The model solution of diluted brine continuously flows through the system with Li+ slightly concentrated and Mg2+ significantly removed by ICP driven by external pressure and perpendicular electric field. In a typical case, our results showed that this system could focus Li+ concentration by ~1.28 times while decreasing the Mg2+/Li+ ratio by about 85% (from 40 to 5.85). Although Li+ and Mg2+ ions are not separated as an end product, which is preferably required by the lithium industry, this method is capable of decreasing the Mg2+/Li+ ratio significantly and has great potential as a preprocessing technology for lithium extraction from salt lake brines.Ion concentration polarization (ICP) is a promising mechanism for concentrating and/or separating charged molecules. This work simulates the extraction of Li Global demand for lithium has increased significantly over the past decades, driven by the expanding requirement of rechargeable lithium batteries for portable electronic devices, electric vehicles, and grid storage applications. Generally, lithium has been obtained from two sources—hard rock ores and continental brines ,2. Extra+ and Mg2+ ions. This is because magnesium and lithium elements possess similar chemical properties, and magnesium must be removed in most lithium applications [Essentially, the key task of lithium extraction from salt lake brines is the separation of Liications ,6. So faications ,8, adsorications , solventications ,11, calcications , and memications ,14, etc.+ into insoluble substances and then separate them from the solution. This method is commonly used in low Mg2+/Li+ ratio brines of salt lakes in South America, yielding the largest portion of the world’s lithium productions today [2+/Li+ ratio salt lake brines. The adsorption method uses ion sieve adsorbents to absorb Li+ selectively from the brine and extract lithium in subsequent stages. It works well for high Mg2+/Li+ ratio brines. Still, its processes are complicated, time-consuming, and suffering from the cost and efficiency problems of the absorbents. Solvent extraction uses an organic extractant to extract Li+ from the brine. However, the organic extractant may solve into the brine in this process, causing environmental pollution [+ and Mg2+, which could be driven by mechanical pressure (nanofiltration) [+ through the nanoporous membranes while Mg2+ cannot pass through. The advantages of nanofiltration are low energy consumption, environmental friendliness, and easy operation. However, the total salinity of the feed solution must be low, and the cost of an ion-selective nanofiltration membrane is high [+ through the membrane while blocking the permeation of multivalent Mg2+ [Generally, the precipitation method uses chemical reactions to convert Lins today . Howeverns today , and it ollution . Calcinaollution . Membrantration) ,14 or bytration) . In a na is high . In an eent Mg2+ ,22. This+ and remove Mg2+ simultaneously. For the first task, i.e., the concentration of a specific kind of ions, or generally a charged species, Wang et al. developed a micro-nanochannel ICP system to preconcentrate proteins and peptides [EF) applied to it becomes equal to the fluid drag force (DF) at a specific location, it will be trapped there. When a large number of molecules arrive at this location, they gather and get concentrated there [A preferable method for lithium extraction must be able to concentrate Lipeptides . In theipeptides ,25,26,27peptides . This lopeptides , when thed there . Using ted there .DF, proportional to the size, and EF, proportional to the charge) will be different. As a result, they will be focused at different locations in the microchannel. If one applies a pressure-driven flow to make the fluid drag force DF of a charged molecule greater than the maximum EF at the boundary of IDZ, this molecule may squeeze through IDZ and flow out of the microchannel. In the meantime, other co-charged molecules remain trapped at the boundary of IDZ because their fluid drag forces are lower than the maximum electric forces at that location. In this way, selective trapping and separation of co-charged species are realized. Based on this understanding, Ouyang et al. selectively focused DNA molecules in the microchannel but let the proteins pass through [+ and Mg2+ through numerical simulation. They achieved a very low Mg2+/Li+ ratio in their product solution, but Li+ concentration is also very low [+ enriched solution selectively through a branch channel, achieving simultaneous concentration of Li+ and removal of Mg2+ [If there is more than one type of co-charged species, their force balances  charged particles . In thei+ and Mg2+ ions and check its potential role in lithium extraction from high Mg2+/Li+ ratio salt lake brines.Now that the FF-ICP system has the potential to focus and separate the charged species at a macroscopic scale, one may ask if such a system is capable of concentration and separation of simple ions. This paper will answer this question through numerical simulation. More specifically, we will evaluate the performance of the FF-ICP system in separating Li+, Na+, Mg2+, K+, and Cl− ions flow from left to right, driven by external pressure. Similar to the device in , the micEF to anions and a downward EF to cations and produce IDZ near the AEM at the interfaces between microchannels and the upper side of the chamber. This electric field also generates an upward electroosmotic flow, which applies an additional component to DF of all the species in the chamber, on top of the fluid drag imposed by the rightward pressure-driven flow (PDF). As a result, when a cation, e.g., Li+ or Mg2+, enters the chamber from the left side, it is subjected to an up-right directed DF and a downward EF. If the drag force in the y-direction D,yF is greater than the y-component of the electric force E,yF, the ion will move upward when moving rightward with the fluid.In the meantime, microchannels at the upper and lower sides of the chamber are connected to reservoirs of NaCl solution. A strong electric field is applied from top to bottom. This electric field will apply an upward D,yF is smaller than D,yF, the ion moves downward. If the y-components of two forces are equal, the ion will be balanced in that location. Because of the ICP effect, the electric field at the boundary of IDZ is significantly higher than in the other regions. These uneven distributions of electric force define different equilibrium positions in y-direction for different cation species. As shown in + ion enters the chamber at the center of the inlet, it is subject to a larger D,yF than E,yF (because the downward electric field there is low). Hence, it will move upward as it is moving with fluid in the right direction. When it is closer to the IDZ region, the electric field will become stronger, and the electric force will increase. This upward motion will stop when the two forces  are equal. It will move rightward and run out through microchannels at the right side of the chamber. In the meantime, Mg2+ is subject to a 2-times higher electric field and a 1.46-times . We apply a constant inlet flow of u1 and a constant outlet flow of speed u2 at the location of the microchannels on the lower and upper boundaries, respectively. This treatment is based on the fact that the electroosmotic flow has the plug shape in a microchannel, and the concentration of the solution in the lower and upper sides is different. At the inlets of microchannels at the left side of the chamber, constant pressure of P1 is applied. At the outlet of microchannels on the right side, a constant flow speed outu is set. We use a simplified model for our simulation study, as shown in V is applied on these membranes’ segments. At the lower boundary of the chamber, the segments corresponding to the microchannels are grounded. To simplify our computation model, we move the AEM embedded to the microchannels at the upper side of the chamber to the chamber boundary (the green sections). For the electric field, a positive electric potential For the fluid flow, the Navier–Stokes equation for an incompressible Newton fluid is employed.Here i = 1 for Li+, i = 2 for Na+, and i = 3, 4, 5 for Mg2+, K+, and Cl−, respectively. Symbols e representing the elementary charge and Transport of charged species is modeled via the Nernst–Planck equations and the mass conservation equation.As shown in P1; (ii) the concentration of all ionic species is equal to those in the reservoir:On the inlet boundaries of microchannels at the left side, (i) the pressure is On the outlet boundaries of microchannels at the right side, (i) the free boundary condition is applied for mass transport; (ii) the fluid flow speed is the constant + is C2,1, the concentration of Cl− is the opposite number of the sum of other four cations:i. On the microchannel portion of the lower boundary, (i) the electric potential of the lower boundary is 0; (ii) the velocity of the fluid is constant V is applied on the membrane to generate electric field; (ii) the velocity of the fluid is the constant velocity  a voltage The other black lines and black dashed lines are the microchannel walls, (i) no-slip condition for fluid velocity; (ii) impermeability to all anions and cations:+, Mg2+, and K+ to converge the simulation. After the system is stable, we set it out to facilitate ion exchange between the chamber and the reservoir below.Simulations were carried out using COMSOL Multiphysics software (version 5.6) on a Dell workstation (Precision 7920) equipped with an Intel Xeon processor (Gold 6128) and 112 GB of RAM. Steady-state simulations were used for all studies. Solution convection was modeled with the “Creeping Flow” interface. Moreover, the “Transport of Diluted Species” and the “Electrostatics” interfaces were coupled to solve the “Nernst–Planck–Poisson” equation; 3,833,759 quadrilateral elements were utilized for meshing. Near the membrane region, extremely fine meshes are used to ensure sufficient solution accuracy. To obtain the highly nonlinear solution under high electric potential, we needed to start from low voltage and sweep the high voltage parameter. Initially, the down boundary should be set as no flux for LiAs shown in V and velocity u, and clarified how these parameters affected system performance to prove the feasibility of the proposed ion separation method. To analyze the behavior of the separation system, we started with the setting of a particular parameter. Then, we studied the effects of two critical operational parameters, the voltage L = 90 μm, H = 31.5 μm  [V is from V = 0 to V = 30VT, with the thermal voltage VT equal to 25.8 mV [− at P1 = 100 Pa, T = 300 K, 3, and Using a simplified brine consisting of only five ions  . After d density . At the  25.8 mV . The ass+ is not an essential research item. Although the content of this ion in the brine is high, the Li+ can be collected in the subsequent steps [+ ions from it. Instead, we have to focus on the extraction quantity of Li+ ions, especially the Mg2+/Li+ flux ratio in the microchannel and use this parameter as a separate indicator. Steady-state solutions are used to study the performance of the system. The governing Equations (1)–(5) are solved with the above boundary conditions (6)–(10).The concentration of Nant steps . TherefoV = 30VT, and the PDF constrains the fluid velocity We simulate the steady-state behavior of this system at y ≤ 