causes them inconvenience in their daily lives, which in turn affects their mental health . AccordiThe first stage of the study focused on understanding the preferred outdoor recreational environments and activities of the participants. The interview results were used as a reference for the researchers when selecting the natural environment. In the first stage, the study used photo-elicitation interviews, which were conducted in previous studies –59, to cBambusa oldhamii), Giant Elephant’s Ear [Alocasia macrorrhiza (L.) Schott], and Parasol leaf tree (Macaranga tanarius). We chose three forest trails with similar landscapes. The three trails featured mild slopes that are easily traversable by the general public. Our research assistants filmed these forest trails using panoramic cameras and a handheld stabilizer. The camera stabilizer could absorb bumps and shakes if the camera was jostled or moved over uneven surfaces to ensure that the shots still appeared smooth. The videos were shot at a height of 165 cm and a walking speed of 3 km/h, mimicking a recreational hiking experience wherein a person may slow down and pause along the trail. However, designated still shots were not included in the videos. The video photographers also put the camera in front of them so that they themselves would not appear in the videos and possibly distract the patients. To avoid any people from appearing in these videos, we asked trail users to wait for a few minutes and kept a distance from these people as much as possible (at least 50 m) before shot these videos so that there were no people in these videos. After the videos were shot, video stitching editing was used to stabilize the image and minimize any shaking. Finally, three panoramic videos featuring similar landscapes (mild forests with slopes) were made. Each of the videos had a duration of about 2 min. The three videos were combined into 1 number of 6-min 360-degree video in this study. To avoid the influence of other attractive landscape elements on the psychological response of the subjects, trails with bodies of water, such as lakes and streams, were excluded from the study. In addition, to minimize the influence of varying ambient and atmospheric conditions such as sunlight, the study was conducted between 11 a.m. and 3 p.m., excluding rainy and cloudy days.Based on the interviews and the purpose of the study, the research team selected three trails within the same area of a forest close to suburban areas as the focus of the panoramic video . The stuvia a short interview conducted by research fellows and a confirmation by a clinical research nurse on each participant’s health condition.In preparation for this experiment, the patient volunteers were asked to avoid any unusual medications and alcohol in the 24 h before each experiment session. If they had to take medication, the researcher had to be informed first to facilitate the assessment of suitability for study participation. While all the participants were not habitual smokers, they were all requested to not smoke or consume caffeine in the 2 h prior to the experiment; this was done after we consulted with a nephrologist about the anxiety situation if participants were asked not to smoke or drink coffee. The participants were also asked to avoid using the toilet during the experiment. The status of most of these potential momentary confounders was rechecked at the beginning of the experiment The experiment was conducted every morning starting at 8 a.m. At the beginning of the experiment, the nurse helped research fellows confirm the mental health condition of all participants. As dialysis patients are on hemodialysis for 4 h at a time, they usually start feeling anemic and dizzy by the third to fourth hour. Data collection was mainly done during the first hour of the treatment period, taking into account the physical condition of a patient. First, the patient volunteer was equipped with a portable ECG device and then a VR headset. After the participant had rested for at least 5 min T0, , their HIn this study, personal background information including age, work status, and experience with VR equipment was obtained during the experimental phase of the panoramic video. Patient volunteers were asked to answer the MMSE questionnaire, which served as a measure for self-perceived mental health . Both thHeart rate variability measures were used to express the interaction between the sympathetic and parasympathetic nervous systems with reference to cardiovascular function. In brief, the sympathetic nervous system is described as dominant in times of anxiety, while the parasympathetic nervous system is dominant in periods of relaxation . HRV parThe overall experimental duration for wearing the sensors was 23 min (T0–T3), the 5 min (T0) of wearing it at the beginning was not included in data analysis. Given that HRV signals can contain disturbances of technical (poorly attached electrodes) or physiological origin (ectopic beats) , data prWe used the PAD emotional state model to measure the psychological response from the participants. The PAD emotional state model was proposed by Mehrabian . The modT-test among the means before and after the VR nature experience; this simplified version of three questions related to the PAD emotion scale was then used .p < 0.05 level. All statistics were performed in IBM SPSS Statistics 24.0 .The data analysis included changes in physiological and psychological data. Physiological changes in the continuous measurement (HR and the HRV parameters) were calculated by comparing the mean values of the pre-experiment period (T1), mid-experiment period (T2), and post-experiment period (T3). The repeated measures ANOVA was used to analyze the statistical significance of physiological changes in the outcome variables before, during, and after the video watching per experiment. Two-way repeated measures ANOVA was used to analyze the statistical significance of the data before and after the video watching among three experiments. Meanwhile, the psychological changes were analyzed by the weekly PAD emotional state model questionnaire. Descriptive statistics were used to understand the mean and standard deviation of emotional states. The repeated measures ANOVA was used to analyze the differences in the PAD emotional states of the subjects each week. Significance for the repeated measures ANOVA was considered at the Initially, 26 participants were enrolled in this 3-week experiment, including 15 females and 11 males. The mean age was 65.11 years. A total of 9 were employed, while the other 17 were unemployed. None of the participants had had any experience with VR headsets and panoramic videos prior to the experiment in this study. All participants completed the experiment during the first and second weeks. The HRV equipment malfunctioned for 2 of the participants in the first week, preventing the collection of physiological values and resulting in the sample data of these 2 participants being deleted, thus leaving 24 samples. The same incident recurred in the second and third weeks for 1 of the participants, finally leaving only 23 samples.This study aimed to discuss the effects of VR experience on the level of stress measured using HR and the power of HRV. We also compared the differences in HR and HRV parameters from the first to the third week through the repeated measures ANOVA. As to the changes of physiological parameters, the descriptive statistics showed that the VR nature experience have positive influence on HR and HRV parameters. The subjects’ physiological data showed a slight decrease in HR value before and after watching the video each week, while all HRV values were slightly increased in each week –9, thus M = 3.69) and dominance the lowest (M = 3.18) among the weekly averages.We also measured the average changes in the PAD emotional states after experiencing VR for 3 weeks. F = 3.669; P = 0.033]. The HR value after video-watching (Mean = 70.97) was significantly lower than the value before video watching (Mean = 72.11). In Week 3, the HR values were significantly different among the phases before and after video-watching . The HR value during video-watching (Mean = 73.14) was significantly lower than that before video watching (Mean = 73.80).To compare the differences among the three phases each week and understand the effect of the experience on physiological response, repeated measures ANOVA was used. The statistical results showed that the immersive experience of VR has a significant effect on HR among the phases before and after video-watching in Week 1, and there is also a significant effect on HR among phases before and during video-watching in Week 3. In Week 1, the HR value were significantly different among the phases before and after video-watching [M = 84.21) was significantly lower than that before video-watching (M = 116.23)  . In the F = 4.361; p = 0.020 < 0.050; Additionally, we presume that there was significant difference of HR and HRV parameters between the mean of the phase before and after the video-watching. We thus used the two-way repeated measures ANOVA to test the significant difference of the HR and HRV mean before and after video watching among 3 weeks. The statistical results showed that the interaction of phase and time have significant effort on the difference of HR value between the phase before and after video watching among 3 weeks . Above all, the arousal dimension value in Week 1 was the lowest (Mean = 3.35), while in Week 2 it was the highest (Mean = 3.65). The pleasure and dominance mean scores were the highest in Week 1  and then gradually decreased with increasing frequency over the 3-week period “The video feels similar to the walking I used to do.” —P4 (Week 1)“I like that it feels like I am walking really. The trees and water in the video are very nice, as well the call of the insects and birds.” —P5 (Week 1)“It was good that some videos were interspersed with specific spots or walking content.” —P6 (Week 1)“I don’t go out much anymore, so watching these videos has triggered my desire to go out and take a walk.” —P14 (Week 2)“The images are very realistic and are similar to my own experience of going out for a walk. Sometimes they are exactly the same.” —P16 (Week 2)Most of the patients who were willing to be interviewed responded positively to the experience. Only a few felt dizzy after wearing the VR headset or began to experience other uncomfortable physical sensations after wearing it a few times. In addition, some respondents thought that just experiencing a walk in the forest was a bit boring. These factors resulted in a small number of respondents feeling bored after repeated exposure to the scene, which has been discussed in the section on limitations of this study.