To assess the attitudes and responses of parents of pediatric patients towards virtual dental clinics during COVID-19.t-test, one-way ANOVA test, Shapiro–Wilk and histogram.A total of 102 parents of pediatric patients who were scheduled for virtual (video or telephonic) clinic appointments for new patient consultations and follow-up clinics were included in the study. Parents and patients could attend the virtual clinic from a personal computer, tablet, or smartphone. An electronic self-administered questionnaire was sent to the parents through email after consultation (video or telephonic) which consisted of demographic data and a ten-item, five-point Likert-scale assessing: (i) parent satisfaction; (ii) ease of use; (iii) the effectiveness including increasing access to clinical services; (iv) reliability of the teledentistry system and (v) usefulness for patients. Statistical analyses used were Out of 102 parents, 52 attended video clinics and 50 attended the telephonic clinic. The majority of the parents were between 30–39 years of age, and about 73% had no previous experience with either virtual or telephonic consultation. Ninety-four percent of parents were satisfied with vide clinic consultation, and most of them agreed that accessing clinical services through a video clinic was easy to understand, comfortable, and time-saving. The majority of the parents (94%) agreed and strongly agreed that they will use video clinics again in the future for consultation.Parents’ response to the use of virtual clinics for pediatric dentistry during COVID was positive. The majority of the parents stated that they would consider using teledentistry for future consultation. Dentistry has seen many ups and downs during the past two years since the emergence of coronavirus disease (COVID) . Direct The present study protocol was approved by the institutional ethical committee at Majmaah University Saudi Arabia, with the number IRB No: MUREC-NOV-11/Com-2021/11-2. Written informed consent was obtained from each participant prior to their inclusion in the study.Parents of pediatric patients attending the virtual and telephonic dental clinic were selected from the patient list in the dental clinics using a simple random sampling method from the dental clinic system of Riyadh. The sample size was calculated using. Parents of patients attended the pediatric dental department, College of dentistry at Majmaah University, Saudi Arabia, during the pandemic situation, they agreed to participate in a virtual pediatric dental clinic consultation (video clinic or telephonic clinic) and gave their written informed consent to participate in the post-consultation online survey included in the study. Parents of either gender who agreed to attend a virtual pediatric dental clinic (video clinic or telephonic clinic) and gave their written informed consent to participate in the post-consultation online survey were included in the study, while those who were unable to give informed consent or who disagree to participate in the post-consultation survey were excluded from the study.Data was obtained from parents of pediatric patients who were scheduled for virtual (video or telephonic) clinic appointments for new patient consultations and follow-ups over four clinics. Parents were free to choose among the two types of virtual clinics. Patients and parents were allowed to attend the virtual clinic from either their personal computer, tablet, or smartphone. A total of 102 parents participated in the post-consultation survey. An electronic self-structure questionnaire was sent to the parents through email after a virtual consultation. The questionnaire was designed to collect demographic data including age, gender, occupation, and previous telehealth experience. The later part of the questionnaire consisted of a ten-item, five-point Likert-scale questionnaire assessing: (i) patient satisfaction; (ii) ease of use; (iii) the effectiveness including increasing access to clinical services; (iv) reliability of the teledentistry system, and (v) usefulness for patients. The commencement of the study and data collection happened at the end of the year 2021. The video and telephonic clinics were conducted during the month of November 2021. The same person was involved in the consultation for both the clinics and also in data collection. The time commitment for each patient was 15–20 min.t-test was used to compare the average total score between gender by the telephonic clinic and virtual clinic separately. The stacked bar charts were displayed to show the telephone and virtual clinic survey results. All analyses were done using Statistical Package for Social Sciences (SPSS) software Version 21.0 .The number and percentage were reported for the age category, gender, occupation, and previous experience with telehealth overall and clinic-wise. The bar chart displayed the previous experience with telehealth overall and clinic-wise. A one-way ANOVA test was used to compare the average total score between age groups and occupations in the telephonic clinic and virtual clinic separately. The All the parents responded positively to the post-consultation online survey without any complaints regarding their understanding of the questionnaire. Out of 102 parents, 52 parents opted for video clinics while 50 chose telephonic clinics for consultation. In the present study, 63.7% of the parents were female while 36.3% were male and the age range of parents was <19–60 years, with the maximum number (41.2%) of parents between 30–39 years. Out of 50 (49%) employed parents, 23 attended video clinics while 27 chose telephonic clinics. However, out of the 17 (16.7%) parents who were students, 14 opted for video clinics and three attended telephonic clinics . Approxip > 0.05) and video clinics (p > 0.05). Among the age groups, the parents belonging to the <19 years group reported minimal mean scores (13.2 ± 7.15), while parents of the 50–59 years age group achieved high mean scores (19 ± 3.56) for telephonic clinics. The males observed with higher mean scores for telephonic clinics than video clinics (P > 0.05). The females observed higher mean scores for telephonic clinics than video clinics (p < 0.05). In the case of telephonic and video clinics, males had lower mean scores than females (p > 0.05). Among the age groups, the parents who were students achieved high mean scores (22.67 ± 3.05), while parents of the employee group achieved low mean scores (16.63 ± 4.01) for telephonic clinics. Within the age groups, the parents of 30–39 years had higher mean scores for telephonic clinics than the video clinic, which was statistically significant (p < 0.001). The parents who students and employees had high scores for telephonic clinics(22.67 ± 3.05 and 16.63 ± 4.01) compared to video clinics(10.14 ± 0.53 and 11.30 ± 3.65) with statistically significant (p < 0.001).None of the comparison of overall means scores for various age groups, gender, and occupation that participated in the study  was founAlmost 87.3% of parents stated that they would consider video clinics for future consultations amid the coronavirus situation. About 94% of parents were satisfied and happy with video clinic consultations since they saved their time . Most ofThe dental practice has been primarily affected by coronavirus disease worldwide. Since dentistry involves direct face-to-face contact with the patient and many dental procedures involve aerosol production, the dental practice was put to a halt, except for emergency services, for a certain period during the initial phase of coronavirus spread in an attempt to prevent community viral transmission . This waA study from Saudi Arabia assessed mothers’ knowledge of COVID 19 and evaluated their attitude and fear regarding dental visits during pandemics . They obA similar survey study was undertaken by Within the limitations, the present study reveals the positive response of the parents of pediatric patients after using virtual pediatric dental clinics and their willingness to utilize teledentistry for future consultations amid COVID-19. Teledentistry has been accepted by patients and their parents in means of video and telephonic clinics due to its easy accessibility, comfort, risk-free and time-saving nature.10.7717/peerj.15289/supp-1Supplemental Information 1Click here for additional data file.10.7717/peerj.15289/supp-2Supplemental Information 2Click here for additional data file.10.7717/peerj.15289/supp-3Supplemental Information 3Click here for additional data file.


