Accommodative functions are known to differ between myopes and emmetropes. It is not known whether accommodative facility differs at near between younger adolescent and older adolescent myopes and emmetropes.To examine whether accommodative facility differs at near between younger and older adolescent myopes and emmetropes.119 participants aged between 11–21 years were recruited. Refractive error was measured using cycloplegic retinoscopy. Near monocular accommodative facility was measured for 60 seconds, using a +2.00D/–2.00D handheld flipper and N6 print at 40 cm. Participants were classified into two age groups: (i) younger adolescents (range: 11–14 years) and (ii) older adolescents (range: 15–21 years). The criterion applied to define myopia was spherical equivalent refraction: ≥–0.50D) and spherical equivalent refraction: –0.25D to +0.75D) for emmetropia. Univariate Analysis of Variance was carried out to analyze the interaction of age groups and refractive groups on near accommodative facility.1,115 = 13.44; p = 0.0001). Younger adolescent emmetropes  and younger adolescent myopes  had significantly lower monocular near accommodative facility compared to older adolescent emmetropes (9.52 ± 3.27 cpm), but did not show any difference when compared to older adolescent myopes (p > 0.05). This indicates a significant association linking age and refractive error to near accommodative facility .Near monocular accommodative facility was significantly lower (p = 0.003) in younger adolescents (5.87 ± 3.72 cpm) compared to older adolescents (8.11 ± 4.11 cpm), indicating age as a significant main effect (FYounger adolescent myopes and younger adolescent emmetropes had reduced monocular near accommodative facility than older adolescent emmetropes, but not when compared to older adolescent myopes. Refractive error is known to influence various accommodative functions including accommodative response, accommodative convergence to accommodation (AC/A ratio), dark focus of accommodation or tonic accommodation, nearwork-induced transient myopia (NITM), and accommodative facility and response times .Accommodative facility is an important visual function to measure, especially for children and adolescents whose visual tasks involve more frequent changes in fixation from near to a distance and vice versa. Positive response times are measured as the time taken to accommodate in response to the minus lens, and negative response time is measured as the time taken to relax accommodation in response to the positive lens . ResponsEarlier studies show that distance accommodative facility differs significantly with refractive error in pre-adolescent children (6–8-year-olds) or young adults (18–35-year-olds). However, it is unclear whether monocular near accommodative facility is different between myopes and emmetropes during adolescence. Late-onset myopia that develops after 15 years of age is linked to environmental factors, namely excessive nearwork . AccommoThis was a cross-sectional, clinical study for which the participants were recruited from the outpatient clinic of Sankara Nethralaya, which mainly catered to the needs of patients with age-related cataracts and refractive errors. Children who came to the outpatient clinic only for primary eye care services, like routine eye examinations and annual refractive error monitoring, were invited to participate in the study. Participants with a low degree of myopia (≤ –0.50D and > –6.00D) as per the definition of the International Myopia Institute  with a bAll participants underwent a baseline visual acuity assessment using a Bailey-Lovie log MAR chart and a preliminary ocular examination, including a slit lamp examination and a dilated fundus examination to exclude participants with any ocular pathologies. Binocular vision testing was carried out for all participants to exclude participants with any binocular vision anomalies.Binocular vision testing included measuring the near point of accommodation and the amplitude of accommodation using a push-up test, pencil push-up test, and penlight red-green goggle test for a near point of convergence measurement, and a phoria and gradient AC/A ratio measurement using Maddox rod technique. Suppression was checked by asking participants if they perceived both red and green colored lights while performing the pen-light red-green goggle test and if they perceived the spotlight and the streak of light during the Maddox rod test.Participants were classified into two different age groups based on the cut-off criteria recommended by the American Academy of Pediatrics , namely:Refractive error was measured objectively by retinoscopy (the Welch Allyn technique), followed by subjective refraction. Defogging was done to achieve a subjective end point, and it was verified using the duochrome test. All participants underwent a cycloplegic refraction as per the guidelines of the outpatient department for examining pediatric patients. Cycloplegia was achieved by instilling two drops of 1% cyclopentolate hydrochloride and one drop of 1% tropicamide, with the drops being administered in five minute intervals. Cycloplegic refraction was carried out after 30 minutes from instilling the last drop.Monocular near accommodative facility was measured using flippers, with the best-corrected spectacle refraction for all participants. Monocular facility was measured in order to eliminate the effect of convergence during binocular facility testing. The non-tested eye was occluded. Monocular accommodative facility was measured for a duration of 60 seconds, using a +2.00D/–2.00D handheld flipper and a near point card with N6 print held at 40cm for all participants. The participants were instructed as follows:“You should look at the smallest row of letters and try to keep them clear. Two types of lenses will be flipped in front of your eyes. Initially, the letters may remain blurred for few seconds. They will become clear after a few seconds. You should say, ‘clear’ as soon as the letters become clear through both lenses. The test will be done for one minute, and the number of flips will be counted”.Participants were given a practice run for half a minute before the actual measurements were made.The total number of cycles over a 60-second period was measured. When the subject was able to clear both lenses, the facility was counted as one full cycle. When the subject was able to clear only one side of the flipper — either the plus or minus side — facility was counted as a half cycle. When the subject was unable to clear the lens within the total 60 seconds, the facility was recorded as zero. The unit of accommodative facility was cycles per minute (cpm).Data on near accommodative facility was analyzed using SPSS Version 14.0. The association between the distribution of accommodative facility, refractive groups, and age groups was analyzed using Chi-square test of association. Data was analyzed to determine whether accommodative facility differed between age groups and refractive groups. Univariate Analysis of Variance was carried out with near accommodative facility as the dependent variable. Age and refractive error were the independent variables. Subgroup comparisons between age groups (younger adolescents and older adolescents) and between refractive groups (myopes and emmetropes) were done using independent samples t-tests. Post-hoc multiple comparisons for differences between age group and refractive groups — namely, younger adolescent myopes, older adolescent myopes, younger adolescent emmetropes, and older adolescent emmetropes were done using a one-way ANOVA with Bonferroni correction.A total of 134 participants were recruited, out of which 15 were excluded due to other conditions listed in There were five myopes who could not clear the lenses within the one-minute test, of which two were in the younger adolescent group, and the remaining three were older adolescents. All emmetropes were able to clear the lenses within the minute.2 = 0.81, df = 2, p = 0.67), with an accommodative facility of 0– 6 cpm being equally common in both myopes and emmetropes. The percentage of myopes and emmetropes with monocular near accommodative facility between 0–6 cpm was myopes: 43.5% and emmetropes 44.1%, greater than 6 and up to 12 cpm – myopes: 47.1% and emmetropes 41.2%, and a facility of more than 12 and up to 18 cpm – myopes: 9.4% and emmetropes 14.7%.The frequency distribution difference of monocular near accommodative facility between myopes and emmetropes is shown in 2 = 6.82, df = 2, p = 0.03). 59.1% of younger adolescents and 34.7% of older adolescents had a monocular near accommodative facility between 0–6 cpm; 34.1% of younger adolescents and 52% of older adolescents had a facility of greater than 6 and up to 12 cpm, and only 6.8% of younger adolescents and 13.3% of older adolescents had a facility of more than 12 and up to 18 cpm. Accommodative facility of 0–6 cpm was more common in younger adolescents than older adolescents.The frequency distribution difference between the younger adolescent age group and the older adolescent age group for monocular near accommodative facility is shown in 2 = 15.74, df = 6, p = 0.015), with 84.6% of the younger adolescent emmetropes having 0–6 cpm, while 15.4% of them had greater than 6 and up to 12 cpm, and none of them had accommodative facility greater than 12 and up to 18 cpm. In the older adolescent emmetropic group, only 19% of the participants had accommodative facility of 0–6 cpm, while 57.2% of them had accommodative facility greater than 6 and up to 12 cpm, and 23.8% of them had greater than 12 and up to 18 cpm. In the younger adolescent myopic group, 48.4% had accommodative facility of 0–6 cpm, 41.9% had greater than 6 and up to 12 cpm, and 9.7% had more than 12 and up to 18 cpm. In the older adolescent myopic group, the percentage of participants with accommodative facility between 0– 6 cpm, greater than 6 and up to 12 cpm, and more than 12 and up to 18 cpm were 40.7%, 50%, and 9.3% respectively. Monocular near accommodative facility of 0–6 cpm was more common in the younger adolescent emmetropic group followed by the younger myopic adolescent group.The frequency distribution for monocular near accommodative facility in younger and older adolescent myopic and emmetropic groups is shown in 1,115 = 0.067; P = 0.80), with no significant difference in mean monocular near accommodative facility between myopes (7.09 ± 4.23 cpm) and emmetropes . , with a significantly lower cpm in young adolescents (5.87 ± 3.72 cpm) compared to older adolescents  . . Age gro= 0.003) .1,115 = 4.60; P = 0.03)  , with siMonocular near accommodative facility was not significantly different between younger adolescent myopes (6.48 ± 4.12 cpm) when compared to older adolescent myopes . No significant difference in monocular near accommodative facility was found between older myopic adolescents (7.44 ± 4.35 cpm) and older emmetropic adolescents ; younger emmetropic group (4.77 ± 2.05 cpm) did not differ significantly from older myopic adolescents .The results of the present study show a significantly reduced monocular near accommodative facility in the younger adolescent emmetropic group compared to the older adolescent emmetropic group. But monocular near accommodative facility was not significantly reduced in the younger adolescent age group when compared to the older