Powder X-ray diffraction (PXRD) shows that the stoichiometry of Li2S and LiI has a significant impact on the amorphization of xLi2S-(100-x)LiI system. Furthermore, the analysis of electrochemical impedance spectroscopy (EIS) indicates that the amorphization of xLi2S-(100-x)LiI system is strongly correlated with its ionic conductivity, which is primarily attributed to the effect of grain boundary resistance. These findings uncover the latent connections between amorphization, grain boundary resistance, and ionic conductivity, offering insight into the design of innovative amorphous SSEs.Solid-state electrolytes (SSEs) hold the key position in the progress of cutting-edge all-solid-state batteries (ASSBs). The ionic conductivity of solid-state electrolytes is linked to the presence of both amorphous and crystalline phases. This study employs the synthesis method of mechanochemical milling on binary  To makeatteries . Typicalatteries . Halide al anode . Oxide Sal anode . Each SSal anode . Notablyal anode .2S-P2S5 binary system SSEs can be prepared by mechanical milling and exhibit a high ionic conductivity (>10–4 S/cm)  . In addi) LiI (10 ≤ x ≤ 90) were synthesized by mechanical ball-milling method for the first time. PXRD analysis indicates that the amorphization degree of xLi2S-(100-x)LiI system is significantly influenced by the stoichiometry of Li2S and LiI. Furthermore, electrochemical impedance spectroscopy (EIS) analysis reveals a strong correlation between the amorphization degree of the xLi2S-(100-x)LiI system and its ionic conductivity, with the effect of grain boundary resistance being the primary contributing factor. Additionally, the increase of Li2S content in xLi2S-(100-x)LiI may restrict the grain boundary impedance reduction caused by amorphization.In this study, the amorphous SSEs of binary xLi2S-(100-x)LiI  were synthesized through a ball milling process. First, the starting materials of Li2S  and LiI  were ground in an agate mortar for 30 min to get the homogeneous mixture. Then, the stoichiometric mixtures of Li2S and LiI were ball-milled at 500 rpm for 33 h in a grinding jar with ZrO2 balls using planetary ball mill . The ball-to-powder mass ratio is 20:1 during sample preparation, and each cycle running for 15 min and resting for 5 min. The entire preparation process were carried out under an argon atmosphere .The amorphous SSEs of binary λ = 1.541,874 Å) and a Bragg–Brentano geometry, for identify the phases of xLi2S-(100-x)LiI binary system. PXRD data were collected with 2θ ranging from 20° to 90° at a scan rate of 0.14° s−1. Before measurements, each sample was placed on a zero-background sample holder in an Ar-filled glovebox and protected by a Kapton film for the hygroscopicity of xLi2S-(100-x)LiI.PXRD measurements were conducted at room temperature on an Empyrean diffractometer from Malvern Panalytical using Cu Kα (xLi2S-(100-x)LiI binary system were obtained through EIS measurement. Powder samples of xLi2S-(100-x)LiI were cold pressed into pellets under 4 tons in an insulative mold, and the pellets were placed between two stainless steel rods served as blocking electrodes. EIS measurement was performed on electrochemical workstation analyzer (AUTOLAB M204) in a frequency range from 1 MHz to 1 Hz with an amplitude of 50 mV. Moreover, the Nyquist curves were fitted by equivalent circuit to obtain the bulk resistance and grain boundary resistance of xLi2S-(100-x)LiI SSEs.Ionic conductivities of xLi2S-(100-x)LiI  system significantly depends on the stoichiometry of Li2S and LiI. Before ball-milling, all PXRD patterns of xLi2S-(100-x)LiI exhibit sharp-peak feature, which indicates their good crystallinity (xLi2S-(100-x)LiI after ball-milling exhibit different degrees of broadening (xLi2S-(100-x)LiI binary system LiI lead to obviously different amorphization degrees, even under the same ball-milling conditions. As shown in 2S and changes from 0.239 (x = 10) to 1.124 (x = 70), which demonstrates that the presence of Li2S can promote the amorphization of LiI. In contrast, the FWHM of Li2S seems to tend to remain constant as x increases in xLi2S-(100-x)LiI (x ≥ 50). Interestingly, the amorphization degree of the xLi2S-(100-x)P2S5 binary system is also dependent on the stoichiometric ratios of Li2S and P2S5 (xLi2S-(100-x)P2S5 diminishes as Li2S increases, accompanied by the appearance of sharp peaks of Li2S in the PXRD patterns (xLi2S-(100-x)LiI and xLi2S-(100-x)P2S5 suggests that the amorphization degree depends not only on the stoichiometric ratios but also on the composition of the compound in the binary system.As presented in allinity . In contoadening . Represey system . It shouand P2S5 . Howeverpatterns . Therefo2S and LiI determine the amorphization degree of the xLi2S-(100-x)LiI binary system, which significantly affects its ionic conductivity. xLi2S-(100-x)LiI binary system at room temperature (RT), and each curve exhibits a typical semicircle at high frequency representing the resistance and the linear part at low frequency representing ion blocking electrode. The EIS data were processed based on the formula: Z = (Z0 × S)/l to eliminate the effect of SSE pellet thickness and area on the impedance, in which Z0 is the raw data of the measured EIS, l is the thickness, and S is the area of SSE pellet. Fitting the plot by the equivalent circuit leads to the resistance R, which corresponds to the value of the real part of the Nyquist curve, and the ionic conductivity is calculated according to the formula of σ = l/(R × S). As presented in xLi2S-(100-x)LiI show a non-monotonic variation with the increase of x. As x increased