Accepting the idea that the mental representations of concepts, diagrams, relations, plans, etc., are thought-shapers, I suggest going a bit further. Any kind of representation, be it mental or public, i.e., accessible to others, bears thought-shaping potential, albeit not in the same manner. Just as the idea of embodied cognition takes into consideration environmental facilities and obstacles, I suggest investigating thought processes in a broader context, i.e., placing thought-shapers in the context of their formation. I propose that the elements of the above mentioned definition of thought-shapers are built upon a structure that consists of representational skills, means, and institutions. In accordance with the idea of embeddedness and enactment, the need for communication and the given cognitive and physical aptitudes result in different kinds of expression, i.e., different kinds of representations available to others. When an expressional mode solidifies, it opens up new possibilities and limitations. I propose that mundane, almost unnoticeable affordances and their accompanying limits do shape our thoughts thoroughly. In my argument for the thought-shaper potential of the generative technique of public representations, I will delineate a historical overview of representational means in tandem with the main characteristics of different eras’ crucial ideals and patterns of reasoning. I will close the historical overview with a terminological excursion exploring how publicly available representation and mental representation relate to each other and the kinds of ambiguities that accompany the latter term’s use. Accordingly, embedding thought-shapers, I will outline the evolution of different representational techniques and skills. Then, because language is a decisive representational means, I will investigate its orientating and distortive potential. I will rely on some of Bergson’s lesser-known remarks. I will illuminate how ocular-centrism was able to be a decisive metaphor in science and philosophy for long centuries, until recently even. In conclusion, as a case study, I will illuminate how the term “mental representation” as a highly abstract term facilitates and at the same time hinders philosophical and scientific inquiry. Just as the idea of I am suggesting that not only mental representations have thought-shaper potential, but different techniques for creating public representations also have a considerable effect on the kind of mental representations we can have. Thus I propose that mundane, almost unnoticeable affordances and their accompanying limits do shape our thoughts thoroughly. In my argument for the thought-shaper potential of public representation and its generative technique, I will delineate a historical overview of representational means tandem with the main characteristics of different eras’ crucial ideals and patterns of reasoning.mental representation can facilitate and hinder philosophical and scientific inquiry. This excursion attempts to demonstrate how representational means can result in abstract terms that are capable of playing a crucial role in different fields of inquiry.Because language is a decisive representational means, I will investigate its orientating and distortive potential. I will rely on some of Bergson’s lesser-known remarks. I will illuminate how ocular-centrism was able to be a decisive metaphor in science and philosophy for long centuries, even recently. In conclusion, I will illuminate how highly abstract terms such as In the first part of the article, I will focus on how representational means and institutions affect the intellectual setting . That is, I will investigate how means of expression shape the intellectual focus and interest, and how these means define the accessible and the imaginable. I will not touch upon how moral and political institutions influence our thoughts; the scope of the present paper does not reach beyond the investigation of the interplay between cognitive and bodily skills and the means appropriate to share intentions, thoughts, and ideas. The normative aspect will enter the scene only in the case of objectivity as it emerged in scientific practice to illustrate how technical possibilities shape norms in scientific practice.Unlike mental representation, public representation is meant to be a representation that is accessible to others. It can take the form of words, signs, gestures, icons, and pictures – just to name a few basic variations. Subsequently, I will not pay much attention to how different institutionalized products of public representation affect the behavior, norms, and goals of the individual, but rather focus on the basic structure’s forming potential of different representational practices changing over time; I will focus on the background facilities which, for example, make an advertisement possible.The historical overview will show how the patterns of cognition changed in accordance with the emergence of new representational means and methods. I will investigate how different cognitive and bodily skills along the phylogeny paved the way for new representational inventions. Following the line of history, I will first focus on the organizing power of representations as they provide new epistemic access to the environment and cognitive skills, and accordingly, a basis to form community and group-identity. After taking into consideration basic communicational patterns, I will focus on the organization of thoughts in relation to the dominant scholarly representational patterns.Within cognitive evolution research, we can find different approaches and strategies , and we Cognitive capacity and development are usually understood in terms of representational skills. Cognitive evolution is an extensively studied field of research within this framework. The questions of what exactly made the evolution of the human mind possible, how language could emerge, and what the pivotal differences between primate and our ancestors’ biological settings were that made the disparate development possible, are hotly debated. Notwithstanding, some pillars of argument are more or less beyond question. The importance of the socially engaged mind of hominids is almost uniformly accepted, and accordingly, the role of communicational needs is considered an important facilitator of cognitive development. Though there are some differences among conceptions of the conditions that were necessary for calling language into being, the importance of language itself is also uncontested.hybridizations where, thanks to the coevolution of the brain, culture, and cognition, memory capacity became enhanced by an external symbolic storage system , and finally arose “externally nested cultural products,” viz., theory (The third transition (iii), from mythic to theoretical culture, came about when the increasing memory-load could be alleviated by the emergence of an external symbolic storage system. “At this point, since the Upper Paleolithic, there emerged the , theory , p. 745., theory , p. 284.material engagement theory (MET), which illuminates how archeological findings can help reconstruct cognitive turning-points, and significantly, how material artifacts modify epistemic access to the environment.Donald’s reliance on the social brain hypothesis  reconstrneuroarchaeology operates in terms of a close relation between culture and mind, but in a rather active manner. It is “strictly an interactionist approach, aiming primarily to understand the bidirectional links between brains, minds and culture” ; that true knowledge could be preserved and conveyed exclusively by the soul (Phaedrus 278a); and that because written words bear a thing-like character, they suggest exactly the opposite. Lycurgus, who was afraid of writing, made legislation externalized , create situations which perform similarly to some institutions of primary orality such as “participatory mystique, its fostering of communal sense, its concentration on the present moment, and even in its formulas”  highlights the importance of intuition in relation to the intellect as regards the possibilities provided by language; and a bit later, Heidegger thoroughly criticized Western metaphysics as it distorted the original meaning of important concepts such as ormulas” , p. 136.mselves” , p. 84f.Being and Time he proposed that although language can be investigated as a means of expression, primordially it has a revealing potential, it can call things into being and accurately indicate how we relate to our world. “Nevertheless, the ultimate business of philosophy is to preserve the force of the most elemental words in which Dasein expresses itself, and to keep the common understanding from leveling them off to that unintelligibility which functions in turn as a source of pseudo-problems” , or use the Heideggerian term calculative thinking, which became dominant and overcame meditative thinking10.Subsequently, I will attempt to explicate how the dominance of space in intellectual exchange resulted in a peculiarly one-sided way of thinking. We can call this kind of thinking 11. That is, both concrete and highly abstract concepts entered into the space first set in stone, later written, and then printed on paper, and more recently on the screen. This spatially bound character of the terrain of mental/intellectual engagement has far-reaching effects on our way of thinking.As we can see, ocular-centrism together with alphabetical writing, then printing, and finally digital technology bound the word greatly to vision and spatialized it12 at the end of the 19th century concluded: “The mistake of ordinary dualism is that it starts from the spatial point of view: it puts on the one hand matter with its modifications in space, on the other unextended sensations in consciousness. Hence the impossibility of