“The picture is a little too close to the screen. It makes me feel a little discomfort.” — P1 (Week 3)“The walking pace in the video is a bit slow, which is different from my walking speed. If I watch too long, I’ll feel dizzy.” —P5 (Week 3)“I feel like I’m walking every week, so I don’t get to interact with other people. It makes me feel a bit lonely and bored.” — P18 (Week 3)“I feel like there is no interaction after watching for a long time. The equipment is heavy, and I get a little dizzy.” —P20 (Week 3)The current study aims to understand the effect of watching 360-degree nature videos with VR devices and confirm the influence of duration and frequency of VR nature exposure on health outcomes. Lanki et al.  found thThe results showed a significant decrease in HR between the phases before and after the experience in Week 1. It means that short-term watching of 360-degree video with VR headsets could help reduce stress during a dialysis procedure. However, changes in HRV parameters were not significant in Week 1. Briki and Majed  revealedOur study highlighted the short-term health benefits that patients who were undergoing dialysis treatment received from watching panoramic nature videos using a VR device. However, our study still showed that repeated weekly watching of videos in a dialysis room did not have a positive influence on health and wellbeing. The change in the psychological responses in our study also revealed that the second and third watching did not have an effect on mental health. In the first week of the experiment, the participants registered the highest pleasure and dominance scores toward the panoramic nature video; however, after the experiment in the third week, pleasure and dominance emotion declined to their lowest points. Only the arousal feeling increased progressively with the experiments over three weeks. Furthermore, the interviews with participants also showed that they experienced the most positive responses from the experiment in first week. Most of the negative responses were brought up from the experiment in Week 3. Above all, our study provided admissible evidence that short-term watching of 360-degree nature videos has a benefit on mental health as found in similar studies , 84, whiThe current study adds to previous research in three ways. First, we included patients undergoing dialysis of both sexes with a mean age of 65.11 years. Other studies have focused on healthier, happier subjects such as students , young mWhile this study deepens our understanding of the potential value of VR nature to health and wellbeing, the results are preliminary and need to be interpreted with caution. First of all, this study employs a within-subject design and does not involve a control group. This is due to the challenges involved in recruiting patients receiving hemodialysis treatment who are willing to participate in this study during the same timeframe. Future studies can include a control group with no video watching, or viewing a barren or other types of VR scene, to strengthen the results.Second, we encountered participant drop-out issues during the experiment. Previous studies , 54 indiThird, this study aims to establish preliminary evidence regarding physiological and psychological response from patients receiving repeated 360-degree video intervention over the course of 3 weeks. As such, it was vital that participants watched the same video three separate times, so that we could accurately compare the physiological and psychological responses each time. However, as the results suggested, repeated exposure to the same video might result in the patients feeling accustomed to it or less engaged, leading to reduced effects. As this is a limitation that requires attention for all interventions with immersive technology, programmed variations that better mimic the unexpected encounters in actual green space may be helpful. Therefore, building on our results, future studies may need to consider qualitative differences in the VR nature experience to alleviate the fatigue issue.Additionally, although measures were taken to stabilize the video during shooting and processing, a few participants still reported discomfort wearing the headset or dizziness during the viewing. Such discomfort has been recognized in VR-based studies, which may be due to sensory conflicts. The nature intervention selected in this study is a mild hiking experience based on preference survey, which may be related to the reported dizziness issue and therefore involved forward movement and vertical movement at times.Finally, hemodialysis patients have to receive treatment twice a week under normal conditions. The experiment could be performed within 2 weeks ideally. Due to limitations in terms of staff, time, and restrictions due to the pandemic, the number participants who were available for a fixed period of time within 2 weeks was very few. We had to extend the experiment period to 3 weeks, which made it hard to control for the impact of social context conditions on health response. According to other study protocols , 85, we This study investigated the effects of short-term exposure to nature videos through a VR experience on physiological and psychological health parameters of patients undergoing dialysis. We found decreases in HR and LF parameters in the first 2 weeks, indicating potentially positive effects on cardiovascular health. However, we found slight increases in HF parameters after watching the same 360-degree nature video in 3 weeks. indicating adverse effects on cardiovascular health as well as detrimental effects on the effectiveness of preventive measures.We proved that watching the 360-degree nature video with VR headsets for 6 min could provide short-term physiological and psychological health benefits for hemodialysis patients. Related studies , 29 haveOn an individual level, adopting a lifestyle of spending time in nature is generally related to the hobby development of outdoor recreational activities of dialysis patients who are usually affected by the accessibility and size of green spaces near urban areas. The reserve of large-scale public green areas such as urban forests or forest parks is essential for the development of urban and health care. Thus, medical therapy units could have the chance to provide a technical nature experience for patients with dialysis to increase their intentions toward nature exposure. Future work could concentrate on the creation of technological nature and the identification of specific natural elements such as water, trees, grasslands, and mountains that would attract dialysis patients, allowing them to be physically active and reduce anxiety while undergoing a dialysis procedure . All of The original contributions presented in this study are included in the article/The studies involving human participants were reviewed and approved by the Institutional Review Board (IRB) of Fu Jen Catholic University (Project No. C108015). The patients/participants provided their written informed consent to participate in this study.C-HH: conceptualization, methodology, formal analysis, investigation, validation, data curation, writing original draft, project administration, and funding acquisition. DL: review and editing original draft. Both authors contributed to the article and approved the submitted version.


What is the association between video gaming and cognition in children?As part of the national Adolescent Brain Cognitive Development study and after controlling for confounding effects, results of this case-control study of 2217 children showed enhanced cognitive performance in children who played video games vs those who did not. Clear blood oxygen level–dependent signal differences were associated with video gaming in task-related brain regions during inhibition control and working memory.These findings suggest that video gaming may be associated with improved cognitive abilities involving response inhibition and working memory and with alterations in underlying cortical pathways. This case-control study of children who played and did not play video games examined whether video gaming had a beneficial or detrimental association with cognitive abilities. Although most research has linked video gaming to subsequent increases in aggressive behavior in children after accounting for prior aggression, findings have been divided with respect to video gaming’s association with cognitive skills.To examine the association between video gaming and cognition in children using data from the Adolescent Brain Cognitive Development (ABCD) study.In this case-control study, cognitive performance and blood oxygen level–dependent (BOLD) signal were compared in video gamers (VGs) and non–video gamers (NVGs) during response inhibition and working memory using task-based functional magnetic resonance imaging (fMRI) in a large data set of 9- and 10-year-old children from the ABCD study, with good control of demographic, behavioral, and psychiatric confounding effects. A sample from the baseline assessment of the ABCD 2.0.1 release in 2019 was largely recruited across 21 sites in the US through public, private, and charter elementary schools using a population neuroscience approach to recruitment, aiming to mirror demographic variation in the US population. Children with valid neuroimaging and behavioral data were included. Some exclusions included common MRI contraindications, history of major neurologic disorders, and history of traumatic brain injury.Participants completed a self-reported screen time survey including an item asking children to report the time specifically spent on video gaming. All fMRI tasks were performed by all participants.Video gaming time, cognitive performance, and BOLD signal assessed with n-back and stop signal tasks on fMRI. Collected data were analyzed between October 2019 and October 2020.A total of 2217 children  participated in this study. The final sample used in the stop signal task analyses consisted of 1128 NVGs (0 gaming hours per week) and 679 VGs who played at least 21 hours per week. The final sample used in the n-back analyses consisted of 1278 NVGs who had never played video games (0 hours per week of gaming) and 800 VGs who played at least 21 hours per week. The VGs performed better on both fMRI tasks compared with the NVGs. Nonparametric analyses of fMRI data demonstrated a greater BOLD signal in VGs in the precuneus during inhibitory control. During working memory, a smaller BOLD signal was observed in VGs in parts of the occipital cortex and calcarine sulcus and a larger BOLD signal in the cingulate, middle, and frontal gyri and the precuneus.In this study, compared with NVGs, VGs were found to exhibit better cognitive performance involving response inhibition and working memory as well as altered BOLD signal in key regions of the cortex responsible for visual, attention, and memory processing. The findings are consistent with videogaming improving cognitive abilities that involve response inhibition and working memory and altering their underlying cortical pathways. Most psychological and behavioral studies2 suggest detrimental associations of video gaming, linking it to subsequent increases in depression, violence, and aggressive behavior in children after accounting for prior aggression. However, researchers have been divided with respect to whether playing video games is associated with cognitive skills and brain function. In contrast to the negative associations with mental health, video gaming has been proposed to enhance cognitive flexibility by providing skills that can be transferred to various cognitive tasks relevant for everyday life. One formulation for this broad transfer is that video gaming shares a number of perceptual and attentional demands  with common cognitive tasks and can enhance reaction time (RT), creativity, problem solving, and logic.4Ask any parent how they feel about their child’s videogaming and you'll almost certainly hear concerns about hours spent in a virtual world and the possibility of adverse effects on cognition, mental health, and behavior. A contributing factor to these concerns is the growth of video gaming within the last 20 years. In tandem, the demographic makeup of gamers has also been rapidly changing. In children aged 2 to 17 years, a large 2022 survey in the US showed that 71% play video games, an increase of 4 percentage points since 2018.3 gaming was found to be associated with attentional benefits including improvements in bottom-up and top-down attention, optimization of attentional resources, integration between attentional and sensorimotor areas, and improvements in selective and peripheral visual