from 10 to 70, the ionic conductivity of xLi2S-(100-x)LiI increased from 1.03 × 10−6 S/cm to 8.43 × 10−6 S/cm. Subsequently, after x continued to increase to 90, the ionic conductivity appeared to drop significantly to 1.78 × 10−7 S/cm. The above non-monotonic ionic conductivity changes may be attributed to both the amorphization degree of LiI and the content of Li2S in xLi2S-(100-x)LiI. In the first stage (x from 10 to 70), the amorphization of LiI is the dominant factor in influencing the ionic conductivity of xLi2S-(100-x)LiI (x from 70 to 90), the adverse effect of Li2S content on ionic conductivity may play a major role.The stoichiometric ratios of Li00-x)LiI . HoweverxLi2S-(100-x)LiI in depth, the Nyquist plots were fitted with the equivalent circuit consisting of bulk resistance (Rb), grain boundary resistance (Rgb) and constant phase element (CPE). As illustrated in xLi2S-(100-x)LiI . Besides, the variation of Rgb is significantly higher than that of Rb. The Rb and Rgb of 70Li2S-30LiI with the highest ionic conductivity are 3,632 Ω cm and 116.1 kΩ cm respectively. In contrast, the Rb and Rgb of 90Li2S-10LiI with the lowest ionic conductivity are 9,925 Ω cm and 5,566.4 kΩ cm respectively.To understand the ionic transport mechanism of the amorphous 00-x)LiI . ObviousRb and Rgb on x in xLi2S-(100-x)LiI, the differences between Rb and Rgb on logarithmic scale are presented in xLi2S-(100-x)LiI undergoes the significant change with x from 10 to 90 LiI, which is consistent with the results of the Nyquist curves fitted with the equivalent circuit. As shown in σ′) of the complex ionic conductivity as a function of frequency. Typically, the frequency independent plateaus (marked by arrow) correspond to the ionic conductivities at the grain boundary of SSEs LiI. In addition, the imaginary part (Z″) of the complex impedance as a function of frequency is plotted in x can also corroborate the results of Nyquist curves fitted with the equivalent circuit.Furthermore, to present the dependence of 10 to 90 , Rb doeuctivity . Also, t of SSEs . As x inxLi2S-(100-x)LiI depends directly on the grain boundary conductivity σgb and is almost unaffected by the bulk phase conductivity σb. On the other hand, in combination with the PXRD data of xLi2S-(100-x)LiI LiI.Obviously, the above results indicate that the ionic conductivity change of amorphous 00-x)LiI , it can xLi2S-(100-x)LiI (10 ≤ x ≤ 90) binary system was synthesized by mechanical ball-milling method. The PXRD analysis significantly demonstrated that the increase of Li2S content can promote the amorphization of LiI, and the amorphous degree of Li2S tend to remain constant as x increases in xLi2S-(100-x)LiI (x ≥ 50). The EIS analysis revealed that the change in ionic conductivity of amorphous xLi2S-(100-x)LiI depends on the grain boundary conductivity and is almost unaffected by the bulk phase conductivity. In addition, the competitive mechanism between the amorphization of LiI and the content of Li2S in affecting the grain boundary conductivity was found. The findings of xLi2S-(100-x)LiI binary system provide insights into the future design of new amorphous SSEs.In conclusion, the amorphous


In contrast, 55.7% (n = 88) reported using the fountains regularly; over a week, 39.8% (n = 47) used them less than once; 26.3% (n = 31) used them one to two times. Only about a third  reported consuming more water since the fountains’ installation. Teachers’ responses were similar to students’; principals stressed planning and costs. (4) Conclusions: A discrepancy between a good attitude towards and actual use of drinking fountains may exist; school communities may need to look for measures to overcome it.(1) Background: Water drinking is essential to reduce obesity in children, but effective means for implementation remain controversial. Our study assesses students’ and teachers’ use of and attitudes towards drinking fountains in two urban secondary schools. (2) Methods: In a cross-sectional study, answers from students and teachers to a 28- and 19-item questionnaire, respectively, containing closed- and open-ended questions and short interviews with the schools’ two principals were described and analysed using the question-specific number of responses as the denominator. (3) Results: Questionnaires of one hundred sixty-two students and ten teachers were analysed; 36.1% of students responded. Students viewed the schools’ two fountains as a good idea (73.3%,  Drinking sufficient water is critical for children’s diet and healthy life, but unfortunately, it is not a common practice for many children. Newborns and infants are particularly vulnerable to life-threatening dehydration . InadequIn contrast, children often consume unhealthy amounts of sweetened beverages containing a significant number of calories . For exaDrinking fountains could offer a promising approach to address the need for increased water consumption among schoolchildren. For instance, establishing school drinking fountains has been shown to support healthy drinking behaviour by significantly increasing students’ water consumption in several primary schools ,14,15. FIn Germany, the prevalence of overweight (including obesity) children aged three to seventeen years from 2014–2017 was 15.5%, with little change compared to 2003–2006. Still, obesity affected children from the lowest socioeconomic group most, and it had increased from 20% to 25.5% among them . In DortThis exploratory study assesses the use and acceptance of drinking fountains in the two secondary schools addressing students and teachers. Specifically, the study examines the frequency