understanding how the spirit acts upon the body or the body upon spirit” , the conceptual apparatus evolved in accordance with the physical. We need to live and survive in a physical world; therefore, we need means that are in accordance with this world. “to life” , p. 60. Language additionally provides us a conceptual apparatus that can facilitate organizational work within the material world and make use of material goods. But although humans are capable of connecting different phenomena in time, spatial arrangements of things are decisive in thinking and conceptual manipulation. As Bergson put it: “[t]here is a real space, without duration, in which phenomena appear and disappear simultaneously with our states of consciousness. There is a real duration, the heterogeneous moments of which permeate one another; each moment, however, can be brought into relation with a state of the external world which is contemporaneous with it, and can be separated from the other moments in consequence of this very process. The comparison of these two realities gives rise to a symbolical representation of duration, derived from space” , p. 110.Bergson believes that “intelligence is the prolongation of our senses. … If the intellect has been made in order to utilize matter, its structure has no doubt been modeled upon that of matter” , p. 42. in the movement as parts, nor even under the movement as places of the mobile. They are simply projected by us beneath the movement like so many places where, if it should stop, would be a mobile which by hypothesis does not stop. They are not, therefore, properly speaking, positions, but suppositions, views or mental viewpoints” . Creating a new vocabulary as Bergson suggested, establishing a fundamental ontology restoring the power of elementary words, or providing access to the primordial structure of consciousness and cognition as phenomenology suggested, are important steps toward setting the stage for the different approaches of so-called embodied cognition and preparing a paradigm-shift in cognitive psychology as well.In the last section of the present paper, I will delineate how the term “mental representation” was formed, and then, underlining its polymorphic character, I will illuminate the diverse usage of it in relation to the peculiar character of concepts as Bergson and later Wittgenstein called our attention to it. With this short overview of the terminological peculiarity of the state of affairs as regards the usage of the term, I hope to cast light upon how the concept of mental representation shapes inquiry, and therefore our thoughts; and to illuminate that spatially based conceptual framework and analytic thinking can result in ambiguous, sometimes misleading concepts.idea as highlighted by Descartes himself.Representation and isomorphism belong together, though this relation was not uniformly accepted. Isomorphism can be “any degree or kind of resemblance, likeness, or similarity of pattern, structure, or relational organization between entities or events as defined in the broadest sense” , p. XI. Meditations he referred to a kind of ambiguity as regards the term idea. “Idea can be taken materially, as an operation of the intellect … [and] can be taken objectively, as the thing is represented by that operation” ; intentionality, since representations are about something; asymmetry between the representation and the represented; and standing-in relation, i.e., that which a representation stands for is the representation’s content.matches and mismatches to the object at a later time” conscious representation, although “[w]e still do not understand exactly how millions of neuronal discharges, distributed across time and space, encode a conscious representation”. As far as I know, the attempt to find “new mathematical instruments in order to understand these complicated patterns” is still a vivid endeavor unconscious representations as well: the bottleneck of consciousness suggests we have unconscious mental representations competing to become conscious ones model of a tree as a mental representation is the result of the model-making brain’s learning process.“When I look at a tree in the garden, I don’t have the tree in my mind. What I have in mind is a model (or representation) of the tree constructed by my brain. This model is built up through a series of guesses and predictions” , p. 170.(4)neural activation pattern. As As conscious percepts, ideas also have a (5)specialized neurons18.Neural activation patterns as representations of conscious percepts seems to be even more puzzling if we take into account the working of certain neural pattern, i.e., as a mental event described in terms of neuronal activity; and (ii) in the sense of the content of consciousness, as something that usually can be reported and “refers to a mental entity that stands for something in the external world” (The above listed usages apparently suggest at least two distinct senses: (i) in the sense of l world” , p. 107,19.In the first case, representation is publicly available, i.e., we have access to neural states via brain imaging technologies. However, the neural representation of a mental state raises the question ‘‘What does a mental state consists of?’’ If it is the result of a certain neuronal pattern, then we can consider it being the cause of the state. Hence, the representation of the neural pattern is basically the representation of the cause of the given state. If we think that a mental state consists in/of certain neuronal patterns, then the reconstructed image of it is a public representation. But we have to account for other expressions of the given mental state, i.e., its bodily and/or linguistic expressionIn the second case we should ask “How we can have access to the content of consciousness at a neuronal level?” As Dehaene suggested we cannot yet crack the code of how the brain creates a mental state , p. 179,mental representation was introduced as a shortening of what could be the content of the conscious experience and/or cognitive state of which we can find the neural correlate. But the extensive use of the term suggests there is something beyond the neural correlates and the bodily and linguistic expression that is to be found a “gaseous thing” (We have no evidence that cognitive processes involve mental representation, it is merely presupposed; and there is no provable criterion of the becoming of a mental representation in neural activity. We have direct access only to the scenery, behavior, report, and recorded neural states. In accordance with this information, s thing” , p. 31f Recent work in embodied cognition sheds some new light on the role of representation. idea and later representation, clearly demonstrating how difficult it is to comprehend mentality. These insights suggest that disorienting concepts make us ask questions that are unanswerable despite the opportunities provided by sophisticated technical devices.The idea of looking for influential factors beyond the realm of mental representations as thought-shapers is parallel with the idea of understanding cognition beyond brain-bound processes. Representational means as a facilitator and definer of the expressible, and therefore shaper of the epistemic accessible, are decisive. At the beginning of the so-called secondary orality, Bergson aptly described the peculiarities of concept formation as well as the ambiguities raised by the term Representational skills paved the way to creating new representational means and systems. This intertwined relation of cognitive and external/technical facilities introduced a new attitude toward the world: science became an increasingly specialized enterprise with testable methodology to capture the different segments of reality. It is considered as an ever progressive enterprise with reliable, mostly not counterintuitive results. But in the meanwhile, it goes largely ignored that this reliability is only partial – that evidence is valid only within a well-defined framework; the access to the investigated part of the world is decisively influenced by the theory by which we attempt to illuminate further details, i.e., we are basically biased by the applied theory and by the applied methods and means since these determine what is accessible and imaginable for us. As we can see, the understanding and apprehension of the world or a particular phenomenon is decisively defined by the means we use for description and/or depiction. If we can use only words as definitions, particulars are not considered; if particulars are duplicable, we face the dilemma of whether general features or particular cases or rather structural relations are favorable. Beyond these biasing factors, there is an even more encompassing deceptive mediator of thought: language. As it evolved and became increasingly refined in accordance with the needs of different areas of interest, it suggested a structure of reality akin to its own nature, viz., differentiating and at the same time generalizing, highly abstract though metaphoric. Though the universe of concepts refers to the world of things, it is expected to provide access to mental phenomena as well.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. 