Video calling is one of the most energy-intensive features in apps requiring the simultaneous operation of the mobile camera, display screen, audio speaker, and internet services. This feature impacts a smartphone battery's runtime and lifetime. This paper is the first of its kind experimental study, which quantifies the operating profile  of video call feature in multiple widely used social media apps, which include WhatsApp, Facebook Messenger, Zoom, Skype, WeChat, Google Hangouts, Imo and Viber. One smartphone each of Vivo and Motorola has been evaluated as the manufacturer-provided application programming interface (API) allowed real-time measurement of the operating profile. Results indicate that the video calling feature for Facebook Messenger and Imo is the most energy efficient. In contrast, Google Hangouts is up to 35% more energy-intensive for video calling than other apps. Measurements also show that Vivo's in-service battery temperature is lower than Motorola due to its efficient chipset. For instance, during active Google Hangouts operation for 1 h, Vivo temperature is limited to 46 °C, whereas Motorola temperature rises to 52 °C. Finally, the influence of app algorithms and codecs on energy efficiency is also discussed with regard to operating performance. As a result, video calling and video chat apps have seen a significant rise in the market3. A record 62 million downloads of video calling apps were reported in March 20204. Zoom led the way as its meeting attendees increased from 10 million in December 2019 to 300 million in April 20205. With this client boost, the company's quarterly revenue in 2023 increased more than 1.07 billion dollars, which is 600% greater than the revenue in 20196.The requirements for video call applications (apps) on smartphones have increased for meetings and lectures in both educational and industrial sectors8. Further, the reduced runtime will likely result in larger cyclic requirements impacting the requirements for sizing batteries and determining battery warranties9. Additionally, energy-intensive apps can accelerate battery capacity fade by consuming discharge currents greater than 0.6C and causing elevated operating temperatures above 60 °C10. This can lead to degraded smartphone performance and even catastrophic failures11.With increased video call operations, smartphone performance requirements have also increased. As the video call feature uses the camera, speaker, microphone, and WiFi (or mobile internet), the video calling app significantly reduces the runtime of the smartphone battery13. To settle the “Batterygate” case in 2020, Apple agreed to pay $113 million to customers affected by the underperforming iPhone models13. Similarly, the Italian Authority for Market and Competition fined Samsung $5.7 million in 201814. In the most recent lawsuit (July 2021), the Spanish Consumer Protection Organization accused Apple of slowing down iPhone smartphones15.Many performance degradations, unexpected shutdown and even battery explosion cases have been reported in recent years. For instance, Apple admitted that it did slow down certain iPhones, but stated that it did so to extend the phones' life. Apple mentioned that when the lithium-ion batteries (LIBs) in the devices aged, they could not meet peak current needs. Consequently, an iPhone may shut down abruptly to safeguard its electrical components16. According to reports, various Samsung18 and Xiaomi19 models also exploded in the same year. Smartphone manufacturers typically recommend an operating temperature of no more than 45 °C20, whereas certain video calling and gaming applications can raise the smartphone temperature to 60 °C7. Due to energy-intensive features such as video calling and gaming, the chipset may become overloaded, resulting in increased current consumption and a subsequent rise in temperature above 50–60 °C10. This increase in temperature, combined with an increase in battery degradation, can lead to catastrophic failures, such as battery explosions22. Therefore, to evaluate the resource efficiency and operation of various features of an app, it is essential to obtain the application's discharge profile  during its operation on in-service smartphones23.Along with degraded performance, numerous customers have reported battery explosions in normal conditions. In 2021, a man sued Apple for second-degree leg burns caused by an exploding iPhone24 compare the energy usage of Google Meet and Zoom using the software-based measurement tool Batterystats without hardware confirmations. In addition, the results provide the average energy consumption of two apps but do not provide information on the actual discharge current or temperature rise during operation. Trestian et al.25 evaluated Android video stream power consumption at a range of playback quality settings, video codecs in different scenarios. The results demonstrate that energy consumption is determined by signal quality and network load, followed by codec and playback quality. However, the results are obtained from the average energy consumption value and do not give information on the actual discharge profile of video calling apps. Anwar et al.26 also present a study that evaluates the influence of code structure on the energy consumption of Android apps. They demonstrated that by optimising the code's structure, energy consumption may be reduced by up to 10.8%. Kang et al.7 also presented a study that evaluated the thermal performance of smartphones during the operation of various apps/features such as Google Hangouts, Skype, video recording, Player Unknown's Battlegrounds (PUBG), and others. However, the study did not establish a correlation between the current drawn and the smartphone's battery life. Similarly, Zhang et al.27 conducted a thermal analysis for virtual and augmented reality apps without considering the runtime or battery health.Some studies have evaluated the in-service functionalities of smartphones. For instance, Wattenbach et al.10 showed a thermal analysis of smartphones on fixed C-rates from 0.4C to 1C with a maximum temperature of 98.56 °C, much higher than the recommended temperature limit of 65 °C for LIBs. Nascimento et al.28 also presented controlled environment research in which they monitored external temperature changes in a smartphone battery during testing under different environmental conditions  at constant charge and different discharge rates . According to the cycling tests, when the battery is exposed to a cold environment, the battery performed the same charge/discharge cycles in 35% less time compared to dry and temperate environments. Further, Kwak et al.29 and Sun et al.30 compare and optimize the capacity degradation for three smartphone battery chemistries at different C-rates. While the aforementioned studies are useful, they do not emulate in-service operations.Existing research on in-service smartphone operation is limited, with many papers presenting analysis on controlled charge/discharge of smartphone batteries, which does not readily capture or emulate the field conditions with actual app usage for consumers. For instance, Kim et al.7. This paper, therefore, evaluates the performance of smartphones during in-service operation by directly measuring the current discharge profile, terminal voltage, and battery temperature profile using internal sensors. The suggested approach leverages the manufacturers’ built-in mobile sensor data using an application program interface (API). This work does not incorporate indirect estimation or parameter averaging, and our earlier work presents the developed API and algorithm11. This paper analyzes how eight major video-calling apps  consume energy and impact a smartphone's runtime performance. The discharge profile affects the battery's life directly through the C-rate effect or indirectly through the combined temperature and current spike effect31.While most papers conduct tests on smartphones and their batteries in a controlled setting or at a constant C-rate, limited in-service smartphone analysis is presented in the literature primarily focusing on thermal analysis. To the best of the authors' knowledge, no feature-specific assessment of video calling apps exists, even though video calling is one of the most energy and thermally inefficient features11. While there are ways to probe smartphones for in-service data externally, these methods add uncertainties and measurement errors, reducing the overall accuracy33. Therefore, the presented scheme in this work is the most accurate measurement for discharge profiles using only the smartphone's inherent sensors for data acquisition. In addition, this paper addresses a significant research gap in the field of smartphone battery characterization, where the lack of user-accessible data and reliable measurement methods for battery discharge profiles has hindered progress in the development of battery degradation models for smartphones and has limited the ability to optimize battery performance under different lifecycle conditions. The data obtained from this study is highly reliable  and can be used to develop accurate battery degradation models that can aid in the optimization of battery performance for different smartphone models and lifecycle conditions. Furthermore, the results presented in this paper are also connected to the energy efficiency of video and audio codecs of video calling apps. Thus, this study provides valuable insights for researchers and developers in this field, enabling them to improve the energy efficiency of video and audio codecs and enhance the overall performance of video calling apps.This paper presents the experimental data  of eight major video-calling apps for two smartphones (Vivo and Motorola), as the two manufacturers only provide the requisite APIs for limited models for in-service operation. Our earlier research on seven smartphone manufacturers—including Samsung, Google, Huawei, Oppo, Vivo, Motorola, and Xiaomi—discovered that all other major manufacturers do not provide user access to this dataThe rest of this paper is arranged as follows. "11 to monitor the battery's current, voltage, and temperature. The data is subsequently saved in the smartphone's internal memory.The availability of in-service battery data, such as current, voltage, and temperature, depends on manufacturer-supplied software interfaces and the functionality of a smartphone’s built-in sensor hardware. As the sensors are in-built, in this work, we utilize an Android Package Kit (APK) using the manufacturer-provided API11. Table Resolution of the parameters and sampling frequency of the API update period is critical for correctly gauging parameter fluctuations. Our research found that almost all major manufacturers do not provide information at high granularity to analyze the detailed discharge profile of apps. The Vivo (V9) and Motorola (Droid Turbo) have been chosen for this analysis as they allow the suitable resolution of discharge current and the quickest update timeThis study employed smartphones in an excellent operational state to conduct targeted assessments exclusively for experimental purposes rather than general usage. The battery capacities of these smartphones were examined by subjecting them to three complete discharge cycles, from 100 to 0%, at a temperature of 25 °C. The outcomes revealed that both smartphone batteries exhibited an approximate discharge capacity of 98% compared to their initial nameplate capacities at the time of conducting the experiments. These findings imply that both smartphones met acceptable benchmarks, indicating that the batteries had not experienced significant capacity deterioration due to calendar or cyclic aging. Based on these results, smartphones are considered suitable for video call experiments, which require consistent battery performance over an extended period.34 and Panasonic35, conduct their battery capacity evaluations at a temperature of 25 °C. Therefore, the experiments' environmental temperature of 26 ± 0.5 °C is appropriate.To evaluate the discharge profile, the Vivo (V9) and Motorola (Droid Turbo) phones were initially charged to their maximum battery capacity (100%) to ensure consistent terminal potential across all experiments. Following this, each video calling app was operated for 60 