of the fountains’ use, the users’ attitudes and drinking behaviours, and the potential determinants.Tap water in Germany undergoes regular checks and is safe for drinking. Authorities also regulate the number of sanitary facilities in schools, including an adequate number of mostly flat taps with sinks for hand washing (which are inconvenient for bottle filling), depending on the number of students. The two drinking fountains installed in our study setting are water taps without bubblers (adding water without carbon dioxide), located on the schools’ floors. Both fountains fill bottles placed under a sensor. The Hauptschule’s fountain also produces a small, curved jet of water for drinking directly, activated by a button see . Apart fThe study has a descriptive, cross-sectional design using questionnaires. The questionnaires contain 26 closed and two open items for students  and 17 cThe questionnaire’s content resulted from literature research, consultation with the schools’ principals, and views from child health experts. A small group of children assessed the questionnaire for understandability. Apart from sociodemographic items, the questionnaires included items on water fountain use and potential determinants of drinking behaviours, such as the availability of alternatives, prior experiences, flavour preferences, the role of peers, and aspects of health literacy. The open-ended questions allowed commenting on, for example, the appearance and function of the water fountains.R version 5.9.1 with the principals of the two schools following a topic guide . The best rates had students of the Hauptschule (63%) compared to students of the Gymnasium (31.1%) and teachers 43.5% (10/23). The analysis included all 162 questionnaires returned by the students . Howevern = 86) were female, 39.5% (n = 64) were male, 6.2% (n = 10) indicated diverse, and one participant each preferred not to answer this question or left the answer open (n = 78) were in year 6.Of all students, 53.1% (wer open . The medn = 88) of all students responded that they used the drinking fountain regularly (n = 138), and many children denied bringing fewer drinks from home since the drinking fountains were put into operation . In addition, 39.8% (n = 47) used the fountains only less than once, and 26.3% (n = 31) used them one to two times per week, while 31.1% of respondents (n = 50) reported regularly purchasing drinks. A fifth of respondents (n = 33) knew about drinking fountains from their primary schools.More than half  and 31% (n = 46) of respondents, respectively, although juice spritzers were also popular .Whether brought from home  or purchn = 118), 73.1% (n = 117), and 70.5% (n = 110), respectively). However, only 26.5% (n = 43) appear to consume more water since installing the drinking fountains , 25.5% (n = 41), and 30.1% (n = 47), respectively) (n = 150) of respondents described water as “healthy”, while juice spritzers were considered “somewhat healthy” by 51.6% (n = 81) and “somewhat not healthy” by 38.9% (n = 61).Responses to the question about considering healthiness when selecting drinks, fellow students’ use of the drinking fountain, and coverage of healthy drinks as topics in the classroom were less definite (complete agreement by 19.8% (ctively) . HoweverThere were only marginal differences in students’ responses between the two schools to the questions on attitudes towards the drinking fountain, regular use, and drinking more water since the drinking fountains have been in place .Univariate ordinal logistic regression analyses did not reveal significant risk factors for students’ use of  and attin = 61), whereby the most frequently expressed wish was for sparkling water . Other wishes of the students related to the fountains’ design, alternative ways of accessing water , or a simpler operation. Further comments were made by 38.9% of the respondents (n = 63), whereby 30.2% (n = 19) of the entries welcomed the drinking fountains project.Seventy-four percent (120/162) of students used the questionnaire’s free text option to suggest changes to the drinking fountains (multiple answers). About half of all answers recorded referred to the drinks offered  or partly (n = 2). However, out of the ten, only four indicated using the fountains regularly, and out of those two, “less frequently than once a week”; the other two did not answer , will further limit the generalisability. Nevertheless, the cross-sectional design and the mix of quantitative and qualitative methods meet the aim and objectives of this explorative study and may trigger a more in-depth investigation. Furthermore, the study represents real-life data that add value to data collected under controlled conditions without biases caused by incentives and additional resources. Its findings and conclusions generated hypotheses about the acceptability and users’ behaviours that may result in more extensive studies with different designs to test them.In summary, most students in our study value and are aware of water as a healthy drinking choice and approve of drinking fountains in principle. However, only a fraction of students use the fountains regularly, often infrequently, and the availability of only one fountain per school limits access. The observed discrepancy between attitude and use observed in students might hold for teachers, too. Principals stress the fountains’ advantages, costs, and organisational challenges. Enhanced involvement of teachers in drinking fountain promotion and systematic engagement of students with water drinking opportunities for a healthy diet may increase students’ use and acceptance.