group the myopic group. This shows that age group has differential effects on monocular near accommodative facility within the emmetropic group but not the myopic group.The younger adolescent myopic group showed a significantly reduced monocular near accommodative facility when compared to the older adolescent emmetropic group, but not when compared to the older adolescent myopic group. These findings show that age group and refractive group together can impact monocular near accommodative facility, thus showing some evidence for the effects of interaction between age and refractive error on monocular near accommodative facility. Pandian et al.  did not In this study, monocular near accommodative facility was not different between the myopic and emmetropic groups. This is consistent with previous studies, which also showed no refractive group difference . The preIt is worthy to note that myopes and emmetropes showed no significant refractive group difference. However, when subdividing the groups further into different age groups, 11–14-year-old younger adolescent emmetropes showed a significant difference compared to 15–21 year-old older adolescent emmetropes. On the other hand, within the myopic group, no significant difference was obtained between young adolescents myopes compared to older adolescent myopes.Previous studies on accommodative facility testing have reported that differences in target size, target distance, test lens power, variations in test duration and time of testing affect accommodative facility . A low-pIn the present study, the mean near accommodative facility was 7.09 cpm for myopes and 7.71 cpm for emmetropes, which is lower than the values reported by O’Leary and Allen  for myopThe mean facility rate for the overall sample in the current study is lower than the previously reported monocular near accommodative facility values of 11 and 14 cpm among 7–12-year-olds and 13–17-year-old South Indian children respectively . This coIn the present study, although response times were not quantified, clinical reports suggest that younger adolescent myopes and emmetropes with reduced accommodative facility had difficulty clearing the positive lens side of the flipper with delayed negative response times. Jiang and White  showed dThe results of this study add to the present knowledge about accommodative facility: monocular near accommodative facility is reduced in younger adolescent emmetropes when compared to older adolescent emmetropes. But such difference did not exist in the myopic group. However, the younger adolescent myopes did show a difference with reduced accommodative facility when compared to older adolescent emmetropes. This has not been reported previously.These findings highlight the importance of near accommodative facility testing in clinical practice by optometrists while evaluating emmetropic and myopic adolescents aged 14 years and younger, since they show a reduced monocular near accommodative facility, which is reportedly a significant predictor for myopia progression. The study findings also stress the need for near accommodative facility testing — particularly its inclusion in the battery of accommodation tests in the myopia evaluation clinical protocol, along with accommodative lag when examining children and adolescents of different age groups. It is a simple and easy test that can be performed even in low- and medium-resource clinical settings.There are however, several limitations of this study. Whilst the overall sample is large, there are smaller sample sizes in some groups, and the data is cross-sectional, so no longitudinal predictions can be made. It is possible that a smaller number of participants in the younger emmetropic group might have favored the results, and therefore, this needs to be examined in a larger number of participants. We could have measured response time to substantiate delayed negative response time, which can be done in future studies. Distance accommodative facility was not measured in this study, as this has been done before. Moreover, since near accommodative facility is linked to myopia progression in young adults , the preTo conclude, for this clinical sample, there was significantly reduced monocular near accommodative facility between younger adolescents and older adolescents. Emmetropes and myopes in the younger adolescent age group had reduced monocular near accommodative facility when compared to emmetropes in older adolescent age group, but not when compared to older adolescent myopes.


This study aimed to identify the determinants of mental health and smoking-related behaviors among Korean adolescents with drinking experience. Secondary data from the Korean Youth Risk Behavior Web-based Survey (2021) were analyzed. The final study sample consisted of data from 5905 adolescents with a history of smoking. Chi-square and multivariate logistic regression analyses were used to examine the factors related to drinking experience. The factors that influenced alcohol drinking were sex, school level, academic performance, self-reported depression, and smoking. The results of this study showed that there are numerous factors affecting adolescents’ drinking experience. Early education and interventions are needed to reduce alcohol consumption among adolescents. Integrated attention and support from society, school, and family are necessary so that they can cope with and adapt to stress in a healthy way. Drinking that begins in adolescence is associated with long-term effects, such as decreased memory and attention . NeurotoOwing to the 2019 Coronavirus Disease (COVID-19) pandemic, social restrictions and controls have been implemented in many countries. School closures and transitions to online classes have led to an increase in psychological difficulties among adolescents, such as depression and anxiety disorders, isolation, and interpersonal problems ,4. AdverSubstance use is strongly associated with attempted and completed suicide ,9. RecenMany countries have conducted annual youth health behavior surveys among adolescents because of these risks. South Korea, specifically, has a higher prevalence of alcohol use than other countries and a culture of tolerance for drinking; greater access to alcohol incurs large social costs across the country ,12. Roug(1)Identify general characteristics, mental health characteristics, smoking behavior characteristics, and drinking experiences of adolescents.(2)Identify the factors that affect the drinking experience of adolescents.Accordingly, this study identifies the effects of general and mental health characteristics and smoking-related behaviors on adolescents’ drinking behaviors. This study utilized secondary data on youth health behaviors collected by the Korean government, with the aim of gaining insights into nursing interventions and alcohol abstinence education targeting adolescents. The specific research objectives were as follows:Since 2005, the Korea Centers for Disease Control and Prevention (KCDC) has been conducting the Korean Youth Risk Behavior Web-based Survey every year using a self-administered questionnaire to identify health-related behaviors, including alcohol use, smoking, and mental health status among first- to third-year high school students in Korea . SecondaThe 17th Korean Youth Risk Behaviors Web-based Survey (2021)  data useIn this data , 17,939 students answered “yes” to the question “Have you ever had more than one glass of alcohol?”.The n Youth Risk Behaviors Web-based Survey was conducted after review and approval by the Medical Research Ethics Review Committee from the KCDC regarding the scales and investigation process used for the ethical consideration of the participants. Prior consent was obtained from all participants before data collection. In addition, due to the secondary nature of the data, prior to the research, the researcher applied for an exemption from the Institutional Review Board of the institution to which the researcher belonged and was exempted from deliberation (JBNU 2022-06-014).Data analysis was performed using IBM SPSS Statistics for Windows v. 25.0 . A chi-square test was conducted to assess the differences between the demographic, mental health, and smoking-related characteristics of Korean adolescents in the sample. Additionally, multivariate logistic regression analysis was performed using these variables. The weights for each variable in this study were already reflected in the original data provided by the KCDC, and the weights were calculated by multiplying the value obtained by multiplying the reciprocal of the extraction rate and the reciprocal of the response rate by the weight post-correction rate. Moreover, the calculation of biased results was controlled through the composite sample design, and the value was calculated using the weighted average.Gender was indicated as “boy” or “girl”, school type was “middle school” or “high school”, and subjective academic performance over the previous 12 months was reclassified as “high”, “middle”, or “low.” Residence area was classified into “metropolitan cities”, “small cities”, or “rural area”, and the type of residence was reclassified into “living with family” or “living with someone other than family”. Economic status was reclassified as “high”, “middle”, and “low”.Mental health characteristics included depression, stress perception, suicidal ideation, and perceived sleep satisfaction. Depression experience was classified as ‘yes’ or ‘no’ to the question “Have you ever felt so sad or hopeless that you stopped your daily life for 2 weeks in the past 12 months?” Perceived stress was assessed with the question “In general, how much stress do you usually feel?” Participants were asked to answer this question on a scale of “high”, “a little”, and “none”. Suicidal ideation was classified as “yes” or “no” to the question “Have you ever seriously thought of suicide in the past 12 months?” Perceived sleep satisfaction was reclassified into “sufficient”, “average”, and “insufficient” in response to “Do you think that you get adequate sleep to recover from fatigue on weekdays?”