31.5 μm), the Li+ ions concentration was much higher than the feed. We put the collector there to get a high-resolution separation effect. The box indicates the location of the collector. Comparing the two pictures a,b, we c+ flow through the upper right of the chamber where the collector box is located  [+ by 20%. However, it is necessary to reduce the loss of chemicals additive further to enhance the stability of the membrane. Our system can operate stably without worrying about material loss.The advantage of this system is that the analytes are continuously flowed through the system by a PDF while vertically separated and concentrated by ICP. Compared to other focusing systems , it has  reduced . The typo is 15) . They haHowever, some limitations of this work should be noted. First of all, this work is based on first-principles numerical simulation (no experience/parameter approximation). Therefore, the proposed system should be finally verified through experiments. Secondly, in the conventional electro-membrane process, high current density usually produces various nonlinear effects  ,45,46,472+ and Li+ ions through numerical simulation based on FF-ICPF. This method could perform enrichment perpendicular to the flow direction of the analyte. Furthermore, the maximum Mg2+/Li+ ratio can be decreased by ~85% under the electroneutrality limit. However, after trying various channel structures and parameters, the enrichment factor cannot be increased, which is the inherent disadvantage of this system. Numerical simulation shows that this limiting behavior is confined by the accumulation of the charged particles, which affects the shape of the electric field gradient. In the future, if the Joule heating is added, the simulation would be more accurate.We have proved the feasibility of continuous separation of Mg


Video chat allows people to connect when not physically together. Using video chat while sharing a meal (VideoDining) may decrease loneliness and improve older adults' nutritional intake. We conducted a cross-sectional online survey study using Amazon Mechanical Turk in June 2020. The objectives were to learn about eating with others, the use of video chat, and interest in VideoDining in older adults during the pandemic. There were 1331 survey attempts with 167 responses meeting the criteria for age (65 years of age or older), U.S. residency, and quality. Participants were 64% male, 77% white, 65% college-educated, and a median age of 67 years (IQR=2 years). Few participants lived alone (17%), yet 76% reported feeling isolated. Eating with others regularly, defined as several times a week or more, declined in the pandemic . The use of video chat and eating when video chatting increased during the pandemic versus pre-pandemic . The majority of participants said they would VideoDine (50%) or consider trying it (37%). Interest in VideoDining did not vary by age, race, or gender. Participants who used video chat were more likely to say they would VideoDine than participants who had never used video chat . This data suggests most adults 65 years of age and older, already using the Internet, are experiencing isolation and decreased mealtime commensality during the pandemic. The vast majority are using video chat and are interested in trying VideoDining.


However, while those in the GTP group were significantly more likely to be fantasy-prone, those with PVG were the ones who played most per day. Those in the PSMU group were characterized by being female and/or extroverted, frequently using social/sharing platforms, and seldom playing video games. A hierarchical binary logistic regression revealed that males were more likely to experience GTP. Increases in PVG, fantasy proneness, and neuroticism increased the odds of GTP. Future work can benefit from considering the role of GTP in gaming disorder, since intrusive thoughts, cognitive biases, and poor impulse control are pivotal in the initiation and maintenance of dysfunctional playing behaviors.The study of the effects of interactive media has mainly focused on dysregulated behaviors, the conceptualization of which is supported by the paradigms of addiction. Research into Game Transfer Phenomena (GTP) examines the interplay between video game features, events while playing, and the manipulation of hardware, which can lead to sensory-perceptual and cognitive intrusions  and self-agency transient changes  related to video games. GTP can influence the interpretation of stimuli and everyday interactions and, in contrast to gaming disorder, are relatively common and not necessarily negative. However, some players have reported feeling distress due to their GTP. This study focuses on how dispositional and interactive media habit factors are related to GTP and two forms of problematic interactive media [problematic video game playing (PVG) and problematic social media use (PSMU)]. A sample of 343 university students who played video games completed an online survey . Not all who had experienced GTP were identified as exhibiting PVG or PSMU, but all of those in the PVG group had experienced GTP. Overall, the profiles of the groups, including GTP (91.4%), PVG (28.5%), and PSMU (24.8%), were in accordance with previous findings. Those in the GTP and the PVG groups were characterized by being male, being highly engaged in the game (either while playing or  N > 6,000, 15–60 years old)  .This paper examined and compared GTP with two forms of problematic media use .Game transfer phenomena is in the continuum between everyday involuntary phenomena  to unusual phenomena that are commonly linked with psychopathology  . ParticiGame transfer phenomena has mainly been reported in awake states after playing, but it has also been experienced when trying to fall asleep . Experimafter playing, but in some circumstances and for certain games, players have reported experiencing GTP while playing  . “InternIn terms of characteristics, playing video games and using social media differ substantially, even though some social media sites include video games, and many video games have a social component . For instance, playing video games requires focusing on earning rewards, mastering challenges, visual–motor coordination, involvement in fantasy, detachment from reality, and sometimes socializing . In contThe preference for different kinds of media and activities according to different individual profiles is thus expected. Differences have been established in terms of dispositional characteristics between video game players and avid social network users. Video game players tend to be males, although in recent years, more females have started to play video games . Males uWhile video game players are usually considered tech-savvy, introverted, interested in sensation seeking, desiring to escape from reality, and fantasy-prone , social Problematic playing and gaming disorder have been connected with a variety of personality traits, including neuroticism, high impulsivity, and high aggressiveness  while alTo date, little is known about the dispositional factors involved in experiencing GTP and their relationship with the problematic use of other interactive media. Therefore, for the first time, this study explores the interrelationship and areas of overlap between GTP and two forms of problematic media use, herein referred to as PVG and PSMU. This study mainly focuses on examining those personality traits that reflect attitudes, behaviors, feelings, and thoughts that have been found to increase one’s vulnerability to problematic media use . A furth(1)Is GTP associated with PVG and PSMU, and what is their prevalence in the sample? Evidence suggests that there is a relationship between GTP and PVG , but the(2)Which video game and social media habits can be observed among those who have experienced GTP and have PVG or PSMU? Spending excessive time playing video games and using social media are core characteristics of PVG and PSMU, respectively. However, excessive playing time appears not to be needed to experience GTP .(3)Does engagement in a game differ for those who have experienced GTP as opposed to those who have PVG or PSMU? Game engagement has been conceptualized in different ways. Some consider it to be the subjective experience that involves flow, absorption, immersion, and presence ; this is(4)Is gender associated with GTP, PVG, or PSMU, and if so, which gender is predominant among those who have experienced GTP compared to those who have PVG or PSMU? Most studies have found no association between gender and GTP . However(5)Which personality traits characterize those who have experienced GTP or have PVG or PSMU? Certain personality traits, such as openness to experiences and fantasy proneness, have been suggested to be relevant for GTP . Problema risk of developing PVG and PSMU; thus, this study avoids erroneous inflation of problems associated with interactive technologies.Problematic media use is examined in this paper considering patterns of behaviors that involve conflict and dysregulated use of media, but which do not necessarily connote a severity of clinical relevance. The findings should be interpreted as pointing to A total of 481 participants completed an online survey on playing video games and social media use. Participants who did not play video games were excluded. The final sample consisted of 343 respondents. Of these, 58.7% were male and 41.3% were female. Most participants were 19 years old or younger (49%), with the next largest group being those 20–25 years old (46.6%). Most stated that they were single (73%). All participants were students at a western Canadian university who received course credit for their participation.After informed consent was obtained, which was developed in accordance with the requirements of the ethics committee of the university, respondents were asked to provide three demographic pieces of information: gender, age, and marital status. Questions and scales about media consumption, video game engagement, individual characteristics, and dream-related information were included in the main part of the survey. The online survey was available for student participation over the entire academic year 2017–2018. The measures used to answer the research questions of the study are described below.The Game Transfer Phenomena Scale (GTPS) is a 20-item Likert-type scale of frequency with responses ranging from 1 (“never”) to 5  . The subThe Problem Video Game Playing Questionnaire (PVGQ) is a nine-item scale scored with “yes” or “no” responses that was developed to assess PVG  based onThe Questionnaire on Video Game Consumption Habits (VGCH) consists of a 24-item questionnaire to measure video game consumption habits and general preferences for video games , includiThe Bergen Social Media Addiction Scale (BSMAS) takes portions of a previous scale, the Bergen Facebook Addiction Scale (BFAS) , as, oveAdditionally, a total of nine different types of applications were included in the questionnaire, although only eight applications received enough participant data to be part of the analyses of frequent use of social media and sharing platforms such as Facebook, YouTube, and Instagram (MUF) .The Game Engagement Questionnaire (GEQ) is a 19-item scale  that wasThe Big Five Inventory (BFI) is a scale with 44 items that are used to determine which traits a participant has that ultimately determine the extent the Big Five Factors