The relationship between cyber video game addiction and impulsivity is controversial. Some studies have shown a significant link, others have found no association between the two behaviours.To study impulsivity in adolescents with problematic use of internet video games.This was a cross-sectional, descriptive and analytical study, conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The rate of addiction to video games was assessed by the 20-item “Internet Gaming Disorder-20” (IGD-20) scale and impulsivity by the 30-item “Barratt Impulsivity Scale” (BIS-11). Both scales are validated in Arabic.The study involved 360 secondary school students, with a mean age of 16.62 +/- 0.822 years. The sex ratio was 1.09.A gaming addiction was found in 4.7% of cases.Similarly, impulse control disorder was noted in 23.6% of adolescents.Problematic internet game use was significantly related to motor impulsivity (p=0.025).There was no significant association between cyber video game addiction and cognitive or non-planning impulsivity.According to the results, impulsiveness is a factor to consider for understanding the development of addiction to internet video games. Thus, impulsiveness should be taken into account to explain problematic gaming behaviour as well as to design preventive and treatment interventions.None Declared


IL33 stimulates expansion of IL5-producing type 2 innate lymphoid cells (ILC2), which triggers a cellular switch in the intrathymic availability of IL4. This enables eosinophil production of IL4 to re-establish thymic mesenchyme prior to recovery of thymopoiesis-inducing epithelial compartments. Collectively, we identify a positive feedback mechanism of type 2 innate immunity that regulates the recovery of thymus function following tissue injury.As the primary site of T-cell development, the thymus dictates immune competency of the host. The rates of thymus function are not constant, and thymus regeneration is essential to restore new T-cell production following tissue damage from environmental factors and therapeutic interventions. Here, we show the alarmin interleukin (IL) 33 is a product of Sca1 Although thymic function declines with age, the thymus also has the ability to regenerate following injury. Here, the authors demonstrate that IL-33 and type-2 innate lymphoid cells trigger the expansion of eosinophils following radiation injury, which in turn produce IL-4 to stimulate the recovery of the thymus mesenchyme during thymus regeneration. Thus, thymus function enables the host to mount effective immunity against pathogens and cancers, and benefit from therapeutic interventions including successful vaccination strategies. Importantly, the process of intrathymic T-cell production is not cell-autonomous and instead depends upon complex interactions between developing thymocytes and multiple thymic stromal compartments. These include a diverse range of thymic epithelial cells (TEC) as well as mesenchyme and endothelium that collectively control both thymocyte development and tolerance induction5. Importantly, although the thymus remains functional throughout life, the rates of thymopoietic function and T-cell production are variable. For example, while chronic age-related thymic involution results in a progressive decline in T-cell development, the thymus is also highly sensitive to stimuli that cause acute tissue damage, resulting in detrimental effects on thymus function8. Perhaps most significantly, chemo- and radio- therapeutic interventions used in cancer treatment provoke the loss of thymic stromal environments, which disrupts thymus function and causes a decline in T-cell production and increased patient morbidity and mortality due to secondary immunodeficiency9. To combat this, the thymus possesses effective endogenous regeneration mechanisms that restore T-cell production. Here, the recovery of thymus function occurs via the effective restoration of the intrathymic stromal microenvironments that are required to re-establish new waves of thymopoiesis. In our previous studies, we identified an essential role for eosinophils in thymus regeneration10, findings which highlighted the importance and potential of targeting the innate immune system to therapeutically enhance thymus recovery. Here, we have examined the cellular and molecular mechanisms that control eosinophil-dependent thymus regeneration, and studied the effector role of eosinophils in this process. We show that the alarmin interleukin (IL) 33 is expressed by a Sca1+ subset of thymic mesenchyme cells and is essential for thymus regeneration. IL33 influences the recovery of thymus function during regeneration through the targeted expansion of intrathymic type 2 innate lymphoid cells (ILC2), known producers of the cytokine IL5. Increased availability of IL5+ ILC then promotes an expansion of thymic eosinophils, which shunts intrathymic production of the type 2 cytokine IL4 away from CD1d-restricted natural killer (NKT)-cells and towards eosinophils. Finally, we show that IL4 is required for recovery of IL33+ thymic mesenchyme following damage, indicating that IL4 is the effector molecule of eosinophils in thymus regeneration, which operates by restoring IL33+ mesenchyme as a positive feedback loop. Collectively, identification of this intrathymic innate network that restores thymus function following injury provides new insights into how this primary lymphoid organ is controlled by innate immune components, and offers direction towards new therapies for immune recovery following tissue damage.The production and selection of αβT-cells in the thymus is an essential feature of the vertebrate adaptive immune system. During this process, intrathymic T-cell development is initiated by thymus colonisation of lymphoid progenitors and culminates in the generation of self-tolerant major histocompatibility complex (MHC)-restricted CD414. Given the importance of both these cell types in thymus regeneration10, we examined the importance of the alarmins IL25 and IL33 in the context of a sublethal irradiation model (SLI) of thymus regeneration10. Here, Il25−/− and Il33−/− mice were treated with SLI alongside WT controls, and harvested at d35 post-SLI, a point that represents the timing of full thymus recovery10. In these experiments  in