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Energy malnutrition was observed in 43%. The independent factors associated with energy malnutrition were tidal volume (VT)  and Th12 erector spinae muscle cross-sectional area SMI (Th12ESMSMI) . In decision-tree profiling of energy malnutrition, VT was extracted as the first distinguishable factor, and Th12ESMSMI as the second. In ROC analysis, VT < 647 mL  or Th12ESMSMI < 10.1  was the cutoff value for energy malnutrition. Energy malnutrition may be an early warning sign of nutritional disorders.Weight loss is a factor that affects prognosis in patients with chronic obstructive pulmonary disease (COPD) independent of lung function. One of the major factors for weight loss is energy malnutrition. There have been no reports on the factors related to energy malnutrition in COPD patients. This retrospective observational study aimed to investigate these factors. We included 163 male subjects with COPD. Respiratory quotient (RQ), an index of energy malnutrition, was calculated by expiratory gas analysis using an indirect calorimeter. RQ < 0.85 was defined as the energy-malnutrition group and RQ ≥ 0.85 as the no energy-malnutrition group. Factors related to energy malnutrition were examined by multivariate and decision-tree analysis. We finally analyzed data from 56 selected subjects (median age: 74 years, BMI: 22.5 kg/m In Japan, about 70% of patients with chronic obstructive pulmonary disease (COPD) have a %ideal body weight (%IBW) of less than 90%, and the frequency of nutritional disorders is higher than in Europe and the United States ,2,3,4. MIn general, one of the major factors for weight loss is starvation or energy malnutrition. It was reported that weight loss in COPD was mainly due to inadequate nutritional intake . Among mIn elderly COPD patients, in addition to decreased energy intake and increased resting energy expenditure due to effortful breathing and inflammatory cytokines, there is often a long fasting time between dinner and breakfast. This means that there is a possibility of starvation, or energy malnutrition, in the early morning. Determination of early morning starvation or energy malnutrition and examination of its associated factors will contribute to the early detection and prevention of malnutrition and weight loss. However, there have been no reports on factors related to energy malnutrition in COPD patients. In this study, we used an indirect calorimeter to measure metabolism during early morning fasting. We calculated the respiratory quotient (RQ), which is an index of energy malnutrition, and investigated the actual state of energy malnutrition in patients with stable COPD. Furthermore, we examined the relationship between respiratory function, biochemical blood tests, muscle mass, and physical function.This study was a retrospective observational study designed to investigate the factors associated with energy malnutrition in male outpatients with COPD. From October 2020 to March 2021, a total of 163 male outpatients with COPD attended Japan Community Health Care Organization Saga Central Hospital. Inclusion criteria: male outpatients with COPD who (1) were 60 years of age or older, (2) able to perform all physical function tests, and (3) had undergone a biochemical examination and CT scans for Th12 level.2) and carbon dioxide production (VCO2) were measured for 15 min, and the average of the last 10 min was used for analysis [2 and VCO2 were then used to calculate the RQ for each patient (RQ = VCO2/VO2). The RQ is a dimensionless number used in calculations of basal metabolic rate (BMR) when estimated from carbon dioxide production. It is calculated from the ratio of carbon dioxide produced by the body to oxygen consumed by the body. The respiratory quotient value indicates which macronutrients are being metabolized, as different energy pathways are used for fats, carbohydrates, and proteins [Energy metabolism was measured with the use of an indirect calorimeter . Subjects were not to eat or drink anything after 9:00 p.m. on the day before the measurement, except for the consumption of calorie-free water or tea. In addition, the amount of food eaten on the day before the measurement was questioned to confirm. There were no subjects who had insufficient food intake. All measurements were taken at 9:30 a.m. in a fasted state after bed rest for at least 30 min as in previous studies . Oxygen analysis . The meaproteins . In addiproteins . Basal eIn general, the turning point for the substrate of thermogenesis from carbohydrate dominant (npRQ ≥ 0.85) towards fat dominant (npRQ < 0.85) is 0.85 of non-protein RQ (npRQ) . In addiBefore measuring energy metabolism, anthropometry measurement was performed to determine body weight, body mass index (BMI), body fat, and skeletal muscle mass using bioelectrical impedance analysis . Skeletal muscle mass was normalized by the square of height, and the data were expressed as skeletal muscle mass index (SMI).Spirometry was performed by three well-trained pulmonary technologists according to the manual of the American Thoracic Society/European Respiratory Society Task Force, using the same spirometer  for all participants . The forVenous blood was collected in the morning after 12 h of fasting. To examine liver function, lipid metabolism, glucose metabolism, and muscle metabolism, which may affect starvation, before measuring energy metabolism, blood samples were taken and analyzed for these parameters: albumin (Alb), transthyretin (TTR), C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), total cholesterol (T-Cho), HDL cholesterol (HDL-C), LDL cholesterol (LDL-C), triglyceride (TG), creatinine (Cre), and blood glucose (BG).Skeletal muscle mass was calculated by normalization with a CT scan  at the level of the 12th thoracic vertebra (Th12). In this study, the cross-sectional area of total skeletal muscle and erector spinae muscle (ESM) at the Th12 level were selected . This an®-short form (MNA-SF) assessed nutritional status. Subjects whose total score < 12 were categorized as at risk for malnutrition, while those whose total score ≥ 12 were categorized as having normal nutrition status [Grip strength was measured using a hand dynamometer . Maximum grip strength was measured three times with the dominant hand, and the maximum value was used as the measurement value. Knee extension strength was determined using a hand-held dynamometer . Subjects were instructed to press the dynamometer to straighten their knees. They then maintained their max efforts for an extra 5 s. Gait speed (m/s) was calculated by the 10 m walking test (10MWT) . The 10Mn status .p < 0.05.Data were represented as median (interquartile range (IQR)), range, or number. Values for differences between the energy malnutrition and non-energy malnutrition groups were analyzed by use of Wilcoxon rank-sum tests. In addition, logistic regression analysis was used to analyze the independent factors related to energy malnutrition. For the selection of candidates for logistic regression analysis, we used the single factor regression analysis (Spearman’s tests). Factors associated with energy malnutrition were profiled using decision tree analysis. A decision-tree algorithm is a data-mining technique that reveals a series of classification rules by identifying priorities and therefore allows clinicians to choose an option that maximizes the benefit for the patient . DecisioWe finally analyzed data from 56 selected subjects who fulfilled the criteria for exclusion as follows: outpatients with COPD who (1) had severe liver malfunction; (2) had severe diabetes; (3) suffered from inflammatory, endocrine, or gastrointestinal diseases; (4) had other malignancies, malabsorption, or motor disorders; (5) were using home oxygen (because the RQ cannot be accurately measured) .2. Subjects with GOLD stage I, II, III, and IV were 21.4%, 41.0%, 32.1%, and 5.3%, respectively. Subjects with mMRC dyspnea scale score 0, 1, 2, 3 and 4 were 25.0%, 46.4%, 14.2%, 10.7% and 3.5%, respectively. The median MNA-SF was 12 points, and the nutritional status was comparably normal. The median NRADL score was 95, and the median patient was almost independent in ADL. The median Alb, total TTR, and CRP were 4.2 g/dL, 28.3 mg/dL, and 0.09 mg/dL, respectively. The median T-Cho, Cre and BG were 197.5 mg/dL, 0.87 mg/dL and 103.0 mg/dL, respectively. The median RQ was 0.85, and the median energy oxidation rate was 50.8% for carbohydrates and 49.2% for fats . Otherwise, there were no significant differences in biochemical tests, body composition, or physical function between the two groups  group had significantly lower carbohydrate oxidation rate, had significantly higher fat oxidation rate, and had significantly lower VT than subjects in the non-energy malnutrition group (RQ ≥ 0.85). However, there was not any significant difference in REE, RR, or VE between the two groups. Subjects in the energy malnutrition (RQ < 0.85) group had significantly lower MNA-SF scores and had significantly lower Th12 muscle mass, Th12ESM mass, and Th12ESMo groups .r = 0.349, p = 0.0084), Th12ESMSMI  and MNA-SF  were significantly correlated. In a logistic regression analysis with VT, Th12ESMSMI, and MNA-SF as explanatory variables and energy malnutrition as an objective variable, the independent negative risk factors for energy malnutrition were both VT  and Th12ESMSMI   BMI < 22.6 and %FEV1 < 58.2%  between RQ and other parameters showed that VT (= 0.034) . The dec < 58.2% .SMI for distinguishing energy malnutrition. When the VT cutoff value was set at 647 mL, the area under the curve (AUC) was 0.72, and the sensitivity and specificity were 87% and 50%, respectively. Furthermore, when the cutoff value of Th12ESMSMI was set at 10.1, the AUC was 0.70, with a sensitivity of 65% and specificity of 74% . Regarding the relationship between VT and malnutrition, Arora NS et al. reported that malnutrition decreases both respiratory muscle strength and maximal spontaneous ventilation, possibly impairing respiratory muscle strength to cope with the increased ventilatory load in thoraco-pulmonary disease . In addiSMI as a risk factor for energy malnutrition. Nutritional impairment in COPD patients has been reported to cause a high rate of lean body mass loss [In addition, logistic regression analysis identified Th12ESMass loss ,38,39,40SMI less than 9.59, and %FEV1 less than 58.2% had 100% energy malnutrition   or Th12 ESMC, 0.70) . Both VTThis retrospective observational study has several limitations. First, the number of subjects was too small to allow for sufficient multivariate analysis. Second, the study was conducted at a single center, which may have led to various selection biases. Third, subjects on home oxygen were excluded from the study because of metabolic measurements by indirect calorimetry, and subjects with severe disease were not included. Therefore, further studies designed as prospective, multicenter studies in COPD patients with various conditions are required to explore the impact of energy malnutrition on skeletal muscle and physical functional performance in COPD patients. Moreover, as for metabolic measurements, we could not measure non-protein RQ because of the lack of 24-h urine storage in outpatients. Therefore, we could not take into account the energy metabolism of protein.SMI. Energy malnutrition may be an early warning sign of nutritional disorders. Taken together, it is beneficial to be able to predict energy malnutrition using clinical indicators.In conclusion, we have shown that 43% of the subjects with stable COPD had energy malnutrition, suggesting the possibility of early nutritional impairment and the need for early nutritional intervention. Furthermore, the factors associated with energy malnutrition were VT and Th12ESM