min and then charged back to full capacity. Consequently, the phone was discharged with the second test app, and so on. During this time, only the video call function of the particular app was in play with experimental conditions held constant to mitigate any heterogeneity between apps. During each experiment, there was an approximate 10–15 min rest period between charging and discharging. All apps were evaluated via WiFi connectivity, and the internal speaker sound volume and screen brightness were maintained at maximum levels with an ambient temperature of 26 ± 0.5 °C. It is noteworthy that renowned manufacturers of lithium-ion batteries, such as SamsungIn addition to the discharge profile, which includes current, terminal voltage, and temperature, the spread of current drainage provides valuable insights into the performance of video calling apps. To evaluate this spread, the probability density function (PDF) and the normal distribution function (NDF) were used. The PDF describes the probability distribution of all current levels generated by multiple video calling apps. The NDF is derived from the PDF and represents a normal distribution of the current levels. The peak value in the NDF represents the mean value of the current levels, while the standard deviation of the NDF represents the variability in the current levels. By recreating the current profile using these functions, it is possible to assess the smartphone's performance under various usage scenarios and identify potential areas for improvement. The PDF and NDF functions can be used to recreate the equivalent current profile of smartphones during video calling sessions. By applying the recreated current profile, it is possible to test the battery's degradation under varying environmental conditions, such as temperature, and identify any potential performance limitations. PDF and NDF can also be used to develop degradation models that predict the expected battery performance and estimate the battery's remaining lifespan. These models can be beneficial in optimizing battery life and improving overall smartphone performance.36, while the Vivo V9 has a resolution of 400 PPI37. Higher resolution corresponds to increased pixel density and consequently greater power consumption. Additionally, the Vivo V9 (14 nm technology37) utilizes a more energy-efficient processor than the Motorola Droid Turbo (28 nm technology36). Furthermore, other aspects, such as heat dissipation design, influence smartphone performance. Table 37. However, it's inappropriate to compare the overall energy efficiency of the apps between both phones due to differences in hardware.In addition to app usage, battery drainage also depends on smartphone technologies such as screen type, resolution, and processor technology. For example, the Motorola Droid Turbo features a resolution of 565 PPIThe section examines the discharge characteristics of eight video calling applications as observed on the Vivo V9 and Motorola Droid Turbo smartphones. It also explores and categorizes the energy efficiency of these apps based on their algorithmic functionalities. Finally, it discusses each app according to its runtime performance on both devices.11 where, for most manufacturers, the updating time of the voltage sensor is large  relative to the current sensor (milliseconds). Each experiment had an approximate 15-min rest period between charging and discharging. At the start of each experiment, the battery surface temperature ranged from 30 to 35 °C, influenced by factors like chipset heat generation and could not be precisely controlled in a real-world scenario. Further, manufacturers such as Samsung demonstrated that the battery's nominal capacity remains consistent between temperatures of 25 °C and 35 °C45.Figures A higher starting current spike causes an initial voltage drop for some apps. For instance, in the cases of Google Hangout, the current is high at the start (> 2800 mA), then gradually drops to a lower value of around 1200 mA. As a result, the voltage profile has an initial voltage drop to 3.6 V followed by an increase to 3.9 V as the current decreases. Furthermore, the temperature rises steadily throughout the video call operation for both smartphones and becomes largely flat after 15–20 min of operation. For the Vivo V9, Google Hangouts, Imo, and Viber display the maximum temperature increase of 46 °C, 48 °C, and 49 °C, respectively. For Motorola, Google Hangouts accounts for the maximum rise in temperature of 52 °C, and Facebook Messenger accounts for the lowest temperature, remaining under 40 °C. Lower operational temperature is highly beneficial as it reduces the aging rate of the battery. The experimental readings of current, voltage, and temperature are provided in the supplementary file for both phones.46. To facilitate further analysis, the PDF and NDF are also presented in Figs. Relying only on the mean current discharge is insufficient for categorizing these apps. Current spike information is often essential as spikes cause an increase in temperature (joule loss) and accelerated battery deteriorationThe mean current alone is not sufficient for the lifetime assessment of smartphone batteries. For instance, the average current requirement for Zoom is 857 mA Table  compared45, LG47 and Sony48) recommend discharging the battery at up to 0.3C. In addition, numerous studies on various battery chemistries reveal a considerable capacity degradation above 0.3C50. Further, many studies also establish that C-rate operation over 0.3C results in battery temperature above 50 °C52, accelerating other reliability concerns such as solder joint failures54, thermal crack56 and electro-migration57. Therefore, a safe limit for LIB operation is set at 0.3C. So, to analyze the power usage for all eight apps, the probability of current spikes occurring above 0.3C is also shown in Tables 58.For optimum performance, smartphone manufacturers  for these eight different apps, as shown in Fig. The paper evaluated the video calling functionality of two smartphones during in-service operation and, for the first time, quantified and reported the drainage profile of eight commonly used apps  by comparing discharge profiles . The two smartphone manufacturers (Vivo and Motorola) were selected for this study because they provide the requisite APIs for discharge profiles required for high granularity data shown in this work. The results of this study can be used to test battery degradation under different environmental conditions, identify performance limitations, and build a degradation model to predict battery lifespan and performance.The discharge profile depends on the app requirements as well as the smartphone technology . For video calls on the Motorola smartphone, Google Hangouts was the most energy and temperature intensive, with a mean discharge current of 1330 mA (0.34C) and an end temperature of 52 °C for 1 h of operation. This was followed by Skype (1185 mA), Zoom (1087 mA), Viber (1037 mA), WeChat (936 mA), WhatsApp (934 mA), Imo (917 mA) and Facebook Messenger (814 mA). Along with mean current, information about current spikes is required to evaluate the impact of the discharge profile on battery life. For Google Hangouts and Skype, the probability of current spikes above 0.3C was more than 50%, significantly higher than all other apps. In the case of the Vivo smartphone, Google Hangouts was still the most energy-intensive app.The results also indicate that the apps' audio and video codecs considerably impact energy usage during the operation. Regardless of the video or audio quality, apps using the VP9 video codec and G.711/G.722 audio use 35% more energy than apps utilizing the H.264 video codec and Opus audio codec. It also indicates that battery runtime numbers are significantly lower than the manufacturer-suggested phone runtime. For instance, for Motorola, the runtime of up to 48 h is misleading for many consumers; the actual runtime ranged from 2.9 to 5 h. Therefore, manufacturers should provide a time window (minimum to maximum) to give consumers more practical information on actual battery runtime.Overall, results demonstrate that Google Hangouts is the most energy-intensive app for video calling for the two smartphones under test. On the other hand, the most energy-efficient apps for video calls are Facebook Messenger and Imo. The diversity in video and audio codecs across apps is the primary cause of the disparity in energy consumption.The two smartphone manufacturers (Vivo and Motorola) were selected for this study because they provide the requisite APIs for discharge profiles required for high granularity data showed in this work. Other manufacturers, including Apple, Samsung, Google, Huawei, Oppo, Vivo, Motorola, and Xiaomi do not provide this data. We believe the manufacturers should be forthcoming in providing this data for third-party assessments leading to suitable suggestions for lifetime enhancements.Supplementary Information 1.Supplementary Information 2.Supplementary Information 3.Supplementary Information 4.Supplementary Information 5.Supplementary Information 6.Supplementary Information 7.Supplementary Information 8.Supplementary Information 9.Supplementary Information 10.Supplementary Information 11.Supplementary Information 12.Supplementary Information 13.Supplementary Information 14.Supplementary Information 15.Supplementary Information 16.


Despite the attempt by the Japanese government to reduce alcohol consumption, reduction of alcohol consumption requires improvement. We explore this issue from the impulsivity perspective and investigate whether a causal relationship exists between impulsivity and drinking behavior. We used data from the Preference Parameter Study of Osaka University to capture respondents’ drinking status. Our probit regression showed that procrastination, a proxy measure of impulsivity, was significantly associated with drinking behavior, while hyperbolic discounting, a direct measure of impulsivity, was insignificant. Our findings suggest that impulsive people will discount their health in the future; thus, the government should consider impulsivity in policymaking. For example, awareness programs should focus more on future healthcare costs from alcohol-related problems so that impulsive drinkers can understand how much they may need to spend in the future compared to current satisfaction with alcohol drinking. Alcohol consumption has been an important public issue in Japan for several decades . Heavy dTo solve this important public issue, investigating people’s psychology of drinking could be rewarding. There is empirical evidence that suggests that people’s drinking status depends on their impulsivity or strong present-bias, which makes people myopic about future rewards ,10,11,12N = 6181).We utilized data from the Preference Parameters Study (PPS) conducted by the Institute of Social and Economic Research at Osaka University. The PPS is a panel survey that has collected information on socioeconomic characteristics and preferences from a representative sample of the Japanese population since 2003. Our study utilized the 2009 wave due to the availability of data on the respondents’ drinking behavior and time discount rates—our main variables. After excluding the missing data for demographic and socioeconomic characteristics, our sample included 2992 individuals—approximately 48% of the 2009 dataset’s respondents  or its equivalent a day, every day; 5 = drink 3 cans of beer (36 oz) or its equivalent per day, every day; and 6 = drink 5 cans of beer (60 oz) or its equivalent a day, every day). Following Putthinun et al. [Regarding the independent variables, we calculated the respondents’ time discount rates from the responses to the five questions presented in −9. Moreover, the mean standardized discount rate of the respondents for the current period (DR1) is 65.79% when that of after three months (DR2) is 64.25%. There are no significant differences between DR1 and DR2 for the overall sample. Thus, hyperbolic discounting is not identified as an overall trend within the sample. However, the sign effect shows differences in that DR4 is generally higher than DR5 in the sample.Many of the previous studies have suggested that time preference, such as time discount rate, hyperbolic discounting, and