eosinophils numbers in Il7raCre control mice at d7 post-SLI, this was significantly diminished in ILC2 KO mice  window after damage induction, and suggests that despite their expression of IL4 in the steady state, ILC2 are not likely to operate as key providers of IL4 during the regeneration process. Given the evidence that eosinophils are a major source of intrathymic IL4 post-SLI, and the knowledge that Sca1+ mesenchyme cells are targets of IL414, we wondered whether Sca1+ mesenchyme was also affected in eosinophil deficient ΔdblGATA mice28. At steady state, numbers of Sca1+ mesenchyme were comparable in ΔdblGATA and WT mice  mice on a C57BL/6 background, we showed that at steady state, thymic GFP+ cells consisted mainly of NKT-cells. In our current study, we used the same 4Get mice, but on a Balb/c background to ensure strain comparability with Il4ra−/−, ΔdblGATA mice used here. Interestingly, at steady-state in Balb/c 4Get mice, as in C56BL/6 4Get mice, the majority of GFP+ cells in thymus were NKT cells. However, following SLI irradiation of Balb/c 4Get mice, the majority of GFP+ cells were eosinophils, which contrasts with a dominance of NKT cells in C57BL/6 mice after SLI10. Thus, SLI irradiation and thymus regeneration in Balb/c mice results in a shift in the cellular source in IL4 production towards eosinophils. This important requirement for the type 2 cytokine IL4 in Balb/c mouse models fits well with the known bias of this strain to type 2 immunity compared to C57BL/6 mice32. Furthermore, the finding that the intrathymic cellular sources of IL4 in Balb/c and C57BL/6 mice differ post-damage may indicate differences in the mechanisms of thymus regeneration in C57BL/6 and Balb/c mouse strains. This demonstrates the importance of mouse background in both the design of future studies and interpretation of previous studies, and indicates further work is required to examine how strain-specific differences occur during thymus regeneration.Here, we have the cellular and molecular mechanisms that control thymus regeneration following injury. In particular, we re-investigated the role played by eosinophils in thymus regeneration+ mesenchyme following damage, creating a positive feedback loop for IL33-mediated control of tissue repair in the thymus. Importantly, we also show that IL4 administration can restore thymus regeneration in ΔdblGATA eosinophil deficient mice, which provides direct evidence that the requirement for eosinophils in thymus recovery is at least in part explained by their expression of this type 2 cytokine. Taken together, the ability of IL4 and IL33 to boost regeneration in Balb/c mice fits well with the idea that IL33 operates upstream in a mesenchyme>ILC2>eosinophil>mesenchyme pathway. Here mesenchyme production of IL33 expands thymic ILC2, which increases intrathymic IL5 availability that causes an increase in IL4+ eosinophils. Interestingly, analysis of ILC2 frequency after damage shows they are depleted from the thymus 1 day following SLI treatment, indicating that the requirement for, and involvement of, ILC2 in thymus regeneration occurs within a narrow time window. In contrast to the effects of IL33, IL4 likely operates downstream in thymus regeneration, with IL4 production from eosinophils forming part of a positive feedback loop that then aids regeneration of thymic mesenchyme. Interestingly, a direct comparison of the individual effects of IL4 and IL33 showed that they exert similar positive effects on thymus regeneration. Moreover, a combination of IL4 and IL33 did not further enhance thymus recovery compared to either cytokine alone , Il4ra−/−39, Il33cit/+ (IL33cit reporter) and Il33cit/cit (IL33KO)17, IL25Tdtom/Tdtom (IL25 KO)40, IL4GFP24 . The following mice were on a C57BL/6 background; Red5xRagGFP mice generated in-house by crossing IL5tdTomato reporter (Red5) 15 with Rag2pGFP transgenic16 , ILC2-deficient Il7raCreRorafl/fl mice were generated by crossing Il7raCre41 and Rorafl/fl42 mice. For experiments involving the comparison of thymus regeneration in WT, Il33−/− and Il25−/− mice, all animals were born and maintained in the Biomedical Services Unit at the University of Birmingham. For experiments analysing effects of IL25 and IL33 on thymus regeneration in WT mice, Balb/c mice (strain code 028) were purchased from Charles River. Housing and experimental methods were performed at the Biomedical Services Unit at University of Birmingham, following approval by the local Animal Welfare and Ethical Review Body (AWERB) and UK National Home Office.Female mice at 8–10 weeks of age were used throughout this study. They were housed under barrier conditions in ventilated cage racks, and sacrificed by cervical dislocation. The animal facility is maintained under artificial lighting (12 h) between 7:00am and 7:00 pm, with a controlled ambient temperature of 22 °C  ±  2 °C, and relative humidity between 45% and 65%. The following mice were on a Balb/c background: Balb/c WT, DdblGATA10. For thymocyte, NKT and ILC analysis, thymi were mechanically disaggregated before surface staining. Reagents used for eosinophils/iNKT/ILC were anti-CD45, clone 30-F11, Brilliant Violet 786 (1:100), APC-eFluor 780 (1:800), Brilliant 605 (1:800), eBioscience, anti-TCRβ clone H57-597, APC-eFluor 780 (1:200), eBioscience, anti-CD11b clone, M1/70, PE (1:400), BioLegend, anti–Siglec-F clone ES22-10D8, APC (1:200), Biotin (1:100) Miltenyi Biotech, anti-CD4 clone RM4-5, Brilliant Violet 711 (1:50), Alexa Fluor 700 (1:100), FITC (1:200), BioLegend, anti-CD8α clone 53-6.7, Brilliant Violet 510 (1:200), BioLegend, anti-TER119 clone TER-119, Brilliant Violet 421 (1:100), Alexa Fluor 700 (1:200) BioLegend), PBS57/mCD1d tetramer, APC (1:200), National Institutes of Health Tetramer Core Facility, anti-IL7Rα clone A7Ρ34, Brilliant Violet 421 (1:100), APC (1:100), eBioscience, anti-KLRG1 clone 2F1/KLRG1, PerCP Cy5.5 (1:200), BioLegend and anti-NK1.1 clone PK136, Brilliant Violet 650 (1:100) Invitrogen. Lineage panel used for ILC analysis10 was anti-CD3ε clone 145-2C11, PE Cy7 (1:200), Biolegend, anti-CD5 clone 53-7.3, PE Cy7 (1:200), eBioscience, anti-CD11b clone ICRF44, PE Cy7 (1:200), Invitrogen, anti-CD11c clone N418, PE Cy7 (1:200), Invitrogen, and anti-B220 clone RA3-6B2, PE Cy7 (1:200), Invitrogen. For TEC, mesenchyme, and