The right cerebral hemisphere plays a crucial rule in spatial cognition, spanning from perception of elementary features, such as location, color, line orientation or shape to representation of different spaces . One important aspect of its contribution concerns the perception of space symmetry and the representation of objects and scenes, with reference to the midline or body axis. This representation results from a balance between spatial attention processes depending from the two hemispheres. Healthy participants tend to show a discrete deviation of the midline plane representation toward the left side, that is likely to result from the predominance of the activity of the right cerebral hemisphere, mainly oriented toward the contralateral side of space. The visuospatial abilities of the right hemisphere, especially for the representation of the midline plane are crucially engaged in painting and drawing processes in artists. Interestingly, the distortions created by painters of the Cubism period, characterized by an asymmetry of objects and body representations, a specific enlargement or reduction of parts of space, or even by complex distortions of 3D space are analogous to those classically reported in right-brain-damaged patients . Understanding the pathological mechanisms of these representation disorders provides meaningful information to apprehend visual artist creations and esthetic perception of space. In the same way, when looking at an oil-painting of the Fontainebleau forest made by a French painter of the Barbizon school, Camille Corot (1796/1875), in the same era, we could name and identify the different space parts of the image . This distinction between two types of explicit space representation for perception – verbal and visuospatial – is also relevant for the clinical description of cognitive deficits due to focal damage of the brain, especially following a damage of the right hemisphere, where different deficits could be described. These deficits are evidenced in tasks of drawing from memory or by copy. They may be omissions, additions or distortions of parts of the object or the entire object.One popular distinction for the internal representations of the surrounding world in humans is between verbal and visuo-spatial dimensions  and the midline axis . These dFigures 3). The disorder remained unchanged when patients were asked to draw in a blindfold condition  can be characterized by a systematic enlargement of the left-hand side of objects drawn from memory and by copy. This much infrequent deficit is observed in right-brain-damaged patients, regardless of the presence of the unilateral neglect syndrome, and has been termed “hyperschematia” . In a prondition . Hyperscondition . PatientFigure 4).Importantly, when patients were asked to perform an estimation of the two horizontal length of two rectangles, by perceptual matching, the comparison of the performances of seven patients with left hyperschematia and controls revealed only a trend toward significance. However, the analysis of the individual scores of patients indicates that only four out of the seven patients showed a rightward overestimation; two patients performed as the control group of neurologically unimpaired participants, and one patient presented with an opposite pattern, namely a leftward overestimation. A disorder of perceptual estimation of lateral extent cannot account for hyperschematia in drawing, being possibly instead an associated deficit with no direct causal relationships with hyperschematia. Conversely, when patients were asked to reproduce the length of a horizontal segment (line extension task), the comparison of the performances of seven patients and controls showed a significant overextension in leftward line extension, while rightward line extension was within the normal range  are required. Moreover they suggest that this non modality-specific distortion of space representation could be due to a lateral anisometry of the internal representation of space, namely: the spatial medium with a leftward relaxation , 2008. TMore generally, a disproportionate enlargement of space representation may also affect bodily space. The first description was provided by the French otolaryngologist Pierre The visuospatial abilities of the right hemisphere, especially those dedicated to the representation of size (and volume) and the midline plane, are crucially involved in painting and drawing processes in artists. Many artists have been interested in the perception and representation of space from the Renaissance to modern times. At the beginning of the twentieth century (1907), Georges Braque and Pablo Picasso created a new artistic movement “Cubism,” which proposed a new approach to the perception and representation of space. Cubism was a revolution in painting and sculpture, and also influenced architecture, literature and music. Their goal was to deconstruct the Euclidean space and to materialize new alternative representations. This new space of cubists was characterized by a substitution of the frozen perspective of classical painters by a moving perspective. The discovery of cubists has been to show all objects from all sides at once, i.e. merging several viewpoints .Figure 6A). These asymmetries of size and volume contribute to creating distortions in the representation of space and object, and thus materialize a new space in Braque’s own words: ‘What attracted me greatly and which was the main direction of Cubism was the materialization of this new space that I felt. So I began to do mostly still-life, because in nature, there is a tactile space, I will say almost manual. It was this space that attracted me a lot. For this was the first Cubist painting, the search for space. “G. Braque. (cited in: This deconstruction of space concerned the symmetry of size (and volume) and the representation of the plane midline. It can be illustrated by the oil painting intitled “Guitare et bouteille de marc sur une table” , which is a still life composed of several objects placed on a pedestal table. In addition to removing all coherent perspectives, the shape of the represented objects is asymmetrical; for example, for the guitar, the left half of the widened box is enlarged contrasting with an enlargement of the opposite part of the rose and the neck . This deconstruction-reconstruction of the bodily space and the distortions that are attached to it allowed Georges Braque to represent all the possible perspectives of the bodily space on the same plane with a displacement of the middle axis of the body. These contribute to create a new esthetic representation of bodily space that Braque will further deepen in his subsequent works.G. Braque also applied this new materialization of space to the bodily space. The oil painting untitled “Le Duo” painted in 1937, is an illustration. Braque represented two persons in front of an upright piano. The body of the woman sitting in front of the piano is unstructured; the bodily space is separated into two asymmetrical halves: an enlarged left hemi-body seen from the front and in the light and a shrunken right hemi-body seen in profile and in the shadow (see It is interesting to compare these distortions with the spatial distortions produced by patients with hyperschematia. In these two a priori remote situations, there is a loss of the symmetry of representation of size and volume and a displacement of the representation of the middle axis. In G. Braque, these distortions are the result of a creative and conscious process, while the “hyper schematic” ones result from an unconscious process as suggested by the patients’ unawareness of the disorder. Nevertheless, in both situations, the result consists in the building up of an asymmetric representation of space and body midline.However, these two types of distortions ask about the neural processes underlying the building of these representations of size, volume, and bodily space. These result from a balance between spatial attention processes of the two hemispheres. Healthy participants tend to show a discrete deviation of the midline plane representation toward the left side, reflecting the predominance of the right cerebral hemisphere activity for the contralateral space. This predominance is dramatically reduced after damage of the right hemisphere producing various distortions of extrapersonal and bodily space . HyperscSimilar neural processes may be at work during artistic creation, reinforcing the idea that one intriguing aspect of the ‘spatial brain’ is its capability to construct non-Euclidian representations of extrapersonal and bodily spaces. This widening of the left side spatial representation can be seen as an alteration of the internal function of measuring distances, also called the metric in mathematics. The patient would then present a non-constant right-to-left metric that would increase perceived distances in the controlesional side. Unconsciously, the patient distributes his painting homogeneously in a reference system whose calculation of distances undergoes a transformation gradient on a right / left axis. According to the same scheme, Cubist artists would make the voluntary choice, based on a more or less conscious evaluation of space, of modifying the metric of their drawing locally on its elements and thus produce multiple deformations depending on the position on the final work similarly as they do to encode depth in their paintings.All authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.GR designed the work acquired, analyzed, did interpretation of data for the work, and drafted the work. GV and YR did interpretation of data for the work and revised the work critically for important intellectual content. EC revised the work critically for important intellectual content. PR analyzed data for the work and revised the work critically for important intellectual content.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.