sign effects, impacts health risk behavior ,16,17. TA if received immediately (t = 0) is valued as t periods are delayed in the future. Thus, the present time value (V) of receiving (A) at time (t) is given as:The knowledge of economics assumes that rational people discount the value of things exponentially with delays . Technicy period .k is a parameter that indicates the rate at which the value is discounted.However, the psychology field proposes that people have a propensity for hyperbolic discounting . This meIP is the degree of the respondent’s impatience, based on the standardized time discount rate. HD and SE indicate the hyperbolic discounting and sign effect variables, respectively. X is a vector of individual characteristics, and ε is the error term. Our full estimated equation is as follows:Since our dependent variables were binary variables, we employed probit regression. We estimated the following equation:Regarding the respondents’ demographic and socioeconomic characteristics, being male, married, and divorced have positive and significant associations with alcohol consumption at the 1% and 5% significance levels, respectively, while being unemployed has a negative association. The results further show that age has a positive association with drinking behavior, whereas age squared has a negative association with drinking behavior. This implies that age has a nonlinear relationship with drinking behavior. Regarding the health risk behaviors, smokers are more likely to be daily drinkers, whereas frequent gamblers show no significant relationship.Further, drinking behavior shows a significant difference in some demographic characteristics, such as age and sex. Therefore, we conducted a subsample regression of the model, classified by sex and some age groups, to clarify the relationship between impulsivity and drinking behavior in more detail. Finally, we checked the robustness of results by measuring some variables differently. For example, rather than using a five-point scale, we used procrastination as a binary variable where 1 represents the answer “got it done at the last minute” to the question “Thinking about when you were a child and you were given an assignment in school, when did you usually do the assignment?” We also used the high school graduate variable as an alternative to a university degree. However, our results remain largely the same. We have not shown the results in the manuscript to save space, but they are available upon request.Alcohol consumption has been an important public issue in Japan for several decades . We inveOur probit regression results showed that hyperbolic discounting had an insignificant relationship with drinking behavior; this is inconsistent with the extant literature—Vuchinich and Simpson , Field eFurther, we revealed that the sign effect was positively and significantly associated with drinking behavior in the full sample and female subsample. We believe that those showing the sign effect are unlikely to discount the loss of networking during drinking opportunities as much, and may value this more than the gain of maintaining health. Caluzzi et al.  claim thRegarding the respondents’ demographic and socioeconomic characteristics, we found that being male, older (until reaching middle age), married, divorced, having children, and employment status were significantly associated with drinking behavior. Regarding the male, divorced, and employment status variables, the results were consistent with the extant literature that has reported that males consume more alcohol than females ,27,28,29Regarding the health risk behavior and psychological characteristics, smokers tended to significantly consume alcohol; this is consistent with the results of the previous studies ,35.Our study had some limitations. First, we utilized hyperbolic discounting and procrastination as the direct and proxy measures of impulsivity, respectively. Although both measurements have been utilized in the extant literature, such as Kang and Ikeda  and IkedWe examined the causal relationship between impulsivity and alcohol consumption behavior among the Japanese population. Our probit regression results showed that procrastination, a proxy for impulsivity, was associated with drinking behavior. However, hyperbolic discounting, a direct measure of impulsivity, was not associated with drinking behavior. Further, we found that demographic, socioeconomic, health risk behavior, and psychological characteristics were associated with drinking behavior. We suggest that sociocultural and socioeconomic characteristics may mitigate the effect of impulsivity on drinking behavior.N = 2993) that include a wide range of demographic and socioeconomic characteristics. Second, our study is the first attempt to examine the relationship between impulsivity and drinking behavior by controlling for the sign effect. Our results may assist policymakers by providing a preliminary idea on how impulsivity is associated with alcohol-drinking behavior, which they can utilize in designing policies to control alcohol consumption in Japan, particularly among specific socioeconomic groups.We believe that our results make the following contributions to the literature. First, our study is the first to address sampling bias and sample selection bias by utilizing large-scale data (


Escherichia coli (DEC) is one of the most common etiological agents of moderate-to-severe diarrhea in Low- and Middle-Income Countries (LMICs). Therefore, determining the source(s) of DEC in index cases and exposure environment is important for developing a prevention strategy. The current study aims to investigate the prevalence of DEC among children under 5 years and their exposure environment in Ogun State, Nigeria. Methods: Samples from 228 diarrheic children and their exposure environment were collected and screened for E. coli. Bio-chemically compatible distinct colonies were molecularly characterized using a 7-virulence-gene multiplex PCR with virulence factors (VFs) indicative of four pathotypes of E. coli: enterotoxigenic (ETEC), verotoxigenic (VTEC), enteropathogenic (EPEC), and enteroinvasive (EIEC). Representative pathotypes were subjected to antimicrobial susceptibility and over-expressed efflux pump assays. Results: One or more VFs typical of specific pathotypes were detected in 25.9% (59/228) diarrhea cases consisting of ETEC (21.5%) and EPEC (0.4%), while hetero-pathogenic pathotypes were found in 4.0% of cases. Of the food sources, 27.9% (101/362) were positive for DEC, of which ETEC accounted for 21.0%, VTEC 1.9%, EPEC 0.6%, EIEC 0.6%, and hetero-pathogenic pathotypes were 3.9%. Furthermore, ETEC was the only pathotype detected in the wastewater (4/183). Interestingly, the consumption of street-vended foods was the most significant (p = 0.04) risk factor for DEC infection in the study area. A total of 73.3% of selected DEC pathotypes showed resistance to antimicrobials, while 27.5% demonstrated over-expression of efflux pump activity. Conclusion: The high prevalence of ETEC across all sources and the occurrence of hetero-pathogenic DEC in diarrheic children and food sources emphasizes the importance of establishing a better strategy for the control and prevention of diarrhea among children in low- and medium-income households.Background: Diarrheagenic  Diarrhea is one of the leading causes of death in children under 5 years, accounting for an annual 1.7 billion global cases with an estimated mortality of 1.3 million deaths, with approximately 25% of this observed mortality occurring in Low- and Middle-Income Countries (LMICs) ,5. DiffeEscherichia coli (DEC) is one of the most common etiological agents of moderate-to-severe diarrhea in LMICs [E. coli (STEC), enterohemorrhagic E. coli (EHEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), enteroaggregative E. coli (EAEC), diffusely adhering E. coli (DAEC), adherent-invasive E. coli (AIEC), and cell-detaching E. coli (CDEC) [E. coli [E. coli pathotypes and associated risk factors that predispose children under 5 years with diarrhea to DEC infection in South-West Nigeria.Diarrheagenic in LMICs . Variousin LMICs . The DECi (CDEC) ,9. The Ei (CDEC) ,11,12. H[E. coli . Previou[E. coli ,15,16. A[E. coli ,18,19,20[E. coli ,21. HoweChildren of both sexes under the age of 5 years presenting with diarrhea and without any prolonged illnesses were enrolled for this research. Children with diarrhea, prolonged illnesses (even when under five years old), and older than 5 years were excluded from this study.This study was a cross-sectional hospital-based study conducted between July 2020 and February 2022 at the paediatric wards of six hospitals: Sacred Heart Hospital (7°10′00.2″ N 3°21′20.2″ E), Mowe Primary Healthcare Centre (PHC) (6°48′28.7″ N 3°26′07.9″ E), Ibafo Health Clinic (6°44′38.2″ N 3°25′16.7″ E), Ofada PHC (6°51′54.7″ N 3°25′39.4″ E), Mokoloki PHC (6°52′55.8″ N 3°22′04.8″ E), and Federal Medical Centre (7°08′44.7″ N 3°22′41.4″ E). These hospitals are known to receive high number of paediatric patients across the state. In addition, the demography for this research was noted for low-middle-income earners and high population density. Diarrheal outpatient children ≤ 5 years of age attending these hospitals and whose parents consented to participation in the research were enrolled.Diarrheal stool samples were collected with the help of trained nursing staff. Briefly, samples were collected by allowing the diarrheal child to pass stool on a nylon wrap placed over the rim of a plastic potty or in a disposable diaper. Then, a sterile plastic spoon was used to transfer the stool to a clean, sterile universal bottle prefilled with Cary Blair transport medium . Sample collection was carefully performed to avoid contamination with urine, soil, or water. In addition, samples from food sources  were fed to the child, and wastewater samples from the households of the diarrheic child were also collected in a clean, leak-proof container. Fruits and vegetables that could not be obtained from the households were bought from markets in proximity to the index cases. All samples were labelled, packed, sealed, and sent to the laboratory within 24 h for analyses. Interviewer-administered questionnaires were used to obtain information about clinical manifestations and sociodemographic characteristics, including gender, age, occupation (of the mother), and sanitary wares of the diarrheic child from the parent(s). The data obtained were used to explore risk factors for DEC-associated diarrhea in children within the study population.E. coli colony was performed by plating the samples onto sorbitol MacConkey agar  and incubating for 24–48 h at 37 ± 1 °C. Determination of E. coli isolates was carried out using the following biochemical tests: carbohydrates fermentation, gas production, hydrogen sulphide production, citrate utilization, urease production, indole, and motility. Isolates positive for lactose–glucose and gas production, non-hydrogen sulphide-producing, negative citrate and urease, positive indole, and motility were ascribed as E. coli. The E. coli strain ATCC25922 was used as a positive control. After identification, pure E. coli isolates were stored in brain heart infusion broth  with 20% glycerol and stored at −80 °C before the molecular analyses the next day.Standard culture methods were performed on all samples immediately after reception in the laboratory. The isolation of a single E. coli colony was extracted following a method previously described by Choo et al. [E. coli isolate-BHI culture broth was aliquoted into 2 mL snap vials, centrifuged at 5000× g for 3 min, the supernatant discarded, and the cell pellet resuspended in 1 mL sterile distilled water, pulse-vortexed, centrifuged, and the supernatant discarded. The cell pellets were resuspended in 200 µL double-distilled water and heated at 100 °C for 15 min in a dry heat block , after which the vials were immediately cooled on ice for 5 min. Then, they were centrifuged at 8000× g for 7 min, and 100 µL of the supernatant was used as template DNA for subsequent PCR.The DNA of a single o et al.  with sliE. coli virulence genes using specific primer pairs for verotoxin genes (vtx1 and vtx2), intimin gene (eaeA), heat-stable enterotoxin A genes (estA-human and estA-porcine), heat-labile