play a part in their personality . On a scThe Creative Experiences Questionnaire (CEQ) was developed as a 25-item questionnaire scored with “yes” or “no” responses to determine fantasy proneness . Sample U tests were used with non-normal distributed continuous variables, and chi-square (χ2) tests were used for categorical variables. The last step consisted of performing a hierarchical binary logistic regression for GTP. All statistics were two-tailed with a 0.05 level of significance, and the effect sizes were computed. A Bonferroni correction was applied to obtain an adjusted p-value. The original alpha level (0.05) was divided by the number of tests performed in each t-test, and the categories in the chi-square test. Bonferroni correction has been recommended when a large number of tests are conducted without preplanned hypotheses previously collected for the data and for protection against Type I error . Bivariate and multivariate statistics using non-parametric and parametric tests were performed. Multiple imputations were computed to analyze the patterns of the missing data. The missing data were completely random and below 2%. The missing cases were not imputed since a rate of 5% or less had been found to be inconsequential, and statistical analyses are considered to be biased with 10% missing data . Prelimi I error .n = 298); 86% had experienced more than one type of GTP, and 71.1% had experienced five or more different types of GTP (based on the 20 items of the GTP). The types of GTP reported by at least half of the sample were hearing music from a video game (69.4%), seeing or visualizing images (74.3%), thinking about using something from a video game in real life (61.4%), misinterpreting sounds (59.7%), wanting or feeling the urge to do something in real life after seeing something that reminds one of the video game (55.6%), and hearing sounds from a video game (55.1%). The least common type of GTP was mixing up video game events with actual real-life events (21.4%).Most participants had experienced at least one instance of GTP  = 0.51, p < 0.001]. No correlation was found between GTP and PSMU or between PVG and PSMU. Almost one third were classified with PVG  and one in four with PSMU  (see the “Measures” section for the cutoff points used). Moreover, the chi-square tests showed that 31.0% of those who had experienced GTP had PVG, and 24.1% had PSMU. A significant association was only found between GTP and PVG , although the effect size was small. Those who did not have PVG were significantly less likely to have experienced GTP. Every participant considered as having PVG had also experienced GTP.Correlation coefficients showed only a strong positive correlation between GTP and PVG . There were also more males in the PVG group, and in this case, males were significantly more likely to be in the PVG group, while females were significantly less likely to be in the PVG group . There were more females in the PSMU group, and females were significantly more likely to be in the PSMU group, while males were significantly less likely to be in the PSMU group . Overall, the effect sizes were small  by the full sample were Instagram (35.4%), YouTube (21.3%), and Facebook (16.8%).The majority of the participants had been playing video games for more than 4 years (81.8%). Most played either every day (29.2%) or once a month (27.1%), either for less than 1 h per day (33.1%) or 1–2 h per day (28.4%). The favorite game titles listed among the participants were Chi-square tests were conducted to examine experience playing, frequency of playing, and daily playing time. All the effect sizes were large  was significantly associated (SR = 3.9) with the No GTP group .Comparing the GTP vs. the No GTP group showed no differences in terms of experience playing or daily playing time. Only significant differences were found for the frequency of playing. However, 2(3) = 17.551, p < 0.001], daily playing time , and frequency of playing . According to post hoc tests, only those who had been playing video games for months were significantly less likely (SR = −2.8) to be in the PVG group. Moreover, according to the post hoc test performed with the frequency of playing, only playing every day was significantly more likely (SR = 6.1) to be associated with the PVG group. Lastly, post hoc test showed that playing 2–3 h a day (SR = 2.4) or playing more than 3 h a day (SR = 4.0) was significantly more likely to be associated with the PVG group.Comparing the PVG vs. the No PVG group showed significant differences in terms of experience playing . The post hoc test showed that only playing once a month (SR = 2.3) was significantly more likely to be associated with PSMU.Comparing the PSMU vs. the No PSMU group in terms of playing habits showed only significant differences in frequency of playing . Males were 5.2 times more likely than females to experience GTP. Every unit increase in neuroticism significantly increased the odds of GTP by 1.129 (12.9%). Openness was not a significant predictor of GTP.The predictors were entered into three blocks. Block 1 contained the personality traits according to the five-factor model that were higher in the GTP group and gender. This first block explained the 17% of variance of GTP (Nagelkerke’s R2 = 0.361); Model . Males were then 13 times more likely than females to experience GTP, and every unit increase in fantasy proneness increased the odds of GTP by 1.489 (48.9%).In Block 2, fantasy proneness was additionally added, which increased the predicted power of the model when the BFI personality traits and gender were held constant. This block that contained all the variables in the model explained the 36% of the variance of GTP (Nagelkerke’s R2 = 0.496); Model . PVG emerged as the strongest predictor of GTP. Every unit increase in PVG significantly increased the odds of GTP by 2.391 (139.1%). Every unit increased in fantasy proneness significantly increased the odds of GTP by 1.300 (30.0%). Males were 4.3 times more likely than females to experience GTP. Neuroticism was no longer a predictor of GTP  was high (91.3%) . Most paPrevious research has shown inconsistencies in the prevalence of PVG and PSMU, the measurement of which substantially depends on the scales and thresholds used to confirm the conditions. Prior studies conducted with the scales that were chosen in the present study have reported a high prevalence of PVG  and PSMU  . SurprisIn line with a previous study , PVG emeNo significant associations were found in daily playing time, playing experience, and GTP, similar to a previous study . InteresThat no significant association between gaming habits and GTP was found might suggest that individual factors  are even more relevant for GTP. However, one should be aware that the frequency of playing and session length have been found to predict severe levels of GTP  compared to low and moderate levels of GTP. Particularly, playing in a gaming session of 6 h or more was significantly associated with severe levels of GTP .In terms of social media use, Instagram, YouTube, and Facebook were the most frequently checked social/sharing media. The frequent use of social media was only significantly higher in those classified with PSMU. When taking a closer look at the platforms used by the sample, both those who experienced GTP and those with PVG had significantly higher scores on YouTube use compared to those with PSMU. This can be explained by the fact that YouTube is a popular outlet that is frequently used by players for watching and sharing videos on gameplay and news of upcoming games. High Facebook and Instagram scores were significantly associated with PSMU, which is understandable insofar as these platforms facilitate the interchange of text, images, and videos usually for socializing purposes.Engagement, as a subjective experience while playing and engagement in game-related activities, and preference for playing were other factors investigated in the present study. Both types of engagement were significantly high for those who had experienced GTP and those who had PVG. However, engagement in game-related activities and preference for playing over other activities were significantly low in those with PSMU. High engagement in game-related activities and preference for playing over other activities by those who experienced GTP and those with PVG are not surprising.Moreover, engagement, as measured along a unidimensional continuum gauging subjective phenomena such as flow, absorption, immersion, and presence, may make the game more gratifying and therefore more appealing to continue playing . The detvia demographics and personality traits. The only dispositional factors that have been investigated previously in the context of GTP are age and gender, and the majority of previous studies have found no association between gender and GTP  on GTP. When neuroticism and openness as part of the five core personality traits were examined, neuroticism emerged as a predictor of GTP, and males were more likely than females to experience GTP. Neuroticism has been associated with reports of vivid daydreaming and proneness to hallucinations , which aMoreover, when PVG was included in the model, males remained more likely to experience GTP and only fantasy proneness was a predictor of GTP among the personality traits, and PVG became the strongest predictor of GTP. This may suggest that those with PVG who are fantasy-prone are the ones more susceptible to experience GTP. These results contrast the bivariate results that showed no significant association between PVG and fantasy proneness.In summary, those who have experienced GTP and those with PVG were characterized by being male, having played video games for several years, and playing frequently. They were highly engaged in the game while playing , valued playing video games, and preferred playing video games over other activities. The differences between the GTP and the PVG groups were that while those in the GTP group were more likely to be fantasy-prone, those with PVG played 2–3 or more hours per day. The profiles of those experiencing GTP and PVG differed from those with PSMU, the latter of whom tended to be females and extroverts who seldom played video games, showed less preference for playing games, and frequently used social or sharing platform sites instead, such as Facebook and Instagram.The empirical results reported herein should be considered in light of some limitations. First, regarding the sample selection, the generalizability of the study’s findings is limited, since the study used a convenience sample of university students whose participation was rewarded with course credits. This raises issues such as the potential for self-selection and social desirability biases. Furthermore, since the study focuses on video games, the analyses of PSMU are restricted to those participants who have PSMU and play games. This may limit comparisons with other studies where these criteria are not applied to those with PSMU. However, it is important to note that even in the segment of those with PSMU, the results in the current study are reported according to previous studies on PSMU.Second, even though the scales for assessing PVG and PSMU have been widely used e.g., , there aThird, the criterion of having experienced at least one GTP was used to classify participants with GTP rather than considering the severity of GTP , the latter of which might be more consistent with the extreme behaviors exhibited in problematic playing and gaming disorder. This decision probably contributes to the extensive overlap between GTP and PVG because all of those with PVG had experienced GTP. However, this decision was made for the following reasons: (i) it facilitated comparisons with previous studies at this early stage of the investigation of GTP, and (ii) only a few individuals tend to present severe levels of GTP , and we Finally, the effect sizes of several comparisons suggest that the differences between the samples were small. The use of severity criteria for GTP and a scale with core factors for gaming disorder may yield larger effect sizes. Furthermore, to reduce the familywise error rate due to multiple comparisons, Bonferroni correction was applied. However, it is recommended that future studies examine all the significant variables and their relationship with personality traits, since this is the first time that these have been examined in the context of GTP. Examining the different modalities of GTP  and personality would lead to an improved understanding of GTP, since the different forms of GTP may have different underpinnings.Despite the potential limitations considered above, it is notable that the results, to a large extent, are supported by findings in previous research into GTP and problematic interactive media use.In terms of dispositional factors, this study showed that males are more likely to experience GTP, although this association between gender and GTP should be investigated even further, since different studies have shown inconsistent results.Furthermore, the expected emergence of fantasy proneness as a predictor of GTP but the absence of openness should be investigated. Evidence has suggested that fantasizers tend to be open to the experiences . HoweverOverall, gender, personality traits, and PVG appear to predict the likelihood of experiencing GTP.Beyond the contributions to the understanding of GTP, this study supports previous findings regarding personality factors, gender differences, and patterns of media use in individuals who play video games and those who have a preference for social networking. One of the most interesting findings was that those who play most per day were significantly more likely to have PVG, but not GTP.This study can be viewed as an early step in differentiating GTP from problematic media use, in this case, PVG and PSMU. It showed the interplay between PVG and GTP, and that there is no relationship or similarity between PSMU and GTP, as denoted by the differences in personality traits, preference in media, and patterns of media use. Nevertheless, to better understand the relationship between GTP, problematic playing, and gaming disorder, the results should be tested again using a scale that is up-to-date and developed in accordance with the diagnostic criteria recommended for assessing gaming disorder. Moreover, different criteria for classifying GTP should be considered when comparing GTP and PVG groups. The severity levels of GTP should also be considered, which may facilitate the differentiation between GTP and PVG but most importantly because severe levels of GTP have been associated with distress and dysfunction and playing for sessions of 6 h or more.As has been shown in this study, different factors influence GTP and PSMU. Thus, further research attempting to identify idiosyncratic characteristics influencing the occurrence of GTP could contribute to the theoretical differentiation between PSMU and problematic gaming.Finally, future work can benefit from considering the role of GTP in gaming disorder, since intrusive thoughts, cognitive biases, and poor impulse control are pivotal in the initiation and maintenance of dysfunctional playing behaviors.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation, to any qualified researcher.The studies involving human participants were reviewed and approved by Ethics Committee of MacEwan University. The patients/participants provided their written informed consent to participate in this study.JG designed the study, obtained ethical approval, and supervised two students in mounting the survey online, cleaning the data, calculating subscale scores, and coding self-reports of dreams. Only parts of this study were used herein. AO conceptualized the background for the write-up, performed the statistical analysis, and wrote most of the article. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Ceratomyces and Hydrophilomyces are provided.A rapid biodiversity assessment of insects and associated Laboulbeniales fungi was conducted over the course of five nights in August, 2018, at two central Florida lakes: Lake Eustis and the nearby protected and restored National Natural Landmark, Emeralda Marsh Conservation Area (EMCA), which encompasses a portion of Lake Griffin. Lake Eustis was surveyed for Laboulbeniales in 1897 by mycologist Dr. Roland Thaxter but has not since been investigated. Because Lake Eustis has been urbanized, with the lake perimeter almost entirely altered by human development, the site offers a look into Laboulbeniales diversity across a 121‐year timeline, before and after human development. By surveying Lake Eustis and EMCA, a modern case study comparison of Laboulbeniales and insect diversity between a developed and a protected and restored system is made. A total of 4022 insects were collected during the rapid assessment. Overall, insect abundance was greater at EMCA, with 3001 insects collected, than 1021 insects collected from Eustis. Although family‐level insect richness was comparable between sites, with 55 families present at EMCA and 56 at Eustis, 529 out of 3001 (17.6%) of the insects collected at EMCA were hosts to parasitic Laboulbeniales fungi, whereas only 2 out of 1021 (0.19%) collected from Eustis were infected. A total of 16 species of Laboulbeniales found at EMCA compared with only one at Eustis. The current number of Laboulbeniales species documented at Eustis was incredibly depauperate compared with the 26 species and two varieties recorded by Thaxter in 1897. These findings suggest the possibility of utilizing Laboulbeniales as indicators of ecosystem health, and future research should investigate this question further. A figure displaying host–parasite records and a species list of Laboulbeniales are presented. Finally, updated occurrence records for species of  Two lakes in central Florida were surveyed for insects and the associated fungal parasites, Laboulbeniales. One of the lakes had been the site of intensive restoration efforts while the other lake is highly developed and un‐restored. This study found stark differences in fungal diversity between the sites, and explores the possibility of the use of Laboulbeniales fungi as indicators of environmental health. Knowledge of insects and fungi can be described as highly uneven, with representative members, often those associated with agriculture, industry, or disease, receiving vastly more attention than other groups  or Hericium bembedjaense  are microscopic obligate parasites on arthropods, primarily occurring on insects. Laboulbeniales are considered the most diverse lineage of insect‐associated fungi, with ~2325 described species in 145 genera, but current estimates indicate there are at least 40,000 species awaiting description , a tremendous contribution to mycology.One early and prolific researcher of Laboulbeniales was Dr. Roland Thaxter. During his career at Harvard University between 1891 and 1932, Thaxter described >1000 species of Laboulbeniales and made substantial contributions to our understanding of their development and general biology. Most of his life's work on Laboulbeniales is contained within a five‐volume set of his 1.4One of Thaxter's collection sites for Laboulbeniales was in Eustis, a small central Florida city on the east shore of Lake Eustis. Beginning in the early 1800s, colonial Europeans forcefully established Eustis on Seminole land , n.d.. TAutoicomyces acuminatus, Cantharomyces pusillus, Ceratomyces ansatus, C. camptosporus, C. cladophorus, C. confusus, C. filiformis, C. floridanus, C. longicornis, C. minisculus, C. mirabilis, Chitonomyces affinis, Ch. dentiferus, Ch. distortus, Ch. floridanus, Ch. hydropori, Ch. lichanophorus, Ch. occultus, Ch. paradoxus, Ch. psittacopsis, Ch. uncigerus, H. halipli, Hydrophilomyces reflexus, Hy. rhynchophorus, Laboulbenia retusa, L. texana var. rostellata, L. texana var. tibialis, Rhynchophoromyces elephantinus, Teratomyces mirificus, and Zodiomyces vorticellarius.According to his travel records, Thaxter was in Eustis during the very early days of the city, from September 25th to October 10th, 1897 Pfister, , before Eustis has changed considerably over the last 100 years, with a majority of the lake perimeter being cleared for housing and other human infrastructure . In addition, since Thaxter's visit in 1897, no research has been published dedicated to Laboulbeniales in Eustis, or even from the state of Florida.The overall goal of this study was to conduct a biodiversity assessment over time, as well as between two habitats. By returning to Eustis and attempting to re‐collect species recorded by Thaxter, the goal was to provide insights into shifts in biodiversity of Laboulbeniales and their associated insects since 1897. Because Eustis is now impacted by urbanization, Emeralda Marsh Conservation Area (EMCA), was also sampled as a control. EMCA includes a portion of Lake Griffin and surrounding habitat and is located ~14 km from the east shore of Lake Eustis. Due to its designation as a National Natural Landmark since 1974 and subsequent and ongoing restoration efforts, EMCA provides a closer approximation of the habitat in which Thaxter sampled  are part of the Central Valley Region (Region 7508) of Florida Figure . Lakes i2, and that of Lake Eustis is~31 km2. The average depth of Lake Griffin is ~2 m, and that of Lake Eustis is ~3 m. The bottom of the Lake Griffin is composed of soft organic matter measuring an average of 1.7 m thickness  was 50% pervious/impervious . Over the past 30 years, aquatic and wetland restoration efforts in and around EMCA have focused on revegetation, re‐establishing connectivity with Lake Griffin, and reducing phosphorus and pesticide loading  were calculated for both insects and Laboulbeniales. Comparisons are presented from the two time periods for collections in Eustis (1897 and 2018) as well as between Eustis and EMCA. As this was a case study resulting from a single collection event at each site, actual statistical comparisons could not made as it would have been psuedoreplication.3A total of 4022 insects were collected during the rapid assessment Figure . Insect Ceratomyces filiformis, C. longicornis, C. mirabilis, Chitonomyces sp., Hesperomyces virescens, Hydrophilomyces gracilis, Hy. hamatus, Laboulbenia philonthi, L. sp. 1, L. sp. 2, Zodiomyces vorticellarius. Only one species, Hesperomyces virescens, was found at Eustis. Infections on insects from EMCA all occurred on the following Coleoptera families: Hydrophilidae, Staphylinidae (rove beetles), Coccinellidae (lady beetles), Carabidae (ground beetles), Tenebrionidae (darkling beetles), and Chrysomelidae (leaf beetles). Infections on the two insects from Eustis were both on Coccinellidae. The vast majority of infected insects, 519 out of 529 in total, were members of the Hydrophilidae, with the remaining ten infections occurring on the other families. Relative insect abundance by order at both sites is shown in Figures At EMCA, parasite prevalence was 17.6%, with 529 out of 3001 of the insects being host to Laboulbeniales fungi. Comparatively, only ~0.19%, or 2 out of 1021 insects collected from Eustis were host Laboulbeniales. Eleven species of Laboulbeniales were found at EMCA , leg. P. Kaishian, .  