Malnutrition is a nutritional disorder that has a high incidence and can lead to multiple poor prognoses, such as frailty. Early identification and correct evaluation of malnutrition are essential for improving clinical outcomes. Objective: Therefore, we aimed to explore the applicability and effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criterion for identifying undernutrition in older inpatients.In total, 223 participants aged ≥60 years were involved. Nutrition was evaluateded employing MNA-FF and GLIM criteria, which adopts a two-step procedure. The first step was to use three different methods for nutritional risk screening: NRS-2002, MNA-SF, and MUST. The second step is to diagnose undernutrition. The Clinical Frailty Scale was used to assess frailty. Sensitivity, specificity, Youden index, kappa values, and positive and negative predictive values were measured to test the validity of the GLIM criteria. Logistic regression models were used to assess whether there was a correlation between malnutrition and frailty.We found that 32.3–49.8% of inpatients were at risk of malnutrition based on the GLIM diagnosis using the three different screening tools, 19.3–27.8% of patients were malnourished. The GLIM criteria with MNA-SF as the diagnostic validation and MNA-FF as a reference showed high consistency , sensitivity (90.5%), and specificity (86.4%). Logistic regression analysis showed that malnutrition, using MNA-SF with the GLIM criteria, was relevant to higher likelihood of frailty . Conclusions: The GLIM criteria with the MNA-SF may be a more reliable malnutrition assessment process in elderly inpatients.


A trauma resuscitation is dynamic and complex process in which failures could lead to serious adverse events. In several trauma centers, evaluation of trauma resuscitation is part of a hospital’s quality assessment program. While video analysis is commonly used, some hospitals use live observations, mainly due to ethical and medicolegal concerns. The aim of this study was to compare the validity and reliability of video analysis and live observations to evaluate trauma resuscitations.In this prospective observational study, validity was assessed by comparing the observed adherence to 28 advanced trauma life support (ATLS) guideline related tasks by video analysis to life observations. Interobserver reliability was assessed by calculating the intra class coefficient of observed ATLS related tasks by live observations and video analysis.P < 0.001) higher when the same resuscitations were analysed using video compared to live observations. During real-life resuscitations, 8.7% (p < 0.001) more ATLS related tasks were observed using video review compared to live observations. In absolute terms, a mean of 2.9 (during simulated resuscitations) respectively 2.5  ATLS-related tasks per resuscitation were not identified using live observers, that were observed through video analysis. The interobserver variability for observed ATLS related tasks was significantly higher using video analysis compared to live observations for both simulated  and real-life witnessed resuscitations .Eleven simulated and thirteen real-life resuscitations were assessed. Overall, the percentage of observed ATLS related tasks performed during simulated resuscitations was 10.4% (Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These outcomes may guide the debate to justify video review instead of live observations. With the implementation of trauma systems, severe trauma patients are resuscitated with a systematic approach. The initial management of severely injured patients is performed by several (para) medical healthcare professionals and extends over a series of sequential processes that begin with the first responder on the accident site and ends with definitive treatments such as surgery or intensive care at the hospital.This interdisciplinary response to injuries has resulted in significant improvements in mortality and morbidity of severely injured patients –3. ResusA trauma resuscitation is a dynamic process, where several tasks are performed simultaneously or in quick succession. During these resuscitations, the Advanced Trauma Life Support (ATLS) guidelines, which are acknowledged worldwide, provide guidance to the trauma team by prioritizing diagnostic and therapeutic processes . NeverthThe validity and reliability of trauma team evaluations are crucial, as these evaluations are the foundation upon which quality assessments and education are built. Video analysis has been described as an effective approach to assess trauma team performance, as it provides an accurate documentation of resuscitation. For example, the ability to replay a video allows for a detailed analysis of (non-)technical skills and processes during the resuscitation –22. HoweThis study was a prospective observational study to compare the validity and reliability of life observations versus video analysis as methods to assess ATLS adherence in simulated and real-life trauma resuscitations. Audio recordings were also included in the video recorded (simulated) resuscitations. First, eleven simulated trauma resuscitations were assessed. Three simulated resuscitations were assessed by two live observers and eight additional simulated resuscitations were assessed by one live observer. Next, all eleven simulated resuscitations were assessed by two observers by using videos . Additionally, thirteen real-life resuscitations were assessed. All real-life resuscitations were assessed by two live observers and two video assessors Fig. . Through®. During each training session, a scenario of a severely injured patient was simulated. The trauma team composition during simulation was comparable to the composition during real-life resuscitations, only without a neurologist and radiology technician; a review by Kreb et al.  and real-life resuscitations [0.99 (0.99–1.00) vs. 0.86 (0.83–0.89)] Table .Table 2iThis is the first study to compare validity and reliability of live observations and video analysis to evaluate trauma resuscitations on ATLS adherence. From our study results, video analysis appears to be more valid compared to live observations, as significantly more ATLS related tasks were observed. Furthermore, the degree of agreement using video analysis was significantly higher compared to live observers. Superiority of video analysis over live observations of real-life resuscitations have been seen in previous studies for the evaluation of non-technical skills. Reliability of the T-NOTECHS, a tool to assess non-technical skills, was measured using video analysis . In thatA key implication of the results is that video analysis might be more appropriate for ongoing quality assurance programs in level one trauma centers compared to live observations. In a recent nationwide survey across United States’ level one and two trauma centers, 65% of respondents reported that video analysis resulted in performance improvement initiatives, 24 and 41% stated that video analysis has led to changes in institutional guidelines.  