attention. Video gamers (VGs) may also benefit from an enhanced visuospatial working memory capacity according to Boot et al,5 who found that VGs outperformed non-VGs (NVGs) on various visuospatial working memory tasks, such as multiple object tracking, mental rotation, and change detection. Working memory improvements were similarly found after video game training in experimental vs control group research designs.7 This finding is consistent with other studies suggesting that even short video game training paradigms can enhance cognitive control–related functions for long durations, such as reading abilities in dyslexic children8 and, more particularly, working memory.3In a previous review investigating video gaming and cognitive tasks,11 have compared brain activity between VGs and NVGs. When presented with a complex visuomotor task, Granek et al4 found that VGs exhibited more blood oxygen level–dependent (BOLD) activity in the prefrontal cortex but less overall brain activity compared with NVGs. In 1 study using an fMRI attentional letter detection task, Richlan et al9 found no significant behavioral performance differences between 14 VGs and 14 NVGs, but VGs showed more brain activation in multiple frontoparietal regions and different activation patterns, suggesting that VGs may recruit different regions of the brain to perform attentional tasks. In the same study,9 no differences between the 2 groups were observed during a working memory visuospatial task in overall performance (in accuracy or RT) or in brain activation. In a more recent study, Trisolini and colleagues10 investigated sustained performance between VGs and NVGs in 2 attentional tasks. The results indicated that although VGs displayed significantly stronger performance at the beginning of the task, a substantial decrease in performance was observed over time. By the end of the task, NVGs performed more accurately and quicker. Moreover, in a study11 investigating the short-term impact of different activities performed during a break before an n-back working memory test in an fMRI scan, 27 young adults who played video games during the break displayed poorer working memory task performance and less BOLD activity in the supplementary motor area compared with those who had listened to music. However, VGs showed neither performance nor BOLD differences compared with those who spent the break resting. The authors reasoned that the video-gaming demands may have fatigued specific cognitive resources that rely on the supplementary motor area and reduced the ability of VGs to focus attention on the subsequent working memory task.11 This finding is in contrast with another study3 that suggested that even short video game training paradigms can enhance cognitive control–related functions, particularly working memory, with the enhancement linked to activity changes in prefrontal areas, such as the dorsolateral prefrontal cortex and the orbitofrontal cortex.Task-based functional magnetic resonance imaging (fMRI) studies12 the largest long-term study of brain development and child health in 21 research sites across the US. We hypothesized, based on the literature, that VGs would perform better on the tasks and have altered cortical activation patterns compared with NVGs in key areas of the brain involved in inhibitory control and working memory.In brief, although several studies have investigated the association between video gaming and cognitive behavior, the neurobiological mechanisms underlying the associations are not well understood because only a handful of neuroimaging studies have addressed this topic. In addition, findings from fMRI studies on video gaming in children and adolescents have not been replicated, which could be in part attributable to the relatively small sample sizes included in the analyses (N<80). In this study, we assess video-gaming associations with cognitive performance and brain activation during response inhibition and working memory using task-based fMRI in a large data set of 9- and 10-year-old children from the Adolescent Brain Cognitive Development (ABCD) study,5 The fMRI paradigms were preprocessed with standard automated pipelines using Analysis of Functional NeuroImages and included the stop signal task (SST) and the n-back task. Children were asked to report how many hours per week they play video games on a computer, console, smart phone, or other devices. Consent (parents) and assent (children) were obtained from all participants. The ABCD study was approved by the appropriate institutional review boards: most ABCD research sites rely on a central Institutional Review Board at the University of California, San Diego for the ethical review and approval of the research protocol, with a few sites obtaining local IRB approval.This case-control study used data from the baseline assessment of the ABCD study 2.0.1 release in 2019, which recruited a large sample of 9- to 10-year-old children from whom neuroimaging and behavioral data were acquired and quality controlled according to standard operating procedures for the ABCD study consortium.14 by using epidemiologically informed procedures to ensure demographic variation in its sample that would mirror the variation in the US population of 9- and 10-year-olds.15 A probability sampling of schools was conducted within the defined catchment areas of the study’s nationally distributed set of 21 recruitment sites in the US. All children in each sampled school were invited to participate after classroom-based presentations, distribution of study materials, and telephone screening for eligibility. Exclusions included common MRI contraindications , inability to understand or speak English fluently, uncorrected vision, hearing or sensorimotor impairments, history of major neurologic disorders, gestational age less than 28 weeks, birth weight less than 1200 g, birth complications that resulted in hospitalization for more than 1 month, current diagnosis of schizophrenia, moderate or severe autism spectrum disorder, history of traumatic brain injury, or unwillingness to complete assessments. The ABCD study sample also includes 2105 monozygotic and dizygotic twins. The ABCD study’s anonymized data, including all assessment domains, are released annually to the research community. Data on race and ethnicity are not included in the ABCD study data. Information on how to access ABCD study data through the National Institute of Mental Health Data Archive is available on the ABCD study data-sharing webpage.16The ABCD sample was largely recruited through public, private, and charter elementary schools. The ABCD study adopted a population neuroscience approach to recruitment17 which recommends that video-gaming time be limited to 1 to 2 hours per day for older children.Participants were administered a screen time survey that asked how much time they spend engaged in different types of screen time on a typical weekday and a typical weekend day. The different screen time categories were as follows: “Watch TV shows or movies?”; “Watch videos (such as YouTube)?”; “Play video games on a computer, console, phone, or other device ?”; “Text on a cell phone, tablet, or computer ?”; “Visit social networking sites like Facebook, Twitter, Instagram, etc?”; and “Video chat ?” For each of these activities, the participants responded with how much time they spent per day doing them. They could answer none, less than 30 minutes, 30 minutes, 1 hour, 2 hours, 3 hours, or 4 hours. Answers were mostly none for the texting, social networking, and video chatting categories, as expected for this age range. For each participant, a total weekly video-gaming score was derived as the sum of (video-gaming hours per weekday × 5) + (video-gaming hours per weekend day × 2). A total weekly watching videos score was also derived for each participant. Using the video-gaming score, we defined a group of NVGs who never played video games (0 gaming hours per week) and a group of VGs who played 3 hours per day (21 hours per week) or more. This threshold was selected because it exceeds the American Academy of Pediatrics screen time guidelines,z scores . IQ scores were derived from the National Institutes of Health Toolbox cognition battery19 as the mean of crystalized intelligence and fluid intelligence composite, age-corrected scores. Demographic characteristics were compared between VGs and NVGs using a 2-tailed t test except for sex, which was compared using a χ2 test (The child’s age and sex were reported by the parent at the baseline assessment. A trained researcher measured children’s height (to the nearest inch) and weight (to the nearest 0.1 lb). Height and weight were assessed 2 times, and means were recorded. Height and weight were converted to body mass index (BMI) age-, sex-, weight-, and height-specific  χ2 test .20 Raw scores of behavioral  and psychiatric categories  were compared between VGs and NVGs using a 2-tailed t test.Mental health symptoms were evaluated using the Child Behavior Checklist (CBCL).21 with the multiple scanner systems of participating sites.22 High spatial and temporal resolution simultaneous multislice and multiband echo-planar imaging task-based fMRIs, with fast integrated distortion correction, were acquired to examine functional activity. For the 3-T scanners (Siemens and GE), the scanning parameters were as follows: matrix, 90 × 90; 60 slices; field of vision, 216 × 216; echo time/repetition time, 800/30 milliseconds; flip angle, 52°; and resolution, 2.4 × 2.4 × 2.4 mm. The fMRI acquisitions (2.4-mm isotropic with repetition time of 800 milliseconds) used multiband echo-planar imaging with slice acceleration factor 6. The order of fMRI tasks was randomized across participants. The fMRI preprocessing pipeline included a within-volume head motion estimation and correction and a correction for image distortions. Estimates of task-related activation strength were computed at the individual participant level using a general linear model implemented in Analysis of Functional NeuroImages 3dDeconvolve, with additional nuisance regressors and motion estimates. Hemodynamic response functions were modeled with 2 parameters using a γ-variate basis function plus its temporal derivative.The ABCD imaging protocol was designed to extend the benefits of high temporal and spatial resolution of imaging protocols of the Human Connectome Project23 Quality control criteria included excluding participants based on poor image quality, motion, or task performance. The full details of the tasks and fMRI acquisition, preprocessing, and quality control are described in the eMethods in the 21The SST and n-back task were selected from the ABCD imaging battery to probe inhibitory control and working memory, respectively. Participants practiced the 2 tasks before scanning to ensure they understood the instructions and were familiar with the response collection device. These 2 tasks yield robust neural activation patterns as demonstrated previously.23), which was used as the performance variable in analyses that assessed individual differences in response inhibition ability. The SSRT was computed by subtracting the median stop signal delay of all successful stop trials from the nth percentile go RT, where n represents the percentage of successful inhibitions . To evaluate behavioral task performance in the n-back task, D'  was computed for both the 2-back and 0-back conditions by calculating each participant’s hit rate (the proportion of targets for which the participant correctly indicated a match) and the false alarm rate (the proportion of nontargets for which the participant incorrectly indicated a match or did not respond). The hit and false alarm rates were then z transformed.The adaptive