from: Jackson, IL, USA, 1909 ; Morelos, Mexico, 1948 ; Alachua, FL, USA, 1954 (RKB 1773A); Musuas, Nicaragua, 1945 (RKB 1987); Turrialba, Costa Rica, 1955 (RKB 1990A); San Antonio, El Salvador, 1957 (RKB 3708E); Porto Alegre, Brazil, Date N/A (RKB 1314).Additional Specimens examined: Within the collection of Dr. Richard Benjamin, currently housed at SYRF, there are heretofore unreported specimens of 4.3Tropisternus glaber. , leg. P. Kaishian, .  from: Oaxaca and Michoacán, Mexico, 1948 ; San Diego, CA, USA, 1953 ; Dixie, FL, USA, 1954 (RKB 1759); Los Angeles, CA, USA, 1954 (RKB 1774); Chiapas, Mexico, 1964 (RKB 2304B).Additional Specimens Examined: Within the collection of Dr. Richard Benjamin, currently housed at SYRF, there are heretofore unreported specimens of 4.4Tropisternus glaber. , leg. P. Kaishian, .  from: Trinidad and Tobago, 1913 (RKB 1607C00); Orange, FL, USA, 1945 (RKB 1929C); Jalisco, Veracruz, Michoacán, and Morelos, Mexico, 1948 ; Champaign, IL, USA, 1950 (RKB 1239); Puno Dept., Peru, 1951 (RKB 1943A); Albany, WY, USA, 1951 (RKB 1795); San Diego, CA, 1953 ; Alachua, FL, USA, 1954 (RKB 1753F); Turrialba, Costa Rica, 1955 (RKB 1990C); San Antonio, El Salvador, 1957 (RKB 3708B); Marzan Dept., Honduras, 1957 (RKB 3511G); Chiapas, Mexico, 1964 ; and Yellowstone National Park, WY, USA, 1971 .Additional Specimens Examined: Within the collection of Dr. Richard Benjamin, currently housed at SYRF, there are heretofore unreported specimens of 4.5Tropisternus glaber. , leg. P. Kaishian, [PK4F].  in or outside the original locality.Remarks: This species was described from Eustis, FL, USA on 4.6Tropisternus glaber. , leg. P. Kaishian, [PK3F].  from: IL, USA, 1907, 1908 ; Lee, TX, 1908 ; Trinidad and Tobago, 1913 (RKB 1607B); Puno, Peru, 1918 ; Pima and Santa Cruz, AZ, USA, 1935, 1936 ; Orange, FL, USA, 1945 (RKB 1929B); San Luis Potosí, Morelos, Oaxaca, Nayarit, Veracruz, Mexico, 1948 ; Bernalillo, USA, 1949 (RKB 3934B); Champaign, IL, USA, 1950 ; Angol, La Araucanía and Coquimbo Dept., Chile, 1950 ; Chiapas, Mexico, 1950 (RKB 1531); San Diego, CA, USA, 1953, 1954, ; Putnam, FL, USA, 1954 (RKB 3406); Turrialba, Costa Rica, 1955 (RKB 1989B); San Bernardino, CA, USA, 1956 (RKB 2038C); Santa Barbara, CA, USA, 1957 (RKB 2050); Puebla and Michoacán, Mexico, 1957 ; Morazan Dept., Honduras, 1957 ; Loja, Ecuador, 1958 ; Barinas, Venezuela, 1958 ; San Diego, CA, USA, 1960 ; Chiapas, Mexico, 1964 ; and Yellowstone National Park, WY, USA, 1971 ; OR, USA, Date N/A (RKB 1958A).Additional Specimens Examined: Within the collection of Dr. Richard Benjamin, currently housed at SYRF, there are heretofore unreported specimens of 4.7Hydrophilomyces was erected by Thaxter  before moved to Hydrophilomyces in 1908. These species were not re‐collected in this study, however, two other members of the genus—H. gracilis and H. hamatus—were collected. As with Ceratomyces because relatively few contributions have been made to this genus, it is of value to update occurrence records for all species of Hydrophilomyces found during this study. In addition to the data obatined here additional occurrence and range extension data are published for the first time.The genus  Thaxter  and now  Thaxter , Spegazz Thaxter , Thaxter Thaxter , Sarna a Thaxter , Majewsk Thaxter , 1994, H Thaxter , Rossi , leg. P. Kaishian, [PK11F]  from: Ocala, FL, USA, 1962 ; Tavares, FL, USA, 1967 (RKB 2968); Thomas, NE, USA, 1967 .Additional Specimens Examined: Within the collection of Dr. Richard Benjamin, currently housed at SYRF, there are heretofore unreported specimens of 4.9Phaenonotum sp. , leg. P. Kaishian,  ; Data curation (lead); Formal analysis (lead); Funding acquisition (lead); Investigation (lead); Methodology (lead); Project administration (lead); Resources (lead); Software (lead); Supervision (lead); Validation (lead); Visualization (lead); Writing‐original draft (lead); Writing‐review & editing (lead).https://doi.org/10.5061/dryad.47d7wm3f5.This article has earned an Open Data badge for making publicly available the digitally‐shareable data necessary to reproduce the reported results. The data is available at


Daily sitting time increased from 2.7 to 5.0 h per weekday . For gender, continent, country, level of handball league, and playing position, no significant differences (group and interaction effects) were observed. The largest change in PA behavior was in walking (minutes per day: ηp2 = 0.755), with males displaying the greatest decrease . In terms of magnitude, difference between genders was greatest for sitting time (difference in d = 1.20). In conclusion, while COVID-19 measures were essential to preserve public health, PA was compromised and sedentary behavior increased because of these public health measures regardless of gender, playing position, and competition level.This study investigated effects of home confinement on physical activity (PA) in Team Handball during the COVID-19 outbreak. A total of 1359 handball players participated (age: 23 ± 6 years). Participants from Europe, Western Asia, and North Africa answered an online version of the International Physical Activity Questionnaire (IPAQ) considering “before” and “during” confinement. COVID-19 home confinement has had a negative effect on PA . The largest decrease was in the sum parameter “all PA” -min/week, η Since late December 2019, the world seems to have come to a standstill with the Coronavirus disease 2019 (COVID-19) outbreak. In the face of the ongoing pandemic, public health authorities and governments have enforced increasingly restrictive recommendations and escalation measures, including self-isolation, quarantine, and even lockdowns of entire communities and territories [These restrictions are necessary to curb infection rates, yet such limitations may compromise normal daily activities, traveling, physical activity (PA), and adherence to exercise as a result of gyms being closed, group gatherings being forbidden, and increased social distancing ,2. In adThe mandated restrictions concerning outdoor activities, including the regular practice of exercise and PA during the COVID-19 outbreak, are leading to reductions in exercise and PA. In fact, even athletes that complete strength and endurance training programs at home have suffered from reduced aerobic capacity . ConsequHandball is an Olympic sport played worldwide and at a professional level in many countries, relying on high-intensity intermittent activities with increased demands for muscular strength, explosive strength, speed, agility, reactive agility, power, flexibility, and muscular endurance . ResultsAs described previously , when atWhile it is important to note reductions in PA during the pandemic, these findings are not ubiquitous, and may be dependent upon several factors. For example, Lesser and Nienhuis  observedConsidering the profound impact COVID-19 has had on working conditions of athletes, the present study considered handball players worldwide from various leagues, competition levels, and playing positions. The study aimed to rapidly assess how COVID-19 may have affected these groups of players during the ongoing crisis and its major consequences on society. Specifically, we aimed to determine changes since the COVID-19 outbreak and how PA of handball players compared to before the pandemic using questionnaires. Our primary hypothesis was that PA would decrease as a result of the restrictions. A secondary hypothesis was that individuals at a higher competition level and males would have experienced a greater reduced in PA than individuals at a lower competition level and females.An important criterion for the selection of questionnaires was the proof and evidence of validity and reliability ,24. The The IPAQ-SF is available to the public in all language versions. In our study, the IPAQ-SF was administered in English, German, French, Arabic, and Japanese. The survey included 25 questions on gender, demographic information , competition level, handball league, playing position, playing experience, competitions per years, health status, PA . All PA- and sitting time-related questions were presented in a differential format, to be answered directly in sequence regarding “before” and “during” confinement conditions ,25,26. En = 758, 56%), Kuwait , and Saudi Arabia .In total, 1359 of the 1500 invited participants responded. A total of 85% (1153/1359) participants were recruited in Asia , while tn = 901, 66%) than the number of recruited women , all differences between males and females reached the a priori level of significance .The mean age of all participants was 23 years and ranged from 18 to 60 years. BMI varied from 14.3 to 43.4 kg/m2 . Except n = 391) participants played in the first league (n = 631). Only 25% of players played in the third or fourth league (n = 337). Two-thirds of the subjects were male (n = 901) and age varied from 18 to 45 years ; “q” was equal to “1 − p”; “Δ” was the accuracy (=3%); and “p” was the percentage of change in social participation from “before” to “during” confinement period.The sample size was calculated according to the following predictive equation :(1)N=Zα/p = 0.578) of subjects experienced an increase in shared feelings with family members [n = 1041. We recruited our sample size assuming a dropout rate of 40% (n = 416). Therefore, we invited 1500 subjects to participate in order to generate a sufficiently large sample size as a precondition for a sufficient calculation and interpretation of effects (meaningful vs. non-meaningful).Comparable to Ammar et al. , the “p” members . ConsequA steering group of PhD scientists and academics  designed the electronic survey at the University of Qatar . In addition, the survey was subsequently evaluated and amended by handball players, coaches, and International Handball Federation (IHF) handball experts. Thereafter, the survey was reviewed and edited by >35 colleagues and experts before being disseminated via the Google platform (online). Members of the consortium distributed the link to the survey via several methods: e-mail, official faculty pages, ResearchGate™, LinkedIn™, and other social media platforms such as Facebook™, WhatsApp™, and Twitter™. The general public assisted in the dissemination through promotion of the survey within their networks. The selection for the group was deliberate by the research group and the criterion of selection was based to include handball players aged ≥ 18 years of age and in good health (no pain and diagnosis at the time of examination), from different country in the world, different competition leagues, ranking level, amateur or professional, different position, and gender. The exclusion criteria included a positive COVID-19 test or existence of cognitive decline. In total, the uniform resource locator (URL) of the online survey was sent to 1500 potential participants, of which 1359 returned valid questionnaires that were included in the analysis (participation rate of 91%). The description