found a p < 0.001). Thereby, the authors noted that evaluation of surgical activity was still possible using this method.To mitigate privacy threats, proper informing, security, and anonymization methods should be adopted while performing video analysis. Quality improvements through video assessment should be secure and anonymized, and personnel should be informed being video using a clear sign at the entrance of the emergency and updated using local hospital information platforms. Data should be stored securely and must comply with local regulations, and access to the videos should be restricted to only a few key personnel. All of these actions should be well-documented and regularly evaluated. Finally, there are some recently described advanced methods available that could significantly ano[nymize] patients and personnel in the trauma room. In the study by Silas et al.  videos oOur study methodology included a sample size calculation, and was able to sufficiently demonstrate differences in reliability and validity between video analysis and live observations to assess the adherence of ATLS related tasks. Another strength of this study is that both real life trauma resuscitation and simulated resuscitation were evaluated. However, there are limitations to our research that should be considered. First, recall bias may have been introduced, as the life observers were the same persons as the video assessors. Therefore video assessors may have remembered some parts of the resuscitation as they also have witnessed the same resuscitation in real life. This effects is tried to minimalize as, the videos are assessed 5 till 30 days after the resuscitation occurred. A longer period between the actual resuscitation and is not possible as videos were removed within thirty days due to local hospital security and privacy policies. Second, this study assumed only false negative observations and no false positive observations, implying that live observers or video analysis would miss tasks, but no tasks would be observed that did not occur. However, false positive observations are theoretically possible and are more likely to occur during live observations compared to video review. A assessor could reviewed parts of the resuscitation multiple times during video analysis in case the assessor has reservations about a specific activities, which is not possible during live observation. By assumption no false positive observations would occur, the assessment of this study was limited to whether the task was performed or not, and did not evaluate whether it was performed well or not. However, in this study, no ATLS-related tasks were identified by live observers that were not found using video analysis, indicating that the chance of false positive observations appears low. Third, the interrater variability of live observers for simulated resuscitations should be interpreted with caution. Only three of the eleven simulated resuscitations were assessed by two live observers, which means that analysis of interobserver variability for live observers in simulated setting included only three cases. Therefore, values found for interobserver variability of live observers in simulated resuscitations are more uncertain than interobserver variability of video analysis or live observations during real life resuscitations, which are reflected in the confidence intervals. Finally, no patient related data was gathered; therefore, we were not able to take severity of injury into account. Resuscitations of severely injured patients are more dynamic, and may therefore be challenging to observe for live observers, while in contrast, video assessment creates the opportunity to replay a video which may even increase reliability of the assessment in these resuscitations. Therefore, we strongly advise to use video analysis to assess trauma resuscitations.Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These important outcomes may guide the debate to justify video review instead of live observations, albeit with possible ethical concerns. Future work should evaluate ways to overcome the ethical issues in order to provide a more efficient way of analyzing and retaining trauma resuscitation procedures.


Basic surgical skills teaching is often delivered with didactic audio-visual content, and new digital technologies may allow more engaging and effective ways of teaching to be developed. The Microsoft HoloLens 2 (HL2) is a multi-functional mixed reality headset. This prospective feasibility study sought to assess the device as a tool for enhancing technical surgical skills training.A prospective randomised feasibility study was conducted. 36 novice medical students were trained to perform a basic arteriotomy and closure using a synthetic model. Participants were randomised to receive a structured surgical skills tutorial via a bespoke mixed reality HL2 tutorial (n = 18), or via a standard video-based tutorial (n = 18). Proficiency scores were assessed by blinded examiners using a validated objective scoring system and participant feedback collected.The HL2 group showed significantly greater improvement in overall technical proficiency compared to the video group , and a greater consistency in skill progression with a significantly narrower range of scores . Participant feedback showed the HL2 technology to be more interactive and engaging with minimal device related problems experienced.This study has demonstrated that mixed reality technology may provide a higher quality educational experience, improved skill progression and greater consistency in learning when compared to traditional teaching methodologies for basic surgical skills. Further work is required to refine, translate, and evaluate the scalability and applicability of the technology across a broad range of skills-based disciplines.The online version contains supplementary material available at 10.1186/s12909-023-04122-6. Current approaches to surgical skills training commonly utilise the support of didactic video tutorials as these have been shown to effectively teach basic skills such as suturing . HoweverMixed Reality (MR) technology offers an immersive experience in which real and virtual elements of an environment co-exist. Headsets allow multiple users to remotely link and collaboratively interact through bidirectional communication and interaction with spatially recognised 3D holographic content within the real visualised environment. This technology can therefore provide specific 3D imaging, generic dynamic physiological and anatomical models, or procedural animations to improve the learning offer, whilst also allowing remote access to educations that may widen accessibility and lower barriers to educational opportunities. The HoloLens 2 (HL2)  is an untethered MR headset, and is an example of such technology. It has been successfully used across a range of educational settings including teaching ward rounds , and hum36 novice clinical medical student participants were recruited. All had undergone summative assessment in simple suturing competencies as part of their curriculum prior to participation in the study but had not previously undertaken the surgical skill being taught and assessed. Demographic data were collected, and preferred learning style data self-reported by participants using the VARK  model; a validated inventory that identifies student learning preferences .This was a single blind randomised study with 18 participants randomised to each group. Each group received a structured surgical skills tutorial on performing and closing an arteriotomy: a conventional video-based tutorial group, and a MR HL2 group. The allocation ratio for each group was 1:1 via block randomisation prior to participation. The study received institutional educational ethics approval (EERP2021-027a) and informed consent was obtained from all participants.Appendix A. In the first stage, all participants were provided with identical basic written instruction on how to undertake an arteriotomy and closure. The task was then performed on a surgical model to provide a baseline assessment of proficiency. In the second stage, the video group received tuition through a pre-recorded structured skills video. Participants were able to independently replay all, or parts of the video at their preferred pace while practising the skill for 20 min. The HL2 group received instruction on how to fit and use the HL2 device and technical support was provided for participants who had difficulties in using the technology. They received the same structured surgical tutorial that was enhanced with the addition of bespoke interactive holographic content and instruction delivered through Microsoft Dynamics 365 Guides , and were again given 20 min to practice the skill whilst utilising the MR content. The MR tutorial provided to the HL2 group is shown in Fig. The study took place in three stages and employed a modified Peyton’s four-step approach to skills teaching for both groups . ParticiAppendix B.Assessment tools such as the Objective Structured Assessment of Technical Skill (OSATS) have been shown to measure surgical skill proficiency accurately and validly . In thisStandard descriptive statistics were utilised. The distribution of data was checked for normality using the Shapiro-Wilks test. Comparison of scores between groups were analysed by a T-Test for parametric data and a Mann-Whitney U (MWU) test for non-parametric data. Variance was assessed by an F-test. A Chi-squared test was used to test relationships between categorical data. P-values < 0.05 were considered significant. Statistical analysis was carried out using GraphPad Prism for Mac Version 9.0.0. Data is displayed as mean ± standard deviation.There was no difference in age  or sex  between the HL2 and video groups respectively.17,17 = 2.64 p = 0.026).There was no significant difference in total baseline proficiency scores for the HL2 and video groups . The HL2 teaching group showed a significantly greater gain in raw point proficiency scores compared to the video group  as illustrated in Fig. There was no significant difference in baseline scores for instrument selection for the HL2 and video groups . The HL2 teaching group subsequently had a significantly higher mean score for instrument selection choice when compared to the video group .There was no significant difference in baseline scores for suture quality for the HL2 and video groups , and both groups demonstrated equal improvement in performance .The impact of participant learning styles on proficiency are summarised in Fig. Participant feedback is summarised in Table This randomised study has shown that students who participate in surgical skills tuition delivered via MR technology demonstrate greater and more consistent skill progression, in addition to reporting a higher quality educational experience when compared to traditional video-based skills tuition.The HoloLens teaching session gave consistently better results to all learners. Specifically, it led to significant improvements in instrument selection and more consistent improvements in technical performance. These observations could be due to the nature of the HoloLens content that supported a more structured approach