algorithm used in the SST allowed for calculation of the stop signal RT  mean framewise displacement less than 0.9 mm for both runs, (6) met task-specific performance criteria .Participants were included if they had (1) 2 fMRI runs per task, (2) cortical vertex and subcortical voxel data available at the time of analysis, (3) hemispheric mean BOLD signal within 2 SDs of the sample mean for each task, (4) at least 200 2 tests were used to compare the demographic characteristics between NVGs and VGs. The Permutation Analysis of Linear Models (PALM) general linear model26 was used to run vertexwise permutation analyses comparing cortical task-specific BOLD signal between NGVs and VGs for correct stop vs correct go and incorrect stop vs correct go conditions of the SST, as well as 0-back vs fixation and 2-back vs fixation conditions of the n-back test, with age (months), sex, scanner serial number, IQ, puberty, and combined parental income included as nuisance covariates. The analyses accommodated the nonindependence of the participants by incorporating information on sibling status as a nested covariate in the model using PALM’s exchangeability blocks,27 which restrict the shuffling to only occur among the observations that share the same family index, that is, within-block only. In addition, performance measures, including SSRT and correct go RT in the SST as well as D′ and correct RT in the n-back, were compared between NVGs and VGs using analysis of covariance . All statistical tests were 2-sided. False discovery rate–corrected P values and statistical maps were considered significant at P < .05.Collected data were analyzed between October 2019 and October 2020. Analysis of variance and χ20 as the sum of the scores of all of the problem and psychiatric items, respectively. The model was specified in R software, version 4.0.4  using the structural equation modeling package lavaan,28 version 0.6-7. The direct effect of video gaming on BOLD signal (parameter b1) served to check whether any initial association remained significant after controlling for the covariates. This determination was accomplished by letting each covariate predict both video gaming and BOLD signal such that each covariate could have direct effects (represented as b2 and b3) as well as an indirect effect on BOLD signal via video gaming (b1 × b2)  . In thisA total of 2217 children  participated in this study . The fint scores from the CBCL showed that none of the measures in either group was high enough to reach clinical significance.The NVG vs VG between-group comparisons showed that groups did not differ on age, BMI, or IQ, but gamers were disproportionately male and had less combined parental income . AlthougP < .001). Analysis of covariance tests compared task performance measures between NVGs and VGs, with age, sex, IQ, scanner, sibling status, and combined parental income included as covariates. Analyses showed that video gaming was associated with improved performance in the SST and n-back tasks (P = .006). Following a similar pattern, 0-back D'  and 2-back D′  measures of the n-back task were significantly higher in VGs relative to NVGs (P = .001) , with a mean (SD) rate of correct inhibitions of 51.4% (0.06%). The distributions for D′ were as expected, with children performing better on the 0-back task (mean [SD] D′ = 2.51 [0.9] mmilliseconds) than the 2-back task (mean [SD] D′ = 2.0 [0.3] milliseconds) (ck tasks  and not  = .001) .In the correct stop vs correct go condition of the SST, vertexwise analyses showed significantly greater BOLD signal in VGs compared with NVGs in the bilateral precuneus . No signP < .05. Similar patterns of BOLD differences between VGs and NVGs were observed in male and female groups examined separately. No significant differences were observed in the 0-back vs fixation condition of the n-back task.In the 2-back vs fixation condition of the n-back task, a significantly greater BOLD signal was observed in VGs compared with NVGs in bilateral parts of the dorsal posterior cingulate gyrus, subparietal cortex, middle and superior frontal gyri, and precuneus . MeanwhiP ≤ .001). However, video watching and total behavioral and psychiatric problems did not have significant direct (b3), indirect (b1 × b2), or total ([b2 × b1] + b3) effects on the BOLD signal in either model. Of importance, the direct effect of video gaming on the BOLD signal remained significant in both models.The two structural equation models (for the SST and n-back task) showed good fits with root mean square error of approximation less than 0.04, a comparative fit index greater than 0.9, and Tucker-Lewis Index greater than 0.9. Video watching was positively associated with video gaming for both models . The behavioral performance findings in the n-back task are also in accordance with previous studies showing enhanced visuospatial working memory performance in VGs compared with NVGs33 and in experimental vs control groups after video game training sessions.34 In both tasks, the significantly shorter RTs in VGs compared with NVGs while simultaneously performing more accurately may reflect improved cognitive skills acquired through video gaming and not caused by impulsive responding. According to a previous EEG study,35 earlier latencies in the visual pathways are another feature found in VGs, which may contribute to faster RTs in visual tasks after years of practice. The enhanced cognitive performance on both the SST and n-back task is supported by previous studies showing that VGs outperform NVGs on a range of cognitive tasks36  and on crystallized and fluid intelligence measures assessed via the Youth National Institutes of Health Toolbox.37 In addition, supporting our findings, research on video game training in groups of NVGs using action video games  demonstrated that video game training consistently led to transferrable improvements in cognitive performance.38The behavioral performance findings in the SST sample are in line with the behavioral findings of the studies by Chisholm et al3 in children and young adolescents using response inhibition tasks showing more activation in VGs in parietal areas of the cortex, including the precuneus. More broadly, the findings agree with the evidence that VGs display enhanced overall recruitment in a range of attentional control areas during response inhibition tasks.3 Of interest, in a previous study39 investigating changes in resting state functional connectivity after video game practice in young participants using a test-retest design, the key finding was increased correlated activity during rest in the precuneus, suggesting that this area exhibits a practice effect associated with the cognitively demanding video games.39 Advantages for VGs in various attention-demanding tasks have also been reported by Cardoso-Leite et al.40 Moreover, in line with our findings, an electroencephalography study41 showed that heavy-use VGs had larger event-related potential amplitudes relative to NVGs in response to numerical targets under high load conditions, suggesting that heavy-use VGs may show greater sensitivity than NVGs to task-relevant stimuli under increased load, which in turn may underpin greater BOLD changes and improved behavioral performance compared with mild-use VGs and NVGs.The imaging findings showing a greater BOLD signal associated with video gaming during the SST in the precuneus—a brain region involved in a variety of complex functions including attention, cue reactivity, memory, and integration of information—are consistent with previous fMRI studies33 that used a visuomotor task and showed less activation in occipitoparietal regions in VGs and improved visuomotor task performance; these findings suggest a reduction in visuomotor cognitive costs as a consequence of the video gaming practice. In addition, in line with our results, Granek et al,4 using an increasingly complex visuomotor fMRI task, observed greater prefrontal activation in 13 VGs who played a mean (SD) of 12.8 (8.6) hours per week during the preceding 3 years compared with 13 NVGs, which the authors related to the increased online control and spatial attention required by VGs for processing complex, visually guided reaching. Similarly, Gorbet and Sergio42 found that VGs showed less motor-related activity in the cuneus, middle occipital gyrus, and cerebellum, which they explained as an indicator that VGs have greater neural efficiency when conducting visually guided responses. In addition, previous fMRI research has found significantly greater activation related to video gaming in regions associated with working memory, including the subparietal sulcus and the precuneus.44 In a more recent study,45 changes in BOLD signal in the subparietal lobe, precentral gyrus, and precuneus from before to after training using a video game with a working memory component predicted changes in performance in an untrained working memory task, suggesting a practice-induced plasticity in these regions.Our finding of less activation in VGs in occipital areas while performing better on the n-back task is consistent with a previous fMRI studyAlthough video watching is highly confounded with video gaming in our fMRI samples, our models indicate that the response inhibition and working memory effects remained significant when controlling for video watching , suggesting that the observed BOLD alterations in the SST and n-back task are more specific to video gaming than video watching. This finding is important because it suggests that children must actively engage with a video’s content, as opposed to passively watching a video, to exhibit altered brain activation in key areas of the brain involved in cognition.46 because they do not all equally involve interactive  and executive function processes. In addition, single vs multiplayer games may also have differential impacts on the brain and cognition.46 Not including the video-gaming genre in our analyses is a limitation of the current study because the screen time survey in the ABCD database does not include additional information on the genre of video games played. Future large studies investigating the association between video gaming and cognition would benefit from including game genre as a moderating variable in analyses. Another limitation of the current study is the use of only cross-sectional study designs, which cannot provide enough evidence to resolve causality or the directionality of the associations among video gaming and other variables. For example, we cannot resolve whether mental health issues or brain function changes precede and drive video gaming or whether video gaming results in mental health symptoms or altered neuroplasticity. Future works benefiting from the longitudinal design of the ABCD study will enable researchers to move beyond association toward causation using causal approaches, such as discordant twin analyses, bayesian causal networks, and machine learning.This study has some limitations. Video games regroup a variety of gaming categories that include action-adventure, shooters, puzzle solving, real-time strategy, simulation, and sports. These specific genres of video games may have different beneficial effects for neurocognitive development34 in which episodic and short-term memory gains were maintained during a 3-month follow-up period. The longitudinal design of the ABCD study will enable within-participant testing for the correlates of accumulated video-gaming practice over the years. By using methods such as cross-lagged correlations or causal inference, researchers can assess whether video gaming is associated with subsequent behavioral issues or neurocognitive development in adolescents.Overall, even with consideration of the correlational nature of these cross-sectional data, the current findings are consistent with video gaming being associated with better performance on cognitive tests that involve response inhibition and working memory and altered BOLD signal on these tasks. Thus, although the CBCL scores were elevated in children who play video games for 3 or more hours a day, the results raise the intriguing possibility that video gaming may provide a cognitive training experience with measurable neurocognitive effects. Future ABCD data releases will allow researchers to test for longitudinal effects in which video gaming might improve response inhibition, working memory, and other cognitive functions, as previously suggested in a longitudinal intervention study