.Characteristics of smoking behavior included the number of smoking days in the last 30 days and the time of first smoking. The number of smoking days in the last 30 days was classified as “non-smoking”, “1–2 days per month”, “3–5 days per month”, and “≥ 6 days per month”; the first smoking period was classified as “elementary school”, “middle school”, and “high school”.The sociodemographic characteristics of this study were as follows: The gender of the sample showed a high proportion of boys, and most of the participants were high school students. In addition, 60.3% of students reported living in small cities or rural areas, and 46.6% of students reported belonging to middle-income households in terms of economic status.Overall, 40.4% of all participants experienced depression, 45.9% of students reported they were highly aware of stress, and 21.5% of students reported that they had suicidal thoughts. More than half of the students had insufficient sleep. For smoking-related characteristics, only 28.8% of participants smoked only once. The time of smoking initiation was the highest in middle school.Further details regarding the general characteristics of the study participants are shown in p < 0.001). In terms of school grade, there were more with drinking experience than those without drinking experience, which was statistically significant . In the case of academic achievement, those in the drinking experience group were higher than those in the group without drinking experience, and it was statistically significant .For gender, it was found that there were more participants in the drinking experience group than those who had no drinking experience, which was statistically significant .There was a statistically significant difference in the area of residence between the drinking and non-drinking groups .There was a statistically significant difference in economic status between the drinking and non-drinking groups  , middle school students , and low academic performance . Students with these characteristics showed an increased possibility of drinking. The (p < 0.001). In contrast, students who had sufficient sleep  and students who slept an average amount  showed statistically significantly lower rates of drinking behavior. The p-values were 0.004 and 0.040, respectively. Smoking 1–2 times a month , 3–5 times a month , and over 6 times a month  significantly predicted an increased possibility of drinking. The p-values were 0.029, 0.004, and < 0.001, respectively.Statistically significant factors in mental health characteristics were as follows. Students who responded that they were depressed  showed an increased possibility of drinking p <0.001).In addition, starting smoking in middle school  and high school  significantly predicted drinking behavior (This study analyzed the factors influencing drinking experience based on data from the Korean Youth Risk Behavior Web-based Survey conducted by the KCDC in 2021. It was found that gender, school year, and academic performance were statistically significant predictors of drinking experience. Some studies have already reported that drinking behaviors were higher in male students . This stResults also indicated that the proportion of high school students who had experienced drinking was high, supporting a previous study showing that the risk of drinking increases with age . HoweverFurthermore, students with low grades drank more and were predicted to drink more. The highest stress among Korean adolescents was academic . In KoreThe influencing factor of residential area was not significant, but the drinking rate among students in small cities and rural areas was high. This was similar to the findings that drinking and binge drinking were higher among young people living in rural areas than in urban areas ,21. StudAmong the mental health characteristics, depression was statistically significant in drinking experience and possibility, but suicidal ideation was not. Despite the results of this study, suicide attempts are higher when substance abuse begins at an early age . In SoutAmong the mental health characteristics, students who did not get enough sleep had a significantly higher drinking experience rate and a higher possibility of drinking experience. Insomnia rates among Korean adolescents are extremely high, mainly due to excessive academic pressure . Sleep pThe longer the number of days smoked, the higher the rate of drinking experience, which became an influencing factor. In the pre-COVID-19 surveys, high school students had a high smoking rate ,30, consRecently, alcohol consumption and smoking rates among adolescents have declined globally ,14. Sout


Performance analysis based on artificial intelligence together with game-related statistical models aims to provide relevant information before, during and after a competition. Due to the evaluation of handball performance focusing mainly on the result and not on the analysis of the dynamics of the game pace through artificial intelligence, the aim of this study was to design and validate a specific handball instrument based on real-time observational methodology capable of identifying, quantifying, classifying and relating individual and collective tactical behaviours during the game. First, an instrument validation by an expert panel was performed. Ten experts answered a questionnaire regarding the relevance and appropriateness of each variable presented. Subsequently, data were validated by two observers  recruited to analyse a Champions League match. Instrument validity showed a high accordance degree among experts (Cohen’s kappa index (k) = 0.889). For both automatic and manual variables, a very good intra-  = 0.984; intra-class correlation coefficient (ICC) = 0.970; k = 0.917) ) and inter-observer   consistency and reliability was found. These results show a high degree of instrument validity, reliability and accuracy providing handball coaches, analysts, and researchers a novel tool to improve handball performance. The analysis and evaluation of sports performance is one of the research areas that has become increasingly relevant in the study of team sports, especially in collaborative—opposition sports ,2,3. To The efficient use of observational instruments for game analysis requires two essential conditions: validity and reliability. While the former evaluates the adequacy and appropriateness of an item or aspect , the latStudies in collaborative/opposition team sports based on the use of observational methodology have multiplied exponentially. Consequently, the design and validation of ad hoc observational instruments have become common and frequent in elite sports, aimed at identifying performance factors . One of Regarding handball, the scientific evidence shows a clear orientation towards the design of observational instruments for technical–tactical game analysis, mainly at the offensive level . Some exOne of the fastest-growing research and development areas in handball is performance analysis based on artificial intelligence—AI . The adoTo the best of our knowledge, no handball performance analysis software has been able to determine in depth the impact of factors affecting the dynamics of game pace in handball  beyond the outcome of the actions , homogenising the tracking, automatically generating statistical models in situ and classifying players according to specific performance parameters . Therefore, and because of the frequent use of observational methodology for technical–tactical game analysis in handball according to performance factors and the present relevance of AI based on game-related statistics in sport, the objective of this study was to design and validate a recording instrument based on observational methodology  capable of identifying, quantifying, classifying and relating individual and collective tactical behaviours in handball, ensuring compliance with the principles of validity, reliability, accuracy and generalisability. The authors hypothesise that Handball.ai will further analyse competitive handball performance according to automatic time and event control , instantaneously generate statistics based on mathematical models independently of the tracker’s intervention  and complete simplified event tracking based only on the team in possession of the ball.A nomothetic observational, follow-up and multidimensional design was used for the present study : nomotheThe process begins with data capture, which can be accomplished through different means, such as video cameras, sensors or tracking devices. These data are collected during sporting events and provide valuable information on athlete performance, tactics used, game dynamics and other relevant aspects. Once the data are collected, AI comes into play. Machine learning algorithms and natural language processing are used to analyse and extract meaningful information from observational data. These algorithms are pre-trained using sample data sets containing labelled examples, allowing the AI to learn patterns and trends from the data .Therefore, the AI in the Handball.ai tool can perform a wide variety of tasks in sports observational analysis. For example, it can automatically identify and follow players during a match, detect movement patterns and analyse the tactics and strategies used by teams. It can also perform advanced statistical analysis, such as calculating the average performance of a player in different situations or comparing the performance of different teams. In addition, the AI can provide visualisations and graphical representations of the data, making it easier for coaches, players and fans to understand and analyse. These visualisations can include motion graphs, heat maps, tactical diagrams and other visual elements that help reveal hidden patterns and trends in observational data.The design and validation of the instrument followed a four-stage process . The firThe second phase was to define the variables in a criteria system and category analysis. Descriptors were established, characterising the behaviours and classifying them, based on the scientific literature, into different categories and variables .The third phase was the validation of the instrument. The content validity was determined by expert judgement. First, a questionnaire was created. Ten experts of different nationalities participated in the validation process.An invitation explaining the context, description and purpose of the study, together with a guide to assess the following aspects of the components and their levels, was sent via email: The experts assessed the “wording” and “suitability” sections of each item, using a quantitative Lickert-type scale from 1 to 10. In addition, they made an overall qualitative assessment of each element regarding whether they considered it appropriate, where they expressed their alternatives to certain aspects that they would personally improve. To do so, they recorded: (a) the degree to which each item belongs to the object of study (“suitability”). A quantitative score was given by each expert to each unit of the instrument to determine the relevance with which each item should form part of the observation instrument. (b) Degree of precision and correctness (wording): by means of using quantitative scores given by the experts, the degree to which each item was correctly worded and defined was observed. (c) Degree of qualitative comprehension: the reflections provided by the experts on the different questions of the instrument were collected. Subsequently, the data were transformed to a 0.1–1 scale, averaging the experts’ responses for each criterion and category, according to factor. All the categories of the instrument presented agreement and acceptance values above 0.8 and were accepted .Once the instrument had been validated, a fourth and final phase was carried out to validate the data. For this purpose, the observers were trained and made several observations of the same match to achieve data reliability using Cohen’s kappa concordance coefficient , as indiTo validate the instrument (third phase), 10 experts of different nationalities participated in the validation process. The sample who participated to validate the instrument had to meet the following inclusion criteria established in the research: (I) qualification: coach with Master Coach level certified by the EHF  or Level III EHF Rinck Convention; (II) years of experience: have been training for more than 10 years in national and international categories; and (III) current season: be training in the national category in the current season .For data validation (fourth phase), two observers were