to skill practice for the participant. The interactive tutorial provided reinforcement and immediate confirmation of the key procedural steps by producing holographic representations of each surgical instrument in order of use, in addition to highlighting the correct instrument within the surgical field and providing visual guidance for exact instrument placement on the surgical jig, as illustrated in Fig. Differing participant learning styles appeared to influence the effectiveness of the intervention. Participants were either multi-modal learners or reported a single preferred learning style, with an equal distribution across each study group. Participants who included auditory learning as one of their preferred learning styles performed similarly across the two study groups as would be expected given that the audio commentary provided for both teaching modalities were identical. Participants who included visual and kinaesthetic learning as one of their preferred learning styles performed significantly better in the HoloLens group. Although both groups received the same video material and practice time, the addition of holographic content and markers, and interactive task guide in the HoloLens group created a more dynamic learning environment that supported a multi-modal approach to learning. It is well documented that more interactive teaching sessions delivered through a diverse range of media lead to increased engagement and better performances , 19.Suture quality remained consistent across the two interventions. This was a secondary measure of the study, and instructions and tuition on improving suture quality were not delivered with novel MR content. The lack of significant difference between groups may be accounted for by the limited specificity of the suture quality assessment methodology, however, this observation may also reflect the fact that the students did not have the opportunity to reach a performance plateau in their motor skills , with inThe global need for improved surgical skills teaching is clear , and thiUnfamiliarity and the learning curve associated with new technologies often results in slow adoption , howeverMost participants  who used the HoloLens did not experience any negative symptoms with the device, with the few symptoms that were experienced being mild. Studies have shown that prolonged use of the HoloLens may lead to symptoms such as headaches or fatigue . The vidA key limitation of this study was provided by the technology itself which remains in relative infancy. The battery life of the device and other technical aspects of its operation were principal concerns. When running a Microsoft Dynamics 365 Guide, such as used in this study, it is much shorter than advertised and lasts for only 90 min. Whilst not of direct consequence in this study as each participant used the device for 40 min, it may limit the scalability of the technology across a wider range of subject areas and skills that require a longer instructional period. Further to this, periods of minimal head movement, for example whilst watching a video through the device, can lead it to automatically go to sleep and therefore interrupt the tutorial. Finally, the device is designed to be operated through specific hand gestures such as tapping the inside of the wrist with two fingers to return to the main menu. Whilst through to be unique in other settings, these were sometimes confused with normal movements undertaken in clinical contexts such as putting on gloves which once again may unintentionally disrupt the tutorial; this could be easily resolved through basic software developments that consider the clinical context. This study was conducted in an institution that had the technical resource to develop the bespoke content, and financial resource to purchase the devices which cost of around $3,500 each. Expert technical knowledge is required to effectively create and deliver the MR content, even with a mature software package such as Dynamics 365 Guides that was used in this instance. A multi-step process is required to film and segment the video content, generate bespoke 3D holographic content through a distinct software application, create a task-specific spatially orientated practice environment in which the suturing skill was performed and finally to link these in a single joined-up interactive guide. This resource requirement may act as a barrier to adoption and the potential scalability of the technology, however, over time it is likely the cost of the technology will fall and therefore it will become a more feasible option for widespread use in medical education. In addition, any technology-based trial, particularly involving novel technology, will likely be affected by some degree of technology bias.Further to the technical limitations, this study looked solely at improvements in proficiency in a tightly defined individual task over a short period of time, potentially limiting the applicability of the findings to generalised surgical proficiency over the longer term. Secondly, whilst insignificant, there was a difference in baseline participant performance between each group that may have partially contributed to the observed findings. Future studies would benefit from retesting participants at longer time interval to determine if MR teaching methods minimise longitudinal skill fade and improve knowledge retention, and from stratifying participants according to baseline proficiency to assess their effectiveness across different performance levels. It is also important to assess the efficacy of the technology across a wider range of topics, skills and contexts.This study has shown that a HoloLens delivered mixed reality teaching programme has the potential to produce greater skill progression, more consistency in learning and a higher quality educational experience compared to traditional video-based methods for surgical skills training. Although in its infancy, further work to refine, translate and evaluate the scalability and applicability of the technology will allow it to be readily adopted across a broad range of skills-based disciplines.Below is the link to the electronic supplementary material.Supplementary Material 1Supplementary Material 2


During the last decade, surveillance cameras have spread quickly; their spread is predicted to increase rapidly in the following years. Therefore, browsing and analyzing these vast amounts of created surveillance videos effectively is vital in surveillance applications. Recently, a video synopsis approach was proposed to reduce the surveillance video duration by rearranging the objects to present them in a portion of time. However, performing a synopsis for all the persons in the video is not efficacious for crowded videos. Different clustering and user-defined query methods are introduced to generate the video synopsis according to general descriptions such as color, size, class, and motion. This work presents a user-defined query synopsis video based on motion descriptions and specific visual appearance features such as gender, age, carrying something, having a baby buggy, and upper and lower clothing color. The proposed method assists the camera monitor in retrieving people who meet certain appearance constraints and people who enter a predefined area or move in a specific direction to generate the video, including a suspected person with specific features. After retrieving the persons, a whale optimization algorithm is applied to arrange these persons reserving chronological order, reducing collisions, and assuring a short synopsis video. The evaluation of the proposed work for the retrieval process in terms of precision, recall, and F1 score ranges from 83% to 100%, while for the video synopsis process, the synopsis video length compared to the original video is decreased by 68% to 93.2%, and the interacting tube pairs are preserved in the synopsis video by 78.6% to 100%. Nowadays, video surveillance cameras are used as a crucial device everywhere, inside and outside buildings, to monitor people and prevent law-breaking, violence, kidnapping, etc. However, these cameras produce massive videos with an extensive duration. Thus, searching for a certain activity within these videos involves browsing the entire video content from the beginning to the required activity, which is considered an exhausted and time-consuming operation. Different solutions are proposed to tackle this challenge by summarizing these videos as video fast-forwarding , video aRecently, the research community presented a new smart technology that can create a condensed representation from the original video without losing significant activities from its content. This smart technology is called video synopsis. This technology improves the functionality of the surveillance videos because it helps the final user lessen the browsing hours of the captured video to minutes or seconds. Moreover, video synopsis affords a video condensation technique that relies on activities rather than those based on frames, so it achieves higher efficiency, as it provides the opportunity for better condensation due to its accurate analysis of video details. The video synopsis is generated by shifting all the objects in time to be presented simultaneously and creating a shorter video with a maximum number of activities, as shown in The video synopsis challenge is to obtain the activities’ best rearrangement to exhibit most of these activities in the shortest time span without collisions of activities. Recently, various video synopsis procedures have been addressed to tackle this challenge. Li et al.  introducHe et al. ,6 defineMoreover, Nie et al.  presenteAdditionally, Ghatak and Rup  evaluateHuang et al.  confirmeSome other studies have addressed the video synopsis from other points of view. Feng et al.  