The contactless recording of a photoplethysmography (PPG) signal with a Red-Green-Blue (RGB) camera is known as remote photoplethysmography (rPPG). Studies have reported on the positive impact of using this technique, particularly in heart rate estimation, which has led to increased research on this topic among scientists. Therefore, converting from RGB signals to constructing an rPPG signal is an important step. Eight rPPG methods , local group invariance (LGI), the chrominance-based method (CHROM), orthogonal matrix image transformation (OMIT), GREEN, independent component analysis (ICA), principal component analysis (PCA), and blood volume pulse (PBV) methods) were assessed using dynamic time warping, power spectrum analysis, and Pearson’s correlation coefficient, with different activities  and four regions of interest (ROI): the forehead, the left cheek, the right cheek, and a combination of all three ROIs. The best performing rPPG methods in all categories were the POS, LGI, and OMI methods; each performed well in all activities. Recommendations for future work are provided. Photoplethysmography (PPG) is an optical measurement technique for estimating cardiovascular parameters such as heart rate and blood pressure ,2. PPG sr) between the estimated and ground truth health-related information. This can be of limited help in determining whether the rPPG signal is of high quality because it only assesses the signal indirectly. The metrics most often used to compare the ground truth PPG with the estimated rPPG are the MAE or r of all sample points [r, although to a human observer, the signal might seem very similar.In the current body of literature, the rPPG signal is frequently compared solely to the extracted health-related information, such as heart rate or blood pressure, rather than to the ground truth PPG signal ,6. The ee points . Furthere points . HoweverA lower-quality rPPG signal is often used for heart rate measurement since frequency analysis or peak detection algorithm are sufficient. A higher quality signal is required to determine more complex health-related information, such as diastolic or systolic blood pressure. The diastolic peak and notch are especially important for estimating health-related information that goes beyond heartbeat. To compare the quality of the signal of multiple rPPG methods, we used dynamic time warping (DTW), which, to the best of our knowledge, is new in this field.r of these two signals. In this study, we evaluated eight non-deep learning rPPG methods , local group invariance (LGI), the chrominance-based method (CHROM), orthogonal matrix image transformation (OMIT), GREEN, independent component analysis (ICA), principal component analysis (PCA), and blood volume pulse (PBV) methods) and compared the similarities between the estimated rPPG and the reference fingertip RPPG signals using three evaluation metrics.The DTW algorithm is a popular alternative approach for comparing the similarities of different time series . By alloFor non-deep learning approaches, the procedure from the video to the rPPG signal has already been explained in detail by Boccignone et al.  In this Due to blood volume changes, some areas of the human face influence the reflected light more than other areas. In this study, we evaluated some of the most frequently used ROIs for rPPG in the current literature: the right cheek, left cheek, and forehead ,13. MoreThe landmarks that separate the ROIs from a frame that contains the face of the participant were detected with MediaPipe Face Mesh . In the The rPPG method is used to convert an RGB signal to an rPPG signal. All rPPG methods explored in the literature are listed in 1Resting. The participant is seated indoors with only minimal head movement.2Gym. The participant is doing an indoor workout on a bicycle ergometer.3Talk. The participant engaged in a conversation in an urban scenario with natural light.4Rotation. The participant made arbitrary head movements while indoors.For the evaluation, the LGI-PGGI dataset from Pilz et al.  was applEach video is over 1 min in length. The pulse oximeter’s average sampling rate was 60 Hz, while the rate of the RGB camera was 25 Hz. A recent study  showed tUnder specific constraints, the goal of DTW is to provide a distance metric between two input time series by allowing “elastic” transformation and time shifting . The disThe average distance is calculated between a 10 s reference fingertip PPG signal and a 10 s rPPG window extracted from the video. The length of each video was cut to 1 min, resulting in six windows per video. Four different ROI cases, six participants with four different activities, and eight different rPPG methods, which created six windows per video, were evaluated, resulting in 4608 rPPG windows to compare with the reference fingertip PPG signal. As seen in The hlPS is commonly defined as the Fourier transformation of the autocorrelation function. This analysis is very popular for PPG and rPPG signals, as the peak in the PS graph corresponds to the heart rate. The frequency of the maximum in the PS graph from the PPG matches the heartbeat. In this study, we analyzed the absolute difference between the peak frequency of the rPPG signal and the PPG signal as an evaluation metric in the PS graph. As seen in r is calculated for each sampling point in a windowThe The overall evaluation score (OS) was calculatedThe PPG and rPPG signals were normalized with min–max normalization and compared with DTW, The first objective was to evaluate the performance of the different rPPG methods for different ROIs. The more challenging video activities, Talking, Gym, and Rotation, were compared to the easiest activity, Resting .With only minor movements in the Resting video activity, a smaller ROI, such as a forehead, can outperform the combined ROI approach. However, with more movement and natural lightning, as seen in the Talking video activity, the combined ROI case is best. In the natural light from the Talking video activity, the performance of the smaller ROIs, the left cheek and right cheek, was significantly worse than the performance of the forehead ROI. This result seems explicable because noise is less of a factor with a larger surface area.Moreover, the landmark tracking of MediaPipe Face Mesh  was exceThe second objective was to evaluate the performance of the different rPPG methods for different video activities. As seen in There is a unique ranking of the rPPG methods for each video activity. For the Resting and Gym video activities, LGI was the best method. For the Talking and Rotation video activities, the CHROM rPPG method showed particularly good results. For the difficult video activities, Gym and Talking, LGI was one of the two best performing methods. This data makes sense because earlier studies from the group behind developing LGI  have shoAs previously mentioned, a PS analysis was conducted. Only the first low-frequency envelope amplitude in the PS graph was compared because it determines the heart rate. The results are shown in The achieved To find the best rPPG method overall, all values were normalized with min–max normalization, and the weighted sum was taken. DTW, LGI, POS, and OMIT were the best overall methods for all the video activities combined, as seen in This study demonstrated that none of the studied rPPG methods are the best for all the investigated cases. It has been shown that rPPG methods perform differently depending on the movement, the lighting conditions in the video, and the error metric that is applied. It is remarkable that in the Resting video activity, no major performance differences were found for the top five rPPG methods for BPM estimation; the differences in performance became greater in more challenging video activities. The performance of the POS rPPG method was the best overall among all the categories, and it was by far the best in the Gym video activity for BPM estimation. Thus, POS was the best rPPG method for BPM estimation in this study.The performance of the POS rPPG method was superior to the other tested methods for the more difficult datasets with indoor lighting, such as the Gym and Rotation video activities. The great advantage of POS is that it is a mathematical model, which can be beneficial for medical applications to blind sourcing approaches. In the study by Boccoignone et al. , the POSWindowing was performed on the RGB signal. Thus, blind source separation rPPG methods, such as PCA and ICA, could perform differently if windowing is applied to the rPPG signal. PCA and ICA try to find the most periodic signal in the RGB signal, which can lead to errors since motion can also be periodic, for example, in the Gym video activity. In this review, the ICA rPPG method did not show good results overall. The PBV method normalized the hole input color channels, which is why the windowing time also had a large influence. POS applies temporal normalization; therefore, in the POS method, a 10 s window starts and ends with a small amplitude. Eventually, the To determine the optimal ROI, further research is needed. Through the 458 landmarks in MediaPipe Face Mesh , the ROI1We advise focusing research on optimal environmental conditions , as no high quality rPPG signal could be achieved with a good 2We recommend using larger ROIs (such as forehead and cheeks) for challenging video activities (such as shifting background lights) and smaller ROIs (such as only a forehead) for easier activities.3We suggest using DTW as an error metric for comparing different ROIs, rPPG methods, and filters, because it handles time offsets very well, and it is very suitable for comparing signals from the different methods.4We advise using LGI, OMIT, or POS to obtain a high quality rPPG signal.In the future, additional research is needed to obtain a high quality rPPG signal over a longer time window, which is suitable for blood pressure estimation or other health-related information. However, the technology of rPPG is very promising and can be beneficial, especially for a large population, because simple RGB cameras are installed in a variety of mobile devices. The recommendations derived from this study’s findings are summarized below:When comparing the rPPG signal to the referenced PPG signal, it was discovered that the constructed rPPG signals from RGB videos were highly dissimilar, resulting in a low correlation. However, comparing and ranking the rPPG construction methods is still possible. We demonstrated that different rPPG methods with different ROIs performed better or worse in different recording conditions. DTW was proven to be an effective technique for comparing various rPPG signals. In this study, the best-performing rPPG approaches were LGI, POS, and OMIT. In natural lighting conditions, larger ROIs showed better results than smaller ROIs. Future research is needed on the whole pipeline from facial video to rPPG; the impact of different filter combinations or ROI selection is still mainly unknown.