of conditions of lockdown in the countries of the participants is displayed in The survey included an introductory page describing the background and the aims of the survey, the consortium, ethics information for participants, and the option to choose one of five available languages . The inclusion criterion was that participants were handball players aged 18 years or older and in good health. No restrictions in terms of playing level, categories, or playing position were made. Exclusion criteria included the existence of any chronic disease or orthopedic condition that might interfere with the participation in the study, and players with cognitive decline. Before completing the survey, individuals voluntarily consented to anonymously participate in this study.https://policies.google.com/privacy?hl=en, accessed on 27 June 2020). Participants were informed that if they wished to withdraw, responses would not be saved or incorporated into the analyses. Responses were confirmed once participants clicked ‘submit’ [Participants were assured data would be used solely for the research purposed during informed consent gathering. Responses were anonymous in line with Google’s privacy policy  based on the official IPAQ guidelines for young and middle-aged adult (18–65 years old) were used: vigorous PA = 8.0 METs, moderate PA = 4.0 METs, and walking = 3.3 METs. Additionally, we added total PA  as a fourth item and sitting time as a fifth item. The scoring protocol for the IPAQ-SF proposed levels category are:Inactive: Those individuals who did not meet the criteria for categories 2 or 3 were considered ‘insufficiently active’;Minimally active: The minimum pattern of activity to be classified as ‘sufficiently active’ was when a participant achieved a minimum of at least 600 MET-min/week (category 2);HEPA active: ‘HEPA active’ individuals  performed vigorous intensity activities, achieving a minimum of at least 3000 MET-min/week (category 3).In line with the IPAQ-SF guidance, the summation from each item  was used to estimate total PA time per week ,24. Weekp < 0.001), data were analyzed using two-way analyses of variance (ANOVAs). ‘Time’ was considered the within-subject factor, and the between-subject factors were ‘gender’ or ‘handball league,’ depending on the analysis being conducted. Furthermore, we used the variables country and continent as control variable in order to evaluate the level of participation in different countries and on different continents. Subsequently, pairwise effect size was calculated for each parameter by dividing the mean difference of the variable by the pooled standard deviation, which could then be interpreted as small effects (d < 0.5), moderate effects (d ≥ 0.5), and large effects (d > 0.8) [p < 0.05, with partial eta-squared (ηp2) > 0.10, while the effect size (d) was ≥0.8 [All statistical analyses were performed using SPSS version 25.0 for Windows . Following a test of normal distribution (Shapiro-Wilk Test), showing that all variables were not normally distributed (d > 0.8) . A positwas ≥0.8 . Data arIn order to evaluate PA in different countries and continents, we used country and continent as control variables within variance analysis .p2 = 0.06  to ηp2 = 0.67  and sedentary behavior (measured by sitting time) ranged from ηp2 = 0.13  to ηp2 = 0.49 (vigorous MET-minutes per week). No significant differences (gender effects) between male and female were observed  over time for both sexes was observed for walking. The largest change in PA parameters was detected for “all physical activity,” whereby the energy expenditure (min/week: ηp2 = 0.52) was significantly decreased during confinement when compared to before confinement  were observed (rejection of our primary hypothesis). Time effects for PA variables  ranged from ηobserved . In malefinement .p = 0.083, ηp2 = 0.01), gender , and level of handball league , country (29), gender, level of handball league, and playing position.PA exerts well-documented and measured healthogenic effects, and concomitantly, there is clear evidence linking physical inactivity to non-communicable diseases . Many goIn the present study, the number of walking days for at least 10 min per week was decreased from 4.58 ± 1.57 days to 2.89 ± 1.40 days for women and from 4.38 ± 1.25 days to 2.67 ± 1.21 days for men with a decrease of ~40% in women and men. At the same time, the time of each walk decreased from 56.9 ± 13.0 min to 27.2 ± 12.2 min in women and from 62.1 ± 10.6 min to 29.9 ± 13.5 min in men, representing ~50% in both genders. Therefore, energy expenditure of walking per week decreased from 868 ± 364 MET-min/week to 266 ± 188 MET-min/week for women and from 896 ± 301 MET-min/week to 273 ± 192 MET-min/week in men. It is thought that walking PA is part of the activities of daily life, such as moving around the training facility and at work outside of handball training. Thus, the decrease of walking volume in our subjects may reflect an inactive habitual lifestyle. In addition, sitting time would also be considered an indicator of time is spent in the home. The sitting time on weekdays was increased from 2.87 ± 1.44 h to 4.67 ± 1.47 h in women and from 2.66 ± 1.08 h to 5.20 ± 1.00 h in men. These values corresponded to 1.6 time more sitting time in women and 2.0 more sitting time in men. Previous studies have reported healthy population increased time spent viewing television, social networking, using a smartphone, and playing video games during COVID-19 home confinement . Our resComparing walking time per week among athletes versus healthy general populations prior to COVID-19 home confinement, walking time per week was two times higher in our study than in a previous study [According to the results of an international survey concerning the effects of COVID-19 home confinement on PA in healthy populations, sitting time was increased 1.58 times compared to before COVID-19 home confinement . The degHandball is characterized by repeated high-intensity actions such as jumping, sprinting, and changes of direction, interspersed by lower intensity periods ,36. In aThus, it is important for daily handball training to simulate the game at vigorous and moderate intensity. In this study, frequency, time, and metabolic expenditure of moderate to vigorous PA per week was reduced during COVID-19 home confinement. In general, handball players train 2–3 h per session, 4–5 times per week . FurtherRegarding competition level, Mon-López et al.  reportedRegarding gender, Mon-López et al.  showed aIn some surveys investigating the impact of COVID-19 on training in elite and semi-elite athletes in South Africa  and ItalIn a survey of PA during lockdown in the Canadian adult population , the timp < 0.05 level [The mandated restrictions concerning engagement in outdoor activities, including regular practice of exercise and PA in the time of the COVID-19 outbreak, are reducing exercising and increasing sedentary behavior, which can consequently contribute to anxiety, depression, and common chronic health diseases . Concern05 level . The preThis study did not consider the geographical or physical exercise or PA context. However, we hypothesize that players in this study would be unable to gather in training facilities for training or matches, and may have undertaken individual training in their own home and/or backyard because of lockdown. These athletes may have found it difficult to ensure exercise intensity to improve and maintain physical fitness and performance at the required level for handball players because individuals training at home and/or in their backyards may be unable to perform the high-intensity intermittent exercises or handball-specific exercises such as the team training and matches.Handball players’ lives have been disrupted by the COVID-19 pandemic. There are major psychological repercussions of athletes’ confinement due to lifestyle modification, as they have no reference to this new situation . It is en = 758; 56% related to the whole sample and 66% related to the Asia sample) were significantly overrepresented, while our aim was to reach many populations of handball players. Likely, nominated local colleagues that distributed the link in Japan were handball experts, who had more access to handball clubs, local federation, and teams. Consequently, the sample cannot be described as representative. The main limitation in this study, however, as with all self-reporting, is the possibility of reporting bias of PA (overestimation of PA), which is common among respondents of a self-reported questionnaire. However, we have asked the same questions in the survey about the two different periods (before and during home confinement by COVID-19). Thus, we speculate that the degree of bias is similar based on the internal consistency of respondents. It is also possible that recall bias was manifest, and respondents were unable to correctly recall the amount of PA before confinement.There were several limitations in this research project. However, one pertinent strength is the large sample size considered from multiple continents, enabled by our multilingual IPAQ-SF dissemination. We accept that this study has the disadvantage of a regional bias in the responses to the survey, despite this survey being open for handball players worldwide and consortium colleagues having distributed the link to the electronic survey via a range of methods. For example, 85% (1153/1359) of the participants were recruited in Asia. Handball players from Japan . From a statistical point of view, this is disadvantageous for variance analysis as well as the differences regarding performance levels , age, body mass, and height. Therefore, results may be biased by having unbalanced groups [Regarding gender comparison, we used two groups with significantly different sample sizes  and mood  of the players. Moreover, an improvement in monitoring systems for training quantity and quality would be desirable to draw conclusions that are based on objectively measured PA. For example, wearable technologies may be able to further elucidate the effects of COVID-19 confinement on PA, but this would require skills in big-data and web technologies. Finally, it would be of interest to examine the effect of PA changes on psychological wellbeing and how the decrease in physical activity translates into the sports level of players and their teams in future investigations.To our knowledge, this is the first study concerning handball players during COVID-19 that establishes differences by country, gender, playing position, and sporting level. The confinement period has influenced the days, hours, and intensity of PA. Furthermore, COVID-19 confinement induced a marked decrease in PA of all intensities and reduced the mean categorization of participants from HEPA active to minimally active due to COVID-19 impact. These observations may be used to inform development of PA recommendations during prolonged home confinement and reduced ability to train in a team handball and/or indoors setting. There is a need to translate the findings of this research into future recommendations for home-based exercise intervention in order to improve participants’ PA participation to maintain the HEPA active category in handball players during and after the COVID-19 pandemic. Identification of such sporting populations would allow for better-informed and more targeted mitigation strategies.