introducOn the other hand, different researchers address grouping similar activities in the video synopsis system based on a matching strategy or user-defined query. Lin et al.  suggesteAhmed et al.  generateAlthough all the aforementioned clustering and user query-based methods solve the issue of creating an unsatisfactory synopsis video for a crowded scene due to the collision, they do not consider specific appearance attributes such as gender, age, carrying something, having a baby buggy, and upper and lower clothing color. These attributes can help the camera monitor find a suspected person using an appearance description or a particular action happening in the scene. Thus, to achieve this goal, an analysis must be accomplished on the recorded video, depending on the user’s requests; a synopsis video will be constructed to attain the requirements. Accordingly, the process involves video analysis to retrieve the user appeal and an optimization stage to build the synopsis efficiently.In this paper, a framework that sustains a smart-condensed video synopsis system relying on prescribed user recommendations is developed. The proposed system utilizes a highly detailed user-defined description for the desired persons, and then arranges them using an intelligent-optimization technique, the whale optimization algorithm , to consThe proposed technique permits the user to stipulate a detailed description of the desired persons in three distinct aspects, precise visual appearance, motion description, and accessing regions of interest in the scene, contrary to the traditional user-query synopsis methods.Several detailed distinct descriptions of a person are employed to design a user-defined query. These descriptions incorporate an elaborated person’s visual appearance, motion style, and motion type, and personal behavior concerning the region of interest.Persons’ tubes are generated and assembled based on the relationships defined by the user’s query. Furthermore, using an intelligent optimization method, the whale optimization algorithm, the provoked tubes are arranged to construct a highly visually intelligible synopsis video preserving false overlapping between the persons, as well as conserving the correlation time order.The contribution of this work can be abstracted as follows:The sections henceforth are arranged as follows: Although video synopsis is an emerging technology in video analysis research, it faces different challenges, such as creating a synopsis video that involves a suspected person having a specific appearance description consistent with user preferences. In the proposed system, the user submits a query that specifies the detailed descriptions of retrieved desired persons. The descriptions enclose appearance features, such as gender, age (5 age ranges), carrying something or not, having a baby buggy or not, upper clothing color (11 colors), and lower clothing color (11 colors). Furthermore, the user can request to retrieve persons based on a moving direction (8 directions). Moreover, users may desire to retrieve persons entering or exiting a specific region of interest or based on their motion speed. As can be noticed in This phase aims to detect and track multiple persons to generate tubes corresponding to each person and extract elaborated features for each person’s tube.The first step in video synopsis is extracting the background for stitching the generated person tubes. The temporal median method is used to extract the background by applying it to a group of 25 neighboring frames, exploiting the fact that the surveillance videos have fixed backgrounds with little change in the illumination. The background estimation step impacts the visual quality of the synopsis video, but it does not affect the effectiveness of its compression.In this step, the Bytetrack algorithm is utilized to build a motion tube for each person (tracklet), which is a group of bounding boxes throughout the video. The Bytetrack algorithm is carried out in three stages: object detection, object localization, and association. The object detection step is responsible for recognizing objects within the frame. The YOLOX model was adopted for conducting this task. Afterward, the Kalman filter is applied to perform object localization to predict the location of each object in the next frame. The BYTE algorithm is then utilized for the association process to decide whether objects in various frames are related to the same identity. BYTE considers all detected boxes, not only the high scored ones. First, it links high score detected boxes with existing tracklets. Nevertheless, due to occlusion, size variation, and motion blurring, some tracklets are unmatched to a high score detected box. Accordingly, these tracklets are matched to the low detected score boxes. This strategy guarantees a higher tracking performance and less identity switching than traditional multi-object tracking algorithms ,32.For each tracked person, different attributes describing their visual appearance, such as age, gender, upper and lower clothing colors, etc., are extracted. In the proposed algorithm, one of the part-based person attribute recognition algorithms, the attribute localization module  (ALM), iRetrieving persons based on their motion in the video is critical in determining who enters various locations regarding the surveillance scope. Furthermore, specifying the motion style affords awareness about the actions taking place in the scene. The proposed system provides some motion information that can assist the individual monitoring the camera to reveal suspected actions. The variations in the location of each person’s bounding boxes are employed to express their movement through three aspects:Motion style: the speed of change of the bounding boxes’ centroids can state if the person is running, walking, or stopping at a specific area for a while.Motion direction: the system can determine the route of each person through the 8 main directions ;Accessing regions: the camera monitoring man can specify some regions of interest in the surveillance scope to recognize the persons who entered and exited from these regions.This phase commences by applying a user-defined query specifying the desired person’s description. The query is constructed by giving the camera monitor a set of options to select the required person’s specifications, such as age, gender, carrying something or not, having a baby buggy or not, lower and upper clothing color, motion style, motion directions, and accessing a region of interest. Then, these attributes from the user query are matched with the extracted attributes for each person tube to select only the matched one. Afterward, the matched persons are segmented and stitched on the estimated background in an optimized order.The visual appearance and motion features extracted from each tube are compared with the user query to determine the matching ones. These person tubes are arranged to preserve their chronological order. The whale optimization algorithm is suggested to organize the appearance order and the person’s starting time depending on a fitness function.(a)Fitness functionLength, Ecollision, Etrue_collision, and Etemporal represent the synopsis length cost, the activity collision cost, the true collision cost, and the temporal consistency cost, respectively. Moreover, Length is responsible for decreasing the synopsis length as much as possible to not go above the longest tube, while Ecollision reduces the object’s collision after mapping the object’s tubes. On top of that, the role of Etrue_collision is to maintain the intersection relation in the original video to be mapped for the synopsis video and Etemporal preserves the chronological order of the object’s tubes in the generated synopsis. The whale optimization algorithm aims to minimize this fitness function for finding each tube’s starting time in the synopsis video that reduces the object’s tube collision, decreases the synopsis length, maintains the intersection relations as much as possible, and preserves chronological order. Additionally, the proposed algorithm attempts to maintain the counterpart relation in which the two tubes appear temporally and spatially near each other most of the time. If their temporal relationship exceeds 75% and their spatial distance does not exceed twice the person’s width, both tubes are coupled together. Eventually, the synopsis video is created by stitching the motion tubes of the persons in the order given by the optimization step.The fitness function guarantees some constraints confrontation, building a synopsis as short as possible, preventing collisions between persons, preserving true collisions and correlation order. Each of these parameters has a weight value that the user can use to fine-tune the degree of importance of each of them. The proposed fitness function is expressed as(b)Whale optimization algorithmThe whale optimization algorithm is a heuristic optimization algorithm that mimics the humpback whale’s hunting behavior. Their foraging attitude is named the feeding method through bubble-net, which is performed by creating distinguishing bubbles that take a circle-shaped or ‘9’-shaped path. The simulation of hunting behavior to chase the prey is undertaken by using a spiral model to imitate the mechanism of bubble-net attacking of humpback whales. The mathematical model for the whale optimization algorithm includes a model for encircling prey, the spiral bubble-net attacking method (exploitation phase), and prey searching (exploration phase).Encircling preyt is the current iteration, and Humpback whales first recognize the prey’s location and then make a circle around it. The whale optimization algorithm assumes that the best current solution is the location of the target prey or close to it. After determining