Socioeconomic status (SES) is regarded as consisting of education, income and employment. However, the relationship of these three components to alcohol use behaviours, such as risky single occasion drinking (RSOD) is unclear. The aim of the present paper is to specify how the three SES components relate to RSOD in a cross-sectional survey sample of the Danish general population.n = 3600) was analysed by multiple logistic regression to assess the influence of three dimensions of individual SES  on RSOD.Data from a 2011 Danish national representative survey (Components of SES were not found to be significantly associated with RSOD independently nor in combination.In the Danish context, SES was not associated with RSOD. A major aim of social epidemiology is the study of the relationship between socioeconomic status (SES) and health outcomes in populations, and to date it is well known that in almost every country, more people of lower SES report and experience poorer health than those of higher SES; this is especially true in the developed world .SES generally refers to the social standing, rank or class of an individual or group in society . It is oAn argument can be made that education should be the key component of SES in relation to health, because education enables people to understand health information and make healthier choices . FurtherWith regard to the specific health behaviour of alcohol use, research has shown that individual SES  is associated in various ways with risky alcohol consumption –15. In tOne way to further investigate the link between SES and drinking is by assessing the different potential relationships from the various components of SES to drinking patterns. So far, research that attempts to do this is rare, but one such study that used a variety of data sets from UK and USA found a strong mediation effect of income on the relationship between education and health behaviours . SpecifiIn general, people aged 25 years or older have completed their education, thus this adult age group is an appropriate population in which to study the effects of education as a stable component of SES , 24. HowTo shed new light on the links between SES and alcohol indicators, the present study specifically addresses the following research questions: (a) Is education associated with risky single occasion drinking (RSOD) in Denmark? (b) Does income or employment mediate the effects of education on RSOD? We analyse general population survey data from Denmark to address this gap in the alcohol research literature. We examine a recognised indicator of possible problematic drinking, risky single occasion drinking (RSOD), as our outcome variable .Data came from the 2011 national survey of alcohol and drugs conducted by Statistics Denmark for the Centre for Alcohol and Drug Research of Aarhus University. A representative sample of 8000 persons between the ages of 15–79 years old was randomly drawn from the central person registration (CPR) numbers. Upon birth or immigration to the country, each resident is assigned a unique registration number, which is used for official record keeping. Potential respondents  were invited by postal letter to complete a web questionnaire during September and October 2011. Telephone interviews were conducted with those individuals who had not responded after two reminders. The interviewed sample consisted of 5133 respondents representing a response rate of 64%. The Danish Data Protection Agency approved the survey and all confidentiality and privacy requirements were met. Registry data from Statistics Denmark were used to include information about respondents’ years of schooling and disposable income. The survey’s age range was restricted to correspond roughly to the end of tertiary education and at the high-end age for the start of retirement (26–67 years) . This reTo measure alcohol consumption respondents were first asked whether they had drunk any alcohol in the past 12 months or not. In a separate question, current drinkers were asked about their frequency of RSOD during the previous 12 months. RSOD was defined as drinking five or more units of alcohol  on a single occasion. Respondents had a choice of different frequencies, which we coded as one if respondents reported any RSOD at least once per month in the last 12 months or otherwise as zero.The main independent variable of interest was SES, specifically its three components education, income, and employment status. As a measure of education, we used years of schooling. We measured income using personal disposable income, which is the summation of pre-tax income and imputed rent minus interest expenses, tax, and paid alimonies. In the analysis, its logarithmic form was designed to reduce skewness. Data on education and personal disposable income were obtained from Statistics Denmark and merged with the survey data. The survey asked respondents to provide their employment status by choosing from given categories in the questionnaire. For the analyses, we coded one when respondents were employed and zero otherwise.The sociodemographic variables used in the analysis include age groupings , gender and civil status . We also created a binary indicator of whether the respondent was living with children under the age of 18 years. Our indicator of religiosity equals one if the respondent reported attending worship or religious ceremonies more than four times in the last 12 months. Finally, we included area of residence .The pairwise correlation between RSOD and each covariate was examined using the Kruskal-Wallis equality-of-populations rank test and Spearman’s correlation test. To examine the association between components of SES and RSOD, we used multiple logistic regression. To avoid small cell frequencies, we dichotomized RSOD . In the analyses, we followed three steps. In the first step, the relationship between education and RSOD was analysed without including the other components of SES while controlling sociodemographic variables. In the second step, we added income to the model. In the third step, we added employment status.In all analyses, we controlled age, gender, marital status, living with children under the age of 18, religiosity, and area of residence, as these variables appear from the literature to be key sociodemographic factors affecting drinking. We used weighted data, using weights, which were created by Statistics Denmark and are based on national distributions of age, sex, family structure, education, income, and country of origin. We conducted all analyses with STATA 14.0 software .p < 0.001; data not shown). The Spearman rank correlation shows that RSOD was positively correlated with age, education, income, employment, religiosity, and residence areas. Furthermore, education was positively correlated with income and employment .Table Table The present study has disentangled the relationship between socioeconomic status (SES), and risky single occasion drinking (RSOD), by quantifying the associations between a stable component of SES (education) as well as two variable components (employment and income) and drinking in a sample of the Danish general population. None of the components of SES were found associated with engaging in RSOD.The fact that our results show education to be unrelated with reporting RSOD contradicts previous studies from other countries that have reported that lower education is associated with a disadvantageous risk profile such as heavy drinking , 27, 28.Regardless of how our results compare to previous studies, they do provide more recent and comprehensive examinations on how education and income relate to risky drinking in Denmark, and it seems that there are no particularly strong associations. Drinking may simply be normative, regardless of class: several studies, including qualitative investigations, have found daily drinking, binge drinking and intoxication-oriented weekend drinking to be the norm in many settings , 35. SucSome caveats are in order when interpreting the results. Firstly, although the response rate (64%) for our survey is higher than other recently conducted general population alcohol surveys both internationally , 37 and Also, concerning our measures of SES, we defined employment as a dichotomous variable with all other statuses as being currently outside of the labour market, including being a homemaker or a student. However, in line with what is typically done on the literature, we focused only on people within the age span in which people are typically not studying or retired. In addition, it is quite uncommon to be a fulltime homemaker in Denmark.This study offers new data on the relationship between SES and RSOD. Our findings indicate that SES is unrelated to risky single occasion drinking in Denmark. To replicate and extend our findings, future research should include more detailed investigations based on long-term SES measures, such as life-time or permanent income, or income adjusted for household size as these additional measures may better capture the impact of social status on risky health behaviour than single-year measures can .


Dear Editor,et al.  e. (2009) , howeverOn the contrary, access to video lectures may breed complacency with regard to managing the academic workload. The availability of video lectures relies on the student’s impetus to get through the material in their own time. A lack of motivation to work at a sufficient pace may result in the accumulation of an insurmountable workload before impending exams. Therefore, the benefit of video lectures is likely to be heavily influenced by the attitudes of the individual. This was demonstrated by Howland and Moore (2010)  who explLive lectures may provide a more structured learning schedule and promote sustainable management of a student’s workload as the rate of delivery of information is controlled by the medical school. The balance between the use of video and live lectures could be shifted according to the maturity of the students. It is, perhaps, likely that younger students would benefit more from live lectures due to inexperience with managing their workload independently. Older students, on the other hand, may prefer more independence and control of their workload as they must often juggle hospital placements and lectures. Furthermore, the type of information being delivered should also influence this balance. Some topics  are predominantly delivered via didactic lecture-based transfer of information, which is achieved effectively by video lectures . On the To conclude, live lectures promote a sustainable work rate and encourage engagement whilst video lectures are a convenient revision tool allowing students to work at their own pace. As such, video lectures should be viewed as a supplement to live lectures rather than a replacement. To optimise the benefit to students, medical schools should also shift the emphasis on either video or live lectures based on the maturity of the students and the type of information being delivered.


Asians are more susceptible to alcohol flush syndrome and its associated health risks because they are genetically predisposed towards it. Guided by the theory of planned behaviour, this research examined the psychosocial factors associated with moderate alcohol consumption, in order to inform the development of a health campaign targeting young Asian “flushers” in Singapore. We employed a mixed-method design comprising an online survey and focus group discussions. The survey results identified perceived behavioural control as the most salient belief associated with moderate drinking intentions, particularly for Asian flushers. Although Asian flushers had more positive attitudes towards, and perceived behavioural control about drinking in moderation, they were more likely to consider that their peers disapprove of such a practice, compared to non-flushers. Additionally, Asian flushers did not consider themselves as having a higher risk of long-term health effects from alcohol consumption than non-Flushers despite their actual high-risk status. Focus group findings suggest that young Asian flushers have poor knowledge of, and skills associated with moderate drinking, in addition to feeling self-imposed social pressure. The study findings provide practical insights into bridging the information gap on Asian flush and promoting Asian flushers’ drinking in moderation. Alcohol consumption contributes to global mortality and an increased incidence of short- and long-term health consequences, some of which include the development of seven types of cancer: mouth, pharynx, larynx, oesophageal, breast, liver and colon . StudiesFor these reasons, this research aims to understand the issue of Asian flush in Singapore better, particularly as it occurs among university students who tend towards excessive alcohol consumption, either as a symbolic entry point into adulthood, or to gain a broad range of life experiences . PreviouAsian flush syndrome refers to an alcohol flush reaction commonly found among Asians, which is caused by an inherited deficiency in the enzyme, aldehyde dehydrogenase-2 (ALDH2). This enzyme is involved in the body’s metabolism of ethanol . A less Despite Asian flushers’ higher risk standing, most local campaigns on alcohol consumption were not tailored to the needs of flushers in Singapore. For example, a local campaign, entitled “Don’t Choose Binge”, did not segment the population of young drinkers, and prescribed keeping to 4–5 drinks as the recommended behavior—an amount that still poses a significant risk to flushers. Prior research suggests the importance of abstinence for Asian flushers, in order to avoid the health risks that accompany this genetic deficiency. In a study, non-drinkers, who had the ALDH2 deficiency, did not face heightened health risks when they refrained from constant alcohol consumption . NeverthAjzen’s theory of planned behaviour (TPB)  served aAttitudes, which refers to an overall evaluation of the target behaviour, are formed on the based of underlying beliefs about the positive or negative outcomes of performing the behaviour . AttitudA “subjective norm” refers to an individual’s perception of others’ expectations of that person’s performing a particular behaviour . SubjectPerceived behavioural control (PBC) refers to the perceived ease or difficulty of performing a particular behaviour , which sIn addition to these determinants, theoreticians of the TPB postulate risk perceptions, which comprise the perceived susceptibility and severity of risk as distal predictors of intentions, and subsequently behavioural enactment . PerceivThis research aimed to elucidate the motivations behind an adherence to moderate drinking in order to inform the development of effective campaign strategies that target young Asian flushers in Singapore. To this end, we employed a mixed method of research using both quantitative (survey) and qualitative (focus group) approaches. The institutional review board (IRB) at the hosting university approved both the survey and focus groups for this research.We used a survey approach, to understand more about young Singaporeans’ current drinking behaviours, risk perceptions and knowledge, and to identify any salient beliefs that could be addressed in campaign messages. Earlier research has puts flushers at a higher risk of the short- and long-term health effects of alcohol consumption ,11,12,13RQ1: What are important psychosocial predictors of the intention to drink in moderation? RQ2: How do Asian flushers (vs. non-flushers) differently perceive their risks and TPB constructs to engage in moderate drinking?We conducted an online survey with a random sample of undergraduate students who were registered at a large public university in Singapore. We randomly selected a list of student email addresses from the entire pool of undergraduate students’ email addresses. An e-mail invitation was sent to each sampled e-mail address with a link to a survey questionnaire on the web. As a study incentive, each student stood a chance to win a lucky draw for $10 shopping voucher.SD = 1.92). The majority of respondents (92.8%) were occasional drinkers who drank fewer than four times a month. On average, respondents typically consumed 2.52 drinks (SD = 1.88) in one sitting over the past year and their highest consumption on any one occasion was 5.49 drinks (SD = 4.91). Self-identified flushers, i.e., those whose faces flushed immediately after drinking one standard alcoholic drink, comprised 56.7% of the respondents. The gender ratio did not differ between flushers and non-flushers . Students who had consumed alcohol in the past one year and who were above eighteen years of age were eligible to take part in the survey. Out of the 345 individuals who accessed the survey site (a 23% response rate), 208 participants completed the survey. The sample comprised 45.2% male students, and the mean age was 22 , risk perceptions, knowledge about the Alcohol flush reaction, and alcoholic beverage consumption patterns. Unless noted otherwise, all measures were measured using seven-point Likert scales . r = 0.44, p < 0.001, M = 4.56, SD = 1.57). We measured attitudes toward following the HPB’s guidelines on a seven-point scale, using five semantic differential scales . To measure subjective norm, participants reported the extent to which their peers believed flushing was merely a cosmetic issue, and whether they encouraged drinking, and continued drinking even after they flushed . To assess perceived behavioural control, participants reported how easy or difficult it was to follow the guidelines and rated their confidence in following it under different circumstances, such as stress . To assess intention, participants reported the extent to which they intended to follow and were likely to exceed (reverse coded) the HPB’s drinking guidelines  and long-term  health impacts. To gauge knowledge, we asked to what extent the respondents understood the symptoms of the alcohol flush reaction , the scientific explanation behind it , and to what extent it was associated with long-term health risks . For risk perception, we assessed the respondents’ perceived susceptibility and severity of health consequences of high-risk drinking both in the short-term and long-term. To calculate risk perceptions, we multiplied susceptibility and severity, separately for the short- . Whereas a perceived risk of long-term health effects was a significant predictor of intention , a perceived risk of short-term health effects was not associated with intention (to follow the guideline). Addressing RQ1, we used ordinary least squares (OLS) regressions to predict the intention to follow the HPB’s drinking (DV). We entered age, gender, status as a flusher, and risk perceptions in the first step, TPB constructs in the second step, and the interactions between Flusher status and TPB constructs in the third step . Step 1 β = 0.41, p < 0.001), followed by attitude  and then subjective norms . At Step 3, we found significant interaction between perceived behavioural control and Asian flush ; compared to non-flushers: the effect of perceived behavioural control on intention was stronger among flushers.The TPB constructs, entered at Step 2, explained an additional 34% of the variance in intentions. Perceived behavioural control was the strongest predictor of intention  and the highest  amounts they consuming in one sitting over the past year. However, both the typical and the highest amounts that flushers consumed exceeded the HPB’s drinking guideline.Using a series of one-way analysis of variance (ANOVA), we further compared flushers and non-flushers’ risk perceptions, TPB constructs and drinking behaviours addressing RQ2 . AlthougflusherM  = 5.43, non-flusherM  = 5.09, p = 0.03) and perceived behavioural control  compared to non-flushers. On the contrary, flushers had less supportive subjective norms than non-flushers . Flushers had a more positive attitude . Only 42% of the respondents believed there was a link between the alcohol flush reaction and long-term health effects.Most of the respondents (87.3%) considered five or more drinks as the threshold of excessive drinking. Our results showed a general poor knowledge about Asian flush, with 60% of the respondents reporting that they do not know about the scientific explanation behind the redness that occurred. Around half of the respondents (51.9%) reported that they were unable to identify the symptoms of the alcohol flush reaction. Flushers were more confident in identifying the symptoms of the alcohol flush reaction than non-flushers  for each hour-long discussion. The focus group included an equal mix of flushers and non-flushers and of females and males. Among the flushers were those who abided by or exceeded the HPB’s guidelines in their drinking sessions. We conducted two focus group discussions to gather insights that could explain key findings from the survey and to test potential message appeals and campaign strategies. Focus groups are meant to identify underlying beliefs and reasons for a behaviour, rather than to arrive at a consensus. Using a snowball sampling, eleven undergraduate students, all ethnic Chinese aged between 23 to 26 years, were recruited , that mostly offered all participants equal opportunities to speak up. Focus groups were audio-recorded and then fully transcribed for the analysis. The researchers conducted a thematic analysis  to identThe focus group discussions found that the respondents, both flushers and non-flushers, demonstrated poor skills in keeping to drinking limits such as the HPB’s guidelines. Generally, the respondents lacked an accurate understanding of what constituted a standard alcoholic drink, which led to the overconsumption of beverages with a higher alcohol content, such as vodka and soju. Objective measures were rarely used to quantify excessive drinking; instead, many used subjective measures of drunkenness to determine whether they were drinking out of moderation. These judgments were mainly based on physiological reactions, such as an increased rate of heart palpitations, and the clarity of their mental or emotional state, such as the sense of ‘losing control’. Some of the comments elicited from peers were:“I think drinking in moderation means as long as I can get back home myself.” “It also depends on what people tell you. So, for example, if they say you look flushed, then they will suggest that maybe you should stop.”There was a general consensus that respondents did not explicitly coerce their drinking peers into consuming more alcohol than they wanted to. Nevertheless, unspoken pressures remained in typical drinking sessions. Most tended to overestimate the social pressure and perceived that their peers expected them to drink more than what was actually expected, resulting in a self-imposed pressure to drink: “If everybody’s getting hammered and they’re laughing, but you are like ‘what’s going on’. If you don’t drink, it’s just not fun. So, you should drink”. These self-imposed pressures are especially pronounced when meeting new people or being offered drinks by seniors. Respondents admitted to drinking out of routine to be accepted by social groups. These same instances were also the occasions where they exceeded drinking limits; be they HPB’s guidelines, or those set for themselves. “I think I used to feel the pressure also, and more when I meet new people. When I meet new people, I feel like there’s something to show.” “When the seniors give you the drink, it’s like you’re obliged to finish it, out of respect more than anything.”Participants, particularly Asian flushers, mentioned that, given the constant bombardment of information with respect to health issues, they were desensitised and averse to the use of fear appeals.“I agree with not using fear messaging. We are too used to being scared. They (HPB) have been trying to scare us all our lives, so I don’t think it is going to work.”Instead, respondents were found to be more receptive to the use of objective measures in understanding drinking in moderation. Notably, flushers appreciated the use of factual data, in the form of infographics that could help them visualise the cost-benefit analysis of reducing their alcohol intake, thereby motivating a positive behavioural change.“We are desensitised. I was thinking of something more logical as well, something like: we are exposed to how many kinds of cancers, and then this small, little drink can increase your cancer risks by that much more.” “Perhaps you could say, ‘If you’re prone to Asian flushing, drink x beers or y shots of hard liquor’. That extra infographic or a recommended amount of intake would help”. Non-flushers generally considered themselves capable of promoting HPB’s guidelines among their Flusher friends. However, the fear of being labelled a buzzkill translated to a general reluctance to discuss the health consequences of drinking for flushers, especially during the drinking session itself. This was compounded by a perception of the long-term health risks as a distant concept that could not be resolved with immediacy. “It’s quite a buzzkill when you say: ‘Did you know that you can contract oesophageal cancer?’ while people drink.”“If you tell someone, ‘You have a high risk of cancer’, it doesn’t really do much, it’s not like he can do anything about it there and then.”Still, non-flushers reported that they would be willing to promote moderate drinking to flushers, outside of the drinking environment, if it affected flushers who were close to them.“I would tell my best friend who flushes easily and drinks a lot. But in a social setting, I wouldn’t want to say, ‘Hey, you’re going to get cancer’. At least not at that time, but maybe on another occasion, at a better time.”This research aimed to provide useful information for the development of a health campaign, addressing the issue of Asian flush among university students in Singapore. To this end, guided by the TPB, we examined the psychosocial factors associated with adherence to the HPB’s drinking guidelines, in order to identify important beliefs that might be targeted in campaign messages. In particular, this study compared risk perceptions and psychosocial factors, between flushers and non-flushers, to offer insights into message tailoring. To our knowledge, this is the first study to examine Asian flushers’ drinking behaviours and their motivations for moderate drinking. Based on a mixed method approach, as recommended in other health research ,30, our The majority of the respondents (93%) were occasional drinkers, typically consuming 2.52 standard drinks in one sitting. However, 87% of the respondents considered having five or more drinks excessive drinking, which is a much higher number than the HPB’s guidelines (one drink for women and two drinks for men). It also exceeds the defined threshold for high-risk drinking (four drinks for women and five drinks for men) . FurtherInterestingly, flushers tended to consume less alcohol than non-flushers, potentially because of the alcohol flush reactions they had experienced . NeverthTo enhance flushers’ risk perceptions, campaign messages could include the scientific explanation behind Asian Flush, especially given that 60% of the respondents were not aware of it. Because Asian flushers are at a higher risk for various types of cancer ,9,11, guIn line with the TPB, the results showed that improvements in attitudes, perceived behavioural control, and subjective norms can help to enhance university students’ intentions towards moderate drinking that follows the HPB’s drinking guideline. Perceived behavioural control, in particular, was most strongly associated with an intention to follow the drinking guideline. This suggests that campaign messages that address perceived behavioural control - for example, by instructing students on how to avoid excessive drinking - would be the most effective at improving university students’ intention to drink in moderation. More importantly, this strategy is likely to be more effective for Asian flushers (vs. non-flushers), given the significant interaction that our study identified between perceived behavioural control and Asian flush.Conversely, flushers generally had a greater intention to follow the drinking guidelines compared to non-flushers. This was explained by flushers’ more positive attitude towards and greater perceived behavioural control about following the guidelines. Flushers were more likely to be favourable towards and experienced at restricting their drinking amount potentially because of past episodes of alcohol flush reaction . HoweverPrevious research into the health risks associated with excessive alcohol intake has also identified social norms as an integral factor in shaping a safer drinking environment, particularly for Asian flushers ,36,37. IThis study had several limitations. First, although we employed a random sampling of undergraduate students enrolled in a large university in Singapore, there was a low response rate (23%). Using the enrolment statistics in 2018, the profile of our sample is similar to the university’s student population in terms of gender and age. However, it is difficult to determine whether a nonresponse bias is present. Additionally, because the survey and focus groups were conducted solely in one university, our results might not be an accurate representation of all university students in Singapore. For example, universities that do not have residences for its student population might report different normative beliefs when it comes to drinking. To improve the generalizability of this survey’s findings, future work should improve the response rate, for example by providing higher incentives, and could randomly sample the true population of interest. Future focus group studies investigating university students’ beliefs on drinking could also include more groups and consider broader psychographics, by including participants from different social backgrounds. Second, respondents were asked to recall their highest drinking occurrence within the past year and to express it in terms of standard alcoholic drinks. This may not have been a familiar concept to them, even though we provided relevant definitions within the survey. Although we clearly stated that participants’ responses are anonymous and confidential, there’s a potential for social desirability bias in reporting drinking amount and flusher status. Additionally, participants may not have accurately remembered their past alcohol consumption. In particular, impaired judgement caused by the influence of alcohol might have led to an over- or under-reporting of actual quantities of alcohol consumption. Future research should seek to improve the measurement of alcohol consumption, for example, by employing actual behavioural assessment.Given the local information gap and the low topical awareness surrounding the issue of Asian flush, this research offers practical insights into the development of effective campaigns that target Asian flushers. Knowledge and the perception of risk with respect to Asian flush were identified as lacking among young adults in Singapore, therefore campaigners should focus on filling the information gaps concerning this topic. Although we focused on young Singaporeans, our findings also offer practical insights for dealing with flushers in other Asian and multi-ethnic countries. Specifically, campaigners should identify Asian flushers within the target population and provide them with tailored-information designed to enhance their efficacy and supportive norms regarding moderate drinking to achieve sustained behavioural changes. Evidence-based communication strategies, culturally-relevant content and innovative initiatives can work to create healthy conversations on the issue of Asian flush.


In this study, we provided the detailed characterizations of our recent HRP-AuNPs/PEDOT:BSA/Pt biosensor, constructed through a simple fabrication procedure with improved stability and good sensitivity. Raman and Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy not only confirmed the synthesis of conductive PEDOT where BSA was the template for the polymerization, but also provided further insights into the stable immobilization of AuNP on the PEDOT:BSA film. Scanning electron microscopy revealed that the attachment of AuNPs were stable under a high salt environment. The current technology demonstrates a feasible procedure to form a functional AuNPs/PEDOT:BSA film that has potential applications in the fabrication of various biosensors and electric devices. While great progress has been made in modern medicine, the development of various innovative diagnostic sensors is becoming extremely important for precision medicine. In comparison with traditional chemical and biochemical approaches that are often complicated and tiresome, researchers are working on constructing diagnostic biosensors with more convenient operation protocols . A good 2O2, has well-known chemical properties and good stability, and is relatively cheap and commercially available [2O2 measurements with differential pulse voltammetry (DPV).Horseradish peroxidase (HRP) is a common enzyme that catalyzes the decomposition of Hvailable . HRP hasvailable ,9, polymvailable ,11, and vailable . Our recvailable . To furt+) from Sigma-Aldrich Corp. , H2O2  and lithium perchlorate trihydrate (LiClO4) from Merck KGaA . Only analytical grade chemicals were used in this study.We purchased HRP, BSA, 3,4-ethylenedioxythiophene (EDOT), and nicotinamide adenine dinucleotide (NAD2) served as the working electrode, while a bare Pt wire was the auxiliary electrode and an Ag/AgCl (in 3 M sodium chloride) electrode was the reference electrode.We employed a CHI-621B electrochemical analyzer  to electrochemically synthesize PEDOT:BSA on the Pt electrode and performed all characterizations in a home-made miniature electrochemical cell. The modified PEDOT:BSA/Pt electrode  under room temperature and a nitrogen atmosphere.Electrochemical synthesis of PEDOT:BSA film and the fabrication of HRP-AuNPs/PEDOT:BSA electrode were described in detail in our recent publication . In this−1 to 1700 cm−1. The X-ray Photoelectron Spectroscopy (XPS) with a VG ESCA Scientific Theta Probe was utilized for the analysis of the elemental compositions of the film. Monochromatized Al Kα radiation with an energy resolution of 0.8 eV was used to record the spectra. For all analyses, the energy calibration of the all species took the C1 s peak as a reference. After background correction, we conducted the deconvolution of the high-resolution spectra into Gaussian curves with XPS PEAK4.1 software.We used an ABT-150S SEM  to visualize the surface morphologies of electrodes and a DA 8.3 FTIR spectrophotometer  to analyze the surface chemical compositions and modifications. A home-assembled confocal micro-Raman spectrometer (Tsinghua University in Taiwan) was employed to provide the Raman spectra from 200 cm2O2. The overactive behavior of the bare Pt may result in the reduction of electrode selectivity [In general, we often employ the cyclic voltammogram to evaluate the performance of HRP modified biosensors ,7,9, whiectivity . By contectivity .Previously, we have often observed that the electrochemically synthesized PEDOT on the bare Pt electrode frequently suffered from severe degradation in sequential measurements. We then discovered that the BSA might take the same role as PSS in improving the durability of conductive PEDOT film . In addi2O2 in a PBS solution with cyclic voltammogram and obtained a very nice linear relationship between the cathodic peak current and the molar concentration of H2O2 [+ contributes to the electron transport between HRP and the electrode, as well as the sensitivity of measurement, which reached 974.8 μA/(mM·cm2), both of which were better than others [2O2 with a nice linear correlation  and 1530 (a2) cm−1 denote the C=O stretching vibration near the N–H bending and amide I as well as C–N stretching vibration near amide II, which are mainly associated with peptide backbone. The peak at 1390 (a3) cm−1 indicates the bending vibration of C–H in the aliphatic side chains of the amino acid residues [To better understand the underlying chemical and physical alternations of the HRP-AuNPs/PEDOT:BSA/Pt electrode during preparation, we performed FTIR analysis for BSA, PEDOT/Pt, PEDOT:BSA/Pt, and AuNPs/PEDOT:BSA/Pt. Curve (a) in residues ,18.1), and 1374 (b3) cm−1 are assigned to the asymmetric stretching vibrations of C=C and C–C in the thiophene ring, respectively. Peaks near 984 (b6), 816 (b8), and 692 (b9) cm−1 represent the stretching vibrations of C–S–C bond in thiophene ring. The peaks between 1062 (b5) and 1220 (b4) cm−1 are due to the bend vibration of C–O–C in ethylenedioxy ring, and the peak of 926 (b7) cm−1 is attributed to the deformation of ethylenedioxy ring. All the information has suggested the successful synthesis of the PEDOT through the electrochemical approach. On the other hand, curve (b) in 5) and 816 (b8) cm−1 have shifted the most, to 1114 (c5) and 864 (c8) cm−1, respectively. Therefore, BSA interacted with PEDOT along its polymer chain and possibly served as the template during the electrochemically synthesis of PEDOT.In comparison with curves (a) and (b), curve (c) in 6), 880 (d8), and 730 (d9) cm−1 that are ascribed to C–S–C bond vibrations in the thiophene ring were greatly enhanced. These alternations imply that the AuNPs possibly made the direct approach to C–S–C to form the Au–S interaction.Nevertheless, curve (d) in FTIR and Raman are highly developed vibrational spectroscopies to explore the molecular motion and characterize chemical bonds of materials. Both techniques have their individual advantages and limitations; therefore, their combination may provide complementary information for the inspection of samples. The Raman spectra of three individual electrodes are exhibited in −1 are assigned to the asymmetric vibrations of C=C in thiophene ring, whereas the peaks near 1432 and 1373 cm−1 are due to the symmetric stretching of C=C and stretching deformation of C–C. Peaks near 996 and 445 cm−1 are assigned to the oxyethylene ring deformation and the O–S–O bending vibration, respectively. A number of relatively weak peaks of PEDOT correspond to the C–C inter-ring stretching near 1275 and 1231cm−1, the deformations of C–O–C at 1104 cm−1, C–S–C near 698 cm−1, and oxyethylene near 574 cm−1 are present. The current spectra are quite similar to the previously reported Raman spectra for PEDOT [Curve (a) indicates the Raman spectra of PEDOT, in which the major peaks that are strongly visible near 1518 cmor PEDOT ,21,22.−1, respectively, indicating the entrapment of BSA in the PEDOT film. Meanwhile, we observe a similar blue shift of peaks, including peaks 1275 to 1313, 1231 to 1246, 996 to 1001, 698 to 706, and 574 to 585, which may further indicate the stable molecular interaction between BSA and PEDOT. Although PEDOT:BSA/Pt displays slightly weaker intensity of Raman spectra to that of PEDOT/Pt, the intensity for the stretching vibration of C–C inter-ring at 1246 cm−1 is enhanced, suggesting the longer chain of PEDOT probably synthesized in the presence of BSA.In comparison with curve (a), curve (b) of the PEDOT:BSA/Pt electrode exhibits similar Raman spectra for PEDOT/Pt, with appearances of C=O vibration and S–S vibration near 1560 and 532 cm−1, implicating the stable interaction between the AuNPs and the thiophene ring.In addition, curve (c) in It has been deduced that electrostatic interactions contribute more to the formation of Au–S than the covalent interaction based on the theoretical calculation . AccordiBased on the initial XPS spectra for PEDOT, PEDOT:BSA, and AuNP/PEDOT:BSA films in the binding energy range from 0 to 700 eV shown in To better understand the underlying information, individual spectra were characterized by curve fitting and deconvolution. The comparison of deconvoluted XPS C 1s spectra is shown in 4; (b) the presence of BSA brought about two new peaks, one was near 533.1 eV for C–O in –COOH and the other was near 531.5 eV for C=O in peptide bond, whereas the peak near 532 eV related to LiClO4 was not affected; and (c) after the attachment of AuNPs, we noticed a similar reduction of peaks corresponding to C–O–C and C=O to that found for C 1s.By inspecting the deconvoluted XPS spectra of O 1s in 1/2 near 165.0 eV and S 2p3/2 near 163.8 eV, with a binding energy difference of 1.2 eV where the ratio of peak areas was about 1:2. The green lines indicate about 42.6% of the S in PEDOT to be in oxidative state. 1/2 near 165.4 eV and 2P 3/2 near 164.2 eV. In comparison with 1/2 near 163.8 eV and S 2p3/2 near 162.6 eV, which might suggest that the formation of C–S–Au weakens the chemical bond of C–S. Although the bond energy of S 2p in the disulfide bonds of BSA is also reduced to S 2p1/2 near 162.7 eV and S 2p3/2 near 161.5 eV, the reduction of the peak area for S–S is less than that for C–S, which indicates that the interaction between Au and C–S is predominant.7/2 and Au 4f5/2 peaks with bond energy difference of 3/7 eV and a peak area ratio of 4:3. After deconvolution, the Au 4f7/2 has two spin-orbit splits of 84.0 eV and 84.3 eV, which implicate Au0 and Au+1, respectively. According to the results of FTIR and Raman, no clear breakage of C–S bonds in PEDOT was found after the immobilization of AuNPs, but notable reduction of XPS peak areas of S 2p1/2 and S 2p3/2 due to the Au immobilization; therefore, in the case of C–S–Au, Au is in its Au0 state and shares the pair of electrons in C–S. On the other hand, Au+ might be in the covalent interaction between S–S and Au. Interestingly, the peak area ratio for A0 and A+ is about 1.7:1 and closely corresponds to the peak area ratio of 1.9:1 for S 2p3/2 in C–S at 162.6 eV and in S–S at 161.5 eV.In addition, the XPS spectra of Au 4f for AuNP/PEDOT:BSA/Pt electrode are shown in 2O2 with cyclic voltammetry (CV) and exhibited the main advantages of durability, sensitivity, and reliability [To fabricate an enzyme-based biosensor, active enzymes are generally immobilized by either entrapment or chemical cross-linking, which often encounter the difficulties in maintaining high efficiency and good consistency. In this study, we proposed a feasible strategy to construct an HRP biosensor by modifying a platinum electrode with a conductive PEDOT:BSA film, which was able to capture AuNPs followed by immobilizing HRP through quick and simple soaking procedures. The biosensor displayed nice linear correlations between the electrochemical current and molar concentration of Hiability . Here, w


In the original article  referencThe Procedures section  states: “The Hawk-Eye system (Hawk-Eye SMART productions) was used for matches in the current study; however, this was not available at any of the matches played in South Africa during the 2015 season.”This sentence should read: “Either commercial or non-commercial video systems were used for matches in the current study; however, these were not available at any of the matches played in South Africa during the 2015 season.”The Analyses section  states: “Thirdly, the effectiveness of sideline video review for identifying HIEs was evaluated by comparing the number of additional HIEs detected on retrospective post-season review between matches with and without the Hawk-Eye system available.”This sentence should read: “Thirdly, the effectiveness of sideline video review for identifying HIEs was evaluated by comparing the number of additional HIEs detected on retrospective post-season review between matches with and without the sideline video system available.”The Hawk-Eye system is mentioned on two occasions in the article:


Nutritional status at the early stages of children’s lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach.Data were extracted from Iran’s Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting, underweight, and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover, the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality.The obtained concentration indices of stunting, underweight, and wasting were respectively −0.177, −0.092, and −0.031. Socioeconomic inequality in stunting and underweight was statistically significant, however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore, maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively.The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem, they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition. Despite the significant improvements in children’s health and the reduction of the overall rate of malnutrition in the world, developing countries are still bearing a great burden of malnutrition and it has remained as a challenge to public health in these countries . GloballNutritional status of children is affected by many socioeconomic factors such as mother’s education and nutritional status, residential area, household wealth, and demographic characteristics –9. For tSince providing evidence on the factors affecting malnutrition and its distribution among socioeconomic groups can help policymakers to take actions for targeted and optimized allocation of resources and to carry out nutritional interventions, therefore, this study was the first attempt to identify and analyze the factors affecting socioeconomic inequalities in malnutrition of children under five in Iran.The data for this study were extracted from Iran Multiple-Indicator Demographic and Health Survey (IrMIDHS)-2010. In this survey, demographic, health, and socioeconomic information of 30960 households  were collected . OverallThe anthropometric indicators such as height-for-age, weight-for-age, and weight-for-height in z-score form are widely used to measure the health of children, particularly for malnutrition. We used the WHO’s  growth cThe wealth index was used as a proxy of household income in order to assess the socioeconomic status of the households. First, data on household assets including TVs, refrigerators, freezers, radios, cell phones, wristwatches, computers, laptops, microwaves, washing machines, vacuum cleaners, dish washers, and cars as well as home ownership and household characteristics including heating and cooling systems, type of fuel in the kitchen, access to the internet, a source of drinking water, having a bathroom, number of rooms, and toilets were arranged and classified. Then, using the statistical method of principal component analysis, the wealth index score was calculated for each household. Finally, to determine the socioeconomic rank of each household, the wealth index scores were divided into 5 quintiles . The method for estimating wealth asset index has been described in details elsewhere .μ is the mean of stunting, underweight or wasting indices, yi is the value of each of the indices of stunting, underweight or wasting in the thi person, and iR shows the rank of socio-economic status of the ith person. In this study, Kakwani formula was used to estimate the concentration index of stunting, underweight, and wasting.Concentration index was applied in order to measure the degree of socioeconomic inequality in child stunting, underweight, and wasting (CI). Kakwani et al  suggesteThe concentration index was decomposed in order to understand the contribution of socioeconomic variables to inequality in childhood malnutrition. This decomposition of the concentration index works only if the regression model is linear , 20. TheFor a continuous outcome variable, a linear regression model linking the outcome variable (y) to the set of k determinants can be represented as follows:kβ represents the coefficient of each independent variable and ɛ is the error term.In which yi) in yi) will bekx, kc is a concentration index for kx, and GCɛ is the generalized CI for the error term (ɛ).If  refers to the inequality in malnutrition among socio-economic groups which cannot be explained by contributors , and birth-order of children, number of under-five children, mother’s education, mother’s age at birth (years), residential area, household size, and socioeconomic status were entered in the multivariate linear regression model as independent variables. The effectiveness of independent variables on socio-economic inequality in malnutrition had been proven in previous studies –23.All statistical analyses were conducted in Stata 14.1 .P-value<0.01); however, this socioeconomic gradient was not observed in wasting . The concentration index value in terms of the area of residence showed that the urban children in the lowest quintiles were suffering from greater burden of stunting compared to the rural ones. In contrast, the concentration indices for underweight and wasting in rural areas were somewhat greater than urban areas.The obtained concentration indices of stunting, underweight, and wasting were respectively −0.177, −0.092, and −0.031 at the national level. Socioeconomic inequality in stunting and underweight was statistically significant and the children in the lowest quintile were bearing greater burden of malnutrition . The rest of the inequality in under-five child malnutrition was influenced by the inequality in areas of residence and the number of child deliveries.This study was conducted beyond the previous studies with the aim of creating a clear picture of the nutritional status of under-five children in socio-economic groups and measuring the inequality in stunting, underweight, and wasting as well as identifying the determinants associated with this inequality through the decomposition of the concentration index using IrMIDHS 2010 data.Our results indicated that the prevalence of stunting, underweight, and wasting among under-five Iranian children was respectively 10.13%, 5.7% and 3.29%. The concentration indices of stunting and underweight were −0.177 and −0.092, respectively. Finally, decomposition analysis of socioeconomic inequality in under-five children malnutrition showed that the households’ economic status and maternal education were respectively the most important contributors to the socio-economic inequalities in child malnutrition. The findings of this study were consistent with those of the studies carried out in other countries that showed despite the reduction of malnutrition indices, the average socio-economic inequalities among the groups had increased and their concentration indices were negative , 8, 19.Many programs related to malnutrition including the eradication of iodine deficiency disorders through iodized salt or the promotion of breast-feeding have been conducted in Iran through primary health care network after signing Alma Ata Declaration which was considerably successful . After tDecomposition analysis also revealed that after socio-economic status, maternal education was the second contributor to affect the inequality in stunting and underweight. The risk of growth disorders among children whose mothers had higher education was much lower than those whose mothers had low education levels. According to our study, 16% of inequalities in stunting and 17% of inequalities in underweight were caused by inequality in maternal education levels. Maternal education level was an effective contributor to inequalities in child malnutrition. The contribution of maternal education in stunting was 13% . ParentsLiving in rural areas is the third determinant that explains the inequality in malnutrition. Studying 47 developing countries, a significant difference found between nutritional status of the children in rural and urban areas . FurtherHowever, programs such as National Program for Improving Nutritional Status of Children have failed to properly influence the social determinants affecting the nutritional status of children, especially in poor families, and to gain access to justice in nutritional status . Hence, Firstly, since these data were derived from a cross-sectional survey, the causal assessment of dependent and independent variables should be done with caution. Secondly, this study only evaluated the effects of those variables whose data were collected and measured in the survey, while socio-economic inequality in malnutrition may be affected by other variables such as exposure to diseases or food intake. Thirdly, the economic status of the households in this study was measured through the wealth index based on the household assets. Therefore, the contribution of the economic status in malnutrition inequality might be different from the situation in which the economic status of the households is measured by their income, expenditures or consumption levels.Children in poor families were suffering from malnutrition, especially stunting, and the average reduction of malnutrition indices at the national level had caused it to be hidden among children in poor families. Children in poor families were suffering more from malnutrition not only due to their weaker economic status but also because of their mothers’ lower level of knowledge and awareness. If government and policymakers seek to solve this public health problem among children, they have to take direct and targeted efforts to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.Ethical issues  have been completely observed by the authors.


Binge and heavy drinking are preventable causes of mortality and morbidity. Alcohol consumption by women who parent is damaging to child health, and it is concerning that women in the United States in their reproductive years have experienced increased drinking over the past decade. Although media attention has focused on the drinking status of women who are child-rearing, it remains unclear whether binge and heavy drinking vary by parenting status and sex.N = 239,944 eligible respondents) to study time trends in drinking outcomes by sex, age, and parenting status. Binge drinking increased for both sexes in nearly all age groups, with the largest increase among women ages 30–44 without children (from 21% reporting binge drinking in 2006 to 42% in 2018); the exception was young men (ages 18–29) with children, among whom binge drinking declined. By 2012, the prevalence of binge drinking among young men with children (38.5%) declined to below that of young women without children (39.2%) and stayed lower thereafter. Despite widespread increases in binge drinking, heavy drinking declined or remained stable for all groups except older women (ages 45–55) without children  and women ages 30–44, regardless of parenting status. For binge drinking outcomes only, we saw evidence of interaction in drinking trends by parenting status, but this was shown to be confounded by sex and age. Men and women with children reported consistently lower levels of drinking than those without children. Rates of abstention mirrored trends in binge outcomes for both sexes, limiting concerns about invariance. Study limitations include self-reported data and measurement invariance in binge drinking cutoffs across study years.We examined national trends in binge drinking, defined as 5 or more drinks in a single day for men and 4 or more drinks for women, and heavy drinking, defined as 60 or more days with binge episodes in a year. We used survey-weighted logistic regression from the 2006–2018 waves of the cross-sectional National Health Interview Survey  as particularly concerning; thus, we tested whether increases in drinking in recent years is particularly apparent among women who parent.N = 239,944) from 2006 to 2018.We studied trends in binge drinking and heavy drinking among adults ages 18–55 in a large, nationally representative data set  with children; binge drinking increased for all women, regardless of parenting status.Heavy drinking generally decreased except among older women (ages 45–55) without children.Concerns about increases in alcohol use among women with children should be qualified; all adult women are increasing drinking, and women without children have higher rates of drinking than women with children.Binge drinking increased for nearly all groups, though heavy drinking remained mostly stable.Physicians should be screening all adults—not just select groups of men and women—for alcohol use disorders and referring them to appropriate treatment. Globally, alcohol use is a leading cause of premature death and disability ,2. AlcohDrinking is increasing among US adults, particularly among women ,8,9. AltIncreases in alcohol consumption among women in their reproductive years has become more socially acceptable in the past decade. For example, messaging around alcohol consumption during pregnancy is shifting, with some studies suggesting that low levels of maternal alcohol consumption during fetal development are not deleterious ,31, and In reaction to these shifting norms, media attention has focused on alcohol use by women who parent, conveying alarm toward a growing epidemic of so-called mommy drinking ,40,41,42In summary, although alcohol consumption is increasing in the US, particularly during the developmental window in which most women are bearing and caring for children, the extent to which excess alcohol consumption is increasing among mothers, or varies by parenting status, remains unknown. Establishing and understanding these changing consumption patterns is important for both public health messaging and for clinicians in order to properly assess risk among patients.Therefore, the present study examines US trends in binge and heavy drinking in the past decade in a large, nationally representative set of yearly cross-sectional studies  from 2006 to 2018 that had detailed questions on alcohol consumption as well as household composition and demographic information. We focus in particular on trends after 2006 because available evidence indicates that this is the period in which drinking began increasing among adult women . We consN = 477,409) [We examined trends in binge and heavy drinking using self-reported data from the NHIS from 2006 to 2018  . The NHI477,409) .Eligible respondents were limited to men and women ages 18–55 to be inclusive of the periods in the life course in which adults are most likely to be parenting young children. The average parental age for newborns in the US is 28 years old for women  and 31 ySurvey administrators categorized households into various possible combinations of family types based on marriage status, child-rearing status, and number of and relation of cohabitants. Using these categories, we dichotomized eligible respondents according to whether they lived with children <18 years old or not.Drinking outcomes were ascertained using responses to questions about past-year alcohol use. Alcohol measures were all ascertained by self-report, which is considered both a reliable and valid way to assess these outcomes ,50,51,52To confirm that our findings were not an artifact of measurement changes for women in 2014, we performed a sensitivity analysis examining trends in abstaining from drinking throughout the study period; this was to confirm that increases in binge or heavy drinking were commensurate with decreases in abstaining, regardless of changes in measuring binge outcomes. We present these results with the main models. NHIS categorizes respondents into various types of drinkers: current, former, and never drinkers. Abstaining from drinking was defined as reporting alcohol use in the past year or not: those who reported no lifetime alcohol use, or previous alcohol use but not in the past year, were categorized as past-year abstainers. Those who reported any past-year alcohol use were categorized as current drinkers.Heavy alcohol use is defined as binge drinking at least 5 times in the last 30 days, per commonly accepted guidelines ; howeverWe included control variables for race and socioeconomic status (SES), given that they are associated with alcohol consumption  and SES We controlled for race using the 9 categories provided by NHIS: white, black, American Indian/Alaska native, Asian Indian, Chinese, Filipino, other Asian, other race, and multiple race.We operationalized SES as the ratio of the family income to the national poverty level for reported family size; these were categorized as less than 100% of the poverty level, 100% to less than 200% of the poverty level, and 200% or greater than the poverty level ,58. HousWe use survey-weighted logistic regression to estimate time trends in alcohol consumption within strata defined by sex, age, and family composition, adjusting for poverty level and race, producing an odds ratio (OR) for the effect of survey year on the risk of binge drinking (versus not binge drinking), heavy drinking (versus not), and abstaining from drinking (versus not) for all strata and Wald chi-squared statistics for interaction terms for sex, age, and family composition in marginal logistic models. Because the time trends may not be linear, we considered linear, quadratic, and cubic time terms for both outcomes; we chose the model with the best fit according to AIC and significance of time parameters.χ2 = 13.5162, df = 8, p = 0.0953 for race × year interaction term), heavy drinking , or abstaining from drinking . There was some evidence of interaction by poverty status ; thus, figures set at other reference levels for poverty are shown in Predicted probabilities were generated from the models and charted to visually show trends over time for different strata. For figures, predicted probabilities were set at the reference levels of categorical control covariates: white race (76% of the sample) and >200% of the poverty level (62% of the sample). Tests for interaction indicated no interaction by race for binge  had missing data: 19,498  were missing sufficient information to ascertain poverty status, 61 (<1%) were missing family composition data, and 6,848 (3%) were missing past-year drinking data. As a sensitivity analysis, we imputed missing covariates and outcomes. We imputed these missing values with multiple imputation by fully conditional specification; we imputed 10 data sets using all model covariates as predictors of missing and combined OR estimates using Rubin’s rules . BecauseBetween 2006 and 2018, there were 239,944 NHIS respondents ages 18–55. Of these, 54.2% were women, 62.2% were at 200% of the poverty line or above, 75.5% were white, and 46.1% had children. Among these, 30.6% reported binge drinking, 3.6% reported heavy drinking, and 30.1% reported abstaining from drinking. Prevalence of all outcomes for the complete cases, by sex and year, are available in Men and women with children generally reported binge drinking at lower levels than their gender-specific counterparts without children, regardless of year. Among the oldest age groups (ages 45–55) for both sexes, binge drinking did not appear to vary by child-rearing status. Among men, binge drinking increased over time among nearly all men in older age groups: men ages 30–44, regardless of child-rearing status, increased binge drinking . Among men ages 45–55, those with children increased binge drinking, but those without children remained relatively stable; by the end of the study, the prevalence of binge drinking in these 2 groups was nearly identical .Among women, women with children increased binge drinking across all age groups without children: the probability of binge drinking in the study period increased from 0.38 (95% CI 0.36–0.41) to 0.46 (95% CI 0.44–0.48) among women ages 18–29 , from 0.26 (95% CI 0.25–0.28) to 0.44 (95% CI 0.42–0.47) among women ages 30–44 , and from 0.13 (95% CI 0.12–0.15) to 0.25 (95% CI 0.23–0.27) among women ages 45–55 . Among women with children, older women evidenced increases in binge drinking over the study period, but younger women ages 19–29 did not: the probability of binge drinking in the study period increased from 0.17 (95% CI 0.16–0.18) to 0.32 (0.31–0.34) among women ages 30–44 with children  and from 0.12 (95% CI 0.11–0.14) to 0.26 (95% CI 0.23–0.28) among women ages 45–55 with children .By 2012, the probability of binge drinking for young men with children was lower than that of young women without children . This pattern emerged before the change in measurement of binge drinking for women in 2014 surveys. For all other groups, men consistently reported binge drinking at higher levels.Among women, heavy drinking remained relatively stable regardless of parenting status. Among women in the youngest age group, rates of heavy drinking trended down , and among all other age groups, rates of heavy drinking trended up. Older women (45–55) evidenced increases in heavy drinking, but only among respondents without children . Among women ages 30–44, those with children also evidenced increases in heavy drinking  but remained at lower prevalence than those without children, who showed nonsignificant increases of a similar magnitude . However, for all women, the prevalence of heavy drinking in 2006 was indistinguishable from the prevalence in 2018, regardless of age group or parenting status.Among men, rates of abstaining from drinking have declined in most age groups except for those ages 18–29. In fact, they increased dramatically among men with children in this age group; between 2006 and 2018, they increased from 0.26 (95% CI 0.23–0.31) to 0.38 (95% CI 0.32–0.43). No other group of men evidenced increases in abstinence, regardless of parenting status; these findings are consistent with For women, among those ages 18–29 and 30–44, those with children were more likely to abstain from drinking than those without. However, women were overall abstaining less; among all subgroups of women, decreases in abstinence were observed. Among women with children, the probability of abstaining from drinking in the study period declined from 0.42 (95% CI 0.38–0.46) to 0.37 (95% CI 0.33–0.41) among women ages 18–29, from 0.29 (95% CI 0.28–0.32) to 0.21 (95% CI 0.20–0.23) among women ages 30–44, and from 0.28 (95% CI 0.25–0.32) to 0.21 (95% CI 0.18–0.24) among women ages 45–55. Among women without children, the probability of binge drinking in the study period decreased from 0.25 (95% CI 0.22–0.28) to 0.22 (0.19–0.24) among women ages 18–29, from 0.25 (95% CI 0.22–0.28) to 0.18 (95% CI 0.16–0.20) among women ages 30–44, and from 0.32 (95% CI 0.30–0.35) to 0.21 (95% CI 0.19–0.24) among women ages 45–55.These trends closely mirror increases in binge drinking among women; however, unlike self-reported binge drinking outcomes, measurement of abstaining from drinking remained consistent throughout the study period.χ2 = 164.5704, df = 1, p < 0.001), age and linear time , and family composition and time . No 3-way interactions or 4-way interactions were significant. For heavy drinking, we observed 2-way interactions between sex and year  as well as interactions between age and year . For abstaining, there was no evidence of interaction by year for all predictors. Though we saw evidence of interaction for family composition in 2-way interaction models for binge drinking, these trends were no longer present with the inclusion of sex or age in the model, suggesting that respondents with children were not experiencing declines or increases in binge or heavy drinking beyond the effects from age and sex.Finally, we tested for all 2-way, 3-way, and 4-way interactions formally, and results are shown in Tables We performed 3 sensitivity analyses: first, to confirm that trends in binge and problem drinking among women were not an artifact of changing measurement, we examined trends in abstinence, as discussed above with the main models.Next, to determine whether our results were biased because of missing data, we performed multiple imputation as described in the methods section above. The imputed parameter estimates for each stratum are shown in Finally, to resolve the discrepancy among increases in binge drinking in nearly all subgroups with the declining or static reports of heavy drinking, we examined changes in number of days of binge drinking over time among those who report binge drinking. We conclude that although binge drinking increased, the number of days with binge episodes among binge drinkers largely declined. These findings are shown in detail in the supplement .We examined trends in binge drinking, heavy drinking, and abstaining from drinking in the past decade by sex, age, and parenting status to determine whether women with children were increasingly engaging in binge and heavy drinking compared with trends among other women and men. We found that binge drinking increased for all older age groups regardless of parenting status; among respondents in the youngest age stratum (18–29), binge drinking decreased among men with children. Among women, we saw no evidence that being a parent impacted increased rates of binge drinking. Beginning in 2012, young women without children reported higher prevalence of binge drinking than young men with children. Heavy drinking declined or remained the same for all men regardless of age or parenting status; among women, heavy drinking increased, but only among women in the oldest age group who did not have children. Trends in abstinence mirrored trends in binge drinking: in groups who experienced increases in binge drinking, commensurate declines were observed in abstinence. Although we found evidence of interaction by family composition in binge drinking models, those where confounded by sex and age; these effects were no longer present when sex and age were included in interaction models. We conclude that although the prevalence of binge and heavy drinking is related to parenting status, trends in binge drinking, heavy drinking, and abstaining from drinking over time are not differential by parenting status. Declines and increases over time are attributable to sex and age, not to parenting status per se.Taken together, we do not find evidence that women drinking while parenting children is particularly or uniquely increasing in the US. Men and women who parent drink less than those who do not, and men who parent drink more than women who parent. Our study findings are consistent with previous research showing that alcohol use is lower for parents than for nonparents, a relationship thought to be a function of both lifestyle and selection ,62. AlthAlthough heavy drinking has declined, binge drinking has risen for women across all age and parenting statuses. This apparent discrepancy is elucidated through our examination of changes in the number of days with binge episodes among those who do binge—generally, although endorsing any binge drinking has increased, those who do binge drink were on average doing so less frequently. Although this is reassuring, binge drinking at all is still risky. Binge drinking episodes increase the risk of injury and mortality . Given tWomen who parent have traditionally been subject to increased scrutiny regarding their own health and their decisions about the health of their children. Public concern over “mommy drinking,” which has been subject to numerous media reports ,40,41,42There are limitations of the NHIS that should be considered when interpreting these results. The primary concern was changing cutoffs for measuring binge drinking in women; however, subgroup trends in abstinence closely mirrored trends in binge drinking, suggesting that increased alcohol consumption among women was not an artifact of measurement and that measurement changes did not systematically influence alcohol trends. Alcohol consumption and covariates were self-reported, which can lead to misreporting or underreporting of sensitive information. Because these data are self-reported, we are unable to differentiate trends in alcohol intake from trends in reported alcohol intake. This measurement error may be particularly relevant for women, who experience more stigma related to alcohol consumption . HoweverFurther measurement considerations from this survey include decisions we made around how to classify the stratifying variables of interest. The NHIS did not contain explicit questions regarding parenting status for the years under consideration; we categorized individuals based on whether they lived with a child in the home, which could include respondents who lived with children but were not the primary parents. We restricted our analysis to respondents ages 18–55, but people younger and older do parent. People’s identities and lived domestic experiences are often more complex and nuanced than can be easily captured; for example, the NHIS does not account for people who are gender nonbinary and do not identify as male or female or complex family dynamics such as children with more than 2 parents. The complexities of how changing social, domestic, and sex roles interact with substance use are still being understood.The NHIS is a nationally representative survey and has numerous advantages including large sample size, face-to-face interviewing, and concentrated questions on family composition. Other national surveys also include questions about alcohol consumption. For example, a recent report using the National Surveys on Drug Use and Health (NSDUH), another nationally representative survey monitoring substance use and health, examined trends in binge drinking according to age, sex, and pregnancy status; the authors found similar increases in binge drinking among nonpregnant women in midlife and decreases in binge drinking among younger groups . DiffereThe analyses presented here lay the foundation for future work that assesses the central underlying reasons that women are increasing drinking, including assessment of variation that is attributable to long-term patterns of alcohol use that began earlier in the life course, as well as concurrent secular trends that increase drinking across all age group in more recent times, through such analytical techniques as age–period–cohort analysis . NeverthS1 Appendix(DOCX)Click here for additional data file.S2 Appendix(DOCX)Click here for additional data file.S1 TableSTROBE, Strengthening the Reporting of Observational Studies in Epidemiology.(DOCX)Click here for additional data file.S2 Table*Binge drinking and abstaining showed best model fit with cubic time; heavy drinking showed best model fit with linear time; all models control for race and poverty status.(DOCX)Click here for additional data file.S3 Table*Models adjusted for race and SES. SES, socioeconomic status.(DOCX)Click here for additional data file.S4 Table*Models adjusted for race and SES. SES, socioeconomic status.(DOCX)Click here for additional data file.S5 TableModels adjusted for race and SES. °Reference level for predicted probabilities are at white race and >200% of the poverty line. N.S., not significant; SES, socioeconomic status.(DOCX)Click here for additional data file.S1 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S2 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S3 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S4 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S5 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S6 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race.(TIF)Click here for additional data file.S7 FigUnadjusted prevalences of past-year binge drinking outcomes among men. Red dot denotes men ages 18–29, green dot denotes men ages 30–44, and blue dot denotes men ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S8 FigUnadjusted prevalences of past-year heavy drinking outcomes among men. Red dot denotes men ages 18–29, green dot denotes men ages 30–44, and blue dot denotes men ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S9 FigUnadjusted prevalences of past-year abstaining from drinking among men. Red dot denotes men ages 18–29, green dot denotes men ages 30–44, and blue dot denotes men ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S10 FigUnadjusted prevalences of past-year binge drinking outcomes among women. Red dot denotes women ages 18–29, green dot denotes women ages 30–44, and blue dot denotes women ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S11 FigUnadjusted prevalences of past-year heavy drinking outcomes among women. Red dot denotes women ages 18–29, green dot denotes women ages 30–44, and blue dot denotes women ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S12 FigUnadjusted prevalences of past-year abstaining from drinking among women. Red dot denotes women ages 18–29, green dot denotes women ages 30–44, and blue dot denotes women ages 45–55. NHIS, National Health Interview Survey.(TIF)Click here for additional data file.S13 FigUnadjusted average binge episodes; red dot denotes both men and women, green dot denotes men, and blue dot denotes women.(TIF)Click here for additional data file.S14 FigUnadjusted standard deviation for mean binge episodes; red dot denotes both men and women, green dot denotes men, and blue dot denotes women.(TIF)Click here for additional data file.S15 FigFrom left: predicted probabilities for respondents ages 18–29, ages 30–44, and ages 45–55. Black lines represent men, red lines represent women, dotted line denotes no children, and solid line denotes children. Predicted probabilities fixed at white race and >200% of the poverty line.(TIF)Click here for additional data file.


Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery. Patients with arteriovenous malformation (AVM) are usually treated by means of direct surgery, endovascular embolization, or stereotactic radiotherapy, of which direct surgery is most effective to improve the patients' long-term prognosis. Individualized approach using intraoperative neurophysiological monitoring, neuronavigation, or intraoperative digital subtraction angiography (DSA) is recommended for adequate treatment of patients with AVM –4. RecenIn addition, FLOW800 , a newly developed analytical tool in ICG videoangiography, has recently become available for clinical use to obtain qualitative visualization of the blood flow and vessel strength –11. Thisπ is Pi.A total of consecutive seventeen patients who received surgical resection of intracranial AVM were retrospectively detected in this study. As the data obtained from routine examination was analyzed, nine patients who underwent microsurgery with conventional microscope were excluded. Of the seventeen patients, the remaining eight patients who were treated using intraoperative ICG videoangiography with FLOW800 function were analyzed. Each AVM was classified per Spetzler and Martin grading system . The diaAfter surgical exposure of the AVM, ICG videoangiography was performed in the usual manner to obtain a maximum intensity map with gray-scale and color-coded images indicating the delay time of the exposed operative field. In each angiography procedure, ICG 25 mg dissolved in 5-ml water was administered. In addition, to obtain diagrams for semi-quantitative assessment, ROIs were placed on the individual vessels including the feeders, niduses, and drainers in the exposed area ; in caseAll patients underwent postoperative DSA to confirm complete resection of the AVM. The patients' short-term prognosis on the day of discharge was evaluated using the modified Rankin Scale (mRS).One-factor analysis of variance (ANOVA) was used for the comparison of three parameters according to vessel type. T-test was performed for comparisons of the nidus diameter and CBFi, after confirming normal distribution pattern using F-test. Correlations between the nidus volume and CBFi were evaluated using Spearman's rank correlation test. Statistical significance was defined as P-value less than 0.05. All statistical analyses were performed with Statview .The patients' characteristics, size and location of AVM, number of ROIs, clinical presentation, and short-term outcome are shown in In all cases, immediate reconstruction of the color-coded map was achieved intraoperatively. The delay map showed the surface structure of the AVM with information regarding direction and velocity of blood flow in the exposed vessels. Due to feature of the visualization method, the border between the normal brain cortex and nidus was more evident, enabling accurate determination of the incision point and dissection plane; additionally, the main feeders were clearly visualized and easily occluded. Nevertheless, in some cases, the AVM could not be visualized adequately due to depth of the nidus, angle of surgical approach, or post-hemorrhage swelling of the brain.In semi-quantitative calculation of flow dynamics through time-intensity diagrams, a total of 28 ROIs were placed on the individual vessels of the AVMs. In total, 11 diagrams of the feeders, seven of the niduses, and 10 of the draining veins were obtained; the three parameters according to vessel types, i.e., the feeder, nidus, or draining vein, were calculated. All data are presented as mean ± standard deviation (SD). The mean maximum intensity was 652.8 ± 571.9 AI in the feeders, 534.3 ± 392.7 AI in the niduses, and 915.6 ± 495.1 AI in the draining veins; the mean delay time was 13.3 ± 2.89 sec in the feeders, 14.2 ± 3.64 sec in the niduses, and 13.3 ± 2.03 sec in the draining veins; and the mean CBFi was 212.9 ± 149.2 AI/sec in the feeders, 156.7 ± 102.2 AI/sec in the niduses, and 326.9 ± 161.2 AI/sec in the draining veins . The valComparison of the CBFi value in all the feeders according to the nidus diameter indicated the presence of higher CBFi values in the large niduses (>3 cm) versus the small niduses (P < 0.05) , with meA 51-year-old woman who experienced massive intraventricular hemorrhage due to presence of a post-central parasagittal AVM, Spetzler & Martin grade 3, underwent surgery Figures . In thisA 33-year-old man with an unruptured right-occipital AVM underwent surgical treatment Figures . IntraprIntraoperative ICG videoangiography is widely used and has become an indispensable imaging modality for use in patients undergoing neurovascular surgery –8. This Woitzik et al. first introduced the intensity curve analysis method ; the intIn the present study, we calculated similar parameters in the individual vessels and compared characteristics between the vessels or niduses. All semi-quantitative values obtained through intensity curves were similar among the feeders, niduses, and drainers, which may be due to presence of abnormally high flow in the draining veins from direct supply through the feeders via the nidus, a common occurrence in the AVM.In contrast, the CBFi values in the feeders correlated positively with the diameter and volume of the nidus. Similar results regarding the relationship between the blood flow and size of the nidus have been reported by previous study using indirect methods. A study using echocardiogram-triggered phase contrast MRI showed that the cerebral blood flow (CBF) was markedly higher in the ipsilateral versus contralateral internal carotid artery and correlated with the AVM volume . A studyColor-coded delay maps revealed the surface structure of the AVM as well as the main feeders, facilitating accurate sulcotomy prior to resection of the nidus. However, in the event of deep-seated location of the AVM within the brain tissue, or poor exposure, acquired images would be inadequate due to the depth and angle of the operative field , 11. A lIn conclusion, FLOW800 provided helpful information to surgeons aiming to develop optimal surgical strategy in treatment of patients with AVMs. Moreover, our data suggested that semi-quantitative assessment of ICG videoangiography may be a useful tool for evaluating flow dynamics in patients with neurovascular disease.