BackgroundThe weight-for-height z-score (WHZ) is considered the gold standard for detecting acute malnutrition in children. However, an accurate assessment of WHZ can often be challenging, especially in community settings. Mid-upper arm circumference (MUAC) is a simple and easy-to-perform method to identify children with acute malnutrition. The objective of the study was to evaluate the accuracy of MUAC in detecting acute malnutrition compared to WHZ among children aged 6-59 months in Bangladesh.MethodsWe used anthropometric data for 239 children aged 6-59 months from a cross-sectional study conducted in 2013 in an urban slum in Dhaka, Bangladesh. The sensitivity and specificity of MUAC to detect acute malnutrition were calculated, considering WHZ as the gold standard.ResultsThe mean age of the children was 29.4 ± 12.7 months, with a male-to-female ratio of 1:1.2. The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively. The total area under the receiver operating characteristic curve was 0.816. For detecting acute malnutrition, the sensitivity of MUAC was 61.0% and the specificity was 85.4% for the World Health Organization (WHO) recommended cutoff of <125 mm. Using the Youden index, the best MUAC cutoff point to detect acute malnutrition was <128 mm with a sensitivity of 75.6% and a specificity of 74.7%.ConclusionsOur study demonstrated a low sensitivity of MUAC to identify acute malnutrition at the WHO cutoff of <125 mm. The cutoff could be increased to <128 mm to capture more children with acute malnutrition. Acute malnutrition significantly increases the risk of childhood morbidity and mortality and is reported to be responsible for about 45 million global deaths in children younger than five years of age. More than two-thirds of these children live in Asia, and more than one-quarter live in Africa . ChildreThe World Health Organization (WHO) recommends using the weight-for-height z-score (WHZ) as the gold standard to detect acute malnutrition. A child having a WHZ < −2 standard deviation (SD) is considered to be a case of acute malnutrition . AccuratMid-upper arm circumference (MUAC) is a widely used method to define acute malnutrition in children aged 6-59 months. The WHO recommends a cutoff point of <125 mm to define acute malnutrition with MUAC . MUAC isThe sensitivity and specificity of MUAC to diagnose acute malnutrition varied across the studies -10. The This study used a cross-sectional dataset collected to investigate the association between maternal mental health and child nutritional status . The stuA face-to-face interview with the mother was conducted to collect demographic and socioeconomic characteristics. Socioeconomic status was assessed using the modified Kuppuswamy's socioeconomic status scale . AnthropThe anthropometric data were converted into WHZ using the software WHO Anthro . The folEthical clearance was obtained from the National Institute of Preventive and Social Medicine (NIPSOM) in Bangladesh. The mothers provided informed written consent to participate in the study.Table The prevalence of acute malnutrition was 17.1% and 22.5% based on WHZ and MUAC, respectively (Table Figure This study investigated the diagnostic accuracy of MUAC in comparison to WHZ to identify acute malnutrition in children aged 6-59 months in Bangladesh. The prevalence of acute malnutrition was 17.1% based on WHZ. The area under the ROC curve of 0.816 represents MUAC as a "very good" test for diagnosing acute malnutrition. There was a low sensitivity and a moderate specificity to the WHO-recommended MUAC cutoff of <125 mm. Various studies have reported low sensitivity of the current cutoff of MUAC [This study proposed a new cutoff for MUAC to detect acute malnutrition in Bangladeshi children. The cutoff suggested based on the Youden index was <128 mm. The increase in MUAC cutoff by 3 mm increased sensitivity from 61.0% to 75.6% without much decline in specificity. Similar recommendations for increasing the MUAC cutoff for detecting acute malnutrition were also given in other studies ,18. A stAccording to the Bangladesh Demographic and Health Survey, the prevalence of acute malnutrition among under-five children is about 8% in Bangladesh . HoweverThe strength of this study was that the validity of different MUAC cutoffs was tested in a community setting. A single team of data collectors was used to collect anthropometric data from all children to avoid inter-observer variation. Anthropometric measurements were performed using standard techniques. The UNICEF-recommended tape was used to measure MUAC.The study had several limitations. First, WHZ was used as a reference standard, but WHZ itself is not without its challenges for the identification of acute malnutrition . Second,The sensitivity of MUAC at the WHO-recommended cutoff is low for identifying acute malnutrition in children. The cutoff can be increased from <125 mm to <128 mm to increase sensitivity with a little compromise in specificity. The research was done based on available data from a particular area of Bangladesh. Hence, the study's results cannot be generalized. Further studies with a larger sample size and geographic representation can generate more evidence on the performance of MUAC in detecting acute malnutrition in children in Bangladeshi settings.


Scientific Reports 10.1038/s41598-022-15542-7, published online 15 July 2022Correction to: In the original version of this Article Shelly Masi was incorrectly affiliated with ‘World Wide Fund for Nature - Germany, Reinhardstrasse 18, 10117 Berlin, Germany.’ The correct affiliation is listed below.Eco‑Anthropologie (EA), Muséum National d’Histoire Naturelle, CNRS, Université Paris Cité, Musée de l’Homme 17 place du Trocadéro, 75016 Paris, FranceAdditionally, the order of the accompanying Supplementary Video 1, Supplementary Video 2 and Supplementary Video 3 was incorrectly shown as Supplementary Video 2, Supplementary Video 3 and Supplementary Video 1.The original Article and accompanying Supplementary Information files have been corrected.


Malnutrition is a nutritional disorder and common syndrome that has a high incidence and is easily ignored in hospitalized older patients. It can lead to multiple poor prognoses, such as frailty. Early identification and correct evaluation of possible malnutrition and frailty are essential to improve clinical outcomes in older patients. Therefore, our objective was to explore the applicability and effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria for identifying malnutrition in older patients.In total, 223 participants aged ≥60 years were involved. Nutrition was evaluated using the Mini Nutritional Assessment-Full Form (MNA-FF) and GLIM criteria, which adopt a two-step procedure. The first step was to use three different methods for the screening of nutritional risk: the Nutrition Risk Screening 2002, the Mini Nutritional Assessment Short Form (MNA-SF), and the Malnutrition Universal Screening Tool. The second step was to link a combination of at least one phenotypical criterion and one etiological criterion to diagnose malnutrition. The Clinical Frailty Scale was used to assess frailty. Sensitivity, specificity, Youden index, kappa values, and positive and negative predictive values were used to evaluate the validity of the GLIM criteria. Logistic regression models were used to assess whether there was a correlation between malnutrition, as defined by the GLIM criteria, and frailty.K = 0.629; p < 0.001), sensitivity (90.5%), and specificity (86.4%). Logistic regression analysis showed that malnutrition, using MNA-SF with the GLIM criteria, was relevant for a higher likelihood of frailty .We found that 32.3–49.8% of our patient sample were at risk of malnutrition based on the GLIM diagnosis and using the three different screening tools; 19.3–27.8% of the patients were malnourished. GLIM criteria with MNA-SF as a diagnostic validation and MNA-FF as a reference showed high consistency (The incidence of GLIM-defined malnutrition was 19.3–27.8% using different screening tools. The consistency between the GLIM criteria using the MNA-SF and the MNA methods was high. Malnutrition, as diagnosed by the GLIM criteria with MNA-SF, was significantly correlated with frailty. GLIM criteria with MNA-SF may be a more reliable malnutrition assessment process in older inpatients. Malnusemi-gold standard. It is stated that the correlation between malnutrition and frailty using verification of the GLIM criteria in older adults is demonstrable  can be adopted as a nstrable . The GLInstrable . Variousnstrable –13. TherWith the factors mentioned earlier, our objective was to identify which screening tool can better assess malnutrition as the first step of the GLIM process and to evaluate the correlation between GLIM-defined malnutrition and frailty in older Chinese inpatients.Study data were gathered from the SMART database at Xuanwu Hospital Capital Medical University. SMART is an age-based patient cohort study that contains information from comprehensive evaluations that include nutrition, physical performance, functional status, mental-psychological function, frailty, quality of life. The study's inclusion criteria was age ≥60 years and the participants ability to voluntarily sign an agreement. Participants, recruited from July 2019 to April 2022, were assessed for nutritional status and frailty by trained researchers. Demographic, anthropometric, and hospital data, such as comorbidities, medication, and laboratory indicators, were also collected from patients and the electronic medical record system.Different instruments and methods were used to evaluate the nutritional status of the subjects. The MNA-FF was adopted to assess nutritional status, which is composed of 18 questions within four domains, anthropometry, general condition, dietary status, and a self-evaluation . Partici2 in men and ASMI <5.7 kg/m2 in women. The value of ASMI is estimated using the formula verified by the gold standard of the dual light energy X-ray absorption method in the Asian population . Normally distributed data were assessed using a one-way analysis of variance (ANOVA) and mean ± standard deviation to express the results. Non-normally distributed data were assessed using the Kruskal-Wallis test, and the Chi-square test was adopted to classify the variables; the results are shown as numbers and percentages. MNA is a r adults ; therefoThis study was a single-door design diagnostic study. Diagnostic indicators were qualitative: good nutritional status, risk of malnutrition, and malnutrition. PASS was adopted to calculate the sample size. According to previous literature reports, the prior probability is estimated to be 22% (95% CI 18.9–22.5) . A systeA sample size of 223 subjects were included in the study. The mean age was 74 years and 46.4% were women. k = 0.493 and 0.526, respectively; p < 0.001); however, the consistency between MNA and model B was 'substantial'   at admission. Cross-tabulation of GLIM criteria after different