enterotoxin A (eltA), and invasion plasmid antigen H gene (ipaH) were used in detection of DEC pathotypes as previously described by Persson et al. [® Master Mix with 12.5 mM MgCl2, primers mix, and 4 µL DNA template. The amplification condition comprised an initial denaturation at 95 °C for 15 min followed by 35 cycles of denaturation at 95 °C for 50 s, annealing at 57 °C for 40 s, elongation at 72 °C for 50 s, and then final elongation at 72 °C for 3 min. The PCR amplicons were visualized on 1.8% w/v agarose gel electrophoresis stained with ethidium bromide. The E. coli strain ATCC25922 was used as a negative control.Multiplex PCR for n et al.  as shownE. coli (ATCC25922) was included as quality control organisms in antimicrobial susceptibility determination.The DEC isolates were tested for susceptibility to Ciprofloxacin (CPR), Tetracycline (TE), Ceftazidime (CAZ), Cefuroxime (CRX), Gentamicin (GEN), Cefixime (CXM), Ofloxacin (OFL), Augmentin (AUG), Nitrofurantoin (NIT) using Kirby–Bauer disk diffusion technique  on MuellThe DEC isolates resistant to three or more classes of antibiotics were classified as multidrug-resistant (MDR) . MDR-DECp < 0.05.Descriptive statistic was used to describe the results of this research. Univariate analyses were performed to explore the association between social demographic factors, clinical manifestations, exposure sources, and the presence of DEC among children with diarrhea. The analyses were performed using the Chi-square test implemented in IBM SPSS version 20 , and the level of significance was set at A total of 228 diarrheal stool samples from children under 5 years attending or admitted in both private and public health facilities in Ogun State, Nigeria, were screened for DEC on selective agar, in which 1240 presumptive DEC isolates were obtained. In addition, 924 presumptive DEC isolates were obtained from 362 food sources  and 183 wastewater samples from households and markets in proximity to the patients’ households.estA-p (69.1%), estA-h (9.4%), and estA-p/estA-h (8.6%), as shown in eae gene, which signifies EPEC, was found in 5% of the DEC isolates. Various combinations of virulent genes from two or more pathotypes, known as hetero-pathogenic DEC, were found in some of the DEC isolates. The most prevalent of these combinations were estA-p/eae (4.3%), indicative of the ETEC-EPEC heteropathotype, while four virulent genes combination of vtx1/estA-h/estA-p, vtx2/estA-h, vtx1/vtx2/estA-h, and vtx1/vtx2/estA-p representing the ETEC-VTEC hetero-pathotype. The EIEC-ETEC hetero-pathotype with the virulent gene combination of ipaH/estA-h/estA-p was also detected. However, the eltA gene was not detected in any of the isolates. The most prevalent DEC pathotype among the index cases was ETEC (21.05%), while the ETEC-EPEC (2.13%) was the most prevalent DEC hetero-pathotype. Overall, the prevalence of hetero-pathogenic and DEC pathotypes was 25.9, as presented in A total of 139 isolates were confirmed to be DEC by multiplex PCR . The mosestA-h (11.1%), estA-p (6.4%), and estA-p/estA-h (4.7%)  . The leah (4.7%) . Furtherh (4.7%) . Investih (4.7%) . The disp = 0.012) and abdominal pain  compared to diarrheic children with other etiologies. No statistically significant association  was observed between DEC infection in males compared to females. Children with DEC infection were more likely to be exposed to street-vended foods  than children with diarrhea from other causes.The results of univariate risk factor analysis for the occurrence of DEC infection among diarrheic children under the age of five are presented in The antimicrobial susceptibility profiles of the selected DEC isolates are summarized in Diarrhea of bacterial etiology is often self-limiting, requiring no prior identification for patient treatment. However, in cases of prolonged or severe diarrhea (indicative of invasive infection), the identification of etiological agents becomes necessary for effective treatment . The avaE. coli isolated from children under 5 years presented with diarrhea in hospitals situated in Ogun state. Outcomes from this study showed that DEC pathotypes were detectable in approximately 25.9% of the total diarrhea cases. This prevalence is within the prevalence range of DEC pathotypes earlier reported in Nigeria (18.4–73.8%) [The current study revealed the relative prevalence and risk factors of hetero-pathogenic and diarrheagenic ria 18.4–3.8% [7,14–73.8%) ,32,33,344–73.8%) ,37,38,39E. coli is known to harbor the heat-stable enterotoxin A (estA), which is further classified into two subtypes, known as estA-p and estA-h, because they were initially isolated from strains of pigs and human origin, respectively [estA-p and estA-h in the studied population and in fresh produce suggests environmental contamination with the possibility of a vibrant non-human reservoir of infection, which constitutes an exposure source for children in these communities.Most significant and of great concern in the current study is the high prevalence of ETEC pathotype (21.05%), which was higher than previously reported cases (2.4–18.0%) in other regions in Nigeria ,32,33,34ectively . Heat-stectively ,42,43. Ieae (E. coli attachment effacement) gene within the studied population is indicative of EPEC [eae gene encodes an outer membrane protein, intimin, which mediates adherence of these pathotypes to enterocytes, thereby starting the effacement of gastric epithelial–cell microvilli [The presence of the  of EPEC . The eaecrovilli ,45,46. Ecrovilli . The occcrovilli ,32,33,34vtx1 and vtx2 genes occurred as VTEC/ETEC hetero-pathotypes with a prevalence of 1.3%, which was lower than a single VTEC pathotype earlier reported in other studies [estA/vtx1/vtx2 producing hetero-pathogenic VTEC/ETEC pathotype could increase the progression of clinical manifestations such as hemolytic uremic syndrome (HUS), thrombotic thrombocytopenic purpura, and hemorrhagic colitis [E. coli allows for the emergence of new hybrid strains, which could result in severe outbreaks, heightened levels of pathogenesis, and immune evasion [Hetero- or hybrid pathotypes are terms used to describe new combinations of virulence factors among DEC . In 2015 studies ,31,34,49 colitis ,51,52 th colitis ,53,54; h evasion ,59,60,61In the food samples, the wide distribution of various hetero-pathogenic and DEC pathotypes in the fresh produce samples suggests these food types are an important source of DEC infection in the studied population. This is anticipated because fresh produce is often served raw to children as a form of nutritional supplement and undergoes minimal processing. Moreover, fresh produce is often grown with organic manure laden with a high number of microorganisms ,64,65,66Generally, episodes of diarrhea are often accompanied by clinical manifestations such as watery diarrhea, vomiting, fever, loss of appetite as well as abdominal pain . In thisAccessibility, availability, and timeliness of interventions such as supportive therapy, anti-secretory drug therapy, and specific antimicrobial chemotherapy are critical to reducing diarrhea-associated morbidity and mortality, especially in children under 5 years found in rural and resource-limited populations . AdminisDEC infections are often self-limiting, requiring no interventions ,7. ConveE. coli (ETEC) was found to be the predominant pathotype implicated in cases of childhood diarrhea in the studied population. The detection of DEC in fresh farm produce is a clear indication of food safety risk, especially among children. Consumers of farm products should wash them thoroughly with potable water before consumption to reduce the risk of infection with DEC. Continuous surveillance of DEC pathotypes as part of the routine surveillance program is highly recommended. Further studies to increase our understanding of the implication of DEC hetero-pathotypes on disease progression and severity are recommended. Information from studies of this nature will further enrich empirical treatment, especially in locations where such diagnosis cannot be routinely performed. Antibiotic stewardship should be given priority in LMIC to stem down cases of multidrug resistance. Additionally, the persistence of the DEC pathotype in this study calls for the requirement of re-appraisal of current diarrhea prevention programs available in the country. Continuous education on diarrhea prevention and care for every stakeholder involved in pediatric care is, thereby, recommended.Enterotoxigenic


Mycobacterium marinum was identified, first by next-generation sequencing and finally grown on culture, after eight weeks. Acknowledging the complexity of diagnosing and managing infections by non-tuberculous mycobacteria, and especially Mycobacterium marinum, we provide a review of the current epidemiology, clinical characteristics, diagnosis and management of Mycobacterium marinum infection.Skin and soft tissue infections caused by non-tuberculous mycobacteria are occurring more frequently in recent years. However, chronic skin and soft tissue lesions present a challenge for clinicians, as the diagnostic work-up and definitive diagnosis require knowledge and available laboratory resources. We present here the case of a 66-year-old male patient who presented with painful abscess-like nodules on his right hand and forearm, which worsened after treatment with an anti-TNF-a agent. The fluid specimen taken from the lesion was positive for mycobacteria according to the acid-fast stain.  Mycobacterium marinum (M. marinum) is a rare cause of chronic skin and soft tissue lesions. M. marinum is a non-tuberculous, slow-growing, acid-fast bacillus which causes a granulomatous tuberculosis-like illness in fish and other aquatic hosts. M. marinum is acquired from fish bites or contact with contaminated water. Most cases of human M. marinum infections are limited to the skin, although cases involving deep tissue and systemic illness have been described, especially in immunocompromised hosts. Diagnosis is difficult and requires a high index of suspicion, both from the clinician and from the lab. Treatment can be challenging and usually consists of a two or three drug combination.The investigation of chronic skin lesions is always challenging for a clinician, especially if an uncommon infection is suspected or the patient is immunocompromised. In that case, difficulty in reaching a diagnosis is not unusual because of the need for biologic specimen acquisition, the nature and the microbiologic characteristics of the implicating pathogens, and sometimes, the special laboratory equipment needed for an accurate diagnosis. M. marinum infection in a patient who presented with chronic skin and soft tissue lesions and who had received an anti-tumor necrosis factor alpha (anti-TNF-a) drug following a diagnosis of rheumatoid arthritis.We present the case of an A 66-year-old male patient was referred to the Infectious Diseases Outpatient Department for evaluation due to painful nodules on his right hand and forearm. Upon presentation, he had a painful ulcer on the second finger of the right hand, near the metacarpophalangeal joint. The ulcer appeared with raised borders, a dark-red color, and had a base crater with yellowish exudate. He also had several small to moderate size, painful, abscess-like lesions on his forearm, extending up to the elbow . IpsilatHis past medical history was significant for spinal cord surgery (spondylodesis), hernia repair, left rib fractures, and gastroesophageal reflux disease. He denied smoking, and his current working activities were limited to office management in a private business. His present illness began about seven months ago when he was accidentally injured on the fourth finger of his right hand while he was cutting a diseased palm tree. He reported that the wound healed quickly but later developed a painful ipsilateral hand swelling. He received empirically a short course of antibiotics consisting of cefuroxime, clindamycin, and ciprofloxacin, without improvement. Two months after the initial injury, he consulted an orthopedic surgeon due to the persistent swelling of the right hand. The patient was diagnosed with carpal tunnel syndrome, for which he was operated, albeit with no improvement. Then, he consulted a rheumatologist, who diagnosed polyarthritis and