This study aimed to analyze the literature systematically to determine the clinical characteristics and prognosis of patients with connective tissue disease (CTD) with combined pulmonary fibrosis and emphysema (CPFE) compared to those of patients with CTD-interstitial lung disease (CTD-ILD) without emphysema.We searched MEDLINE, EMBASE, Cochrane Library, and KoreaMed for relevant articles published before July 2019. Studies meeting all the following criteria were included: (1) original research studies evaluating the effect of CPFE on CTD, (2) studies that compared patients with CTD-CPFE to those with CTD-ILD without emphysema, and (3) studies providing data on physical capacity, pulmonary function, or death in patients with CTD. Clinical characteristics of patients with CTD-CPFE were compared with those of patients with CTD-ILD without emphysema, and the influence of CPFE on physical capacity, pulmonary function, and death was analyzed.Six studies between 2013 and 2019 were included. Two hundred ninety-nine (29.5%) and 715 (70.5%) patients had CTD-CPFE and CTD-ILD without emphysema, respectively. Regarding the type of CTD, 711 (68.3%) patients had systemic sclerosis, 263 (25.3%) rheumatoid arthritis, and 67 (6.4%) other CTDs. Patients with CTD-CPFE had a higher frequency of pulmonary hypertension and pulmonary fibrosis > 20% of the total lung volume, higher ratio of the forced vital capacity to the diffusion capacity of the lung for carbon monoxide (DLCO), lower arterial oxygen pressure at rest, and lower DLCO compared to those in patients with CTD-ILD without emphysema. In addition, more deaths occurred among those with CTD-CPFE .CTD-CPFE is associated with worse physical and pulmonary function and more deaths compared to those in CTD-ILD without emphysema. These findings indicate the need for increased awareness and close monitoring of patients with CTD-CPFE. Interstitial lung disease (ILD) is characterized by fibrotic features generally in the lung bases of patients with connective tissue diseases (CTDs), such as rheumatoid arthritis (RA) and systemic sclerosis (SSc), observed on chest computed tomography (CT), high-resolution computed tomography (HRCT), and chest X-ray. Particularly, clinically significant ILD occurs in up to 40% of patients with SSc  and signCPFE, which is characterized by the presence of both emphysema and interstitial pulmonary fibrosis, is a new disease; it exhibits distinct clinical, functional, radiological, and pathological characteristics . The radHence, in this systematic investigation, we aimed to determine the prevalence and characteristics of CPFE compared to those of ILD without emphysema in patients with CTD. In addition, by subgroup analysis, CPFE was compared with ILD with emphysema in patients with systemic sclerosis (SSc), which is one of the diseases of CTD.We searched MEDLINE, EMBASE, Cochrane Library, and KoreaMed for relevant articles published before July 2019. Studies were included in this systematic review if they met all of the following inclusion criteria: (1) original research studies evaluating the effect of CPFE on CTD, (2) studies that compared patients with CTD-CPFE to those with CTD-ILD without emphysema, and (3) studies providing data on physical capacity, pulmonary function, or death in patients with CTD. Studies with fewer than five cases, animal studies, review articles, and studies on patients aged ≤5 years were excluded.Two investigators (KYP and SYY) independently performed data extraction using a predefined form. Any disagreement unresolved by discussion was reviewed by a third author (JBJ). The following variables were extracted from the studies: (1) demographic characteristics, including the first author’s name, year of publication, country where the study was performed, number of subjects, sex, and age; (2) type and diagnostic criteria for CTD; (3) the diagnostic method of CPFE and ILD without emphysema; (4) smoking history; (5) physical characteristics , composite physiologic index, extent of pulmonary fibrosis, and partial pressure of arterial oxygen at rest; (6) pulmonary function test results and DLCO; (7) 6-min walk test results; and (8) the number of deaths.The effect of CPFE on patients with CTD was analyzed in terms of physical capacity, pulmonary function, and death, and patients with CPFE were compared to those with ILD without emphysema. A subgroup analysis of the effects of CPFE was conducted for SSc because lung involvement in SSc is a major factor in the prognosis.Two investigators (KYP and SYY) independently assessed the methodological quality of each study using the Newcastle-Ottawa Scale for assessing the risk of bias for non-randomized studies . The NewThe meta-analysis was performed using the Review Manager Software . The pooled mean difference  in physical capacity and pulmonary function between patients with CTD-CPFE and those with CTD-ILD without emphysema was calculated using the inverse-variance method. The pooled odds ratio  was also computed for sex; the number of smokers; the number of patients with anti-centromere antibodies, digital ulcers, and pulmonary hypertension; and the number of deaths for patients with CTD-CPFE and CTD-ILD without emphysema using the Mantel-Haenszel method.I2 statistic to quantify the percentage of variability that could be attributed to between-study differences. I2 values for all reports were calculated by the random effects model because of the inherent limitations of non-controlled studies. An I2 value > 50% was considered significantly heterogeneous. Statistical significance was defined as a p value < 0.05.We examined the heterogeneity across studies using the The study selection process is shown in Fig. The characteristics of the studies are shown in Table CPFE prevalence was determined in three studies with a relatively large number of patients with SSc –5 Table. In SSc-The clinical characteristics of CTD-CPFE were compared to those of CTD-ILD without emphysema Table . The CTDA meta-analysis on the clinical characteristics of the patients with SSc-CPFE is presented in Table According to the results of our meta-analysis, patients with CTD-CPFE had different clinical features from those with CTD-ILD without emphysema. Patients with CTD-CPFE had higher rates of pulmonary hypertension and lower physical capacity compared to those with CTD-ILD without emphysema. Importantly, mortality was higher in patients with CTD-CPFE than in those with CTD-ILD without emphysema. In a subgroup analysis of SSc, similar results for the features of CPFE were found in the comparison of SSc-CPFE and SSc-ILD without emphysema. Therefore, the prognosis may be poorer with the presence of CPFE as opposed to pulmonary fibrosis without emphysema in patients with CTD. Notably, a recent CPFE study that included some patients with CTD showed that patients with less fibrosis at baseline (< 5%) had a better prognosis, suggesting that fibrosis has a significant influence on the prognosis .Cottin et al. showed that the smoking history and pulmonary function profile were similar between smoking-related CPFE and CTD-related CPFE. Nevertheless, patients with CTD-related CPFE had a better prognosis compared to those with smoking-related CPFE, and those with CTD-ILD without emphysema had a better prognosis than those with IPF . In the In SSc, ILD is one of the most common complications and the most common cause of death , 21. TheYamakawa et al. conducted a surgical lung biopsy study in 21 patients with SSc-ILD . PatholoIn our results, the prevalence of CPFE in smokers was 17%, which shows that smoking is a major risk factor for CPFE. However, in non-smokers, the prevalence was 5.3%, suggesting another possible risk factor for CPFE. Studies on RA-ILD conducted in Korea and the UK showed a high CPFE prevalence (27%) in never-smokers [Moreover, ILD in SSc is more often accompanied by emphysema; thus, the high CPFE prevalence in ILD suggests that ILD itself may be a risk factor for the development of emphysema and that CPFE may be a pulmonary manifestation within the spectrum of CTD-ILD . InteresOur study, which is the first meta-analysis of the effect of CPFE on CTD, has some limitations. First, the small number of studies included in this meta-analysis limits the strength of the evidence regarding the effect of CPFE on the clinical manifestations of CTD. Second, we included various types of CTDs, including extremely rare diseases, in the meta-analysis. While we have conducted a subgroup analysis of SSc, a subgroup analysis of other CTDs with different characteristics, such as RA, is needed. Third, the extent of lesions in ILD and CPFE can vary significantly from patient to patient, when interpreting the results and prognosis.Patients with CTD-CPFE showed greater physical and pulmonary function deterioration, decreased exercise capacity, and increased mortality compared to patients with CTD-ILD without emphysema. Although the prevalence of CTD-CPFE is lower than that of CTD-ILD without emphysema, CPFE should be carefully evaluated using low-dose HRCT and the pulmonary function test.Additional file 1. Search strategy: MEDLINE, EMBASE, Cochrane, and KoreaMed.