screening tools and MNA-FF is shown in < 0.001) . SE was < 0.001) .The PPVs with model A, model B and model C were 69.8, 61.3, and 67.9%, respectively, while the NPVs were 93.3, 97.5, and 96.5%, respectively. Lastly, the area under the curve (AUC) showed that three different screening tools may have great utility value for diagnosing malnutrition in aged patients , the most accurate and reliable GLIM diagnostic criteria were obtained using MNA-SF. The prevalence of risk of malnutrition was 49.7% after screening for MNA-SF, while GLIM-defined malnutrition as 27.8%. More importantly, our results showed that nutritional status, defined by GLIM criteria with MNA-SF, was closely correlated with frailty with a higher OR.We used three different nutritional screening tools to determine the risk of malnutrition, among our participants. NRS-2002 and MUST had similar risk rates of approximately one-third, while nearly half of the patients were at risk as determined by MNA-SF. However, a study from Greece evaluated the predictive value of six different nutritional screening tools for malnutrition in older patients and showed that the malnutrition risk rate with NRS-2002, MNA-SF, and MUST were 97.6, 82.3, and 66.1%, respectively . This isRegarding the uniformity between the MNA and GLIM criteria, the MNA-SF seems to have better consistency. In this study, we identified that when MNA-SF was used as a screening tool, we observed the best consistency and applicability between the GLIM criteria and MNA-FF. Our findings are in good agreement with previous studies –27. A ChPoor nutritional condition is widely known to be often considered one of the potential mechanisms resulting in frailty in older adults . GuideliThe main strength of this study is the first to adopt MNA-FF as a reference, as recommended by the GLIM validation guide, to verify the reliability of the GLIM criteria using different nutrition screening tools for the diagnosis of malnutrition and to analyze the correlation between malnutrition and frailty in older Chinese inpatients. Moreover, we adopted standardized diagnostic methods for malnutrition based on the GLIM process and rigorous statistical analysis. Our study had limitations. First, it was a single center, small sample retrospective investigation, which can increase bias and lead to restricted subgroup analysis and imprecision. Moreover, we used a formula instead of dual-energy X-ray absorptiometry or bioelectrical impedance analysis to measure muscle mass. Although this formula has been verified, we admit that imprecise muscle mass estimates might fail to guarantee the validity of the results. A further limitation of the study is that we did not compare anthropometric indexes  to verify our results, and we will try to use this method to verify in future research. Furthermore, we did not use a complete nutritional assessment, as a gold standard, to assess the nutritional status of older adults. Because participants with serious diseases in this study may not be able to cooperate with this assessment. We will adopt a complete nutritional assessment of participants in our ongoing study (the 3M study) . FinallyIn this single-center cross-sectional study of older hospitalized patients, the incidence of GLIM-defined malnutrition was 19.3–27.8% using different screening tools. The consistency between the GLIM criteria using the MNA-SF and the MNA methods was high. Malnutrition, as defined by the GLIM criteria with MNA-SF, was significantly correlated with frailty. GLIM criteria with MNA-SF could identify malnutrition more accurately and reliably in older patients. In the future, aim to bring older, malnourished patients, diagnosed by GLIM criteria and with the MNA-SF, into the medical insurance scheme, so that patients can benefit.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.This study was approved by the ethics review board of Xuanwu Hospital Capital Medical University (2021-060). The participants provided their written informed consent to participate in this study.TJ drafted and wrote the manuscript. LM and YL designed the study, revised the manuscript and supervised the work. TJ, PL, YZ, and YS gathered the data. All authors contributed to the article and approved the submitted version.This work was supported by the National Key R&D Program of China (2020YFC2008604 and 2020YFC2008600).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer QZ declared a shared affiliation with the author to the handling editor at the time of review.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Is our mental health at risk due to spending a significant amount of time online due to the COVID-19 pandemic? In the new era that we are living in, where we live a life that coexists with the virus, we are participating in video conferences held online rather than on-site in order to slow the spread of the virus. Video conferencing has become our necessity since March 2020, and is becoming a new standard, especially in the MICE industry. Recently, however, people who have excessively used video conference platforms are complaining of video conference fatigue, which is a new negative emotion such as stress, anxiety, and worry as well as general work fatigue. Therefore, this study focused on the mechanism of video conferencing in MICE, which is rapidly digitally converted by the virus, and the digital psychological factors of the participants. This study derived the quality attributes of video conferencing in MICE and empirically analyzed the relationship with digital psychological factors of the video conference participants, such as video conference fatigue, social presence, and flow. One hundred and thirty-eight valid questionnaires collected from participants of several international academic conferences held in EXCO, Daegu, Korea, from 23 to 28 May 2021, were analyzed. The main results are as follows. First, unlike general video conference fatigue, MICE video conference fatigue was not found to be related to the preceding and following variables. This is due to the characteristics of the MICE video conference and the expertise of the participants. Second, social presence was identified as an important variable in MICE video conferencing. Although media-mediated, the feeling of being present with the presenter and participants was found to affect the participants’ flow in the video conference. Third, in this study, the fun factor was identified as the most important video conference quality that can enhance the social presence of the video conference participants of MICEs. MICE, as an abbreviation of Meeting, Incentive Tour, Convention, and Exhibition, collectively refers to events where a large number of people meet for the purpose of business. The March 2020 pandemic changed the MICE industry, limiting the movement and gathering of people. Public health guidelines such as quarantine, social distancing and social contact closure have been in effect to all countries around the world . In the It is also expected that the hosting of MICEs in virtual space will continue for some time as it is predicted that our lives and people’s actions will not return to pre-pandemic standards after the end of the virus . VirtualThe study had the following detailed objectives: (1) to derive video conference quality that reflects the characteristics of video conferencing and to suggest its constituent dimensions; (2) to apply the social presence, which is again attracting attention due to the rapid increase in communication mediated by media, and to suggest its constituent dimensions; (3) to conceptualize video conference fatigue and flow of MICE participants; (4) to examine the relationship between video conference quality and the digital psychological factors of the participants, such as social presence, fatigue, and flow. As such, this study aimed to understand the psychological factors of video conference participants of MICEs and, furthermore, to suggest academic and practical implications for deriving incentives for more people to participate in virtual MICE conferences classified as essential economic activities, even in the global pandemic.Video conferencing is a meeting that proceeds where seeing and listening with each other while transmitting images and voices is through a network from afar . Video cHowever, since it has not been long since video conferencing has changed from a substitute to a necessity, there are few studies that have tried to derive a conceptual definition and attributes of video conferencing, especially in the MICE industry. Lee, Yoon, and Yoon  presenteIn the relationship between video conference quality and related psychological variables, it was found that the quality provided through media-mediated communication, such as video conference, remote education, and online shopping, which has increased rapidly, affects social presence ,15,16. SResearch Question 1: Does video conference quality affect social presence, fatigue, and flow among participants of MICEs?Under the pandemic, the presence theory has been reemphasized with the rapid increase of communication through media such as remote education and video conferencing ,23,24. TIn particular, social presence is attracting attention as a factor that affects the user’s psychologically and behaviorally, such as a mediated attitude toward others, reality illusion, learning, memory, and mental health ,27. AddiIn the relationship between social presence and other psychological variables, a study by Knox  found thResearch Question 2: Does social presence affect video conference fatigue and flow among participants of MICEs?After the pandemic, video conferencing is not a substitute but a necessity . It has The advantages of video conferencing are clear in maintaining social distance and replacing face-to-face meetings during the pandemic. Some people adapt well to a new media platform, for most people, however, it can be a huge challenge . In ordeIn recent research, Bennett et al.  showed tResearch Question 3: Does video conference fatigue affect participants’ flow among participants of MICEs?Flow is a concept originally started by cultural anthropologists in the study of rituals . Flow waRecently, the experience of flow has also been shown in the interaction mediated by media, such as human and computer, and found as an important variable affecting the performance in media-mediated communication, such as remote education and video conferencing, which have surged due to COVID-19 ,63,64,65This study aimed to derive factors for expanding participants to virtual MICE conferencing, by studying the relationship between video conference quality and psychological factors of video conference participants of MICEs, such as social presence, fatigue, and flow. In order to accomplish the main purposes of the study, we set out the following theoretical framework, which we based on the previous studies that have been cited above :A survey for participants of several international academic conferences held in EXCO (Daegu Exhibition and