endothelial analysis43, thymus tissues were digested with collagenase dispase (2.5 mg/ml) (Roche) and DNase I (100 mg/ml) (Roche) before being stained with the following antibodies/reagents: anti-EpCAM1 clone G8.8, Brilliant Violet 711 (1:400), PerCP-eFluor 710 (1:2000), eBioscience, UEA1 Biotin (1:10000) (Vector Labs) detected using streptavidin PE Cy7 (1:1500), eBioscience, anti-Ly51 clone BP-1, PerCP-eFluor 710 (1:600), BD Pharmingen, anti-MHCII clone M5/114.15.2, Alexa Fluor 700 (1:1200), eBioscience, anti-CD80 clone 16-10A1, Brilliant Violet 605 (1:400), BioLegend, anti-CD31 clone 390, PE Cy7 (1:800), Invitrogen, anti-Sca-1 clone D7, PE (1:2000), FITC (1:1000), eBioscience, anti-IL4Ra clone I015F8, PE (1:50), BioLegend, anti-Integrinα7 clone 334908, Alexa Fluor 700 (1:100), R&D, and Zombie Aqua Fixable Viability Kit, Brilliant Violet 510 (1:1000), BioLegend. All flow cytometric data were collected on a BD LSR Fortessa running FACs DIVA (v.9.0) and analysed using FlowJo version v10.8.1.For eosinophil analysis, cells were obtained from thymus tissue after enzymatic digestion using collagenase D (2.5 mg/ml) (Roche) and deoxyribonuclease I (DNase I) (100 mg/ml) (Roche) at 37 °C44, anti-Aire , anti-CD205 . Secondary antibodies were streptavidin 555 (Invitrogen), goat anti-Rat IgM Alexa Fluor 647 (Invitrogen). Sections were counterstained with DAPI  (Sigma), and mounted using Prolong Diamond (Thermo Fisher). All confocal microscopy data was acquired on a Zeiss LSM 880 microscope using Zen Black (14.0.22.201) and analysed using Zen Black (16.0.2.306).Thymus sections of 7-μm thickness were cut from snap-frozen thymus tissue, then fixed in acetone. Sections were stained with the following antibodies: mTEC marker ERTR510 with a dose of 1 × 425 rad (4.25 Gy). Mice on a C57BL/6 background were given 1 × 500 rad (5.0 Gy)10 . Mice were given Baytril for 1 week before, and 1 week after total body SLI treatment. Mice were then harvested at indicated time points to assess thymus recovery.Mice on a Balb/c background were subjected to sublethal total-body irradiationMice were intraperitoneally injected with either PBS or 5 μg recombinant IL4 (PeproTech) complexed to 25 μg anti-IL4 (BioXCell) prior to injection, 2.5 μg of recombinant IL25 (PeproTech) or 2.5 μg of recombinant IL33 (PeproTech). In some experiments, mice received a combination of IL4 and IL33 described above. Injections and harvesting points are indicated in the figures.t test was used for comparisons between two data sets, and graphs were annotated to indicate significance. For comparison of three or more groups, one-way analysis of variance (ANOVA) was performed with an appropriate post hoc test specified in each figure legend to allow for multiple comparisons. Nonsignificant differences are not specified. In all figures, bar charts and error bars represent means ± SEM.Graph Prism v 10.0.3 (GraphPad Software) was used to perform all statistical analyses. Unpaired Student’s Further information on research design is available in the Supplementary InformationPeer Review FileReporting SummarySource Data


Although there are various surgical causes of and therapeutic approaches to the chronically failing ileoanal pouch (PF), cases are often detailed without distinguishing the exact cause and corresponding treatment. The aim of our study was to classify causes of PF and corresponding surgical treatment options, and to establish efficacy of surgical approach per cause.This retrospective study included all consecutive adult patients with chronic PF surgically treated at our tertiary hospital between July 2014 and March 2021. Patients were classified according to a proposed sub-classification for surgical related chronic PF. Results were reported accordingly.n = 25), pouch body complications (n = 12), outlet problems (n = 11), cuff problems (n = 8), retained rectum (n = 2), and inlet problems (n = 1). For these indications, 17 pouches were excised, 10 pouch reconstructions were performed, and 32 pouch revision procedures were performed. The various procedures had different complication rates. Technical success rates of redo surgery for the different causes varied from 0 to 100%, with a 75% success rate for septic causes. A total of 59 procedures were completed in 50 patients  for chronic PF. Most patients had refractory ulcerative colitis as indication for their restorative proctocolectomy (68%). All patients could be categorized according to the sub-classification. Reasons for chronic PF were septic complications (Our sub-classification for chronic PF and corresponding treatments is suitable for all included patients. Outcomes varied between causes and subsequent management. Chronic PF was predominantly caused by septic complications with redo surgery achieving a 75% technical success rate. The incidence of PF is reported to be up to 7 and 9% after 3 and 5 years, respectively [Restorative ileal pouch-anal anastomosis (IPAA) after proctocolectomy is a well-established procedure often used in patients with ulcerative colitis or familial adenomatous polyposis. Functional outcomes are often excellent for the majority of patients, although a significant number of pouches do fail over time . A chronectively , with peectively . Both suectively .Pouch redo procedures and excision aim to improve patient quality of life, while redo procedures have the additional objective of preserving bowel continuity. Both types of procedure are challenging and entail operating deep in the pelvis.. Most researchers describing redo surgery for PF combine all patients irrespective of cause and treatment approach. Studies report overall success rates of redo surgery for PF of approximately 70% –6. AlthoIndication and treatment classification enables reporting on success rates per PF cause and therapeutic intervention. This facilitates (shared) decision-making about the best option for the individual patient. Moreover, introduction of a sub-classification facilitates routine registration of chronic PF and redo-pouch procedures. The aim of our study was to classify causes of PF and corresponding surgical treatment options, and to establish the efficacy of surgical approach per cause.This retrospective observational cohort study included all consecutive adult patients that underwent IPAA