prescribed corticosteroids, methotrexate, and leflunomide, again with no improvement. Of note, the patient denied any other local or systemic symptoms, and the laboratory exams were negative for antinuclear antibodies, rheumatoid factor, and anti-cyclic citrullinated peptide.Mycobacterium tuberculosis (M. tuberculosis) was negative. Specific PCR for other mycobacteria was not available at our institution at that time.During the next two months, because of a lack of clinical improvement when on the disease-modifying antirheumatic drugs, the patient received three doses of infliximab. Approximately 10 days after this treatment, he noticed painful nodules on his right arm and forearm, extending up to the elbow. Some of the lesions automatically drained purulent material, and fluid specimens were sent for microbiologic examination. The Gram stain and culture were negative, but the acid-fast stain revealed many mycobacteria-like organisms . The polymerase chain reaction (PCR) for There were no systemic symptoms and the laboratory work-up was only significant for C-reactive protein elevation . A computed tomography scan of the right upper arm was performed to examine the extension of the lesions and revealed no involvement of deep structures or bone.M. marinum infection was therefore high, although the culture remained negative. The antimicrobials were switched to ethambutol and clarithromycin.He was admitted to the hospital and was started on combination antimicrobials for non-tuberculous mycobacteria (NTM) causing skin and soft tissue infections. Initially, he was given imipenem/cilastatin intravenously in combination with clarithromycin orally, and later doxycycline and amikacin were added due to the slow response. While re-examining the patient’s history, he recalled that an artificial pool containing fish was located around the palm tree he was cutting. The suspicion of Mycobacterium marinum/Mycobacterium ulcerans (M. ulcerans) strains. The cultures became positive after eight weeks of incubation (solid medium incubating at 30 °C). The PCR on that specimen revealed the M. ulcerans strain; however, epidemiologically, that strain was the least possible, and because of the extensive genomic similarity between M. marinum and M. ulcerans, the specimen was sent again for a whole-genome sequencing test. The final analysis revealed M. marinum, which was sensitive to all the antimicrobials tested.The initial sample was sent to a reference laboratory for whole-genome sequencing analysis, which revealed the The clinical response was slow, and therefore, rifampicin 600 mg once daily orally was added to his treatment. Over the next few months, the patient had close follow-up, the lesions significantly improved until they disappeared and he had no recurrence. He received triple therapy for approximately three months and then clarithromycin as monotherapy for another two months, for a total duration of treatment of seven months.M. marinum is a non-tuberculous, non-motile, non-spore forming, photochromogen, slow-growing, acid-fast bacillus that is classified in group 1 of the Runyon’s classification system [M. tuberculosis, M. marinum’s growth is inhibited at 37 °C [n system . The patM. marinum infection is uncommon. It was first described as a zoonotic disease in fish back in 1926. The first human infection was reported in 1951. International data concerning the incidence and prevalence of the infection are limited. The estimated annual incidence in the USA is 0.27 cases per 100,000 adult patients [M. marinum is an opportunistic pathogen of fish and many other aquatic species, including mammals and amphibians, which serve as a reservoir, and it causes a granulomatous tuberculosis-like illness in these hosts [M. marinum is acquired from fish bites or contact with contaminated water , especially if the skin barrier is not intact. As a result, the major risk factors are occupational or environmental exposure, contact with fish tanks and aquariums, or injuries from tools and other equipment  involved in these settings [M. marinum infection. “Fish tank granuloma” and “aquarium granuloma” appear the most accurate, since exposure to these sources is a major risk factor for infection [se hosts . M. marisettings ,5. Many nfection . “Swimminfection .M. tuberculosis but from NTM as well, and may reveal or exacerbate a subclinical underlying disease [M. tuberculosis infection is low [In the great majority of the human cases described in the literature, the pathogen causes skin infections, most commonly located in the upper limbs, especially on the hands and arms, spreading in a sporotrichosis-like pattern . Infecti disease . Some aun is low ,8. Multin is low . This isn is low . Most ofn is low ,11.M. marinum infection in humans is primarily limited to the skin [M. marinum spreads through the lymphatic vessels to the regional lymph nodes and advances in a sporotrichoid form [M. marinum results in the development of multiple nodules (>3) mimicking sporotrichosis [M. marinum infection [M. marinum infection has been reported in HIV patients during the pre-anti-retroviral therapy (ART) period. However, infection is uncommon in the post-ART era [the skin , compristhe skin . The mosthe skin ,5,12,13.oid form . Infiltrrichosis . Less frrichosis . These i-ART era .Most cases of the infection are associated with aquatic exposure (>80%). The hands and/or fingers are more frequently affected (89–95%) ,13,15,17M. marinum have been reported, such as orchitis/epididymitis, lesions mimicking lymphoma, and severe osteomyelitis [Finally, less usual manifestations of myelitis ,20,21,22myelitis ,24.M. marinum is suspected in patients with a compatible clinical picture and a history of injured skin that has been in contact with salty or fresh water.M. marinum, it is possible to have positive interferon gamma release assays due to cross-reactions between M. marinum and M. tuberculosis [M. marinum infection in patients presenting with skin infections who are negative for M. tuberculosis, especially in areas where the incidence of M. tuberculosis is low [The initial clinical and radiological findings are often non-specific . The rourculosis ,29. Thiss is low .M. marinum from fluid or tissue taken from skin or other lesions [The mainstay of diagnosis is the isolation of  lesions . Optimal lesions ,14,15. I lesions .Biopsy specimens should be sent for histopathologic examination, microscopy, culture, and molecular detection (PCR). Histologic examination is diagnostic for mycobacteriosis in 50% of cases since the findings depend on the age of the lesion . The hisM. marinum is a catalase-positive, slow-growing, aerobic organism that grows optimally on Lowenstein–Jensen medium at 30 °C to 32 °C within 2 to 5 weeks and turns yellow with exposure to light [M. marinum is photochromogenic (its colonies turn yellow–orange after light exposure), cannot produce nitrate reductase, and has the ability to grow on a medium containing thiacetazone [M. marinum infection is suspected, laboratory personnel should be informed so that the test can be performed under special temperature conditions [M. marinum as the cause of nodular skin lesions [M. marinum [Microscopic examination after staining and culture using specific media are the cornerstones of mycobacterial identification. Microscopic examination alone is not able to distinguish between tuberculous and NTM species. In the vast majority of cases, the number of bacteria in clinical specimens is low, and thus, Ziehl–Neelsen staining of biopsy specimens or exudate from lesions is rarely positive. cetazone . Biosafecetazone . Both licetazone . Culturecetazone . If M. mnditions . Specimenditions . Culturenditions ,35. A po lesions ,25,36. T marinum .The accurate and more rapid identification of mycobacterium species often requires molecular methods, according to the American Thoracic Society and Infectious Disease Society of America (ATS/IDSA). Molecular methods can be positive even in culture-negative cases. NTM with clinical significance should be identified to the species level . MoleculM. marinum, M. ulcerans, M. ulcerans subsp. shinshuense, Mycobacterium shottsii, and Mycobacterium pseudoshottsii [M. marinum is very closely related to M. ulcerans, with an almost 99.6% identity based on their 16SrRNA gene sequence analysis [M. marinum from M. ulcerans and from other mycobacterial species can be achieved by sequencing three hypervariable regions of the 16S rRNA gene [Examples of PCR-based methods coupled with reverse hybridization are the INNO-LiPA Mycobacteria v2 (Innogenetics), which is based on the amplification of the ribosomal gene spacer (16S–23S), and GenoType Mycobacterium CM/AS (Hain Lifescience), which is based on the amplification of the 23S rRNA gene ,40. Howeshottsii . Phylogeanalysis ,43,44. DRNA gene .More recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is increasingly being used for the identification of mycobacteria in many laboratories, with similar performance to conventional molecular methods . Last, wMycobacterium marinum possess some features that may help distinguish M. marinum from other mycobacteria (tuberculous and NTM) as the cause of the infectious process. The first step in diagnosing M. marinum infection is to consider it as a probable cause of the patient’s symptoms, especially in view of a compatible history of aquatic exposure. Most clinical, laboratory and radiologic findings are non-specific. The tuberculin skin test is also non-specific, as it may be positive in all NTM, whereas IGRAs may have a positive predictive value in an appropriate clinical setting. Specimen microscopic examination alone is not able to distinguish between tuberculous and NTM species. Compared with other NTM, M. marinum grow optimally on Lowenstein–Jensen medium at 30 °C to 32 °C within 2 to 5 weeks and turn yellow with exposure to light, while other NTM grow optimally at 37 °C. Molecular methods can be used to accurately diagnose an NTM infection, even in culture-negative cases. As outlined above, special attention should be paid in order to correctly distinguish M. marinum from M. ulcerans, as these strains are closely related, with an almost 99.6% identity based on 16SrRNA gene sequence analysis.To summarize, M. marinum infection is rare, and as such, no comparative trials of skin and soft tissue infections have been carried out to date. The choice of an antimycobacterial regimen depends mostly on the choice and the experience of the treating physician rather than on hard evidence.It has been shown that prompt evaluation of the clinical presentation exerts a prognostic role and could dictate the optimal treatment plan. M. marinum is 10 times less permeable than the cell wall of M. tuberculosis, thus providing increased survival in unfavorable environments as well as decreased antibiotic penetration [M. marinum is intrinsically resistant to isoniazid and pyrazinamide [M. marinum is susceptible to rifampin [M. marinum has been known to be susceptible to other antibiotic drug classes, such as macrolides (clarithromycin and azithromycin) [The cell wall of zinamide ,25,48. Orifampin ,50, rifarifampin , while iromycin) , sulfonaromycin) , doxycycromycin) , linezolromycin) ,54. Consromycin) ,56,57. Wromycin) .M. marinum infection. According to the 2007 joint American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) treatment guidelines [There are no published randomized controlled trials regarding the optimal treatment of idelines , treatmeIt is not clear which is the optimal treatment for immunosuppressed patients, although interruption of immunosuppression along with dual or even triple treatment consisting of ethambutol plus rifampicin plus a third agent  seems logical .Surgical debridement may be considered as an adjunct to medical treatment in patients with extensive disease, in patients with deep structure disease , and in patients who fail to respond to standard treatment ,60. Adjup = 0.04) and to the skin lesion aspect of the ulcer (p = 0.02). Failure was not related to any specific treatment regimen or to the duration of treatment.In a study of 63 patients across French hospitals , the medM. marinum infections in Denmark [In a retrospective study of 53 patients with  Denmark , monothe Denmark , it was In another retrospective study of 18 patients , monotheOn the other hand, in another study , a singlIn summary, no definite conclusions regarding the optimal treatment regimen can be drawn until controlled trials have been carried out, which is difficult due to the rarity of the disease. It is reasonable to follow the 2007 ATS/IDSA guidelines regarding a treatment duration of 1–2 months after symptom resolution. Treatment with a single-drug regimen can be administered in mild cases which involve only superficial structures. Either tetracycline or clarithromycin seems a reasonable choice. Regarding combination treatment, clarithromycin plus ethambutol seems to be a reasonable option. Rifampin may be combined with clarithromycin or added to the above regimen in patients with deep structure disease due to its better penetration. Surgical evaluation and treatment should be offered to patients with deep structure and extensive disease as an adjunct to antibiotic treatment.M. marinum infection in immunocompetent patients is excellent [Most small ulcers or nodules are self-healed without treatment in 1 to 2 years ,64. The xcellent . Treatmexcellent . Skin-loxcellent ,65, espexcellent . This shxcellent ,67. It ixcellent .M. marinum infections. First, it has depicted the importance of taking a detailed history, as this will raise the clinical suspicion of M. marinum and will correctly guide the diagnostic work-up. More specifically, the association of anti-TNF-a blockade and NTM infections is increasingly recognized. Second, it has illustrated how demanding the laboratory confirmation of M. marinum can be, as classic methods may need to be coupled with novel molecular or sequencing techniques. Last, despite the slow response to treatment, a combination of appropriate antibiotics are effective and most frequently result in the complete resolution of the  cutaneous manifestations.In this case-based review, we have highlighted, on many levels, the challenges of managing skin and soft tissue


N = 105). Students completed self-report survey and implicit measures in lab visits 3 months apart. A structural equation model revealed cross-lagged relations between habit and behavior, and some evidence for a reciprocal relationship between implicit beliefs and habit. Implicit beliefs were related to alcohol behavior across time, but no cross-lagged relationship was observed. Findings provide preliminary support for recent advances in habit theory, suggesting that implicit beliefs and habit may develop in tandem or even share common knowledge structures and schemas.The current study assessed cross-lagged relationships between binge drinking, implicit beliefs, and habit in undergraduate university students ( Binge drinking in young adulthood has been associated with numerous negative outcomes, including both short term alcohol related injury or risk taking , and incTwo key psychological constructs that reflect non-conscious processes in such theories are implicit beliefs and habits. Implicit beliefs as a construct cannot be directly measured and are instead inferred from indirect measures of association such as reaction time tasks or priming effects, rather than traditional self-reported scales . These mHowever, theory-based tests of the relationships between constructs representing non-conscious processes like implicit beliefs and habits have relied heavily on cross-sectional or prospective designs. That is, designs in which all data is collected at a single timepoint, or only a key outcome is measured at a later date. Such approaches assume a recursive-chain causal structure underlies relationships among theory constructs . This asThis is in spite of theory suggesting that such relations may exist. Specifically, theory suggests that previous behavioral experience may maintain implicit beliefs and habits over time. For example, habit theory suggests that habits are developed through repeated experience in stable contexts . Past beWe aimed to fill this evidence gap in a two-wave cross-lagged panel design on a sample of Australian undergraduate students enrolled in a first year course, given the high rates of binge drinking in this sample and the notable change in drinking patterns often observed in first year students . Such deAge = 19.82, SDAge = 2.36; 71 Female, 34 Male). Sample information is presented in 2(1) = 0.37, p = 0.541), ethnicity (χ2(5) = 2.42, p = 0.789), employment status (χ2(4) = 4.82, p = 0.306), or relationship status (χ2(1) = 0.58, p = 0.448). Further, there were no significant differences between those who completed T2 and those who did not on study variables at T1  = 1.15, p = 0.331).Participants were undergraduate university students of legal drinking age recruited using the psychology first-year subject pool, flyers, and social media posts as part of a larger ongoing lab-based longitudinal study. Undergraduate students aged 18–25 years, reporting consuming alcohol socially, and not currently pregnant were eligible for inclusion. Participants were offered course credit or a coffee voucher and entry into a prize as an incentive for participation. A total of 299 undergraduate students completed the baseline measurement battery. However, 189 did not attend the follow-up lab session 3 months later, and 5 participants met the exclusion criteria for the IAT scoring at either time point . Thus, tAt T1, participants were asked to read a brief information passage and complete a consent form. After informed consent was given, participants completed the computerized drinking identity IAT administered by the Inquisit™ experimental software followed by an online survey measuring demographic factors and self-report measures of binge drinking habit and binge drinking behavior. To ensure understanding of the target behavior, participants were presented with a passage defining binge drinking based upon the WHO heavy drinking definition  “Binge . The stuD-score scoring algorithm for the IAT . Trials of over 10,000 ms were not included in D-score calculations, and D-scores for participants who responded faster than 300 ms to 10% or more of the trials are discarded , drinking habit (R2 = 0.600), and implicit drinking identity (R2 = 0.281) at T2 (see ps <0.001). There were statistically significant, modest-strong relationships of implicit drinking identity , habit , and binge drinking behavior  on themselves over time. Implicit drinking identity  and habit  at T1 had small but significant associations with binge drinking behavior at T2. Binge drinking behavior at T1 was associated with habit at T2 with a modest sized effect , but implicit drinking identity was not , reporting a small sized effect which fell short of the conventional cut-off for statistical significance by a trivial margin. Habit  at T1 had a small but statistically significant relationship with implicit drinking identity at T2, but not with T2 behavior where only a trivial effect size was observed .Descriptive statistics, zero-order correlations, and reliability coefficients are available in t T2 see . Factor Several notable findings emerged from this study which build on, and extend, previous research. First, positive and non-trivial relationships between habits and implicit beliefs (H1) and behavior (H2) were observed, consistent with previous research suggesting that appetitive behaviors, such as binge drinking, are influenced by factors that reflect implicit, non-conscious processes and determine future action beyond individuals’ awareness . ResultsCurrent findings provide preliminary evidence of a cross-lagged relationship between habits and implicit beliefs, consistent with theories of habits and implicit beliefs developing in conjunction . We founThe current study has notable value in the presentation of a novel test of cross-lagged relationships between behavior, implicit beliefs, and habit. The findings in support of a cross-lagged relationship between habit and behavior and between habit and implicit beliefs provide preliminary empirical evidence for recent advances in habit theory . These fThe current study sought to test the cross-lagged relationships between implicit beliefs, habit, and binge drinking in a sample of undergraduate students. A cross-lagged relationship was found between binge drinking and habit, but not between binge drinking and implicit beliefs, while the cross-lagged relationship between implicit beliefs and habit missed the traditional significance threshold by a trivial margin. These findings support the assertion from habit theory that repeated past behavior is a key element in the development of habit, and, once developed, habit encourages future behavioral occurrences. Further, the data indicates a potential bi-directional relationship between habit and implicit beliefs, supporting the theory that implicit beliefs and habit may develop in tandem and over time mutually reinforce and strengthen each other. These findings provide an interesting early test of key assertions in habit theory. However, as the current study was limited by its modest sample size following attrition and use of self-reported measures, additional research is required to confirm and further investigate these effects.Click here for additional data file.sj-sav-1-hpq-10.1177_13591053231164492 for Reciprocal relations between past behavior, implicit beliefs, and habits: A cross-lagged panel design by Kyra Hamilton, Daniel J Phipps, Natalie J Loxton, Kathryn L Modecki and Martin S Hagger in Journal of Health Psychologyhttp://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).This article is distributed under the terms of the Creative Commons Attribution 4.0 License (


Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one’s cardiac arrest recorded and available online.We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project.We identified themes of ‘shock, hurt and helplessness’ and ‘surreality and reality’ to describe the experience of having one’s (or a family member’s) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice.Finding one’s own, or a family member’s cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim. Video recording of everyday life is increasing. As of 2021 there were over seven hundred and seventy million government-controlled closed circuit television (CCTV) cameras, most of which are located in China.CA remains a leading cause of death, despite advances in resuscitation science. The first link in the chain of survival is successful recognition by lay persons, health care workers, or emergency call takers. Early recognition is crucial to initiate time-sensitive rescue procedures.16Videos of cardiac arrest are being uploaded to online video-sharing platforms every day, often without the consent of the persons recorded. Canadian research ethics guidance advises that videos in the public domain may be utilized for training and research without additional ethical considerations, such as obtaining permission from the persons in the video or notifying them that the video is being used to offer a mechanism to opt-out.https://osf.io/fxp5g/).This work is part of a larger research programme exploring the care needs of survivors and families post-CATM  using previously validated methods for virtual qualitative research.Twenty-four participants were recruited using snowball sampling. Interviews took place between April 2020 and July 2021 via ZoomData analysis was performed iteratively and alongside data collection until sufficient data was obtained to answer the research questions and recruitment was ceased.Data analysis was carried out primarily by MJD and PGB with analytical input from three co-researchers with experience of CA, who also reviewed a subset of transcripts.Of the 24 persons interviewed, two survivors and one co-survivor were involved in the study’s design and processes as co-researchers. Twelve participants reviewed a summary of the study findings when we shared our data and analysis to obtain feedback on accuracy and clarity. No participants dropped out prematurely nor did they express criticism or request clarification about the findings. Co-researchers received monetary honoraria for their time as well as reimbursement for expenses.Our writing team are healthcare professionals with expertise in cardiovascular care, ethics and resuscitation. We believe that handling these videos requires i) an approach guided by affected survivors and family members, and ii) and adherence to professional and ethical obligations. Trustworthiness in qualitative research requires authors consider their worldview and biasesOur Institutional Review Board approved this study [Pro00108168], and each participant gave informed consent. Participants were free to drop out of the study at anytime and without justification.We enrolled 24 adult participants, ages ranging from the second to ninth decade of life: seven CA survivors, six family members of CA survivors and eleven family members of CA non-survivors  was in the news. And I am reading about what the news says, and the news has found a video from some guy’s Facebook that shows Dad stumbling and people crowding ‘round. I can’t believe what I’m seeing. They make his death a viral video basically, and they don’t think about the effect of this on us or even care enough to let us know.” Study Participant P 2Watching the video (often repeatedly) was reported as reinforcing the initial traumatic experience and inflicting new trauma, as what was unwitnessed became witnessed. Notably, this was worse for family member participants than for CA survivors. The act of uploading, commenting, sharing and liking videos was described as “gross,” “lacking human decency,” “vindictive,” and “attacking.” A common theme was that the arrest (CA) was the first trauma, whereas a second trauma resulted from “betrayal,” “public humiliation,” and/or “voyeurism.”