One of the most challenging aspects of Emergency Medicine (EM) residency is mastering the leadership skills required during a resuscitation. Use of resuscitation video recording for debriefing is gaining popularity in graduate medical education. However, there are limited studies of how video technology can be used to improve leadership skills in the emergency department. We aim to evaluate the utility of video-assisted self-reflection, compared with self-reflection alone, in the setting of resuscitation leadership.n = 10). Each resident acted as an individual team leader for a live real-time resuscitation in the emergency department. The authors classified a patient as a resuscitation if there was an immediate life- or limb-threatening disease process or an abnormal vital sign with an indication of hypoperfusion. Each resident was recorded as the team leader twice. Both control and intervention groups produced written self-reflection after their first recording. The intervention group viewed their resuscitation recording while completing the written reflection. After their reflection, all participants were recorded for a second resuscitation. Two faculty experts, blinded to the study, scored each video using the Concise Assessment of Leader Management (CALM) scale to measure the leadership skills of the resident team leader.This was a prospective, randomized, controlled pilot study conducted in 2018 at an urban level 1 trauma center with a three-year EM residency program. The trial included postgraduate year (PGY) 2 and 3 residents (p < 0.0001). The median gain score in the control group was −1.5 (IQR) versus 0.5 in the intervention group (IQR).Five PGY‑3 and five PGY‑2 residents participated. The weighted kappa between the two experts was 0.45  contains supplementary material, which is available to authorized users. Leadership failure can have disastrous results. A report by The Joint Commission found that team leadership failures in acute healthcare settings were associated with more than 50% of adverse events . ExacerbOne of the most challenging aspects of EM residency training is mastering the leadership skills required during a resuscitation. During Simulation allows for complete control of the resuscitation case to practice logistics, understand procedures, and demonstrate learning points. However, the disadvantage of simulated cases is that they lack the authenticity, pressure and investment that occurs when treating a real, live unstable patient , 8.Debriefing and self-reflection are ways to address the strengths and weaknesses of leadership skills. This practice of analyzing decisions that unfold quickly and have a high impact is commonly used in elite athletics. The exercise takes advantage of behaviorism and visualization to understand what they did, why they did it, and how they will change their behavior next time for a better outcome. Additionally, athletic reflection is often video-assisted. It is seen in the stereotypical situation of football players watching films before a game and has been studied in volleyball and tennis, showing improved long-term memory in tactical knowledge, improved strategy planning, and more meaningful awareness of the environment , 10.There is a tremendous opportunity to translate video-assisted self-reflection to leadership skills in resuscitations. Video-assisted feedback has been shown to improve algorithmic compliance in Advanced Trauma Life Support (ATLS) and cardiopulmonary resuscitation (CPR), with the premise that objective evidence of performance improves motivation and self-efficacy , 12.The basis for the hypothesis that skills will improve more amongst residents who are able to watch videos of themselves leading a resuscitation has its roots in cognitivism. Reflection is critical in cognitivism, the first step of which is to return to and replay the learner’s experience . This stIn this study, we assess the utility of resuscitation video-assisted self-reflection compared with self-reflection alone.We conducted a prospective, randomized, controlled pilot study. Audio and video were recorded of EM residents functioning as team leader during a resuscitation in real-time patients presenting to the emergency department. Recordings were uploaded to an encrypted web-based storage system (Wayne State One Drive) accessible only to the study authors. The Wayne State University School of Medicine Institutional Review Board classified this study as program evaluation/quality improvement and granted exemption. Patient consent was not required based on this classification as quality improvement. We have also adhered to the CONSORT guideline .This study was conducted at an urban, level 1 trauma center with approximately 90,000 adult visits per year and a three-year EM residency program. A total of ten PGY‑2 and PGY‑3 EM resident physicians volunteered to enroll in the study. Recruitment consisted of an email sent to the second- and third-year classes by a PGY‑3 participating in the study offering the opportunity to participate. Study staff would then be present in the emergency department during their shifts to capture data. Inclusion criteria for resident participation included (1) second- or third-year EM residents in good standing, (2) on an EM rotation during the months of August, September, and October 2018, and (3) having a resuscitation on a day that a member of the study staff was present to record. Patients were included if they were triaged as a resuscitation by emergency medical services or a triage nurse, which comprises patients who have an immediate life- or limb-threatening disease process, or patients with a vital sign abnormality with clear evidence of hypoperfusion.The ten resident physicians were randomized into two groups, with an allocation ratio of 1:1. The control group consisted of three PGY‑2 residents and two PGY‑3 residents. The intervention group consisted of two PGY‑2 residents and three PGY‑3 residents. Participants in both groups were recorded leading an adult resuscitation twice for a total of 20 recordings. After the first resuscitation, all ten residents participated in guided self-reflection regarding their capabilities as team leader. For all ten residents, the self-reflection was guided in that they were provided with a “Resident Reflection Sheet”  as opposed to reflecting on their capabilities in an unstructured way. The intervention group watched a recording of their resuscitation while they completed the “Resident Reflection Sheet,” whereas the control group completed the “Resident Reflection Sheet” without access to their recording. All residents in each group were then recorded leading a second resuscitation. No feedback or discussion regarding the resident’s self-reflection was provided prior to completion of the second resuscitation.Two faculty experts with experience in residency leadership and education reviewed all 20 videos to assess the leadership abilities of the resident functioning as the team leader during the case. The faculty experts reviewed the videos in random order and did not know whether they were viewing a video from the control or the intervention group, nor were they aware whether they were viewing a video from the first group of resuscitation cases (prior to the guided self-reflection) or after the guided self-reflection. The faculty experts scored all videos using the Concise Assessment of Leader Management (CALM) instrument , a previously validated instrument designed to require minimal user training to assess leadership skills and to provide formative feedback to learners . Rater tThe key outcome measure in this study was the CALM score before and after video-assisted reflection.Descriptive statistics were used to explore resident characteristics and evaluation timing; ordinal data were described using medians and interquartile ranges (IQRs). Individual scores for each resident generated using the CALM instrument for the pre- and post-test assessments were summed for a total score. A gain score was calculated for each resident by subtracting pre-test scores from post-test scores. Total gain scores on the CALM instrument between the control and intervention groups were compared. Gain scores between the control and intervention group for the CALM instrument were reported as medians (IQR) with a 95% confidence interval (CI). Agreement between the two faculty experts was assessed using the weighted kappa statistic. Consensus was also assessed between the two faculty experts, and was defined as a variation of no greater than one point on the CALM score for each of the 15 individual items in the instrument to account for subjectivity in ratings while still allowing for identification of significant differences in ratings.Five PGY‑2 residents and five PGY‑3 residents participated in the study out of 28 possible candidates. All video recording took place in September and October 2018. The median time between the first resuscitation and resident reflection was three days (mean 9.2 days). The median time between the first and second resuscitation recordings was 16.5 days (mean 19.3 days). Resuscitation cases encountered during the study period are described in Tab. p < 0.0001).Consensus was achieved between the two faculty experts for 95% of the 300 total variables on the CALM assessment tool (15 variables for each video times 20 videos). The weighted Kappa between the two experts was 0.45 , which may give further insight into the residents leadership abilities.Our study showed a positive trend in gain score evaluation of leadership skills for residents utilizing video-assisted self-reflection after resuscitation compared with the non-video-assisted control group. These initial results are very encouraging and support further exploration with a larger sample size and multiple sites.used by each resident to guide self reflection after each resuscitation. The control group only used the resident reflection sheet. The intervention group filled out the resident reflection sheet while watching their video.1. Resident Reflection Sheet: Previously validated instrument designed by Nadkarni LD, et. al to require minimal user training to assess leadership skills and provide formative feedback. Used by our attending experts to score all 20 videos.2. Concise Assessment of Leader Management: