Media multitasking (MMT)—using and switching between unrelated forms of media—has been implicated in altered processing of extraneous stimuli, resulting in performance deficits. Here, we sought to extend our prior work to test the hypothesis that MMT might be associated with enhanced processing of incidental environmental cues during person perception.We tested the relationship between individual differences in MMT and person perception, by experimentally manipulating the relevance of environmental cues that participants could use to make trait and personality judgements of an unfamiliar social target. Relevant environmental cues consisted of neat or messy arrangements of the target’s belongings, whereas irrelevant cues consisted of similarly neat or messy arrangements of the testing room in which participants viewed a video of the target.In general, relevant cues affected ratings of the target’s conscientiousness. Additionally, and consistent with our hypothesis, there was a significant interaction between irrelevant cue condition and MMT, such that high media multitaskers more readily incorporated irrelevant environmental cues into their evaluations of the target’s conscientiousness.These results suggest that high media multitaskers are more responsive to irrelevant environmental cues, which in turn can lead them to form inaccurate impressions of others. In the twenty-first century, humans face a unique cognitive challenge never faced before by our species: to divide attention between multiple media devices, such as smartphones, tablets, computers, and television. Because content across devices often competes for attention, many people attempt to engage in media multitasking (MMT), the simultaneous use of and switching between unrelated forms of media . Anyone who has ever looked up reviews or actor filmographies on their smartphone while binge watching a television show is familiar with this phenomenon. However, the human brain has limited attentional resources  and evolPrevious research has associated MMT with incorporation of extraneous, irrelevant cues during cognitive tasks. In a landmark study researchers showed that high (versus low) media multitaskers were unable to filter extraneous cues in the environment while performing cognitive tasks, leading to the seemingly paradoxical finding of reduced performance in high media multitaskers on a task-switching task . AdditioHere, we sought to extend our prior work to test the hypothesis that MMT might be associated with altered processing of incidental environmental cues during person perception. As an undeniably social species , human bOne category of such cues is the material objects and decor in residential and personal settings, since objects and decorating schemes in one’s personal space often serve as statements of personality and identity , 12. MorIn this study, we tested whether high media multitaskers would incorporate incidental environmental cues into their trait judgments of a social target. To this end, we adapted Gosling and colleagues’ “Room With a Cue” procedure, which examines how people use environmental cues found in offices and bedrooms to make trait judgments about previously unknown individuals . GoslingHere, participants watched a video clip of a previously unknown social target  are visually salient and easy to manipulate in a lab setting, and also because participants in Gosling and colleagues’ study made accurate and reliable judgments along this trait dimension . To alteirrelevant cues in their trait judgments. Specifically, we hypothesized that high media multitaskers would: (1) attribute lower conscientiousness to the target in the video in the messy testing room condition (regardless of the neat or messy room cues in the target’s depicted dorm room); and (2) give higher ratings of conscientiousness in the neat testing room condition .We hypothesized that, replicating previous work, participants would incorporate the relevant (video) cues into their judgments of the target’s conscientiousness , with the possibility that high MMT would be associated with exaggerated effects on their ratings. Critically, we also predicted that high (versus low) media multitaskers would be more likely to incorporate SD = 1.00) were recruited to participate in the study in return for course credit, with the goal of having at least 20 participants per cell in our two-by-two experimental design. Sample sizes in the 25–30 range are sufficient to achieve about 80% statistical power to detect small to medium effects for either main effect or interaction terms [One hundred and three undergraduate students  and irrelevant cue  as experimental factors, and participants’ media multitasking scores as a measured covariate. Accordingly, participants were randomly assigned to watch the video clip depicting either the neat or messy room (relevant cue), and also pseudo-randomly assigned to complete study tasks in either a neat or messy testing room (irrelevant cue). Since participants were often scheduled for the experiment back-to-back, the testing room was initially arranged in either a neat or messy configuration at the beginning of the day, and the testing room condition was subsequently counterbalanced by day. Props used in the messy/neat conditions for the testing room included cups, dishes, a stack of books, binders, pens, folders, a waste-paper basket, paper clips, binder clips, CDs, and miscellaneous papers see Fig. .Fig. 1ScAfter subjects provided informed consent, they were told they would be watching a video and completing several questionnaires. The experimenter brought the participant to the testing room, mentioning that “We are running a bit behind today and most of the rooms have been in use, so we’ll borrow this one.” This deception was necessary to prevent participants from becoming suspicious of the experimental manipulation of room, particularly the messy condition. The experimenter then explained that the participant would be watching a video of a Dartmouth student describing what he did yesterday, and that half of the interviews were pre-scheduled while the timing of the other half was a surprise. All subjects were told that the interview they would be watching was a surprise interview, to clarify that the target’s environment had not been preemptively cleaned or altered. Raters were led to believe that these video interviews were to be subsequently used for research on interview performance and corporate recruiting.The video consisted of messy-background and neat-background versions see Fig. .After viewing the video, subjects were brought into an adjacent room to complete a current state questionnaire, which was designed to provide a time buffer between viewing the video and rating the target. After completing the survey, participants were asked to “answer a few questions about the video.” Items on the trait inventory consisted of 11 conscientiousness items from the Big Five Inventory  interspeN = 995) and was found to have high internal reliability  [“When talking to someone face-to-face, how often do you feel the urge to check your phone for unread messages, notifications?”; or (2) more passive tendencies, including distractibility and interference from using various media, e.g., “How often does your multimedia use interfere with your homework or work?” Each scale item is answered on a 5-point likert scale, with the following response choices: 1-Never, 2-Rarely, 3-Sometimes, 4-Often, 5-Always for “how often” items, and 1-Not at all, 2, 3-Somewhat, 4, 5-Very(much) for all other items. There is one reverse-scored item, and all scale items (reflecting the abovementioned factors) are summed together, with a total possible score range of 18–90. Higher scores reflect a greater tendency to engage in MMT related behaviors.Next, participants completed a questionnaire assessing levels of media multitasking and distractibility. To assess media multitasking tendencies, we used the 18-item Media Multitasking-Revised (MMT-R) scale , 7, whicAt the conclusion of the experiment, all participants underwent a debriefing, were given the opportunity to ask any remaining questions, and reimbursed for their time with course credit.N = 12) who completed the same series of trait ratings. We predicted that the ratings between video conditions would not differ significantly, in which case we could rule out the possibility that actual behavioral differences in the confederate contributed to differences in trait ratings. Independent t-tests confirmed that the confederate’s nonverbal cues did not differ significantly between versions of the video, all p’s > .05. Note, however, that although the confederate was not blind to room condition, this could not influence the results of the primary manipulation of interest (whether the testing room where the video was shown was neat or messy).As it was impossible to conduct a double-blind protocol with our video confederate, we conducted a follow up series of surveys to rule out behavioral confirmation effects as a potential confound. Both versions of the target video were cropped, removing background cues and leaving only the confederate’s face as a source of nonverbal information. Each version was then shown to an independent sample  condition and room (irrelevant cue) condition as categorical predictors, and participants’ (centered) MMT scores as a continuous predictor. Unless otherwise stated, the alpha level for all inferential tests on parameter estimates from the model was set to .05. We also included several interaction terms, including: 1) the interaction between video (relevant cue) and room (irrelevant cue) conditions; (2) the interaction between MMT and the video (relevant cue) condition; and (3) the interaction between MMT and the room (irrelevant cue) condition  = 9.22, p < .001, and captured a reasonable percentage of variance in conscientiousness scores, adjusted R2 = 0.342. Replicating prior research by Gosling and colleagues [b = − 7.83 , t = − 6.65, p < .001. There was no significant main effect of irrelevant cues , p = .305. There was, however, a main effect of media-multitasking, with those participants reporting frequent media multitasking providing higher conscientiousness ratings, regardless of testing room condition, b = 0.141 , t = 2.14, p = .035, As far as the model’s interaction terms, there was a significant interaction between MMT and the room (irrelevant cue) condition, b = − 0.335 , t = − 2.54, p = .013.Overall, the model fit the data well, lleagues , there wN = 16) or average levels of MMT (N = 66), there was no significant change in their conscientiousness judgments as a function of the room (irrelevant cue) condition, all p’s ≥ .282. But, for those reporting high  levels of MMT, there was a significant difference in their conscientiousness judgments, such that those assigned to view the video in the messy room condition made lower conscientiousness ratings of the target than those assigned to view the video in the neat room, b = − 4.22, SE = 1.67, t = − 2.53, p = .013  condition, p = .252.To unpack the interaction between MMT and room (irrelevant cue) condition, we ran simple slopes tests  to examine the effect of the room (irrelevant cue) condition at varying levels  of MMT. These tests revealed that among participants who reported low . First,Given the nature of the effects we observed in the current study, we speculate that there may be implications of media multitasking behaviors in other domains, beyond person perception. For example, those who engage in more frequent media multitasking may have altered attentional processing that biases them to be more responsive toward other cues in the environment  and/or emotionally evocative stimuli . A potentially fruitful avenue of future work would be to examine the development of media multitasking behaviors in children and adolescents and assessing subsequent changes across domains, including person perception, appetitive behaviors, and emotional reactivity. Indeed, recent studies have begun employing longitudinal designs to address such questions, with one study showing that media multitasking and attentional problems not only co-vary, but early adolescents’ media multitasking tendencies may lead to increased distractibility over time . AnotherDespite the significance and novelty of our media multitasking finding for social cognition, there are some limitations in our study design and procedure that necessarily constrain the interpretability and generalizability of the results. First, although we experimentally manipulated multiple cue types (relevant and irrelevant), and participants were pseudo-randomly assigned to all conditions, the observed relationships with MMT are correlational. This precludes any strong inferences as to the directionality of the effects. For example, over time a person might become a high media multitasker, and this may induce changes in attentional processing of various cues. Or, a third variable  may be a confounding factor, predisposing individuals to media-multitasking while also causing these individuals to more readily process extraneous cues—including irrelevant cues that could be incorporated into potentially inaccurate perception of others’ traits and qualities. If the former scenario is the case , chronic media multitasking cannot be manipulated easily in short laboratory sessions. Of course, this is generally true of all research that examines behavior as a function of individual differences or personality. At best, future studies might consider employing longitudinal designs like those employed by Baumgartner and colleagues , 18 thatLastly, we did not incorporate additional measurements to track patterns of participants’ attention while they watched the video in the testing room. Thus, we cannot make strong claims as to the relative viewing time of room versus target cues for the video, as well as potentially switching attention between the video and the peripheral (irrelevant) neat or messy cues in the testing room. Future studies should address this by adding eye-tracking measures to this or a similar type of paradigm, and this would be illuminating to see whether high media multitaskers show distinct or divergent attentional profiles during person perception.To conclude, this study demonstrated that MMT is associated with altered processing of incidental, irrelevant cues that can impact person perception. The study design allowed us to investigate the role of incidental cues in the immediate environment that had greater or less relevance to guide person perception. Although the testing room cues were completely irrelevant to the task at hand, they nonetheless exerted effects on those participants with greater propensity to engage in media multitasking behaviors. This experimental design has ecological validity in that it simulates the type of common, multi-cue contexts in which people often find themselves, such as working on a computer in a neat (or messy) office setting, or doing housework while checking one’s phone. Future studies would benefit from using crossed designs like the one here, in which both relevant and irrelevant environmental cues are manipulated. This would enable researchers to examine whether media multitasking is associated with altered cue processing aspects of social cognition in which implicit processes are often at play, such as racial bias or stereotype formation. More broadly, the present work highlights subtle ways in which media multitasking behaviors are associated with altered perceptual processing of environmental cues.


Malnutrition, a caloric or nutrient imbalance, is particularly common in the older adult population, and food insecurity is a rising concern. This paper will discuss the incidence of malnutrition and food insecurity in the older adult population. It will also discuss federal and state programs in place that work to prevent and combat malnutrition. It will provide strategies for aging network members to engage in these policy discussions.


IntroductionNear-miss obstetric cases are the ones which have survived childbirth after a life-threatening and complicated pregnancy. The aim of this study is to evaluate important characteristics and causes of near-miss cases, compare them with maternal deaths, and assess urgent interventions managing these patients.Materials and methodsThis prospective, cross-sectional study was conducted in the intensive care unit of the Obstetrics and Gynecology department. Clinical spectrum of near-miss patients was compared with that of maternal deaths. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 21.0 .ResultsThe incidence of near-miss events was 31.4/1,000 live births. The incidence of maternal mortality was 8.2/1,000 live births. The ratio of near-miss to maternal mortality was 3.8:1. Hemorrhage, hypertensive disorders, and puerperal sepsis were the leading causes of near-miss cases.ConclusionEvaluation of characteristics of near-miss cases helps in establishing severe maternal morbidity. These high-risk patients must be provided urgent interventions to prevent maternal mortality. Severe acute maternal morbidity (SAMM) or near-miss obstetric cases involve women who survived a life-threatening medical condition, organ failure, or complication with respect to their pregnancy or childbirth. These cases share some of the pathophysiological and clinical characteristics with the women who succumbed to maternal mortality. Near-miss/SAMM cases are of considerable interest to obstetricians and healthcare managers. These cases help evaluate the short-comings in women healthcare facilities and identify the potential areas that need to be addressed .The near-miss concept is efficient in exploring the differences, similarities, and relationships between characteristics of women who survived life-threatening pregnancy-related complications and women who actually died of them, to enable us to thoroughly gauge the quality of obstetric healthcare. This concept is equally applicable in both developed as well as developing countries . Near-miEffective implementation of the near-miss concept will help analyze the high-risk group, plan relevant interventions for dealing with obstetric emergencies, and reinforce the entire healthcare setup for enabling favorable outcome. The aim of this study is to evaluate the characteristics of near-miss obstetric cases in a tertiary care hospital.It was a prospective, cross-sectional study conducted in the department of Obstetrics and Gynecology at the Ziauddin University Hospital, Karachi during a one-year study period . The study was approved by the Institutional Review Board which waived off patient consent as all information was to be collected from patient files.Near-miss was defined, in this study, as per the World Health Organization (WHO) criteria as mentioned by Say et al. . During The mean age of all women in the SAMM group was 29.67 ± 7.88 years. Among the 15 (0.95%) patients who died, five (33.3%) deaths took place either during delivery or in recovery; and the remaining 10 (66.7%) deaths were postpartum in the ICU. Of these 10 women, two (20%) were admitted after a complicated delivery from another hospital and the remaining eight (80%) had delivered in this hospital. All 57 (3.6%) near-miss cases were delivered in this hospital. The incidence of near-miss was 30.1/1,000 obstetric admissions and 31.4/1,000 live births. The incidence of maternal mortality was 7.9/1,000 obstetric admissions and 8.2/1,000 live births. The ratio of near-miss to maternal mortality was 3.8:1. The patient characteristics of both groups are compared in Table In both groups, multi and grand multigravida women were more common and most were admitted through the emergency room. Among medical co-morbidities, hypertension and gestational diabetes were more common in the near-miss group. Uterine fibroids were very common in the mortality group. Overall, PPH was the most common diagnosis as seen in Table As shown in Table As far as management was concerned, magnesium sulphate (MgSO4) infusion was given to all eclamptic patients n=23; 32%). Hemodialysis was indicated in two (2.8%) patients, three (4.2%) patients of PPH required uterine artery re-embolization; 12 (16.7%) patients required non-invasive ventilation, and 32 (44.4%) patients required invasive ventilation. In the hemodialysis group, one patient survived and one did not (50% vs. 50%). In the MgSO4 infusion group, 21 patients survived (91.3% vs. 8.6%). In the uterine artery re-embolization group, one patient survived and two did not (33.3% vs. 66.7%). In the non-invasive ventilation group, nine patients survived and three did not (75% vs. 25%). In the invasive ventilation group, 25 patients survived and seven did not (78.2% vs. 21.8%). Emergency hysterectomy was attempted in two patients, both of whom survived . Previous history of miscarriage, uterine fibroids, and puerperal sepsis were more commonly associated with maternal mortality. MgSO4 infusion for eclamptic patients and assisted ventilation were crucial in saving maternal life.This study highlights crucial similarities and differences in the near-miss and mortality group. It has assessed the clinical spectrum of these patients in much depth. However, the study has its short-comings too. Incidence of antepartum hemorrhage was not taken into account. The study findings cannot be inferred for all obstetric patients, but is only specific for high-risk patients which already fall into the WHO near-miss criteria.This study revealed the incidence of near-miss to be 30.1/1,000 obstetric admissions and 31.4/1,000 live births which is comparably higher than the regional literature. In recent Indian studies, near-miss rate was 20.6/1,000 obstetric admissions . In a PaThe core obstetric complications predisposing pregnant women to near-miss events are almost always similar. The major chunk is formed by hemorrhagic disorders which may be antepartum, peripartum, or postpartum. Pregnancies complicated with hypertension-related disorders (eclampsia) and disorders of morbid placenta become more prone to obstetric hemorrhage. In this study, 45.6% of near-miss cases were caused by PPH and 37% by hypertensive disorders. In comparison, the literature also reports hemorrhage and hypertensive disorders to be the major predictors of near-miss cases as well as maternal mortality [Puerperal sepsis has been an unresolved problem in the obstetric healthcare system of developing countries for a long time now. Sepsis alone has been responsible for as many as 30% of maternal deaths in low-to-middle income countries -9. It isSome pregnancy-related complications leading to high-risk childbirth are almost unavoidable. The benefit of evaluating near-miss events in depth is that the records of these patients and the hindrances they had to witness can help in creating safer and more approachable obstetric healthcare for future patients. Some of these factors may be associated with things lacking at the patient’s end such as desire for home delivery to maintain tradition, inadequate antenatal care, non-compliance with healthcare practitioner’s advice, disbelief in modern medicine, and others. Some factors are associated with delay in reaching a tertiary care institution due to longer distances, lack of transport or funds. Factors related to health system include delay in providing immediate relief and/or referral, lack of adequate intensive care facility, well-trained staff, and others ,10.Obstetric emergencies demand prompt life-saving measures. Accepting the concept of near-miss and identifying the clinical characteristics of these patients is a substantial step towards preventing maternal mortality. Combating these issues at the level of primary care facilities has become essential. Evaluating patients for risk factors and providing high-risk and SAMM patients utmost intensive care can further decrease the ratio of maternal mortality. In order to reduce the incidence of near-miss cases, it is important to address women at basic levels including awareness about antenatal compliance, hygienic deliveries in proper healthcare facilities, and birth spacing.


Sinonovacula constricta) populations to inland saline-alkaline waters (ISWs), we evaluated the tolerance of juvenile S. constricta (JSC) to Ca2+ and Mg2+ concentrations, and determined the effects of these ions on JSC growth and physiological parameters. After 30 days stress, the tolerable ranges of JSC to Ca2+ and Mg2+ were determined to be 0.19 mmol⋅L-1–19.46 mmol⋅L-1 and 0 mmol⋅L-1–29.54 mmol⋅L-1, respectively. The concentrations of Ca2+ (less than 0.65 mmol⋅L-1 or more than 3.24 mmol⋅L-1) and Mg2+ (less than 0.37 mmol⋅L-1 or more than 14.17 mmol⋅L-1) significantly inhibit JSC growth. Physiological enzyme activity no significant response when the concentrations range of Ca2+ and Mg2+ are 0.93 mmol⋅L-1–6.49 mmol⋅L-1 and 0.37 mmol⋅L-1–14.77 mmol⋅L-1, respectively. For transplantation practice, these data indicate that only high concentrations of Ca2+ (3.24–6.825 mmol⋅L-1) and Mg2+ (14.77–33.69 mmol⋅L-1) in target inland saline-alkaline water had significantly impact on growth and physiological response. In addition, present study suggests that the increase in Ca2+ and Mg2+ ion concentrations caused by ocean acidification will not affect the survival, growth and physiology of S. constricta. Current research suggests that S. constricta can adapt to extreme changes in the marine environment (Ca2+ and Mg2+) and may be an excellent candidate for inland saline-alkaline water transplantation practice.To facilitate transplanting razor clam ( In Chin2 of ISW . Saline 2 of ISW . The usevannamei , 2010. Is edulis , Ruditapppinarum , Haliotiaevigata , Trochusiloticus , and Cralomerata .Cyclaina sinensis  are factors that affect the survival and growth of aquatic animals  of the extracellular fluid is similar to that of the ambient seawater . Thus, i2+ and Mg2+ ion contents vary widely in ISWs in different regions of China. For example, the Ca2+ content of ISWs in Haolebaojinao  is only 0.199 mmol⋅L-1 of seawater , and the possibility of this species as a potential candidate for transplantation to ISWs, providing a theoretical basis for this process.al zones . S. conshe ocean . TherefoExperimental animals were treated according to the guidelines of the Institutional Animal Care and Use Committee of Shanghai Ocean University (IACUC-SHOU), Shanghai, China, under examination and approval number SHOU-DW-2018-014. In this tests the animals were artificially propagated as juveniles.2+: 1.71 mmol⋅L-1, Mg2+: 9.23 mmol⋅L-1) for 4 days. In these conditions the total salinity of water is set at 6 ppt, since the salinity of ISW (carbonate type) in China is around 6 ppt  were obtained commercially (Zhejiang Sanmen Donghang). Before experimentation, all JSCs were kept in at 8 ppt seawater for 3 days, then were kept at 6 ppt artificial seawater (Cand 6 ppt . Artificnd 6 ppt . ApproxiS. constrictas were divided into 29 groups for long-term stress testing (2+ (DCMg: G1-G14), and 14 groups with different concentrations of Ca2+ (DCCa: G1–G14). Each of the 29 groups had 3 parallel trials. For each parallel stress trial, 90 JSCs were cultured in an 11 cm diameter round plate for a month. 150 mL test water  was added to the round plate, and the test water was changed once every single day. Feed-water was prepared as follows: test water was used to replace the culture water of Chaetoceros calcitrans by centrifugation, and the concentration of C. calcitrans was adjusted to 400–480 cells μL-1 in test water. For every single feeding, 15 mL feed-water was used to replace 15 mL of test water. JSCs were fed thrice a day.Juvenile  testing , consist+/K+-ATPase (NKA), aspartate aminotransferase (AST), superoxide dismutase (SOD), acetylcholinesterase (AChE), and lysozyme (LZM). At 30-day, live JSCs were used to measure shell length, body weight, and enzymes activity . Nine JSCs (representing three separate tests with three JSCs in each group) were used to measure enzyme activities. Briefly, after shell removal, JSC tissue was homogenized in normal saline water in a ratio of 1 mg: 9 μl. After homogenization, the total protein content of the sample was measured by Coomassie Brilliant Blue Total Protein Assay kit , according to the manufacturer’s instructions. NKA, AST, SOD, AChE, and LZM enzyme activities were measured by corresponding kits from Nanjing Jiancheng Bioengineering Institute Ltd., as previously described (Live JSCs were counted at day 0 (0-day) and at day 30 (30-day). At 0-day, 36 JSCs (6 repeats: 6 JSCs per repeat) were selected to determine the activities of the following enzymes: Naescribed .+/K+-ATPase activity was measured by Pi released from ATP, in the incubation solution containing: 100 mM NaCl, 20 mM KCl, 4 mM MgCl2, 1 mM EGTA, 0.2 mM 2-methyl-8-(phenylmethoxy)imidazol pyridine-3-acetonitrile 40 mM Tris–HCl (pH 7.4) and 3 mM Na2ATP. The incubation time with substrate was 10 min. Pi concentration was calculated from the regression line based on standard Pi solutions. The units of NKA activity are expressed as U (μmol Pi mg prot-1 h-1). AST can transfer amino and keto groups between alpha ketoglutarate and aspartic acid, then generate glutamic acid, and oxaloacetate. Oxaloacetate can be decarboxylated to pyruvic acid by itself during the reaction. Pyruvic acid reacts with 2,4-Dinitrophenylhydrazine to form 2,4-Dinitrophenylhydrazone, which is reddish brown in an alkaline solution. After measuring the OD, the standard curve was checked to obtain AST activity, which is expressed as U (μmol Pyruvic acid mg prot-1 min-1). SOD activity was tested using SOD assay kit by WST-1 method. The WST-1 method depends on produces a water-soluble formazan dye upon reduction with the superoxide anion. The rate of the reduction of WST-1 with O2- are linearly related to the xanthine oxidase activity, and this reduction is inhibited by SOD. Therefore, the 50% inhibition activity of SOD can be determined by the colorimetric method. The SOD activity is expressed as units per mg of protein (U mg prot-1), where the one U represents the amount of enzyme required to achieve a SOD inhibition rate of 50%. AChE hydrolyzes acetylcholine to produce choline and acetic acid. Choline can react with sulfhydryl chromogenic reagent to form Sym-Trinitrobenzene (yellow compound), after measuring the OD, the standard curve was checked to obtain AChE activity, which is expressed as units per mg of protein (U mg prot-1), where the one U represents at 37°C for 6 min of reaction conditions, the amount of enzyme required to hydrolyze 1 mmol of acetylcholine. The activity of LZM was detected using a turbidimetric method, which light transmittance of the bacterial turbid solution. Lysozyme can lysis bacteria by hydrolyze peptidoglycan on the bacterial wall to increase the light transmission of the bacterial turbid solution. After measuring the light transmission, the standard curve was checked to obtain LZM activity, which is expressed as units per mg of protein (U mg prot-1), where the one U equivalent to the activity capacity of standard LZM. All data of enzyme activities are ultimately represented as a ratio of 30-day to 0-day.Na2+ and Mg2+ on JSCs, we designed and conducted an acute stress study. The CK, DCMg-G1, DCMg-G10, DCCa-G1, and DCCa-G13 were used in the acute stress experiment. In this experiment, the animals were exposed to the same conditions used in the long-term stress tests, except that the clams were not fed algae. At 0-h, 12-h, 24-h, and 48-h, ten JSCs from each group were used to measure oxygen consumption, then the hemolymph of JSCs was collected, as previously reported  was added, and samples were incubated in the dark at room temperature for 1 h  assay. In every parallel group, 20 μL haemocyte suspension solution was diluted with TBS to 200 μL. Then, 20 μL of CCK-8 reagent was added and incubated at 28°C for 3 h. For the CK, 20 μL serum was obtained from the haemocyte suspension solution, and was diluted with TBS to 200 μL; then 0 μL of CCK-8 was added and incubated at 28°C for 3 h. After the OD value was measured, the relative metabolic activity was calculated using OD value and the total number of haemocytes (obtained from the phagocytosis test).Survival rate (SR):30N and 0N are the numbers of surviving individuals in the 30-day and 0-day groups, respectively.Shell length growth rate (SGR):30L and 0L are the average lengths of the individuals in the 30-day and 0-day groups, respectively. T is 30 days.Weight gain rate (WG):30W and 0W are the average wet body weights of the individuals in the 30-day and 0-day groups, respectively. T is 30 days.Oxygen consumption rate:Phagocytosis rate and relative metabolic activity:t and Hu are the total haemocyte and un-phagocytic haemocyte numbers, respectively. ODG, ODGB, and HtG are the OD of test sample, the blank OD of test sample, and the total haemocyte counts of the test sample, respectively. ODCK, ODCKB, and HtCK are the OD of control sample, the blank OD of control sample and the total haemocyte count of the control sample, respectively.HSigmaplot 12.3 software was used to identify significant differences analysis and to plot results. Significant differences were analyzed by using single factor analysis of variance  and the LSD method.2+ (higher than 73.86 mmol L-1) and Ca2+ (higher than 207.55 mmol L-1) cause JSCs to die rapidly  causes JSCs to die over an extended period of time. Meanwhile, we observed that the bodies of JSCs were lacked calcium carbonate shells in groups stressed with Ca2+ concentrations lower than 0.093 mmol L-1. However, the JSCs stressed with low concentrations of Mg2+ remained viable , and from 14.77 mmol L-1 to 29.54 mmol L-1 (P < 0.001), and was significantly inhibited in the Ca2+ concentration 0.19–0.65 mmol⋅L-1 (P < 0.05) and 6.49–19.46 mmol⋅L-1 (P < 0.05) (2+ concentration 0–0.37 mmol⋅L-1 (P < 0.05) and 14.77–29.54 mmol⋅L-1 (P < 0.001), and was significantly inhibited in the Ca2+ concentration 0.19–0.65 mmol⋅L-1 (P < 0.05) and 3.24–19.46 mmol⋅L-1 (P < 0.05) (The shell growth rate was significantly inhibited in the Mg < 0.05) . The bod < 0.05) .+/K+-ATPase activity was significantly decreased in JSCs stressed with low concentrations range (0–0.046 mmol⋅L-1) of Mg2+ (-1 of Mg2+ significantly increased NKA activity in JSCs (P < 0.05). Low concentrations and high concentrations of Ca2+ affected JSC NKA activity. NKA activity was increased significantly in the Ca2+ concentration of 0.19 mmol⋅L-1 (P < 0.001), 0.28 mmol⋅L-1 (P < 0.001), and 19.46 mmol⋅L-1 (P < 0.05). NKA and SOD activity patterns are totally consistent when Ca2+ varying. In contrast with NKA, SOD activity is not affected by low Mg2+ (-1) of Mg2+ (P < 0.05), but was significantly increased in the high Mg2+ concentration, 14.77 mmol⋅L-1 (P < 0.05) and 29.54 mmol⋅L-1 (P < 0.001). However, both 0.19–0.65 mmol⋅L-1 (P < 0.05) and 6.49–19.46 mmol⋅L-1 (P < 0.05) concentrations of Ca2+ significantly reduced AST activity in JSCs. AChE activity increased as the concentration of Mg2+ increased (2+ concentration of 0 mmol⋅L-1 and 0.046 mmol⋅L-1 (P < 0.05), but was increased significantly in the of 14.77 mmol⋅L-1 and 29.54 mmol⋅L-1 (P < 0.001). The same trend was observed in the effects of Ca2+ concentration on AChE activity. AChE activity was inhibited significantly in the Ca2+ concentration of 0.19 mmol⋅L-1 and 0.28 mmol⋅L-1 (P < 0.001), but was increased significantly in the 6.49 mmol⋅L-1 and 19.46 mmol⋅L-1 (P < 0.001). Only the Mg2+ – 1.85 mmol⋅L-1, Mg2+ – 3.69 mmol⋅L-1, Ca2+ – 2.32 mmol⋅L-1, and Ca2+ – 3.24 mmol⋅L-1 showed no significant inhibition of LZM activity in JSCs , the Mg2+ concentration 73.86 mmol⋅L-1 showed a decrease at 24 h (P < 0.05) and 48 h (P < 0.001), and the Ca2+ concentration 0 mmol⋅L-1 and 207.55 mmol⋅L-1 began to decrease significantly at 12 h. The Mg2+ concentration 0 mmol⋅L-1 showed no significant change in metabolic activity , is characterized by broad variation in pH, carbonate alkalinity, and Ca2+ (0.775 mmol⋅L-1–6.825 mmol⋅L-1) and Mg2+ (3.07 mmol⋅L-1–33.69 mmol⋅L-1) content. Studying the ion tolerance range of S. constricta is the first and crucial step toward transplanting S. constricta cultures to ISW.Changes of Ca2+ and Mg2+ between different invertebrate species. 2+ and Mg2+ for the survival of L. vannamei larvae were 0.76–8.78 mmol⋅L-1 and 0.36–35.51 mmol⋅L-1, respectively. 2+ concentrations are very important for shrimp. The concentration of Mg2+ in inland saline-alkali water is at least 25% higher than that of seawater at the same salinity. 2+ concentrations are less than 0.3 mmol⋅L-1, the veliger larvae of the zebra mussel (Dreissena polymorpha) cannot survive. Furthermore, the New Zealand mud snail (Potamopyrgus antipodarum) is reported to have a minimum Ca2+ concentration tolerance of 0.125 mmol⋅L-1  stress. However, the tolerance of JSC to high concentrations of Mg2+ is far less than that of C. sinensis. It is worth noting that the maximum tolerated concentration of JSC for Mg2+ is also slightly lower than the maximum measured value of the target-ISW. This suggests that perhaps Mg2+ be one of the limiting factors to the S. constricta transplantation. Thus special attention have to be paid to whether the concentration of Mg2+ ions too high when practicing transplantation. Mg2+-free medium have little effect on the survival rates of JSC and C. sinensis; this may be caused by the presence of dietary Mg2+ ions, or may indicate that the effect of free Mg2+ on survival is a long-term process. Because D. polymorpha depleted of Mg2+ did not survive beyond 51 days. JSC can survival in a wide range of concentrations of Ca2+ (0.19–19.46 mmol⋅L-1), suggesting that transplantation of JSC to target-ISW may without effect of Ca2+, and could be performed in a broad range of Ca2+ concentrations.There is a significant difference in the tolerance of Cammol⋅L-1 . Lin et 2+ is the main cation involved in the shell formation of bivalves, it was chosen in previous growth models , and it is likely that this inhibitory effect will take longer in JSCs.Most evidences in bivalves is based on observations that on simulative conditions, oxygen consumption rapidly rises to levels above normal . Both ceseawater . Divalenembranes . Not dif2+ and Mg2+ have important regulation for both inorganic ion and organic osmotic regulation. In research of G. dibranchiata, it was found that the lack of Ca2+ ions in the environment did not lead to the efflux of Na+ and Cl-, but it caused the efflux of K+ . Mollusc farming does not utilize compound feed directly, like shrimp farming, so the impact of dietary Mg2+ is difficult to eliminate. Of course, the target-ISW does not have the Mg2+-free type of water, and the target-ISW does not significantly inhibit the NKA activity when the Mg2+ content is the lowest. But the higher Mg2+ concentration range 14.77–29.54 mmol⋅L-1 may significantly increase the NKA activity of JSC. In addition, the Ca2+ concentration range of target-ISW may not significant impact on NKA activity of JSC. This suggest that when transplanting S. constricta in the target-ISW, Mg2+ may be one of the main factors to induce individuals to produce intense osmotic and ionic regulation.When osmotic concentration and the ionic composition of the extracellular fluid be changed, the cells release cytoplasmic ions and organic osmolytes into the extracellular fluid to eliminate the osmotic gradient across the plasma membrane . Changesux of K+ . Comparin shrimp . Similar2+ operates synergistically to facilitate glutamate dehydrogenase activity and interactions between this glutamate dehydrogenase and aminotransferase  balance changes  and Mg2+ (14.77–33.69 mmol⋅L-1) concentrations range may significantly affect AST activity. This indicating that changes of Ca2+ concentration in water not only affect digestive enzyme activity but also affect enzyme activity related to protein metabolism, thereby inhibiting growth  may significantly increase the SOD activity of JSC. This suggest that Mg2+ may cause excessive metabolism and produce a large amount of oxygen free radicals when transplanting S. constricta in the target-ISW.The imbalance between Caradicals . The incMytilus sp. is sensitive to environmental salinity. Although the effect of the concentration of Ca2+ and Mg2+ on AChE activity in mollusc has not been clearly reported, in fish, 2+ and Mg2+ concentrations were on the order of magnitude of 10 mmol, and the activity level were maintained at more higher Ca2+ and Mg2+ concentrations. The same situation be found in our study, AChE activity was continuously increased with increasing concentrations of Ca2+ and Mg2+ in water. Although there are some differences in the physiological functions of fish and bivalve, the physiological roles and functional mechanisms of AChE  are relatively conservative. This indicating that the molecular mechanism of bivalve and fish AChE are similar, and the difference between the them may occur in the magnitude of the cation strength affecting the enzyme activity. In our study, indicating that the neurotransmission process of JSC be significant inhibition when the concentration of Ca2+ higher than 6.49 mmol L-1 and concentration of Mg2+ higher than 14.77 mmol L-1. Then the corresponding physiological processes of neuromodulation are inhibited. Obviously, this effect may be existed in both the higher Ca2+ (6.49–6.825 mmol⋅L-1) and Mg2+ concentration range (14.77–33.69 mmol⋅L-1) of target-ISW.The AChE is a hydrolase for the signal termination at cholinergic synapses by rapid hydrolysis of the neurotransmitter acetylcholine . AChE pa2+  Ca2+ concentration  and Mg2+ concentration (higher than 14.77 mmol L-1) affect metabolic immune enzymes; (2) function of haemocyte phagocytosis will be inhibited when the concentration of Ca2+ and Mg2+ in hemolymph sharply rise or fall in short period of time. Because adhesion and aggregation function be limited  and Mg2+ concentration  affect antibacterial enzyme activity. Therefore, this means that when the S. constricta is transplanted to the target-ISW, both the higher Ca2+ (6.49–6.825 mmol⋅L-1) and Mg2+ (14.77–33.69 mmol⋅L-1) concentration range may significantly enhances the metabolic immunity, but the cellular immunity (haemocyte) and bacterial immunity are weakened.Lysozyme is a typical immunoenzyme that specifically lyses bacteria . Usually2+ . In moll process . Howevertrations . In addi limited ; (3) Ca22+/Mg2+ ratio is often reported in shrimp and has important effects on survival, growth and physiology  levels increased by nearly 40%  and Mg2+ (14.77–33.69 mmol⋅L-1) had significantly impact on transplantation practice. In physiology, such effects include accelerated ionic regulation, accelerated metabolism, increased oxygen free radical production, increased metabolic immunity, decreased bacterial and cellular immunity, and inhibit neurotransmission process. The concentrations of Ca2+ and Mg2+ in the target-ISW does not cause all S. constricta to die in the short term, but it inhibits growth and causes a part of individual death during long-term aquaculture. Those implies that we have to choose the right concentration of Ca2+ and Mg2+ or to improve the water quality in target-ISW. Fortunately, the Ca2+ and Mg2+ content of most area target-ISWs is suitable for long-term transplantation of S. constricta. Our study also suggests that the increase in Ca2+ and Mg2+ ion concentrations caused by ocean acidification will not affect the survival, growth and physiology of S. constricta.Stress caused by changes in the concentration of CaAll datasets generated for this study are included in the manuscript and/or the supplementary files.In this study, the animals were artificially propagated as juvenile clams.MP was responsible for experimental design, test operations, data processing, and manuscript writing. ZL was responsible for data processing and manuscript modification. XL was responsible for experimental design. BY was responsible for test operations. TL was responsible for experimental data collection. JL, DN, and ZD were responsible for experimental program guidance.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


N = 980) asked participants to report on their amount of violent video game play and level of aggression as well as how they perceive their friends and examined the association between the participant's aggression and their friends’ amount of violent video game play. As hypothesized, friends’ amount of violent video game play at Time 1 was associated with the participant's aggression at Time 2 even when controlling for the impact of the participant's aggression at Time 1. Mediation analyses showed that friends’ aggression at Time 1 accounted for the impact of friends’ amount of violent video game play at Time 1 on the participant's aggression at Time 2. These findings suggest that increased aggression in video game players has an impact on the player's social network.Meta‐analyses have shown that violent video game play increases aggression in the player. The present research suggests that violent video game play also affects individuals with whom the player is connected. A longitudinal study ( In fact, a great number of studies have addressed the effects of exposure to violent video games  on aggression and aggression‐related variables. Meta‐analyses have shown that playing violent video games is associated with increased aggression in the player  proposed by Anderson & Bushman . Accordi1.2The relationship between violent video game play and aggression has been examined in studies employing cross‐sectional, longitudinal, and experimental designs. Cross‐sectional correlational studies typically show a positive relationship between the amount of violent video game play and aggression in real‐world contexts . Of these, 980 participants  completed the questionnaire at Time 2. Time 1 and Time 2 were 6 months apart. There were no data exclusions, and all participants were run before any analyses were performed. The questionnaire included some further questions  that are not relevant for the present purpose and are reported elsewhere  to 5 (very often), and scores were averaged. Participants were then asked about their amount of violent video game play, employing one item: “How often do you play violent video games ?” (1 = never to 7 = very often).Procedure and measures were very similar to Greitemeyer , with thAfterwards, participants learned that they will be asked questions about people they feel closest to. These may be friends, coworkers, neighbors, relatives. They should answer questions for three contacts with whom they talked about important matters in the last few months. For each friend, they reported the level of aggression (αs between = 0.90 and 0.91) and the amount of violent video game play, employing the same questions as for themselves. Responses to the three friends were then averaged. Finally, participants were thanked and asked what they thought this experiment was trying to study, but none noted the hypothesis that their friend's amount of violent video game play would affect their own level of aggression. At Time 2, the same questions were employed. Reliabilities for how participants perceived the level of aggression for each friend were between 0.89 and 0.90.3Descriptive statistics, intercorrelations, and internal consistencies of all measures are shown in Table 3.1The relationship between the amount of violent video game play and reported aggression was significant, both for the participant and the friends. That is, violent video game play was associated with increased aggression in the player and participants perceived their friends who play more violent video games to be more aggressive than their less‐playing friends. Participant's and friends’ amount of violent video game play as well as their level of reported aggression, respectively, were also positively associated, indicating that participants perceived their friends to be similar to them. Most importantly, participant's aggression was significantly associated with friends’ amount of violent video game play.SE = 0.02, t = 4.72, p < .001, 95% confidence interval [CI] = ). Participant's amount of violent video game play  and the interaction were also significant . At low levels of the participant's amount of violent video game play , friends’ amount of violent video game play was associated with the participant's aggression . At high levels of the participant's amount of violent video game play ( + 1 SD), friends’ amount of violent video game play was also associated with the participant's aggression , but the effect was less pronounced. Participants were thus most strongly affected by whether their social network plays violent video games when they do not play violent video games themselves , whereas age was .It was then examined whether friends’ amount of violent video game play is still associated with the participant's aggression when controlling for the participant's amount of violent video game play. Participant sex  and age were included as covariates. In fact, a bootstrapping analysis showed that the impact of friends’ amount of violent video game play remained significant  = 68.92, R2 = 0.26, p < .001. Most importantly, friends’ amount of violent video game play at Time 1 significantly predicted participant's aggression at Time 2, t = 2.60, β = .09, 95% CI = , p = .009. Participant's aggression showed high stability, t = 16.77, β = .48, 95% CI = , p < .001, whereas the participant's amount of violent video game play at Time 1 did not significantly predict the participant's aggression at Time 2, t = 1.77, β = −.07, 95% CI = , p = .077 , p = .038, whereas age did not, t = 1.93, β = −.06, 95% CI = , p = .054. The reverse effect that the participant's aggression at Time 1 predicts their friends’ amount of violent video game play at Time 2 when controlling for the participant's amount of violent video game play and friends’ amount of violent video game play at Time 1, as well as participant sex and age, was not significant, t = 0.67, β = .02, 95% CI = , p = .504.To examine the impact of friends’ amount of violent video game play on the participant's aggression over time, a cross‐lagged regression analysis was performed on the data. Participant's amount of violent video game play, friends’ amount of violent video game play, participant's aggression at Time 1, as well as participant sex and age were used as predictors for participant's aggression at Time 2. The overall regression was significant, 0.42, 0.5, p < .00SE = 0.04, t = 4.28, p < .001, 95% CI = ). Participant's aggression at Time 1 was also a significant predictor . Friends’ amount of violent video game play at Time 1  and participant's amount of violent video game play at Time 1  were not significant predictors. Participant sex significantly predicted the participant's aggression at Time 2 , whereas age did not . The indirect effect was significantly different from zero , suggesting that participants are more aggressive if their friends play violent video games for the reason that these friends are more aggressive. Figure Finally, it was examined whether the impact of friends’ amount of violent video game play at Time 1 on the participant's aggression at Time 2 would be mediated by friends’ level of aggression at Time 1 (while controlling for the participant's aggression and amount of violent video game play at Time 1 as well as participant sex and age). A bootstrapping analysis (with 5.000 iterations) showed that the impact of friends’ level of aggression at Time 1 on the participant's aggression at Time 2 was significant . Partic4not due to the friends being similar to the participants. Moreover, the reverse effect that aggressive people will become attracted to others who play violent video games was not reliable. The present research thus documents the directional effects that violent video games is associated with increased aggression in the player and that this increased aggression then has an impact on people with whom the player is connected.Violent video games have an impact on the player's aggression  and thus single studies that produce nonsignificant results are to be expected. Importantly, in the present study, a single‐item measure of violent video game play was employed. In contrast, previous research on the relationship between violent video game play and the player's aggression has often employed multi‐item measurement scales that are typically more reliable and precise  and assesses their aggression against new participants (partners). It can be expected that the partners suffer more aggression when the player had played a violent, compared to a nonviolent, video game. Afterwards, it could be tested whether the partner of a violent video game player is more aggressive than a partner of a nonviolent video game player. Given that the partner is not exposed to any video games, firm causal conclusions could be drawn that violent video game play affects aggression in people who are connected to violent video game players. It could be also tested whether the partner of a violent video game player would not only be more likely to retaliate against the player, but also against a third party. In fact, previous research into displaced aggression has shown that people may react aggressively against a target that is innocent of any wrongdoing after they have been provoked by another person  leads to greater acceptance of norms condoning aggression, which are known to be an antecedent of aggressive behavior (Huesmann & Guerra, how participants and their friends play violent video games. A recent survey (Lenhart, Smith, Anderson, Duggan, & Perrin, Another limitation of the present work is that it was not assessed To obtain high statistical power and thus to increase the probability to detect significant effects, data were collected via an online survey. The current sample was drawn from the MTurk population (for a review of the trend to rely on MTurk samples in social and personality psychology, see Anderson et al., In conclusion, violent video game play is not only associated with increased aggression in the player but also in the player's social network. In fact, increased aggression due to violent video game play appears to instigate further aggression in the player's social network. This study thus provides suggestive evidence that not only players of violent video games are more aggressive, but also individuals become more aggressive who do not play violent video games themselves but are connected to others who do play.


Congenital pouch colon (CPC) is a rare congenital abnormality associated with anorectal malformations with high incidence of complications and mortality. The aim of this study is to describe the various types of congenital colon pouch, their management aspects, complications of surgery, and the best management options.The incidence of congenital pouch colon in the present study was 5.3% (18 patients) of all anorectal malformations. Sixteen cases (88.8%) were males and 2 cases (12.5%) were females, (M: F ratio was 8:1). The age of presentation was ranged from 1day to 1year; 17 cases were presented in first week of life. Preoperative diagnosis of congenital pouch colon was done in 7 patients. As an initial procedure tabularization of the pouch with end colostomy was done in 15 cases, window colostomy was done in 2 cases, and excision of the pouch and proximal ileostomy was done in one patient. As a definitive procedure, abdomino-perineal pull-through of the tabularized pouch was done in 15 cases, ileo-anal anastomosis after pouch excision was done in 3 cases.Pouch tabularization and end colostomy had better outcome than other types of interventions. Abdomino-perineal pull through of the tabularized pouch was the definitive surgical procedure for treatment of complete pouch colon in our study. •Congenital pouch colon is a rare disease that requires early diagnosis and treatment.•Window colostomy at the pouch is better to be avoided due to high incidence of complications.•Pouch tabularization and end colostomy has better outcome than other types of interventions. Female patients may present with passage of the meconium from abnormal opening in the perineum or cloaca, such group of patients usually present later .Most cases can be diagnosed with an erect skiagram and the conventional invertogram done for patients with anorectal anomalies.Plain abdominal X-ray may be valuable to determine the type of the of the pouch alleviating the need for the invertogram ,9.The work of this case series has been reported in line with the PROCESS 2018 criteria .2registry.com in the 24th of April 2019, the registration number is 4829, ethical approval was gained also from the Duhok Directorate General of Health at the 12th of March 2019 with reference number 12032019-2.This article had been registered in accordance with the declaration of Helsinki at the Research This is a case series which is a retrospective study included cases of complete congenital pouch colon. The study is a single center experience conducted in Duhok pediatric surgery center in Heevi Pediatrics Teaching Hospital, College of Medicine, University of Duhok, Duhok city, Kurdistan region, north of Iraq.Data collected in the period between the 14th of August 2014 to the 1st of March 2017. During this period 18 consecutive cases with congenital pouch colon who presented to the hospital were included in this study, the majority of them were among the refugees of the camps.The participants were from the pediatric age group presented with CPC malformation, many of them had other associated congenital anomalies such as congenital heart diseases, urogenital malformations and other various congenital malformations.At admission the initial management consisted of placing the patient in the incubator to treat hypothermia, correction of fluid and electrolyte disturbances, decompression of the stomach and bowels through nasogastric tube, administration of 0.1 mg/kg vitamin K as a single dose intravenously, and intravenous antibiotics.Abdominal and the perineal examinations performed by a pediatric surgeon to detect the site of fistula and abnormalities of the sacrum and the perineal muscles. General examination was performed to exclude other associated congenital malformations. Plain skiagram of abdomen and invertogram were the initial and sole investigations which were done for 15 cases. Ultrasonography of abdomen and pelvis were also done in 15 cases and echocardiography in 12 cases.The surgical procedures were divided into primary surgical procedure which was done as an emergency surgery and definitive surgical procedure which was done to reconstruct the bowel continuity and manage any associated fistula. During the primary surgical procedure careful intraoperative evaluation was done to define the anatomical abnormalities. The definitive surgical procedure was done between the fifth to the sixteenth months of age.All the operations were performed by a specialist pediatric surgeon with a surgical experience in dealing with congenital colorectal malformations for the last 10 years.Regular follow up was done for 14 cases for one year to assess the postoperative outcome and to diagnose any postoperative complication. The weight of the patient and fecal continence were evaluated at each follow up visit.3The incidence of congenital pouch colon in the present study was 5.3% (18 patients) of all anorectal malformations. A total number of 18 cases were included in this case series. Sixteen cases (88.8%) were males and 2 cases (12.5%) were females, (M: F ratio was 8:1). The age of presentation was ranged from 1day to 1year; 17 cases were presented in first week of life. Ten cases had absent normal colon and the terminal ileum was opened into the abnormal colonic pouch and the majority of them presented with a good general condition because they presented early less than 24 h from delivery due to acute presentation except one female who presented at the age of one year. All the male cases had an absent anal opening and were presented with abdominal distention, 12 of them had history of passing of meconium in urine, whereas the female cases (2 cases) one of them was presented with the passage of meconium from a vestibular fistula and the other one from a single perineal opening (cloaca). Two cases were preterm.The prenatal history in 11 cases showed that the mother has history of genitourinary tract infections and 10 of them had history of drug ingestion, the family history was positive for the same condition in only one case. Abdominal X-ray showed a large air fluid level in 5 cases (27.7%), multiple air fluid levels in 4 cases (22.2%), free air in the peritoneal cavity in 2 cases (11.1%), double bubble appearance in one case and was not significant in the remaining. In 15 cases there was a fistula which was connected to the urinary system and in the remaining 3 cases the pouch was ending blindly or attached to the urinary bladder by fibrous band. The external anal sphincter and muscle complex were well formed in most cases, while in those with high type anorectal malformation the anal sphincter was poorly developed. The primary surgical procedure consisted of pouch tabularization and end colostomy which was done for 15 (83.3%) cases, while the most common definitive surgical procedure was abdomino-perineal pull through of the tabularized pouch. During surgery tabularization of the pouch with end colostomy after ligation of fistula with the urinary bladder was performed in 15 cases, window colostomy was done in 2 cases who had bowel perforation, and ileostomy was done for one case after excision of pouch. In cases of wide fistula, the pouch had thick wall and tabularization was easier than cases with absent or narrow fistula where the pouch had a very thin wall and was easily perforated. The inferior mesenteric artery was absent in all the cases and the pouch was supplied by a single branch from the superior mesenteric artery. Early postoperative complications included stoma related complications in 12 cases, urinary tract infection in 3 cases and wound infection in 2 cases. Late complications included failure to thrive, anal stenosis, fecal incontinence, and other complications. Histopathology reported the presence of mature ganglion cells, hypertrophied nerve bundles and giant cells (more than 6 nuclei). In all cases the muscle coats were not differentiated to inner circular and outer longitudinal but instead they were arranged in a decussating pattern, the mucosa and submucosa were normal.During clinical follow up three cases died, from pneumonia due to associated duodenal atresia, cyanotic congenital heart disease, and ileostomy retraction and intra-abdominal sepsis.4This condition was first described in 1912 by Spriggs in London Hospital Museum. Later and in 1959, Trusler described the condition clinically. Many criteria should be present to diagnose CPC such as the presence of anorectal agenesis, short total colonic length, colonic pouch of variable length, abnormal blood supply of the pouch, thick wall and muscular colonic wall, fistula between the colon and the genitourinary tract, and the absence of transitional zone between the normal and abnormal colonic segments .The pathogenesis of this rare anomaly is not yet well understood but theories suggest that distal obstruction from any cause may be the most important cause, other authors suggest an early vascular insult from obliterated inferior mesenteric artery which leads to failure of the hindgut development which may be the cause of this condition. Many other factors have been found to be associated with the development of this condition such as environmental factors, genetic and dietary factors like iodine and vitamin B12 deficiency. About 90% of the cases are reported from India but recently there is increasing awareness about this rare anomaly and some cases are now reported from other parts of the world .The most accepted and widely used classification system of CPC is that based on the length of the normal colon that is present proximal to the abnormal segment. In this classification 4 types can be described, type I: normal colon is not present and the terminal ileum opens into the abnormal colon pouch, type II: the terminal ileum opens to the cecum which in turn opens to the colonic pouch, type III: there is a significant normal colonic segment between the ileum and the colonic pouch, and type IV: the colon is almost normal and the pouch involves the sigmoid and the rectum. Some authors describe a 5th type which is extremely rare and only few cases had been reported which consists of 2 colonic pouches with an intervening normal colonic segment ,15.The aim of surgery is to preserve the ileocecal valve when possible, preserve as much possible of colon by tabularizing the pouch, and to provide a continent anal opening. The treatment options are excision in the incomplete types and coloplasty in complete types of CPC. Colostomy when done is usually part of the primary procedure. The surgery can be done laparoscopically successfully ,16,17.The most important step in the management is proper resuscitation, bowel decompression, correction of fluid and electrolytes abnormalities, prevention of hypothermia, antibiotics, and vitamin K administration .We did pouch tabularization and end colostomy in the majority of our cases (15 cases), while window colostomy was done for 2 cases only. Complete excision of the pouch with end colostomy is the procedure of choice when possible, but many surgeons do window colostomy which is very simple and may be appropriate in emergency and critical presentations .In most of the cases the histopathological examination shows non-organized muscle layers with normal ganglion cell in the bowel wall, the presence of abnormal ganglion cells will mandates complete excision of the pouch, but many surgeons do not perform biopsy during the primary surgical procedure such as colostomy ,11.Early post-operative care is aimed at preventing stenosis of the new formed anus by the mean of regular dilatation, making the stool soft and preventing perineal skin excoriation .In most of our patients there were colostomy related complications such as skin excoriation in 12 of them, colostomy prolapse in 2 cases, ileostomy retraction and intra-abdominal sepsis and the patient died from this event. Most authors document that stoma related complications with urinary tract infections are the most common complications ,18.Other complications may include stenosis of the anus, mucosal prolapse, dilatation of the retained pouch with fecal overloading, psychological and sexual problems .Three of our patients died from different causes, the mortality and the overall prognosis depends on the weight and the general condition of the patients at presentation, and the presence or absence of other congenital anomalies. Sacral agenesis, bilateral vesicoureteric reflux and cyanotic congenital heart diseases were the most common associated congenital anomalies. The mortality rate may reach 10–15% after surgical intervention ,20.All authors agree in that there is no primary single procedure for CPC and the staged procedure is tailored for individual patients, patients may have variable associated congenital malformation. Patients presenting with peritonitis, longer and more complex malformations, and patients with cardiac malformations have poor outcomes .The long term outcomes of the CPC appear to be dismal regardless the type of the surgical intervention that has been done, even if the sacrum is normal and the anorectal muscles are well developed .5The present article is focusing on the high incidence of complications and the possible mortality with ileostomy and colostomy in treating patients with congenital pouch colon at the first operation. Pouch tabularization and end colostomy has better outcome than other types of interventions as a primary procedure. Abdomino-perineal pull through of the tabularized pouch is the best definitive surgical procedure for treatment of complete pouch colon.Future studies should focus on the possible prenatal diagnosis and larger number of patients should be included from different geographical areas, prenatal diagnosis when possible allow earlier intervention and possible better outcomes.No conflict of interest present.There is no source of funding other than the authors.Not commissioned externally peer reviewed.Ethical approval was gained from the Duhok Directorate General of Health at the 12th of March 2019 with a reference number 12032019-2.Study design: Dr Ayad Ahmad Mohammed.Data collections: Dr Qadir Mohammed Salih Qadir.Data analysis: Dr Qadir Mohammed Salih Qadir and Dr Ayad Ahmad Mohammed.Writing: Dr Qadir Mohammed Salih Qadir and Dr Ayad Ahmad Mohammed.Final approval of the manuscript: Dr Qadir Mohammed Salih Qadir and Dr Ayad Ahmad Mohammed.4829 Research registry, at 24/4/2019.N/A.Dr Ayad Ahmad Mohammed.


Emerging adulthood, the transitional period between high school and young adulthood, is marked by the formation of identity, the establishment of more mature interpersonal and intimate relationships, and the transition to new adult-type roles. It also is a time of increased alcohol use and abuse, which can have long-term effects on both physical and psychological well-being and may have implications for the attainment of traditional adult roles. Gender, race/ethnicity, marital status, college, employment, peer and family influences, individual temperament, and attitudes about drinking all influence drinking behavior in this population. Attending college may represent a special risk to emerging adults, as increases in alcohol availability and acceptance of drinking on college campuses may lead to increases in heavy drinking among students. The nonstudent population of emerging adults also is an important target for preventive interventions, especially because people in this segment of the population may be less likely to mature out of heavy drinking patterns established during adolescence. Thus, the transition from high school to young adulthood appears to be an ideal developmental turning point during which to target interventions. It concludes with a discussion of the implications of this research for prevention.Numerous historical changes have caused emerging adulthood to become a distinct period in the life course in industrialized countries. One major contributor is the fact that people are waiting longer before marrying. In the United States, the median age of marriage increased from 20 for women and 22 for men in 1950 to 25 for women and 27 for men in 2000 . SeveralEmerging adulthood is marked by a variety of developmental tasks, including identity formation and the establishment of more mature interpersonal and intimate relationships . During Emerging adulthood often is characterized by changes in residence, employment or education, and romantic relationships. It is a time of identity exploration and self-focus; initiation of new roles; development of new social networks; separation from families and old friends; increased choices and opportunities; increased independence; freedom from time constraints and social control; and decreased parental support, guidance, and monitoring .Many people begin to use alcohol before they graduate from high school. However, peak use of alcohol occurs during emerging adulthood, and this excessive drinking appears to be normative behavior. In North America and many other industrialized societies, bingeAmong people ages 21–22, 85 percent of men and 76 percent of women have used alcohol within the last 30 days .55 percent of men ages 21–22 and 33 percent of women ages 19–20 drank five or more drinks in a row in the past 2 weeks .People ages 18–29 have the highest rates of past-year alcohol abuse and dependence .Drinking during emerging adulthood can serve positive functions, such as facilitating friendship formation, but people also experience high rates of alcohol-related problems during this period. For example, people ages 18 to 29 have the highest rates of past-year alcohol abuse and dependence . AlcoholThe transition out of high school may be marked by increases in alcohol use and intoxication . Even meMost emerging adults will outgrow heavy drinking and related problems before adulthood, on their own and without treatment .  .Rates of alcohol dependence were lower for college students than for 18- to 24-year-olds in the general population .College students reported lower rates of heavy drinking while in high school than nonstudents, but increased their use in college to higher levels than nonstudents .Differences in drinking between college students and nonstudents were fully accounted for by background characteristics and living arrangements .EmploymentFull-time civilian employment after high school was related to slight increases in drinking within the past 30 days and to slight decreases in heavy drinking .Joining the military after high school was associated with greater than average increases in current drinking and heavy drinking .Unemployed men, but not women, significantly reduced their drinking .Homemakers reduced their current and heavy drinking, but this change can be accounted for by their marital and parental status rather than by the homemaker role .Sociodemographic characteristics—including gender, race/ethnicity, marital status, parenthood, college status, and employment—all influence drinking patterns among emerging adults, as discussed in the following sections.Research consistently shows that most indexes of alcohol use, and especially heavy drinking, are higher among males than females . Of the Racial and ethnic differences in drinking and related problems have been documented in the literature. In general, White and Native American emerging adults drink more than African Americans and Asians, and drinking rates for Hispanics fall in the middle. In addition, in contrast to the peak in drinking among Whites around ages 19–22, heavy drinking among African Americans and Hispanics peaks later and persists longer into adulthood . CaetanoBeing a parent also was related to reductions in alcohol use for both men and women, although a large part of this effect was simply a result of getting married. Most women who became pregnant eliminated their alcohol use, although most of their husbands did not .Some argue that the college campus environment itself encourages heavy drinking . AlcoholAlthough much of the research targeting emerging adulthood has focused on college students, several studies have noted that heavy drinking and related problems are pervasive among people in their early twenties, regardless of college attendance . CompariIn contrast, figures 1Many psychological and social factors influence alcohol use among emerging adults. As described in this section, these factors have been studied most often in college students.One of the most consistent predictors of substance use among adolescents and emerging adults is sensation-seeking, defined as the pursuit of novel and intense experiences . In factOptimism is an almost universal trait among emerging adults . BecauseThe findings regarding the association between negative mood and problematic alcohol use during emerging adulthood have been inconsistent . Most stResearch has suggested that some people drink to regulate emotional distress. In support of this, Positive expectancies about alcohol’s effects play a key role in the drinking behavior of emerging adults. With age, adolescents increasingly expect benefits from drinking and become less convinced of the risks . HoweverExpectancies appear to predict both drinking initiation in adolescence and maintenance of drinking throughout young adulthood. There has been less evidence that expectancies predict drinking problems across adolescence and young adulthood . As withPeople entering college or the workforce may be especially vulnerable to the influence of peers because of their need to make new friendships. They may increase their drinking to facilitate peer interactions. Although all these influences affect drinking behavior, one of the strongest correlates of drinking among emerging adults, and the subject of the most research on this topic, is perceived norms . Many coDuring emerging adulthood, parental monitoring decreases, and parents therefore have less influence on drinking patterns than do peers. Nevertheless, young people’s relationships with their parents continue to play a major protective role in development during this stage of the life cycle . ParentaIn addition, alcohol problems tend to aggregate in families . This faIn sum, during the transition from adolescence to young adulthood, many people initially increase, and then decrease, their alcohol use. For the most part, the key factors that influence drinking in emerging adulthood are similar to those which influence adolescent drinking, although peer influence becomes increasingly more important than parental influence as the child ages, as do freedom from social control and stress related to attaining adult roles. Thus, moving out of the constraints of high school and away from parents makes emerging adulthood a stage of the life cycle in which people are at high risk for heavy drinking and alcohol-related problems. Maladaptive drinking behavior, in turn, may delay the accomplishment of developmental milestones, creating a self-defeating cycle for some. More research is needed about the intermediate and long-term effects of alcohol use during emerging adulthood, as well as the intrapersonal factors that facilitate or impede maturation out of heavy drinking.Because some emerging adults will maintain or increase their problematic alcohol use over time rather than mature out of heavy drinking and related problems , it is iSeveral studies indicate that the nonstudent population of emerging adults is an important target for preventive interventions, especially because people in this segment of the population may be less likely to mature out of heavy drinking patterns established during adolescence . Nonstud


The origin and prevalence of near-death experiences are unknown. A recent study suggested a link with REM sleep intrusion but was criticized for its selection of control participants. We therefore assessed the association of REM intrusion and near-death experiences with different methods.Using a crowd-sourcing platform, we recruited 1,034 lay people from 35 countries to investigate the prevalence of near-death experiences and self-reported REM sleep intrusion. Reports were validated using the Greyson Near-Death Experiences Scale (GNDES) with ≥7 points as cut-off for near-death experiences.n = 50∕106; 47%) than in people with experiences with 6 points or less on the GNDES  or in those without such experiences . Following multivariate regression analysis to adjust for age, gender, place of residence, employment and perceived danger, this association remained highly significant; people with REM intrusion were more likely to exhibit near-death experiences than those without .Near-death experiences were reported by 106 of 1,034 participants . Evidence of REM intrusion was more common in people with near-death experiences (Using a crowd-sourcing approach, we found a prevalence of near-death experiences of 10%. While age, gender, place of residence, employment status and perceived threat do not seem to influence the prevalence of near-death experiences, we confirmed a possible association with REM sleep intrusion. Near-death experiences can be defined as conscious perceptual experiences, including emotional, self-related, spiritual and mystical experiences, occurring in a person close to death or in situations of imminent physical or emotional threat . ReportsNear-death experiences share phenotypical features with those made during rapid eye movement (REM) sleep  Nelson . REM sleIn a recent case-control study, people with near-death experiences reported significantly more often REM intrusion than age- and sex-matched controls, and the authors suggested that REM sleep intrusion might contribute to near-death experiences . HoweverWe therefore examined the association between REM sleep intrusion and near-death experiences using a different approach. We recruited a large multinational sample of unprimed lay people from a crowdsourcing platform (without any other selection criteria than English language and age ≥18 years) to estimate the prevalence of near-death experiences and to test the hypothesis that near-death experiences are associated with a propensity for REM sleep intrusion.The objectives of this study were two-fold. •Primary objective: To estimate the frequency of near-death experiences and REM sleep intrusions reported in a large sample of adult humans collected from an online crowdsourcing service. •Secondary objective: To test the hypothesis that people who report a near-death experience have a greater frequency of REM sleep intrusions.https://prolific.ac/), was used to recruit a large global sample of lay people. Prolific Academic is a crowdsourcing online platform to recruit human subjects for research that compares favorably in terms of honesty and diversity of participants and data quality , a confidence level of 95% and a margin of error of 5%. However, as previous studies have estimated that 4–8% of the population have had a near-death experience , we deciData were analyzed using R . Categorhttps://osf.io/ykr3g).To prevent HARKing (Hypothesizing After the Results are Known) , we pre-ethical rewards principle (≥ $6.50/h). The Ethics Committee of the Capital Region of Denmark waives approval for online surveys (section 14 (1) of the Committee Act. 2; http://www.nvk.dk/english).Participants gave consent for publication of their (anonymous) data. Participation was anonymous, voluntary and restricted to those ≥18 years. Participants received a monetary reward upon completion of the survey, following the platform’s https://osf.io/ykr3g).All de-identified raw data are provided in the We recruited 1,034 lay people from 35 countries , most of which were residing in Europe and North America. Two-hundred eighty-nine participants  claimed to have had a near-death experience, 106 of which reached the threshold of 7 points or more on the GNDES . Thus, confirmed near-death experiences were reported by 106/1,034 participants  .n = 158; 55%) than not truly life-threatening , and this was irrespective of whether their experience met criteria for a near-death experience according to the GNDES or not , near-drowning 19% (n = 56); intense grief or anxiety 18% (n = 51), substance abuse 11% (n = 33); psychological distress without organic disease 9.7% (n = 28); physical violence other than combat 8.3% (n = 24), critical illness 8.0% (n = 23); childbirth complication 8.0% (n = 23); suicide attempt 6.9% (n = 20); anesthesia/medical procedure 6.9% (n = 20); cardiac arrest/heart attack 5.5% (n = 16); meditation or prayer 5.2% (n = 15); anaphylactic reaction 4.8% (n = 14); combat situation 3.8% (n = 11); syncope 1.7% (n = 5); epileptic seizure 1.4% (n = 4); and other 19% (n = 56).Near-death experiences and experiences with ≤ 6 points on the GNDES occurred in the following situations, listed with decreasing frequency: motor accident 27% ; exceptional vivid senses ; and feeling separated from one’s body, including out-of-body experiences .The most often reported symptoms were abnormal time perception ; exceptional speed of thoughts  than experiences that did not ; and some even claimed to have had more than three .Around one third of participants reporting a near-death experience or near-death-like experience stated having had two or three such experiences  than in people with experiences below this threshold  or in those without any such experience  was much more common in people with experiences above the cut-off point of the GNDES . This estimate is slightly higher than what was reported in previous studies using traditional interview-based surveys in Australia (8%)  and Germp < 0.0001), almost half of all near-death experiences were labelled as stressful. It should be noted that . This finding corroborates and extends data from the previous study by Nelson and co-workers, in which the life-time prevalence of REM sleep intrusion in 55 humans with near-death experiences was compared with that in age- and sex-matched controls (Our central finding is that we confirmed a possible association of near-death experiences with REM sleep intrusion. Following multivariate analysis, REM sleep intrusion was the only factor that remained significantly correlated with near-death experiences (and indeed very much so: controls . Sleep-rcontrols . Indeed,controls .The anonymous nature of our online survey enabled us to avoid the selection bias that was a major point of criticism  of the NDespite the advantages outlined above, online studies have limitations that should be acknowledged . First, In our study, the prevalence of near-death experiences was around 10%. Using a large intercontinental sample of lay people assessed by crowd-sourcing methods, we replicated findings from an earlier case-control study suggesting an association of near-death experiences with REM sleep intrusion . Thus, w10.7717/peerj.7585/supp-1Data S1Click here for additional data file.


In this paper, we report a novel nanoscale wrinkle-structure fabrication process using fluorocarbon plasma on poly(dimethylsiloxane) (PDMS) and Solaris membranes. Wrinkles with wavelengths of hundreds of nanometers were obtained on these two materials, showing that the fabrication process was universally applicable. By varying the plasma-treating time, the wavelength of the wrinkle structure could be controlled. Highly transparent membranes with wrinkle patterns were obtained when the plasma-treating time was <125 s. The transmittances of these membranes were >90% in the visible region, making it difficult to distinguish them from a flat membrane. The deposited fluorocarbon polymer also dramatically reduced the surface energy, which allowed us to replicate the wrinkle pattern with high precision onto other membranes without any surfactant coating. The combined advantages of high electron affinity and high transparency enabled the fabricated membrane to improve the performance of a triboelectric nanogenerator. This nanoscale, single-step, and universal wrinkle-pattern fabrication process, with the functionality of high transparency and ultra-low surface energy, shows an attractive potential for future applications in micro- and nanodevices, especially in transparent energy harvesters. The fabrication process for these patterns has been traditionally realized by photolithography, printing processes, embossing, or writing techniques, of which the relatively high cost and low throughput limit their application for producing complex topologies over large areas. Thereby, self-assembled patterns for large-area patterning, which generally employ physical–chemical or mechanical instabilities within a constrained system to form highly ordered structures, have attracted great attention for many years2–7. Among these methods, mechanically inducing a wrinkle structure on a bilayer system is especially suited to creating highly ordered microstructures across a large surface and features convenient fabrication and a tunable wavelength by adjusting the thickness of the stiff layer and the pre-strain8–12. As a result, wrinkle structures have been used in various applications, such as smart adhesion, liquid/cell shaping, particle assembly, optical surfaces, flexible electronic devices, and energy harvesters13–20. To date, most studies involving wrinkling to create ordered structures rely on plasma or ultraviolet-ozonolysis (UVO) oxidation and metal deposition to create the stiff skin. Although these approaches are quite practical, the material properties of the substrate during oxidation can significantly alter the typical morphologies and even block the formation of the wrinkle structure , whereas the deposition of the metal layer would greatly decrease the transparency of the substrate22. All of these drawbacks limit the practical application of this method in specific occasions that require high transparency and other materials. Alternatively, replica molding (REM) is an efficient and simple method for the duplication of the information  present in the surface of a mold24. The wrinkle-fabrication process can be further simplified and the cost can be reduced by using a fabricated wrinkle mold to duplicate a wrinkle pattern via REM. However, the replication mold needs a low surface energy to avoid adhesion, and the oxygen plasma and UVO oxidation method can increase the surface energy. Surface energy can be decreased by some surfactant coatings; however, these coatings unfortunately will pollute the surface and reduce the precision of the replication. Both reasons make it inconvenient to use the oxygen plasma and UVO method in the fabrication of wrinkle molds.Patterned surface structures on the nano- or micrometer scale have a significant role in the properties of a material, including physical, mechanical, electrical, and optical25–30. In addition, transparent TENGs using indium tin oxide (ITO) or graphene as electrodes have been achieved, which enable applications that require high transparency such as touch screens31–35. Our previous work shows that using C4F8 to treat uncured PDMS could deposit fluorocarbon polymer and a wrinkle structure in single step18–20, which had the advantage of significantly increasing the performance of the flexible TENG. This enhancement was attributed to the roughness of the wrinkle pattern and high electron affinity of the fluorocarbon polymer37. However, the wrinkle structure was large  and disordered, which decreased the transparency of the membrane and restricted its application for applications requiring nanoscale and regular structures. Although using a flat surface could provide the highest transparency, the performance of the TENGs will be weakened to some degree38. Notably, previous work reported that a PDMS surface with nanopattern sizes <310 nm could result in high transmittances (above 85%) owing to an effective graded refractive index profile33. Using a structure of several hundred nanometers provides us with an effective way to realize high-performance and highly transparent TENGs.Energy-harvesting technology that uses the coupling effects of contact-electrification and electrostatic induction, called a triboelectric nanogenerator (TENG), has been considered a promising alternative for renewable and green energy applications, such as self-powered electronic devices, touch sensors, and artificial skins, due to its advantages of high output power, scalability, simple design, and cost-effective fabricationWe propose a novel wrinkle-structure fabrication process by depositing fluorocarbon plasma on pre-stretching substrates. This method possesses three advantages over previous works. First, using the fluorocarbon plasma to deposit fluorocarbon polymer as the stiff layer is universally applicable and capable of fabricating wrinkle patterns on more materials compared with the oxidation process. The highly desirable property of transparency of the fluorocarbon polymer does not affect the transmittance of the substrate compared with the metal deposition. Second, a wrinkle structure with wavelength of <200 nm is obtained through this process, which makes the transmittance of the patterned membrane in the visible region almost indistinguishable from a flat substrate. Third, the ultra-low energy of the fluorocarbon polymer on the substrate stabilizes the surface, which enables the patterned substrate to serve as a mold to efficiently transfer the wrinkle structure to another membrane without requiring surfactant. Due to these features, the processed membranes are assembled to form TENGs, and a significant improvement is achieved compared with the flat membrane, without reducing the transmittance of the whole device.w/w) and degassed for 30 min to remove the interface bubbles. Subsequently, the samples were heated at a high temperature of 70 °C for 1 h to cure the liquid PDMS and Solaris into solid PDMS and Solaris membranes, respectively. The thickness of these two types membranes were both controlled at ~1 mm. The fabrication diagram for the wrinkle structure is shown in 4F8 (>). The platen power and coil power were controlled to be 0 and 200 W, respectively. The pressure was set at 3 Pa and, the inlet flow rate was fixed at 40 sccm, although the plasma-treating time was varied from the 30 to 500 s to change the thickness of the fluorocarbon polymer. Finally, the sample was removed from the oven, and the strain was carefully released to form the regular wrinkle structure, as illustrated in >.The elastomer and cross-linker of PDMS  and Solaris  were each thoroughly mixed in a 10:1 ratio  in PeakForce mode, which is a featured mode of Bruker Corp. that could provide the highest resolution. Then, the results were analyzed by Nanoscope Analysis 1.5 software . The transmittance of the samples was measured using UV–vis spectroscopy with a UV-3600 spectrophotometer . The output voltage of the TENG was measured via a digital oscilloscope  using a 100 MΩ probe , and the current was amplified by a SR570 low-noise current amplifier . The upper surface of the TENG was fixed. Then, a sinusoidal signal with an amplitude of 1.5 V was generated from the signal-source module of the oscilloscope and amplified by an amplifier  to power the modal shaker , which provided a periodic and stable external force to the device.4F8  along a certain profile. Rz is defined by:yip is the number i highest peak along the profile, and yiv is the number i lowest valley along the profile. The Rz increased linearly with the plasma-treating time. Meanwhile, the AFM images of wrinkle patterns under 250, 120, and 60 s plasma-treating times indicated that the defects on the wrinkle structure obviously decreased when increasing the plasma-treating time. This can be attributed to the insufficient thickness and partial coverage of the fluorocarbon polymer at a shorter treating time, as reported by our previous work18.In addition to the property of the substrate, the R2 of ~0.97. With a larger Young’s modulus, the wavelength of the Solaris substrate under the same plasma-treating time was smaller compared with those of the PDMS substrate. The smallest wavelength, ~0.13 μm, was observed at the 30 s plasma treatment time. The Rz also increased linearly with the plasma-treating time. In addition, although more defects were observed at a shorter plasma-treating time, as shown in the AFM images in This wrinkle-structure fabrication method could easily accomplish pattern wavelengths of hundreds of nanometers, which made it possible to provide excellent transmittance to the substrate. Ra dropped slightly from 30.1 to 26.7 nm. The Ra here can be defined by:yj is the absolute values of the surface height deviations of point j within the image measured from the mean plane and N is the total number of points within the image. In addition to the high transparency enabled by the nanoscale wrinkle, another meaningful advantage of this method is the ultra-low surface energy of the fluorocarbon polymer on the surface, which makes it possible to use the fabricated wrinkle pattern as a transfer mold. To demonstrate this capability, we used the patterned PDMS/Solaris membrane to fabricate another membrane with inverse structure, as diagramed in 4F8 plasma-treated wrinkle PDMS increased from 128 V and 4.6 μA to 191 V and 10.7 μA, an increase of 50 and 132%, respectively. Similarly, the output voltage and current of the TENG using C4F8 plasma-treated wrinkle Solaris were 181 V and 9.1 μA, which were improved of 24 and 128%, respectively, compared with the TENG using flat Solaris, as shown in 4F8 plasma-treated flat PDMS in 4F8 plasma-treated flat Solaris in 4F8 plasma-treated wrinkle-patterned samples. In addition, the results also demonstrated that the combination of the high electron affinity fluorocarbon polymer and wrinkle pattern makes the fabrication process of the wrinkle pattern an effective and powerful method for the improvement of transparent TENG performance.To demonstrate the superiority of this wrinkle pattern in the application of transparent devices, the fabricated PDMS and Solaris membranes were laminated with commercial PET/ITO films and formed into a TENG with another PET/ITO film, as diagramed in In this work, we present a nanoscale fabrication process for wrinkle patterns and investigate its advantages systematically. The key feature of the nanoscale wrinkle-fabrication process is the use of a single-step fluorocarbon plasma treatment, which allows us to fabricate wrinkle patterns on different materials. By varying the plasma-treating time, we successfully obtained wrinkle patterns with a wavelength as small as 130 nm. After adjusting the plasma-treating time to control the wrinkle pattern, highly transparent wrinkle patterns were fabricated on PDMS and Solaris membranes, which proved the universality of the method. In addition, the deposition of fluorocarbon polymer effectively reduced the surface energy of the wrinkle pattern, making it applicable as a mold to more efficiently fabricate wrinkle patterns by replica molding. As a demonstration, we used it to form a highly transparent TENG with improved electric performance. This sing-step process to fabricate nanoscale wrinkle structures is universal applicable, low-cost, large-scale, controllable, and replicable, which leads to a strong potential for applications in flexible and transparent devices.