surgery and developed chronic PF, surgically managed by laparoscopic and/or open surgery mostly in combination with TAMIS at our referral center. Patients undergoing redo surgery for all chronic PF indications between July 2014 and March 2021 in the Amsterdam UMC, location AMC, were included. These were patients who underwent initial IPAA surgery in the Amsterdam University Medical Centers (UMC), Academic Medical Center (AMC) location, as well as patients referred from elsewhere. Chronic PF was defined as a long-term (≥ 3 months) pouch-related complication (including pouch dysfunction) requiring pouch redo surgery or excision regardless of the surgical indication and functional outcome of the pouch (with or without permanent diversion by ileostomy). Pouch excision was defined as resection of the primary pouch with construction of a permanent ileostomy. For pouch redo surgery, a distinction was made between a pouch ‘reconstruction’ and pouch ‘revision’. Pouch ‘reconstruction’ was defined as resection of the primary pouch with construction of a new IPAA and ‘revision’ was any other surgical modification of the primary pouch, with or without disconnection of the anastomosis. Bowel continuity was pursued in both types of redo surgery. Early PF indications such as acute postoperative leakage or hemorrhage requiring redo surgery within 3 months after IPAA surgery are not included in this sub-classification. According to local law and the Medical Ethics Committee at the Amsterdam UMC, ethical approval was waived for this retrospective study. All eligible patients received an opt-out letter and could withdraw permission to collect data for this study.. A classification for surgical related chronic PF was developed categorizing different types of PF and subsequent surgical management options to overcome random classification of chronic PF , transa1Patient demographics, medical history, indications for surgery, perioperative and postoperative outcomes were retrieved from electronic patient records. Outcome variables included perioperative mortality, postoperative morbidity and permanent ileostomy presence. Postoperative morbidity was graded according to the Clavien–Dindo classification , and sevn) and their proportion as a percentage. Continuous data were presented as mean and standard deviation (SD) or as median and interquartile range (IQR), according to their distribution. Analyses were performed using IBM® SPSS® for Windows® version 26 .Data were collected and stored in an electronic database. All PF procedures were described according to the suggested sub-classification. Categorical data were presented as amount of redo procedures  with a median age of 45.0 (IQR 34.5–54.3) years. Initial indications for restorative proctocolectomy were predominantly medical refractory ulcerative colitis (68.0%) and familial adenomatous polyposis (24.0%). Further baseline characteristics are listed in Table A total of 59 surgical redo procedures in 50 patients were performed for chronic PF. The median follow-up after pouch-redo surgery was 19.0 (IQR 5.0–33.1) monthsolyposis 4.0%. Furn = 25), pouch body complications (n = 12) e.g. complications of the pouch related to CD (n = 5) and chronic refractory pouchitis (n = 3), outlet problems (n = 11) with (n = 8) and without (n = 3) mega-pouch, cuff problems (n = 8), retained rectum (n = 2), and inlet problems (n = 1). Out of 59 surgical redo procedures, 16 involved a pouch excision and one a resection of the top of the pouch with creation of a definitive ileostomy. The remaining 42 surgical redo procedures involved 10 pouch reconstructions and 32 pouch revision procedures. The 59 procedures were performed in 50 patients, as 7 patients required 2 and 1 required 3 pouch redo procedures. An overview of the performed pouch excisions and redo surgeries per PF cause is provided in Table Indications for surgical treatment of chronic PF were septic complications  or TAMIS and laparoscopic (n = 12) approach. Five procedures were performed via TAMIS only, 3 were performed laparoscopically and 2 consisted of an open abdominal approach. One of the pouch excision procedures required conversion from a combined TAMIS and laparoscopic to a combined TAMIS and open procedure due to severe adhesions. Thirty-five out of 39 (combined) open abdominal surgery procedures were performed via lower midline laparotomy and 4 via Pfannenstiel incision. Pouch excisions were either combined TAMIS and open (n = 10), TAMIS and laparoscopic (n = 5), laparoscopic (n = 1) or TAMIS (n = 1) procedures. The pelvic cavity was filled by pediculized omentoplasty in 14 patients (23.7%), and pouch mesentery was used in 3 (5.1%). In one patient, omento- and mesoplasty were combined and in another, the ileocolic mesentery was used to fill the pelvic cavity. An ileoanal anastomosis was created in 38 redo procedures, 35 (92.1%) of which were hand-sewn. One anastomosis was stapled, and in 2 procedures a Turnbull–Cutait was technique applied; the ileoanal anastomosis was therefore delayed until a second stage. Intraoperative characteristics are listed in Table Out of all 59 procedures, 49 were performed via a combined TAMIS and open n = 7 or TAMIn = 11) had a postoperative anastomotic leak. For acute anastomotic leak, 5 patients underwent a surgical reintervention, 4 patients underwent a combined surgical and endoscopic reintervention, 1 patient underwent a combined surgical and radiological reintervention, and 1 patient had an endoscopic reintervention. The reintervention for acute anastomotic leak was successful in 7/11 patients, which was not correlated to type of reintervention. Postoperative outcomes are shown in Table Patients were discharged from the hospital at a median 6.0 (IQR 4.0–10.0) days after surgery. In 20 33.8%) patients, severe postoperative complications (Clavien–Dindo ≥ 3) were reported. More than half of the reinterventions were indicated for anastomotic leak . Therefore, out of 38 ileoanal anastomoses that were created during redo surgery, 28.9%  had a functional pouch at the end of follow-up. An intended temporary ileostomy after a redo procedure was never reversed in 1 patient despite technical success of the procedure. One patient with technical success proven by computed tomography scan and endoscopy of the