Convention Center), the Daegu metropolitan city, South Korea, was conducted to analyze the relationship between video conference quality, social presence, fatigue, and flow. Two pre-trained surveyors surveyed conference participants who had recently participated in a video conference in the MICE industry. The surveyors stayed at EXCO for four days from May 23 to 28, 2021, and distributed questionnaires to the participants who voluntarily expressed their intention to participate. They explained to the participants the purpose and importance of the survey, and anonymity and confidentiality were ensured in completing the survey. A total of 180 survey questionnaires were distributed, 152 copies were collected, and 138 copies were used for analysis, excluding invalid questionnaires such as insincere responses. Of the 138 participants, 83 were men (60.1%) and 55 were women (39.9%). By age, 73 of the participants were in their twenties (52.9%), 27 were thirties (19.6%), 21 were forties (15.2%), and 17 were over fifty (12.3%). Looking at the number of video conferences participated in, 65 participants were in the 1–2 times category (47.1%), 36 in the 3–5 times category (26.1%), and 37 in the 6 times or more category (26.8%).strongly disagree) to 5 (strongly agree).Video conference quality was derived from 5 factors and 27 items based on previous studies ,11,12,13strongly disagree) to 5 (strongly agree).In this study, the social presence of video conferencing was defined as the psychological involvement in social interaction as a continuous process in which participants recognize the presence of the presenter and other participants See . As suchstrongly disagree) to 5 (strongly agree).In order to measure video conference fatigue, the items used in the study of  were modstrongly disagree) to 5 (strongly agree).Video conference flow is defined as the optimal experience in which participants are completely immersed in the video conference. Based on previous studies ,69,70, sThe questionnaire data collected for this study was analyzed using the SPSS 26.0 statistical program as follows. Exploratory factor analysis was conducted to derive the factors of the quality and social presence of video conferencing. Cronbach’s alpha coefficient was estimated to verify the reliability of measuring tools for video conference quality, social presence, fatigue, and flow. Additionally, correlation values between all the variables were estimated using the Pearson correlation coefficient to identify their relationships. After this process, descriptive statistics for all the variables were computed. Finally, multiple regression analyses were performed to predict the influence relationship between the variables. All the statistical verifications were based on a significance level of 0.05.Exploratory factor analyses on video conference quality (27 items) and social presence (16 items) were performed using principal component analysis with Varimax rotation method. Seven items that hindered unidimensionality or did not satisfy the factor loading of 0.5 or higher were dropped. The quality of video conference consisted of five factors, namely, usefulness, information, interaction, security, and fun. Social presence consisted of two factors, presenter social presence and participant social presence. Each factor with the eigenvalue greater than 1 contained 3 to 8 items. For video conference quality, As shown in Multiple regression analysis was conducted to explain the effect of video conference quality on social presence, fatigue, and flow. As shown in the results presented in Multiple regression analysis was used to predict video conference fatigue and flow with social presence. As shown in the results presented in Multiple regression analysis was conducted to explain the effect of video conference fatigue on the flow. As shown in Video conferencing has become a necessity for people after the COVID-19 pandemic of March 2020 . HoweverFirst of all, in the MICE industry, video conference fatigue was not affected by video conference quality and social presence and was not identified as an important variable such as not affecting flow. In the two years since the March 2020 pandemic, as many meetings, including general business meetings, have mostly been converted to online, several researchers ,48 have On the other hand, in this study, social presence was identified as an important variable in video conferencing of MICEs. Both presenter social presence and participant social presence were found to be influential on video conference flow. Social presence has been emphasized as influencing flow and performance, especially in studies related to remote education and livestreaming broadcasting ,41,42,43In this study, among the factors of video conference quality, fun was found to be the most influential factor that can enhance social presence of the video conference. Most of the participants in MICE video conferences are voluntary, and they have different characteristics from general conference participants, such as networking, escaping from everyday life, and gathering information. Therefore, it is considered that meeting planners should pay attention to the fun factor that can give participants a feeling that the overall process of participating in a video conference is enjoyable and free from ordinary life.Unlike general video conference fatigue, MICE video conference fatigue was not found to be related to the preceding and following variables. On the other hand, social presence was identified as an important variable in MICE video conferences. The feeling of being present with the presenter and participants was found to affect participants’ flow in video conferences. Lastly, the fun factor was identified as the most important video conference quality that can enhance the social presence of video conference participants of the MICE industry.Although this study has great significance in focusing on the digital psychological factors of video conference participants in MICEs, it leaves the possibility of various follow-up studies due to its limitations as an a priori study. First, there are insufficient data due to limitations in accessing research subjects due to the corona virus. At the time of the data collection period of this study, most meetings in MICEs were canceled or postponed due to the second stage of social distancing in Korea. Only a few meetings that were ready to be held as a video conference were held online or as a hybrid (online + offline). Video conferences, which are held entirely online only, make it difficult to access participants, and the total number of participants in hybrid conferences was not large. Therefore, it is necessary to expand the number of participants who have experience in video conferences, which are expected to be continuously used even two years after the pandemic in March 2020 and even after the end of the virus. Second, demographic characteristics may be biased because of the targeting of specific conference participants. Therefore, it will be necessary to expand the research data by targeting participants of conferences in various fields. Third, MICE video conferencing has different characteristics from general business video conferencing in terms of purpose, attributes, and motivation for participation. Therefore, it is necessary to expand a study faithful to the essence of MICE video conferencing by utilizing various related variables.


Arteriovenous malformations (AVMs) are an anomaly of the vascular system where feeding arteries are directly connected to the venous drainage network. While AVMs can arise anywhere in the body and have been described in most tissues, brain AVMs are of significant concern because of the risk of hemorrhage which carries significant morbidity and mortality. The prevalence of AVM's and the mechanisms underlying their formation are not well understood. For this reason, patients who undergo treatment for symptomatic AVM's remain at increased risk of subsequent bleeds and adverse outcomes. The cerebrovascular network is delicate and novel animal models continue to provide insight into its dynamics in the context of AVM's. As the molecular players in the formation of familial and sporadic AVM's are better understood, novel therapeutic approaches have been developed to mitigate their associated risks. Here we discuss the current literature surrounding AVM's including the development of models and therapeutic targets which are currently being investigated.  A brain arteriovenous malformation (bAVM) is a disordered mass of blood vessels in the brain. Vascular lesions are formed where feeding cerebral arteries are directly connected to draining veins with no capillary bed between them . An AVM While it is understood that the rate of cerebral AVM occurrence is similar in males and females, the exact prevalence in the general population is unknown , 4. StudDepending on size and location, the risk of cerebral AVM rupture could be high, resulting in intraventricular or intracerebral hemorrhage, and subsequent symptoms such as seizures, cephalalgia, and myasthenia . AVM rupThe pathogenic mechanisms surrounding the development and rupture of cerebral AVMs are also not yet fully understood. Historically, AVM formation was considered to be solely the result of a congenital abnormality . Recent About 95% of AVM cases are not related to familial conditions . The cau10.1161/SVIN.122.000442]. Regardless of whether conservative treatment is the best option for patients, there remains a need for novel treatments for AVMs as our current therapies still have poor outcomes. Studies have shown that endovascular embolization increased the number of complications from surgery compared to the curative goal ..Eng+/−) itgb8 and smad4 evaluated the role of integrin-8-mediated TGF-β activation in cerebral neoangiogenesis .tegrin 8 , 71. Inhgression , 76.in vivo model of bAVM and revealed upregulation of a CRYAB, a heat shock protein involved in cellular survival, radio-resistance, and possible role in tumor angiogenesis .ENG, Alk1, and Mgp, promote the development of bAVMs. Promotion of pathways affected by these genetic losses through use of tacrolimus and sirolimus has been shown in preclinical studies to reverse formation of AVMs [Various genetic deficiencies, such as loss of function  of AVMs , 98, 99.While several therapeutic drug targets in AVM seem promising, they remain in early preclinical studies. Ultimately, there is still no truly analogous animal model of AVM, bringing in to question the implications of there early findings. However, the limited data showing success of existing repurposed drugs in AVM lends to the validity of the previously mentioned target pathways. Medications such as bevacizumab and thalidomide which are implicated in inhibiting angiogenesis and inflammation are well studied in oncology and have seen off label use for symptomatic AVMs, but the adverse effects of these drugs may prevent there use outside of the highest risk patients.Currentl