.Example of participant feedback:Watching it? Yeah, I watched it. I couldn’t not watch it. And yeah, it affected me big time. And I felt her die in my heart over and over. But it is not just the hurt of losing her anymore, it is the hurt of being betrayed by the person who has access to the security camera and the videos and who shared it. That’s what’s traumatizing now. The new trauma is ‘it’ being on these websites and all the internet people, the trolls commenting about her death, how she died and making fun of it. The internet is a gross place.P1Our participants also reported distress regarding their lack of control over the video, specifically its possession, distribution, and permanence. Participants believed that all video hosting sites should respond to requests to stop hosting and sharing sensitive content such as CA videos when approached by survivors or families.Example of participant feedback:“It is still there you know. We have asked to have it taken down. We wrote YouTube and Google and messaged and commented on the video and maybe one gets taken down, but it just shows up again on another profile. There’s nothing we can do”. P11For some participants, the videos were akin to a transcendent experience; survivors and family members felt “transported back to the event” and “re-immersed.” For family members, it triggered a closeness and co-experience with the victim. For both parties, despite the negative emotions, the videos also enabled sense-making and closure because they expanded their understanding of the details of the CA event. For some participants the videos provided information, they filled a knowledge gap and helped them understand what happened.Many participants (five of seven) also described an “out-of-body experience” from watching their own CA video. Both survivors and family members put themselves back into the event and describe the events in a disconnected and objective manner, akin to being a dispassionate narrator.Example of participant feedback:“You know, I don’t remember anything about my (CA). I guess that’s probably pretty normal. I don’t remember the entire day before it, or until about a full week after. So for me, my experience is like I’m watching myself, having my out of body experience through the CCTV, you know? It is so weird seeing yourself die. Watching my video is like having my out of body death experience”. P7Despite reporting negative emotions such as of distress, re-lived trauma, and helplessness, participants also reported near universal gratitude or perceived benefit after watching their CA video, and regardless of whether survivors or family members. To paraphrase, this made the event real and believable. It filled in uncertainties and solved mysteries.Example of participant feedback:“I am glad I watched it. I had lots of unanswered questions, like, there was a lot of mystery around how she died and what the staff did. It didn’t look like she suffered. I saw the staff and I saw mum. She had the seizure and they all stood around and she was gasping and laying still and gasping, doing the agonal breathing, and the staff were just standing around and she died there. P11Study participants advise that videos be used for education or research after ensuring their use is justified by helping future victims, considering protections for privacy of the person in the video, obtaining permission whenever possible, acting against harm, and protecting the vulnerable. Of note, participant recommendations align with established Western biomedical ethical principles  which are discussed below.Study participants emphasized the importance of using CA video recordings of real CAs only when the potential benefits outweigh the potential harms. Examples of benefits included improved rescuer education and knowledge that might help save future CA victims. Potential harms include emotional distress, reliving the experience, and privacy violation.Example of participant feedback:“Don’t do the research just for the sake of doing research. There’s got to be some kind of justifiable benefit to victims and their families”. P8The recommendation is to proceed when the benefits outweigh the risks. This recommendation reflects the principles of beneficence (promote wellness) and non-maleficence (avoid causing harm); decision-making based on the balance of these principles is a common ethical pursuit in professional clinical practice.Study participants emphasized the need for privacy.Example of participant feedback:“My personal ethics of this is that victims should have privacy. Researchers shouldn’t share anything where the victim can be recognized.” P13The emphasis on privacy and consent mirrors widely accepted ethical principles. In other words, the importance of patient privacy, consent and autonomy are central tenets of research, clinical medicine and nursing.Study participants recommend that educators and researchers make reasonable effort to contact the CA survivor and family to obtain permission to use the video.Example of participant feedback:“It should be the victim or their family’s decision if their video gets shared or used for research or CPR teaching, especially if you can see them. If the research only views the video but doesn’t share it, that seems a lot better to me.” P14Obtaining consent for the use of and sharing of identifiable videos was a paramount concern for participants and addresses survivor and family autonomy to make decisions about issues affecting them. Notably, permission was seen as less critical when videos were not further distributed or where individuals were unidentifiable or anonymous.To study participants, acting in any way that could harm survivors and families was unacceptable. Furthermore, participants spoke of a duty for educators and researchers to stop the sharing of videos that were hurtful or harmful for survivors and families.Example of participant feedback:“I think if anyone, researchers included, comes across something that is terrible. Like a video of a death, violence, hateful kind of stuff it should be reported and taken down. Researchers should be reporting things like this too.” P5Participants articulated that researchers and healthcare professionals have a duty to report or flag videos that could be harmful or contravene web and social media platforms’ terms of service. That is, study participants stressed the importance that professionals intervene when videos pose risks of harming others, which speaks to the ethical principle of non-maleficence.Participants highlighted that certain groups would be more likely to experience video surveillance and suffer a health emergency such as CA (e.g. those living in public spaces such as the streets or prisons). In other words, these individuals would likely be the subjects of a disproportionate percentage of CA videos, meaning an extreme lack of privacy and exposure of their social vulnerability.Example of participant feedback:“I would worry that lots of these sorts of videos would come from people dying in public or in areas under lots of cameras like homeless people, or prisoners or drug users.” P22In this research context, the ethical principle of justice highlights the importance of fair and equitable treatment for all. It urges careful consideration of the sources of video data and the potential harms and privacy concerns, particularly for vulnarable communities.Our study is the first to describe the experience of finding one’s own or a family member’s CA video online without consent. Furthermore, this is the first study to engage survivors and co-survivors in describing how educators and researchers should engage with online CA videos. Through thematic analysis of interview data, we identified experience-based themes such as shock, hurt and helplessness, and surreality and reality. Themes regarding ethical considerations to guide the use of online CA videos include: the research must help, victims deserve privacy, obtaining permission, not causing harm, and protecting the vulnerable.The findings of this study build on the current body of knowledge related to CA, publicly recorded and shared videos, education, and research. The experience of CA, including survivorship, co-survivorship and bereavement, are associated with complex psychological sequalaeVideo is a valuable tool for medical education.Cardiac arrest videos, including those captured and shared without consent, are a valuable data source for improving CA recognition and response,This study has noteworthy limitations. Our participants are limited to Canadians, Americans and Europeans – our findings may not be generalizable to other locations. People from Eastern cultures may have important and different values regarding privacy, autonomy, justice, and the acceptability of online CA video use. We were unable to ascertain differences in participant experience based on survivor/family member demographics, time since arrest, arrest setting or participant relationship to CA victims. Our study focused on themes present across the interviews, possibly at the expense of nuanced differences between participants. Furthermore, our participants had pre-existing interests in research and improving CA education. We acknowledge our desire to use CA videos for education and research and the potential bias this may introduce; however, we employed multiple strategies to address this .1)Will its use benefit future victims? Or is this voyeurism?2)The privacy of the persons involved be protected? If yes, make a reasonable effort to protect the person’s identity.3)Has the person/people in the video consented to its use? Can permission/consent be obtained? If yes, make a reasonable effort to do so.4)Protect victims and the public from harm, report harmful content, and do not interact with harmful content in ways that promote it 5)Do not use videos from specifically vulnerable populations like prisoners, homeless persons, drug users etc., without specific reasons to do so and specific considerations.Overall, according to our participants, educators and researchers should ask the following questions when using online videos of CA:Our data suggests that viewing one’s own or a family member’s online CA video can be traumatizing but may also help the viewer’s understanding of the event. Our participants acknowledged the utility and potential benefits of using CA videos for education and research but emphasized the potential harm that may result from careless online interaction with them. When using online CA videos educators and researchers have a duty to adhere to the principles of privacy, victim and family autonomy, justice, and non-malfeasance. Before undertaking any work with online CA videos potential harms and benefits must considered and reconciled.Alberta Registered Nurses Education Trust.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.