recruited. These expert observers had Level III EHF Rinck Convention certification with 1.5 and 2 years of experience, respectively, in analysing handball using observational software. Both observers were of different nationalities (mean age: 36 years) and had experience as coaches for 13 ± 4 years. A training process of the observers lasted 21 days. The match selected for validation corresponded to the Champions League round of 16 match between Telekom Veszprém HC and OTP Bank PICK Szeged, played on 30 March 2023. To analyse the match, data were accessed using the match recording made by the broadcasting rights company according to the data collection criteria .To define the study sample, the following inclusion criteria were used: (a) the match to be analysed had to belong to an international competition. Because this type of competition has a high level of competitiveness, to access this championship, teams must qualify in their respective national leagues and then pass a preliminary phase that only allows the teams classified in the first positions to continue. For this reason, a match of the 2022/2023 Champions League was used.An ad hoc software was designed to record the individual actions of players during a handball match in real time. This software allows working with the multidimensional observation system and was named Handball.ai™ ). This software allows the collection of match data through a graphical interface containing two windows, one showing the video of the match and the other a graphical representation of the players and their numbers and the different team systems. The software is presented on a screen where different buttons appear to record each variable. A mobile device with a touch screen (tablet) was used to record all the events in real time as quickly and easily as possible .The following variables were defined and described to clarify data collection. The variables that define the individual actions of the players were divided into groups : period,Within the different dimensions, some of the variables are calculated manually, i.e., by the observer clicking. On the other hand, there are other variables calculated automatically by the software. This calculation is performed by means of automatic calculation parameters, i.e., an automatic calculation based on manually marked events .The inter-observer reliability assessment process was similar to methods used in previous research ,75. The Once the training period was over, observation was carried out to validate the data. The same match was recorded by the two observers, and the results were compared between them (inter-observer). One week later, the same match was observed again by the same observers, and the results were compared with the previous analysis (intra-observer).The reliability and internal consistency of the data collected were analysed. To determine the case proportion, Cohen’s kappa index (k) was used, which analyses the agreement degree between observers after excluding the proportion of cases in which the agreement between them is the result of chance . Kappa vCohen’s kappa index (k) was used to determine the degree of agreement among the experts. A Cohen’s kappa concordance was achieved of very good agreement at 0.889 . The anaIn this study we analysed the validity and the inter- and intra-observer reliability of Handball.ai in identifying, quantifying, classifying and relating individual and collective tactical behaviours in handball. The main results obtained in the reliability tests (ICC and Cohen’s kappa) and internal consistency tests , intra-observer and inter-observer, demonstrate that Handball.ai is a valid, reliable and precise tool to register individual and collective tactical behaviours in handball. In particular, the data of the automatic variables collected by Handball.ai (ICC = 0.957 and 0.937) and the data of the manual variables collected by the observers (ICC = 0.913 and 0.904) can be considered very good. Therefore, this reveals that the system is a very reliable software capable of registering automatic and manual variables, serving as an observational instrument to analyse elite handball.The expert panel has played an important role in improving and clarifying the definition, relevance and appropriateness of each variable used in Handball.ai, as in similar studies developed in other sports ,81,82. SHandball.ai contains some dimensions and variables that have been previously validated in other instruments and that serve to contextualise the situation of the game in which the event takes place, such as the period of the match, the phase of the game, the offense system or the defence system ,24,26,28In addition, the instrument includes other variables to expand the information related to a shot on goal, such as shooter position and shot location. These variables have also been widely used in other observation instruments that have been validated ,26,27,29Therefore, this instrument incorporates new variables that had not been included to date in an observation tool with similar characteristics ,24,26,28It would be appropriate to note that although Handball.ai has shown good validity and reliability both intra- and inter-observer in elite handball (0.913–0.957 and 0.904–0.937), we should be careful with the use of this software in other handball modalities, such as beach handball and wheelchair handball.Future studies could evaluate the generalisation of the system with a larger sample of matches in similar or different competitions, such as national teams’ championships or national league tournaments.The findings reported in this study demonstrate that Handball.ai is a valid, reliable, and precise tool for identifying, quantifying, classifying and relating individual and collective tactical behaviours in elite handball competitions. In particular, the main results obtained in the reliability tests and internal consistency, both intra-observer and inter-observer, demonstrate that the data of the automatic and manual variables  can be considered very good.Furthermore, this instrument presents two main advantages compared to other software validated to date. Firstly, the use of AI to collect automatic variables will reduce the time required to record and code the events during the match. Secondly, this instrument incorporates new variables, such as number of possessions and number of 1 × 1 actions that are successfully resolved by the offensive team. These variables will allow coaches to perform a deeper analysis of handball.Therefore, handball coaches and performance analysts should consider the high reliability and internal consistency of the automatic and manual variables to conduct analysis during elite competitions. Specifically, this tool would help technical staff to: (i) design better training programs focused on improving the decisive technical actions of the game; (ii) make comprehensive analyses of the technical–tactical performance  of their opponents; (iii) develop a more effective game plan; and (iv) improve talent identification and player recruitment. In addition, data collected by Handball.ai might be used by researchers for the development of new research in performance analysis in handball.There is no doubt that AI will continue to transform analysis and evaluation of elite sports. Consequently, further research is needed to analyse other AI applications, such as predicting match outcomes, assisting coaches on line-ups, tactics and player rotations, supporting referee decisions during the competition and understanding the value of players from an economic perspective.


Capsicum annuum) represents one of the most widespread functional foods of the Mediterranean diet, and is associated with a reduced risk of developing cardiovascular disease, cancer, and mental disorders. In particular, its bioactive spicy molecules, named Capsaicinoids, exhibit polypharmacological properties. Among them, Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) is the most studied and reported in variegated scientific contributions for its beneficial effects, often linked to mechanisms of action unrelated to the activation of Transient Receptor Potential Vanilloid 1 (TRPV1). In this study, we present the application of in silico methods to Capsaicin for evaluating its inhibitory activity against the tumor-associated human (h) expressed CA IX and XII. In vitro assays confirmed Capsaicin inhibitory activity towards the most relevant tumor-related hCA isoforms. In particular, the hCAs IX and XII showed an experimental KI value of 0.28 μM and 0.064 μM, respectively. Then, an A549 model of non-small cell lung cancer, typically characterized by an elevated expression of hCA IX and XII, was employed to test the inhibitory effects of Capsaicin in vitro under both normoxic and hypoxic conditions. Finally, the migration assay revealed that Capsaicin [10 µM] inhibits cells from moving in the A549 cells model.Hot pepper ( Citrus sp. fruits, etc. Furthermore, it involves a low intake of saturated fat sources and meat, extensive use of fibers and complex carbohydrates, a high intake of monounsaturated fatty acids, and an equal balance between omega-6 and omega-3 polyunsaturated fatty acids. Thanks to the positive impact that the MedDiet has had on human health, in 2010 United Nations Educational, Scientific and Cultural Organization (UNESCO) recognized this ancient way of living as an Intangible Cultural Heritage of Humanity  of Capsaicin . Plates were then incubated under normoxic conditions for 24 h, 48 h, and 72 h and at each time point cells were tripsinized and counted in Burker’s chamber, using the Trypan Blue dye for the discrimination of dead cells.hCA IX and XII, including SLC-0111, CF3-SLC, and FL88. All substances used in this study were dissolved in DMSO. Treated cells were incubated in both normoxic and hypoxic conditions.To test cell viability, a 3--2,5-diphenyl-2H-tetrazolium bromide (MTT) assay was performed 48 h and 72 h after Capsaicin [10 µM] treatment. An MTT assay carried out according to Costa et al.’s protocol . TreatmeThe effects of Capsaicin [10 µM] on A549 cells migration were determined as previously described by Salatino et al. . A549 ceTo quantify the wound closure over time, images of the wound area were captured using a digital inverted microscope EVOS XL (life technologies) and data of area were processed using ImageJ software ver 32 bit .-Cod.: sc-21733-Santa Cruz Biotechnology, Dallas, TX, USA) at 4 °C overnight. Immunoreactive bands were detected using the ECL Western blotting detection system . To normalize the protein samples loaded, we used anti-tubulin antibody . Densitometry analysis was performed using ImageJ software.Total protein extracts were prepared through RIPA buffer methods, using the standard protocol described by Salatino et al. . To sepap < 0.01 and *** p < 0.001.All tests were performed in triplicate and results were expressed as mean ± standard deviations (SD). Differences between groups were analyzed using the two-way test (ANOVA) followed by the Bonferroni test. The analysis was conducted using the GraphPad Prism Software ver 8.0.2.  