the best search agent, the other search agents will update their positions toward the best search agent. This manner is represented by the following equations:Bubble-net strategy for attacking method (exploitation phase)(a)Shrinking encircling mechanismIn this section, two approaches for designing the mathematical model for the behavior of the bubble-net of the humpback whale are presented:The behavior of the bubble-net attacking method is conducted here by decreasing the value of vector (b)Spiral updating behaviorX, Y) and the location of prey , l is a number taken randomly from the interval , and b is a constant value used to define the logarithmic spiral shape.First, the distance between the location of the whale Humpback whales randomly search for prey according to their locations. Consequently, the random values of vector In the proposed system, the whale optimization technique is used to optimize the fitness function in Equation (1) to find the best location of the person tube that minimizes the synopsis length. First, the prey’s location is represented by a vector, and its length is equal to the number of person tubes matching the query. Then, each element of this vector is initialized by the starting frame to stitch this person’s tube in the synopsis video. At each iteration, the whale optimization algorithm attempts to find the best starting frame for each person tube that minimizes the optimization function.The Poisson technique is used to stitch the tubes into the estimated background. However, a mask is first constructed for each object in the bounding box based on specific morphological procedures to obtain the objects without the surrounding background, making the image appear more natural once the object’s tubes have been stitched. Subsequently, the segmented objects are stitched with the estimated background using seamless cloning based on the Poisson method to stitch these extracted objects with the generated background.This section presents the datasets details, the evaluation metrics and the simulation results of the proposed system on the selected datasets. All the experiments are conducted on an 11th Gen Intel(R) Core (TM) i7-11800H with RAM (32 GB) NVIDIA GeForce RTX 3060 and implemented in Python 3.7 with Cuda toolkit version 11.3.Two datasets were selected to evaluate the proposed system which are Oxford Town Center dataset  and MultThe proposed system is evaluated in two stages. The former evaluates the person retrieval process for a user-defined query to examine whether the retrieval system retrieves all the appropriate persons for a specific query or there are missed persons. The latter evaluates the video synopsis performance after stitching all the retrieved persons according to this user-defined query.The person retrieval process relative to a specific query is assessed using recall, precision, and F1 score. Recall indicates the ratio of correctly retrieved positive objects to all objects in an actual class, precision indicates the ratio of correctly retrieved positive objects to the total retrieved positive objects, and F1 score is a weighted average relation between recall and precision, which can be calculated using the following formulas:i and Tj) in the synopsis; the overlap is calculated as the average of falsely overlapped pixels all over the synopsis. NPI represents how much the original interacting tube pairs are lost or not retained in the synopsis video. The lower NPI value indicates high interaction preservation. TD measures the ratio of tubes that lost their timing order with respect to the other tubes. FR, OR, NPI, and TD can be defined asorig) and order(Tsyn) are the time order of a tube in the original and the synopsis video, respectively.For evaluating the video synopsis performance, it was found that no unified standards are defined to measure the accuracy of the synopsis results. However, the earlier methods utilized some metrics to measure the frame condensation ratio (FR), overlap ratio (OR), non-preserved interactions (NPI), and temporal disorder TD . FR reprAs mentioned previously, the proposed system is evaluated in two steps: one for the retrieval process and the other for the synopsis. However, there are no rigid experiments to test the proposed system, thus different queries are proposed for retrieval and synopsis performance evaluation. Because each tube contains many bounding boxes for the same person, some of these bounding boxes are unclear due to the occlusion of the person during their movement through the video. The lack of clarity of the bounding box, as a consequence of the occlusion, affects attribute recognition and the retrieval process. As a result, the attributes are recognized for a specific number of bounding boxes of the same person distributed on their presence duration for estimating the person’s attributes correctly and reducing the time required to calculate the attributes for all the bounding boxes.The retrieval process assessment is attained by calculating recall, precision, and F1 score, which reflects how relevant the results are to the query. It can be noticed from the table that the precision and F1 score values for six out of eight queries are approximately larger than 90%, which reflects that the retrieval system performs well, even though the quality of the surveillance videos is lower. Meanwhile, the suggested system managed to detect all the specified persons in Query4 and missed 14 persons in Query1, although both Query1 and Query4 are related to the gender of the person. This implies that females are detected correctly, while, in some cases, males are incorrectly detected as females. This can happen because of males covering their heads or having colored hair. This result reflects the low recall value of Query1 over Query4. Moreover, Query2 achieved the lowest precision value (83%) because two persons walking beside a baby buggy are recognized as persons having a baby buggy. Thus, the two persons are considered FP. For Query3, the proposed system retrieves the persons wearing the upper clothing with red color. The retrieval system retrieves 31 out of 32 persons correctly; however, the system fails to identify one person’s upper clothing color, which reduces the recall’s value. Furthermore, for Query5, the proposed system distinguishes all persons exiting from a certain region of interest (ROI1). Therefore, recall precision and F1 results are equal to 1. In Query6, only one person is not recognized truly, and they are counted as FN; accordingly, the recall value is reduced. The proposed technique in Query7 searches for old men, and the search results retrieve 43 out of 46 true, and the system fails to recognize three persons as older men, but rather as middle-aged men, so they are considered FN. Additionally, the proposed system identifies a middle-aged person as an older man; thus, it is counted as FP. Therefore, the values of both recall and precision are decreased. On the other hand, the task of Query8 is to retrieve the persons who do not have a bag. The proposed system retrieves 23 false-negative persons due to them walking beside a person holding a bag or due to occlusion, while the system retrieves 29 false-positive persons due to occlusion and having bags with the same color of clothing or background. For evaluating the video synopsis performance, Most user-defined query video synopsis methods create their queries according to their applications and needs. Furthermore, a performance comparison cannot be made based only on the measurements of each research since there is no common baseline for widely used datasets, and most of the surveillance videos are not publicly available. Therefore, the proposed and conventional methods are evaluated regarding the types of the user-defined queries and how each method considers collisions and relations between objects in generating a synopsis.The other generates the synopsis relative to the object trajectory within a period of interest, attempting to preserve the collision without needing object arrangement . The lasThe proposed technique considers three important aspects: retrieving the objects of interest that the user described in detail, keeping the relations between objects, and building a compact synopsis. As can be noticed, the proposed technique covers the various advantages of the previously addressed methods.Furthermore, Building a synopsis video system congruent to users’ demand has yet not been conducted for a large scale of personalized features’ retrieval. In this paper, a video synopsis based on persons’ appearance and motion description features for user request fulfillment is suggested. YOLOX and Bytetrack are presented for the detection and tracking of persons. Afterward, tubes related to a user request are extracted and grouped according to the demanded features. These tubes are arranged based on the whale optimization algorithm to generate a short synopsis video which has fewer collisions between persons, as well as retains true collisions and preserves correlation order. Concerning the retrieval process evaluation, the results demonstrate that there are less false-positive cases  compared to false-negative cases (missed), which results in high precision values with most queries, thus contributing to the retrieval of as many positive cases as possible, where the precision value ranges from 83% to 100%. On the other hand, false positives and false negatives are affected adversely in some cases due to the similarity in persons’ appearance  or due to occlusion or background similarity. In metrics of synopsis process evaluation, the suggested synopsis system proved its ability in achieving low values of collision and time correlation with all queries. Moreover, it confirms the realization of a high percentage of intersection preservation and time correlation.