and the differences were considered significant at ** bind) towards both hCAs’ active sites. To predict if the affinity of the Capsaicin allowed good interaction with the selected targets, we considered as a cut-off the consensus values of −55.66 and −58.81 Kcal/mol for hCA IX and XII, respectively  are reported and analyzed in the The ΔGhCA IX and XII, as shown in By evaluating the docking poses, Capsaicin is well recognized in the catalytic binding site of both hCA IX, the three main binding modes displayed the same arrangement of Capsaicin in the binding site. In particular, the alkyl chain was well enclosed in the hydrophobic pocket formed by the residues L134, V130, L140, A141, V142, V208, and W210. The amide group faced the zinc ion by establishing electrostatic interactions with it and an acceptor Hydrogen bond (H-bond) between its carbonyl group and the backbone of T200. Moreover, in binding modes 2 and 3, we observed that the amide group was also involved in a donor H-bond with the side chain of H94. In all three binding modes, the methoxy-phenol moiety involved a stacking interaction with the side chain of H94, even if it was directed to a hydrophilic cavity with distinct orientations and the following establishment of different electrostatic contacts .Capsaicin was investigated in vitro for its ability to inhibit the most physiologically relevant hCA I and II isoforms , whereas it showed submicromolar values for the remaining isozymes considered. Specifically, Capsaicin as a ligand was 1.7-fold less potent for the constitutively expressed mitochondrial hCAs VA over the VB, with KI values of 0.75 and 0.44 μM, respectively. Quite interesting, for the purposes of the research herein reported, were the inhibition potencies obtained for the tumor-related isoforms. The hCAs IX showed a KI value of 0.28 μM, thus being 10.8-fold less effective when compared to the reference and prototypic CA inhibitor AAZ. It is noteworthy that Capsaicin resulted in a 4.4-fold more effective ligand for the hCA XII isoform. The in vitro kinetic assay reported an experimental KI value of 0.064 μM, which was the lowest among all the enzyme panels reported. In analogy to the hCA IX, a similar trend was observed when the Capsaicin hCA XII values were compared to AAZ, the latter being 11.2-fold more potent.As reported in hCA XI an hCA XII inhibitor substances. Therefore, the viability assay was conducted on A459 cells treated with Capsaicin [10 µM] under both normoxic and hypoxic conditions. These different conditions of incubation were helpful to obtain enhanced expressions of hCA IX and hCA XII in our cellular model, as described by Ilie et al.  treatment on injured A459 cells. The efficient shift from the borders of the scratch to wound healing was low in the sample treated with Capsaicin [10 µM] within 24 h (data not shown) and increased over time both at 48 h and 72 h where the wound area was 40% greater, as shown in In addition, we conducted a Western blot analysis on total proteins extracted from the above-mentioned cultured cells, with the purpose of understanding if the treatment with Capsaicin [10 µM] effectively acts on cellular motility.According to hCA IX and hCA XII in the pathogenesis of different cancer types  inhibited cells moving in the A549 cells model. In agreement with our supposition, other groups had previously demonstrated that an inhibitory effect on the migration of further cancer cells was linked to the suppression of IX e XII ,47.hCA IX induces the expression of MMP-9. As proof of this, we demonstrated, for the first time, how MMP-9 is down-regulated after Capsaicin treatment, identifying an additional element that may support the idea that capsaicin acts on hCA IX.Indeed, the results obtained from our Western blot analysis support what has been said so far. Yang, J.S. et al. described how hCA IX and XII as a target of Capsaicin.Although in vitro results are nothing more than a statement of principle, additional investigations will be required to characterize the molecular response of CA IX and XII to Capsaicin treatment. However, our results, achieved from the in silico test, together with the in vitro assay and the knowledge present in literature, suggest a potential role of


The aim of the study was to expand the current knowledge base on problematic video gaming and ADHD with four questions: (1) Are there differences in the length of video gaming between boys with ADHD and typically developing boys? (2) Are there differences in problematic video gaming between boys with ADHD and typically developing boys? (3) What are the predictors of problematic video gaming? (4) Does problematic video gaming affect academic performance while controlling for the effect of inattention and hyperactivity/impulsivity symptoms? Symptoms of inattention, hyperactivity/impulsivity scale (SNAP IV), the Problematic Video Game Scale, and the Video Game Patterns Questionnaire were administered to 127 parents of elementary school boys in Croatia, 57 of whom were parents of boys with a clinical ADHD diagnosis and 70 of whom were parents of typically developing boys. The results show that there are no differences in length of play and problematic video gaming between ADHD and typically developing boys. A hierarchical regression analysis showed that age, inattention symptoms, and length of play are predictors of problematic video gaming. Inattention symptoms and age are significant predictors of academic achievement whereas it seems that hyperactivity and impulsivity symptoms are not predictors of problematic video gaming and academic achievement in boys. Gaming is one of the most common forms of entertainment for children. Research in the United States prior to the COVID-19 pandemic shows that elementary school children spend on average up to three hours per day playing video games  or up toStudies show that 2–5.5% of adolescents/young adults have a video game addiction .The term ‘video game addiction’ or ‘gaming disorder’ and its synonyms such as compulsive, excessive, and problematic video gaming are regularly and interchangeably used . Gaming In this paper we will use the term problematic video gaming.Gamers with excessive video game use or pathological gamers, children aged 8–18, are likely to have more physical and mental health problems such as hand, neck, and wrist pain , attentiStudies emerging from the review by Giardina et al.  reportedProblematic video game playing is a predictor of behavior problems in both typical children and children diagnosed with ADHD .ADHD is one of the most common neurodevelopmental disorders in children and adolescents , charactAlthough the correlation between ADHD symptoms and problematic video gaming in children and adolescents has been observed in several studies, it has not yet been clarified. It is unknown to what extent symptoms of inattention and to what extent symptoms of hyperactivity/impulsivity account for more problematic video gaming in children with ADHD. In studies by Masi et al. , and KieResearch on the relationship between age and problematic video gaming does not provide clear results. Comparisons of the results obtained are difficult because different studies used different measures of problematic video gaming. In addition, some studies have included only online games, while others have included video games that can be played offline. Some studies on a typical population found that video game addiction decreases with age and is lower in adolescents ,24, one Several studies have shown that time spent playing video games is a predictor of problematic video gaming, both in children  and adulIt has also been noted that among pathological gamers, there are more who have devices available in their bedrooms ,26; howeResearch on the relationship between problematic video gaming and academic achievement does not yield consistent results. Some studies show that video game addiction is a predictor of lower academic achievement ,16,28, wThe aim of the study was to expand the current knowledge base on problematic video gaming and ADHD. The relationship between ADHD symptoms and problematic video gaming in children and adolescents has not yet been clarified. Moreover, results on the duration of play in children and adolescents with ADHD compared with children with typical development have been inconsistent. It is also not known whether there is an association between device availability and problematic video gaming in children with ADHD. Considering that boys are more likely to play video games and exhibit more symptoms of problematic video game playing than girls, we focus on problematic video gaming in boys in this study.The first objective was to investigate whether there are differences in the length of video gaming between boys with ADHD and typically developing boys. Based on previous studies, we hypothesized that boys with ADHD spend more hours playing video games.The second objective is to find out if there is a significant effect of ADHD on problematic video gaming.The third objective is to investigate possible predictors of problematic video gaming. Several research questions were raised. First, to what extent do age, symptoms of inattention, hyperactivity, and impulsivity contribute to the prediction of problematic video gaming? Second, is there an association between the patterns of playing video games and problematic video gaming, and does an ADHD diagnosis moderate this association?The fourth objective was to determine whether problematic video gaming has an effect on academic performance, while controlling for the effect of inattention and hyperactivity/impulsivity symptoms.Overall, 127 parents of elementary school boys (125 mothers and 2 fathers) from different parts of Croatia participated in the research, 57 of whom were parents of boys with a clinical ADHD diagnosis and 70 of whom were parents of boys with typical development. The age of the boys ranged from 7 to 15; the average age was 10.82 years, 37% lived in rural areas, 31% lived in urban areas with up to 100,000 inhabitants, and 31.5% in urban areas with over 100,000 inhabitants. The sampling method in the research was a non-probabilistic convenience sample.The questionnaire was sent to the parents of boys with ADHD who used the services of the Teaching and Clinical Center of the Faculty of Education and Rehabilitation at the University of Zagreb. Parents were also approached through Facebook, more specifically through its groups for parents of children with ADHD and groups for parents of children with typical development. The questionnaire was created using Google Forms and respondents could access it through a link during March and April 2022. Answering the questionnaire was possible through a personal computer or a cell phone. This study was approved by the Educational Rehabilitation Studies Committee, University of Zagreb, Faculty of Education and Rehabilitation Sciences. It was conducted in accordance with the Code of Ethics of the Croatian Psychological Society, the Code of Ethics of the University of Zagreb, and Ethics Guidelines for Internet-Mediated Research of the British Psychological Society. Special care was taken to preserve and protect data collected from research participants. At the very beginning of the questionnaire, respondents were informed that all ethical principles would be respected and that their anonymity would be guaranteed.To conduct this research, a socio-demographic questionnaire was designed with open- and closed-ended questions that were aligned with the research questions and explored the following: age and gender of the respondent and their child/children, the overall academic achievement of the child in terms of grades, and whether the child has a clinical diagnosis of ADHD and/or other developmental disorders.The Croatian version of the MTA version of the SNAP-IV  was usedThe patterns of playing video games were measured using the following: number of electronic devices in the home available to the child for playing video games, available electronic devices in the child’s room, average number of hours played during the week, average number of hours played on weekends, and whether children played more video games during COVID-19.The Croatian adaptation of the Video Game Addiction Test for Parents  was usedAll the analyses were performed using SPSS 25 for Windows . Descriptive analysis included means and standard deviations. The comparison of the groups was based on one-way ANOVA. The Pearson correlation coefficients determined the bivariate correlation. Hierarchical multiple regression analyses enabled the estimation of the variance, explained by predictor variables on problematic video gaming and academic achievement.To meet the objective of the study, a descriptive analysis was first performed. We would like to emphasize that there was no significant effect of diagnosis on problematic video gaming in our groups, as can be seen in To investigate the possible predictors of problematic video gaming, a hierarchical regression analysis was performed. In the first step, we entered the child’s age, and, in the second step, symptoms of inattention and hyperactivity/impulsivity .p < 0.001, and accounted for 9.2% of the variation in problematic video gaming. Introducing symptoms of inattention and hyperactivity/impulsivity, the regression model explained an additional 17.7% of the variation, and this change in R2 was significant, F  = 14.94, p < 0.001. When all three independent variables were included in stage three of the regression model, hyperactivity symptoms were not significant predictors of problematic video gaming. The significant predictors were inattention symptoms and age, which suggest that the prevalence of inattention symptoms and higher age are associated with severe problematic video gaming.The hierarchical multiple regression revealed that at stage one, age contributed significantly to the regression model, F  = 12.66, To investigate whether patterns of playing video games predict problematic video gaming in boys with ADHD, two hierarchical linear regression analyses were performed for the ADHD and control groups. In the first step, we entered the number of available devices and the presence of devices in the child’s room, and in the second step length of video game playing during the weekdays and weekends .p < 0.01. Adding the number of video gaming devices and availability of the devices in the child’s bedroom, the regression model explained an additional 10% of the variation in problematic video gaming, and this change in R2 was significant, F  = 5.20, p < 0.05. Adding the length of video gaming during the week and weekend, the regression model explained an additional 389% of the variation in problematic video gaming, and this change in R2 was significant, F  = 15.61, p < 0.001. In our control sample, we found similar results; at stage one, age contributed significantly to the regression model, F  = 5.44, p < 0.05. Adding the number of video gaming devices and availability of the devices in the child’s bedroom, the regression model explained an additional 15% of the variation in problematic video game playing, and this change in R2 was significant, F  = 6.43, p < 0.01. Adding the length of video gaming during the week and weekend, the regression model explained an additional 41% of the variation in problematic video game playing, and this change in R2 was significant, F  = 22.16, p < 0.001.In our ADHD sample, the hierarchical multiple regression revealed that at stage one, the age of boys contributed significantly to the regression model, F  = 8.02, In both samples, when all five independent variables were included in stage three, the two variables of the length of play were the only significant predictors of problematic video gaming. The length of play variables seem to behave as suppressor variables in both samples for age, the number of available devices in the ADHD sample, and the presence of a device in the bedroom in the control group. We explain it by the higher correlation coefficients of the length of play variables with the criteria, although the patterns differ with regards to diagnosis. In ADHD children, the number of overall devices seems to be more significant compared to device availability in the bedroom in the control sample, with regards to video game addiction; however, both become suppressed by the length of play. To investigate the possible predictors of academic achievement, we performed a hierarchical regression analysis. In the first step, we entered the child’s age, in the second step symptoms of inattention and hyperactivity/impulsivity, and in the third step problematic video gaming . p < 0.05. Introducing the inattention and hyperactivity/impulsivity symptoms explained an additional 22% of variation, and this change in R2 was significant, F  = 14.57, p < 0.001. Adding problematic video gaming did not contribute significantly to the regression model, F  = 0.004, p > 0.05. When all four independent variables were included in stage three, the significant, as well as negative, predictors were age and inattention symptoms. The results suggest that the severity of inattention is associated with the problems regarding academic achievement, as it was the stronger predictor, additionally declining with age in our sample. The hierarchical multiple regression revealed that at stage one, age contributed significantly to the regression model, F  = 4.67., The purpose of this study was to compare ADHD-diagnosed boys with typically developing boys, with respect to playing video games, in order to examine possible predictors of problematic video gaming, and to determine whether problematic video gaming has a differential impact on academic performance with respect to an ADHD diagnosis.There was no difference between the duration of playing during the week and on weekends between the ADHD and control group, which is consistent with Bioulac et al. , while iIn this study, we obtained data on time spent playing video games from parents rather than children, and the results may have been different if we had known the actual time spent playing video games. It is possible that most children, especially children with ADHD, spend more time playing games than parents think, especially if they have the opportunity to play video games in their room.ADHD diagnosis was not a factor that differentiated our participants in regard to problematic video gaming, which is inconsistent with previous research ,19,21,22The performed regression has shown that the symptoms of inattention as well as age had significant effects on problematic video gaming. These results suggest that attention difficulties could be a risk factor for problematic video game behavior in the population of boys, which is consistent with a previous study where path analyses showed the direction of causality, and suggest that attention problems may lead to pathological gaming; however, the inverse result was not obtained . PossiblOur results are in accordance with one previous study by Esposito et al. , which fIn addition, we were interested in whether there was a relationship between the pattern of playing video games and problematic video gaming, with regards to ADHD diagnosis. Devices in a child’s room had a moderate effect in the control sample, while the number of available devices had an effect in the ADHD sample in the first step. In both models, the introduction of the length of play variables had a suppressive effect on those variables and thus they emerged as stronger predictors. Our results suggest that for ADHD boys, the length of play during both the week and weekend is associated with problematic video gaming. In the control sample, we found a stronger effect of the length of play during the weekend, when parents are likely to place fewer restrictions, although both are associated with problematic video gaming. Similar results have been found in some studies ,27. EvenFurthermore, we were interested in whether problematic video gaming affects academic achievement. In the complete model, inattention symptoms and age had a statistically significant effect on academic achievement, whereas problematic video gaming and hyperactivity were not significant predictors. Older age is associated with poorer academic achievement which can be explained by the higher demands that students in the higher grades of elementary school are exposed to. Boys with symptoms of attention difficulties, whether or not they have an ADHD diagnosis, have poorer academic achievement, which is to be expected since attention affects all aspects of learning. Similar results were obtained by Haghbin et al. . In SahiThis is the first study in Croatia to investigate problematic video gaming in children and adolescents diagnosed with ADHD. It is the first study in the available literature in English that has examined the impact of problematic video gaming on academic achievement, as well as the impact of video game device availability on problematic video gaming in individuals diagnosed with ADHD. The strength of this study is that data were collected from different regions of the country, both rural and urban. Another strength of our study design is that data about inattention and hyperactivity, which were collected for the whole sample, have enabled us to investigate these variables in the entire sample, regardless of the diagnosis. This study has several limitations. Given the potential for data collection during the COVID-19 pandemic, the survey was conducted on an online sample, and we would suggest replicating it with a larger representative sample. The duration of play was estimated by parents, and it is possible that they did not have insight into all the situations in which their children played video games, which could have influenced the results. On the other hand, there were questions about whether a child’s self-assessment of the duration of video game play is a reliable measure, especially for children with problematic video game behavior and children diagnosed with ADHD, who have difficulty with self-assessment and sense of time. The studies are difficult to compare because they differ in terms of the age range of participants included, the measures of problematic video gaming, and academic achievement; therefore, further studies are needed to draw firm conclusions.This study shows that attention difficulties, rather than ADHD diagnosis per se, are a significant predictor of problematic video gaming in elementary school boys. The results also show that the duration of play, both during the week and on weekends, is an important predictor of problematic video gaming for both boys with ADHD and typically developing boys. Attention difficulties alone could be a risk factor for poorer academic achievement, regardless of ADHD diagnosis and problematic video gaming. Study findings on problematic video gaming associated with older age suggest a need for the prevention of problematic video gaming at an earlier age.


Uterine arteriovenous malformation (AVM) is a defect due to direct connection between uterine arteries and veins, it has wide range of symptoms and severity, usually causes vaginal bleeding which may be mild or severe and may cause death in some rare cases. Diagnostic methods may include ultrasound, MRI, CT and/or angiography which reveal a high blood flow hypoechoic mass. Many options have been applied as management procedures, including invasive and noninvasive procedures, aiming to save patient life and stop bleeding or preserve fertility in the less severe cases.21 years old primigravida patient developed episodes of severe vaginal bleeding due to AVM after complete molar pregnancy evacuation and chemotherapy, managed successfully by bilateral internal iliac artery ligation and applying compression sutures on the uterus and continuing with compound medical treatment, trying to preserve fertility and ability to get pregnant in the future.We point out AVM types, its sings, symptoms and the diagnostic procedures. We discuss the bilateral iliac artery ligation and applying modified compression sutures on uterus as possible emergency managements to AVM when there is a threatening on life due to huge bleeding. We also mentioned the other surgical and medical treatments.We confirm the importance of keeping AVM in mind as a possible diagnose when there is unknown cause vaginal bleeding. Consider doing bilateral iliac artery ligation and applying the modified compression sutures as emergency procedures to stop or reduce AVM bleeding. •Uterine arteriovenous malformation is a rare condition where there are abnormal connections between arteries and veins.•Transvaginal color Doppler ultrasound is a suitable way to put diagnose.•AVM treatment's options depend on patient's hemodynamic status and on the desire of preserving fertility.•Bilateral iliac artery ligation is one of AVM treatment's options especially in emergency situations. Her main complaints were continuous vaginal bleeding after the evacuation for two months unresponded to medications and general fatigue. Her blood pressure was 100/70 mm Hg and the heart rate was 98 beats/min, laboratory tests: Hb: 9.6 g/dl and B-HCG level = 72,194.12 mIU/mL. The patient had no significant medical and family history, she denied alcohol and tobacco use. The ultrasound showed large uterus , a wholeThe patient was hospitalized with the diagnosis of invasive molar pregnancy and received three high risk courses of chemotherapy, the B-HCG levels reduced then from 72,194.12 mIU/mL to a negative value in 5 months.The patient admitted again in the hospital 5 months later with general fatigue and moderate vaginal bleeding, the HGB = 7.3–PT = 62 %. Five units' whole blood and five plasma units have been transmitted within two days. A Trans Vaginal Sonography with Doppler was made and revealed a heterogeneous mass mostly represent an AVM mass behind the uterus . A compuThe patient was discharged home stable with HGB = 9.9 and was put on continuously combined oral contraceptive pills.She was admitted in the hospital again 25 days later with severe vaginal bleeding and HGB = 5.4, her pulse was 130 and the blood pressure was 100/60 mm Hg, she was tubed in the intensive care unit and whole 6 blood units plus six plasma units were transmitted. Another episode of severe vaginal bleeding occurred to almost of 1.5 L of blood after few minutes later; therefore the decision of surgery was made.Open laparotomy under general anesthesia was done by our staff where we found a vascular mass behind the uterus, in front of rectum behind the peritoneum measuring 5 × 6 cm , we madeShe was discharged home after one week of observation, 5 whole blood units and 15 plasma units were transfused, we gave her single dose of depo provera IM on day 2 after surgery and yasmin tablets for 5 days.Serial later TVS with Doppler showed no obvious vascular malformation behind the uterus, a CT 40 days after surgery did not show the previous vascular malformation , Fig. 7.3AVM is a rare condition usually occurs at fertile age, with no accurate incidence rate because some cases may be misdiagnosed or went undiagnosed and resolved spontaneously There are two types of AVM: congenital AVM which results from abnormal embryologic development of primitive vascular structures, which lead to abnormal connections between arteries and veins and may invade surrounding structures and can involve anybody's tissue The AVM in this case was mostly developed after a complete molarian pregnancy which was treated by evacuation and chemotherapy, even so it may be congenital AVM which activated and gave sings after pregnancy which increases the vasculature of uterus and after chemotherapy which may make vessels walls weaker.AVMS may be existed or developed without presenting any symptom and could regress spontaneously or may cause abnormal vaginal bleeding ranges from mild to severe and potentially life-threatening or may lead to high cardiac output state, cardiac dysfunction and congestive heart failure In our case the patient had experienced life-threatening and heavy episodes of bleeding that needed whole blood transfusion and intensive care unit admission and emergency treatment finally.Different means can be used to diagnose AVM; even so it is challenging to be diagnosed accurately, 2-dimensional grayscale ultrasound scanning could reveal irregular tortuous tubular hypoechoic lesions, showing increased vascularity and turbulent high velocity blood flow when using color Doppler and most recently using transvaginal ultrasound scanning, which can now be used successfully in diagnosing and following up after treatment and in determine the severity of the case depending on PSV (peak systolic velocity) values in the range of 40–100 cm/s and the resistance index of the vessel ranging from 0.25 to 0.55, although uterine angiography was the gold standard diagnostic method in the past, but it is rarely used today to make diagnose unless using it in treatment We used color Doppler which revealed a high vascularity mass behind the posterior wall of the uterus; we did a computed tomography angiography in order to obtain further information about the lesion and its feeding vessels.Despite the importance of the gynecological AVM, till now there is no clear algorithm or specific guidelines to handle with it, all the procedures were based on individual cases-mainly according to the clinical state So, when the patient is hemodynamically stable, the medical treatment can be tried even though there are no strict recommendations to give medicine or to determine the dose. We can categorize it into hormonal, uterotonics, methotrexate. A systemic review has conducted on 121 premenopausal women and found that the success rate was 88 % in general . The medical treatment has many good points, it costs less, noninvasive and has no effect on fertility Another option which has a wide application is uterine artery embolization. A systemic review by Daniel J and his collages included 54 patients found that the TCE (transcatheter embolization) primary success was 61 % and reached 91 % when the procedure needs to be repeated. There were no lines to follow after the recurrence of bleeding; some patient gets benefits of medicines, surgery or re-embolization which was discussed to embolize the contralateral side or the same side. Nevertheless, the clinical state plays main role in this decision Unfortunately, we didn't have this option because of the limitation of sources in our country, the high cost and the rapid deterioration in patients' clinical state.To handle with a uterine AVM surgically we should first understand it with a vascular surgery look. The AVM consists of the nidus which connects the feeding arteries and the draining veins and if we do proximal occlusion with any intervention without penetration the nidus it is likely to develop new collateral feeders However, many procedures were done successfully without doing embolization first, but we noticed that they removed the AVM, not only doing ligation to the feeding artery. Ncol and his colleges ligated the feeding vessels above and below the uterine plexus which was along the left uterine wall in the broad ligament also between the plexus and the uterine wall without opening the myometrium, leading to successful pregnancy In another surgical procedure, the uterine myometrial lesions were resected, and the uterus was reconstructed with an intact uterine cavity beside vessels' ligation, the vaginal bleeding stopped but unfortunately, she didn't menstruate later because of the uterine cavity adhesions During following up of patient who received chemotherapy due to invasive gestational trophoblastic tumor and who developed large arteriovenous malformation handled laparoscopically with bipolar coagulation of the ovarian and uterine arteries and surgical resection of the tumor. The defect in the uterine wall with an intact uterine cavity was reconstructed using sutures. The patient menstruated regularly after that Well, sometimes it is difficult to remove the AVM surgically, like in a case where the decision was to do ligation to the feeding arteries in attempting to resolve the AVM. The patient was scheduled to perform abdominal hysterectomy because of uterine AVM but because of the risk of massive hemorrhage from the expanding vessels the hysterectomy was canceled and only the main 6 arteries feeding the AVM, the uterine and ovarian arteries, and collaterals originating from internal iliac artery were ligated and resolution of the AVM has occurred Another similar case considered the internal iliac artery ligation by open laparotomy as a management of uterine AVM As the internal iliac artery is the main vascular supply of pelvic visceral structures so during peripartum hemorrhage or massive pelvic bleeding bilateral ligation of these arteries can reduces the pelvic arterial blood flow and pulse pressure.However, most of the surgical interventions which included ligation of the internal iliac arteries or the uterine arteries were after an unsuccessful embolization of these arteries or when it was difficult to do the embolization.Levy-Zaubermann et al. reported completely regression of the AVM after laparoscopic internal iliac artery occlusion with nonresorbable clips placed on both internal iliac arteries and both round ligaments after unsuccessful 2 bilateral embolization procedures to the both the right and left uterine arteries because angiography had showed vascularization of the uterine AVM via these two arteries The retrogression in the AVM after ligation of the feeding vessels only might be explained by the thrombosis which occurred in AVM mass after the ligation surgery and subsequent decreased in blood flow Actually, in our case we made the same somehow, after the decision was made to do open laparotomy because of the emergency situation, we did bilateral internal iliac ligation without interruption of the AVM directly and we did a modified compression sutures on the uterus as a method to decrees hemorrhage but these sutures did not include AVM mass because of the fear of rupturing the AVM and causing severe bleeding due to its fragile doughy texture.After the surgery the bleeding has stopped and a massive blood transfusion was done to restabilize the patient. We did the surgical treatment not because of continuing vaginal bleeding which was stopped after surgery but as an attempt to prevent another episode of possible bleeding. However, we weren't sure about the succeeding of our procedure. So we gave her a depo provera injection and combined oral contraceptive pill for 5 days the day after surgery. A pelvic Doppler week later and a CT after 40 days revealed complete resolution of the previous AVM.Currently, hysterectomy is indicated only for those women who do not want a child anymore and have difficulties in accessing the medical facilities Preserving fertility after AVM treatment especially after embolization is still questionable and there are no studies reports data on pregnancy rates after these treatments We still need further information and studies to determine the best management procedure to reduce and stop bleeding, resolve the AVM mass and preserve the uterus and fertility.4AVM can follow molar pregnancy and traumatic procedures on uterus, so it should be considered in every woman comes with abnormal uterine bleeding after molar pregnancy treatment procedures.Transvaginal ultrasound scanning can be used successfully in diagnosing AVM and following it after treatment.Bilateral iliac artery ligation should be considered in life-threatening situations when maintain fertility is preferable, and it could be shared with medical treatment.A modified compression sutures could be applied on the uterus in order to reduce bleeding as a secondary and additional technique to the main procedure.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.The study is exempt from ethnical approval in our institution.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Wessam Taifour.Not applicable.Wessam Taifour: study conception and design, data collection, writing the paper.Fatima Haj Reslan: study concept, data collection, writing the paper.Dema Adwan: study concept, Critical revision of the article.All authors reviewed the results and approved the final version of the manuscript.We have no conflicts of interest to disclose.


The explosive growth of online short videos has brought great challenges to the efficient management of video content classification, retrieval, and recommendation. Video features for video management can be extracted from video image frames by various algorithms, and they have been proven to be effective in the video classification of sensor systems. However, frame-by-frame processing of video image frames not only requires huge computing power, but also classification algorithms based on a single modality of video features cannot meet the accuracy requirements in specific scenarios. In response to these concerns, we introduce a short video categorization architecture centered around cross-modal fusion in visual sensor systems which jointly utilizes video features and text features to classify short videos, avoiding processing a large number of image frames during classification. Firstly, the image space is extended to three-dimensional space–time by a self-attention mechanism, and a series of patches are extracted from a single image frame. Each patch is linearly mapped into the embedding layer of the Timesformer network and augmented with positional information to extract video features. Second, the text features of subtitles are extracted through the bidirectional encoder representation from the Transformers (BERT) pre-training model. Finally, cross-modal fusion is performed based on the extracted video and text features, resulting in improved accuracy for short video classification tasks. The outcomes of our experiments showcase a substantial superiority of our introduced classification framework compared to alternative baseline video classification methodologies. This framework can be applied in sensor systems for potential video classification. In the past few years, the emergence of short video applications has exploded, such as Tiktok, YouTube Shorts, Likee, Bilibili. Most of the short videos in these video applications are tagged when they are released, enabling users to browse videos by category and search within a certain category . These sAt present, the application of deep learning methods in the classification of violent videos  and sociIn addition to visual features, textual features are also widely employed in the field of short video classification. These textual features typically originate from metadata information such as video titles, descriptions, and tags. The advantage of textual features lies in their ability to provide semantic information about the video content, thereby enhancing classification accuracy. Researchers have developed various methods for extracting textual features, including those based on traditional natural language processing techniques such as the bag of visual words (BOVW) model , as wellHowever, at present, users upload short videos with great randomness and divergence, and users’ understanding of video categories generally varies and there is more and more false information, resulting in inconsistent categories marked by users . This inWe propose an improved hierarchical clustering approach for keyframe extraction. Unlike traditional keyframe extraction algorithms, hierarchical clustering does not require a predefined number of keyframes to be extracted. Instead, it adaptively determines which frames are keyframes through clustering to offer greater flexibility. This method is capable of preserving essential information from the video while effectively reducing redundant frames, resulting in more representative extracted keyframes.We investigate the extraction methods of visual features and textual features within videos. The method of combining visual information and text information for video classification is used in this paper. The visual information is first processed by the key frame extraction method to divide the video into multiple images representing the main content. The pre-trained Timesformer network is used for feature extraction to obtain the visual features of the video. At the same time, the text information is also extracted by the fine-tuning-based method in BERT. Finally, these two kinds of features are fused by the feature aggregation algorithm for video classification.We propose a cross-modal fusion short video classification (CFVC) framework. This framework utilizes text features and visual features in a new way, combining the integration of visual attributes extracted from the training dataset and text features extracted from subtitles to achieve cross-modal fusion and integrate them into joint features for downstream classification tasks.Thus, short video classification is essential to determine the category of a video so that videos without user-labeled categories can also be organized in the same way as videos with category labels. A distinct video classification framework is introduced herein which leverages both textual and visual features in a new way. We bring together visual features obtained from the training dataset with text features extracted from subtitles across modalities, and integrate them into joint features for downstream classification tasks. Specifically, the text feature uses the bidirectional encoder representation from the Transformers (BERT) pre-training model, adds context using the attention mechanism, and solves the parallel calculation between sentences ,20,21. VThe subsequent sections of this paper are structured as follows. k represents the count of frames within a video, and N represents a subset of adjacent frames of the video. The main differences between these frameworks are: (1) The first differentiation lies in determining whether the convolution and layer operators utilize 2D (image-based) or 3D (video-based) kernels  is added at the beginning of the input text to indicate that the text belongs to a classification task, and [SEP] tags are used to indicate the segmentation between sentences. The BERT model optimizes its weight through multiple rounds of pre-training iterations. Finally, each input tag corresponds to a 1024-dimensional vector denoted by E or E′. These vectors constitute the hidden state representations T and T′ of the last layer and can be used as feature representations, masked language modeling (LM) and next sentence prediction (NSP), for downstream tasks. The input text type of this article is subtitle information, which consists of a group of sentence pairs A and B. Firstly, word segmentation is performed on the sentence pair, and a piece of text is divided into In this paper, cross-modal fusion techniques are introduced to fuse information from different modalities together to address the problem of multimodal information processing and analysis. In the fusion process, early fusion will inhibit the links within or between modalities, resulting in the loss of video semantics, and the interaction between different modalities cannot be achieved. Therefore, this paper adopts the late fusion method, which inputs each modality information into the clustering network and uses the dot product operation to obtain the final video feature vector. This late fusion way helps to preserve the richness of multimodal information and realizes the interaction between different modalities, which improves the model performance.After the visual features and text features of video frame-level images are extracted by Timesformer and BERT, the frame-level features need to be aggregated to obtain video-level features before video classification. Previously, the long short-term memory network LSTM and gated recurrent unit (GRU) can obtain the timing information of the video. However, the next vector of the locally aggregated descriptors (NextVLAD) network and the AttentionCluster network, which are conducive to scene recognition, are more effective for aggregating visual features and text features.The NextVLAD network reduces the overall parameters of the model by reducing the input dimension and splitting it into multiple groups. It first increases the dimension of The encoding feature NextVLAD divides video features into multiple groups for clustering operations, and introduces an attention mechanism to add weights to different groups. It uses AttentionCluster attention clustering while adding offset operations, thereby increasing the weight of frames strongly related to tags in video content. Finally, several local features are aggregated into a video global feature.To realize the short video classification task, we extract its text information features and visual information features from the video. In our experiments, the textual attributes obtained from videos encompass elements such as video titles, subtitle information, and descriptions of videos. We stem these textual features and remove stop words using the standard BERT contextual attention mechanism. We use the filtering mechanism to perform a zero-fill operation for those that are not long enough, and directly truncate those that are too long to remove interference ,38. For In the experiments, we use Pycharm as the development tool. Based on the Pytorch 1.13.0 deep learning framework, we use Python 3.7 as the development language. The main configuration of the computing server is as follows: (1) Operating system: Ubuntu21.04, (2) CPU: Intel(R) Core(TM) i7-11700K CPU @ 2.50 GHz, (3) Memory: 32 GB, (4) GPU: RTX2080Ti.To explore the scalability of the model, the dataset of this experiment is the BOVText dataset, which is a large-scale bilingual open video text dataset . First oAC), Precision (PE), Recall (RE), and F1 Score. The larger the value of these performance indicators, the better the classification effect, and their definitions are as follow equations.With the objective of assessing the efficacy of multimodal classification results, four prevalent metrics are introduced: Accuracy Single-mode featureThe single-feature experiment is an experiment in machine learning and statistical modeling that uses only one feature to train and test a model. In single-feature experiments, other features are usually considered irrelevant or ignored, because the purpose is to understand the impact of a single feature on model performance, and it is mainly used to compare the accuracy of a single network and a combined network. Based on the outcomes in (2)Cross-modal fusionThe cross-modal fusion experiment refers to the fusion of the video-level features of the data of multiple modalities in the video through the clustering network each time, and then input them into a single network or combined network for classification. This experiment is mainly used for comparing the classification performance between a single modality and a fusion of two modalities. It can be seen from (3)Comparison of public datasetsIn this paper, we first study the video features of different modalities and the adopted feature extraction methods. According to the information characteristics of each video modality, different network models are used to extract the corresponding features, so that it can represent the information of the modality well. Then, through the clustering algorithm, the features of the two modalities are fused to obtain the features of the video, thereby improving the representation of the overall features. The final features are made more useful for classification tasks by means of modality fusion. In experiments, classification evaluation is performed on our dataset. The comparison experiment mainly studies the difference between our model and different models. The experiment results show that visual information has the greatest impact on video classification tasks, and the accuracy of the model can be effectively improved by modality fusion, thus improving the accuracy of classification. Correlative results reveal the effectiveness of our model, which has certain advantages over other models. Due to the limited types and number of videos in the training dataset, the impact of different training datasets on the classification performance has not been further investigated. In future work, we will try to expand the type and number of videos to improve the classification performance.


Dear EditorWe thank Lightner and colleagues for their study on surveillance pouchoscopy in ulcerative colitis patients. The authors reported that neoplasia following ileal pouch-anal anastomosis (IPAA) is rare. They recommended pouch surveillance with random biopsies of the anal transition zone (ATZ) for patients with a personal or family history of colorectal neoplasia (CRN)It is unknown whether routine surveillance improves outcomes of pouch neoplasia, since pouch neoplasia is usually diagnosed after symptom development. As such, all patients in this study had a negative surveillance pouchoscopy in the 2 years prior to pouch carcinoma detectionWe question whether random biopsies lead to earlier detection of (pre)cancerous pouch lesions. The authors reported six pouch carcinomas and none were detected in random biopsies. Moreover, six of seven dysplastic lesions identified with random ATZ biopsies were not confirmed in follow-up biopsies and it could be questioned whether the initial lesions contained ‘true’ dysplasiaFinally, we disagree with the recommendation of pouch surveillance in patients with a family history of CRN. The authors reported a positive family history in only one of 13 patients and previous studies did not identify this as a risk factor for pouch neoplasia.In conclusion, we only advocate pouch surveillance with random ATZ biopsies in high-risk patients with prior CRN. Nevertheless, current data remain scarce and uniform, widely adopted pouch surveillance guidelines are needed to unify practice.Disclosure. The authors declare no conflicts of interest.