pouch is still awaiting reversal of ileostomy created during the redo procedure. The technical success rate of the first redo procedure in this cohort is therefore 71.1% (27/38). After the first redo procedure, functional success was achieved in at least 25/38 patients (> 65.6%). The first pouch-redo procedure failed in the remaining 11 patients; 4 patients required pouch excision surgery with a permanent ileostomy and in 3 the loop ileostomy was converted into a permanent end-ileostomy. A second redo pouch surgery was performed in 4 patients and 3 were successful. An overview of the surgical redo procedures per indication with corresponding success rates is provider in Table Twenty-five patients had a redo procedure due to septic conditions, of which 15 had a chronic sinus caused by a chronic leak. Four patients underwent immediate pouch excision for a chronic sinus, including the patient that had proctocolectomy because of presumed Crohn’s colitis. Five patients underwent a successful pouch revision after debridement of a chronic sinus; in 3 patients a pouch reconstruction was performed, with technical success in all. One of these patients is still awaiting ileostomy closure. One patient required pouch excision after a failed pouch revision for a chronic sinus and another required pouch excision for a septic anastomotic leak after a cuff excision for cuffitis. Eight patients had redo surgery for perianastomotic fistula; 3 had a pouch excision, 3 a pouch revision, 1 a sleeve advancement and 1 a pouch reconstruction. The patient who underwent a pouch reconstruction eventually required a permanent ileostomy due to a recurring fistula. Two patients had a Crohn’s related fistula; one underwent a sleeve advancement and in the other a pouch reconstruction was performed. Both procedures failed due to a recurring fistula. Patients were followed for a median time span of 18.1 (IQR 6.0–33.2) months after their redo procedure.Twelve patients had pouch body related problems. Three patients with chronic refractory pouchitis underwent a pouch excision. Three patients had CD of the pouch body, of which 1 had immediate pouch excision and 1 had a pouch excision after a failed pouch revision for CD. Another patient with CD of the pouch body had the top of the pouch resected with creation of a definitive ileostomy after 2 failed pouch revisions for CD (fistula), as mentioned above. Three patients had dysplasia in the pouch for which a pouch excision was performed in 1 patient and a successful redo pouch was made in 2. One patient with a motility disorder of the pouch underwent a pouch excision. Median length of follow-up of redo procedures was 21.2 (IQR 5.5–43.0) months.One patient with a torsion of the afferent loop underwent pexy of the loop. After this procedure, this patient required a second pouch revision due to a perianastomotic fistula, which was previously described. This patient was followed for 50.3 months.Six of the 11 patients with outlet problems had complicated evacuation of the pouch due to intussusception. Four patients had distal septa in the pouch that intussuscepted into the anus blocking evacuation during straining. One patient had pouch wall intussusception and another had both pouch wall- and septal intussusception. For septal intussusception, 2 patients underwent a successful pouch revision and 1 patient underwent a successful pouch reconstruction. One patient developed septal intussusception after failed redo surgery for efferent loop syndrome in an S-pouch for which a pouch revision was performed. Eventually, this patient underwent permanent ileostomy surgery despite technical success. For anterior pouch wall intussusception, 1 patient underwent successful pexy surgery. A pouch reconstruction was performed in 1 patient with both wall and septal intussusception followed by permanent ileostomy surgery despite technical success. Two out of 3 patients with efferent loop syndrome underwent a pouch revision. In 1 revision was successful and 1 required second redo surgery for septal intussusception, as previously mentioned. The third patient underwent a pouch revision for efferent loop syndrome after a cuff excision for cuffitis, which was technically successful. The patient desired a pouch excision and the creation of a Kock-pouch at a later stage . One of Eight out of 11 patients with outlet problems had a megapouch Fig. . Of thesn = 3, malignancy n = 1). Median length of follow-up was 27.8 (15.5–40.7) months. All patients with cuffitis underwent cuff excision with sleeve advancement. One of these procedures was technically successful. For 2 patients, a pouch excision followed due to a chronic sinus (n = 1) and perianastomotic fistula (n = 1), as mentioned earlier. For 1 patient, second redo surgery for outlet complications followed, as mentioned earlier. All 4 patients with cuff dysplasia underwent cuff excisions with sleeve advancement, which were all technically successful.Eight patients had cuff problems; 4 patients had refractory cuffitis and 4 had cuff dysplasia , followed by redo for outlet disorders  and chronic pelvic sepsis (75%). Cuff excision for refractory pouchitis had a low success rate of 25% as opposed to cuff excision for polyposis (75%). Management of pouch body problems for CD failed in all patients, as opposed to a 100% technical success rate in redo surgery for neoplastic lesions, although there were few patients with these conditions. The relative overrepresentation of patients with familial adenomatous polyposis in this cohort is due to the high amount of patients that were referred from other hospitals. Several complications mentioned in the sub-classification are rare and thus we were able to include only a small number of patients.Postoperative complications including anastomotic defects and need for reintervention was common after redo surgery. In our cohort, severe postoperative complications occurred in one-third of patients and anastomotic leaks occurred after 28.9% of redo procedures, corresponding with available literature reporting anastomotic leak rates after redo surgery between 0 and 41% –18. The With the introduction of TAMIS surgery, redo surgery is performed with increasing regularity and variety . Most ofSeries published on TAMIS surgery for redo procedures after IPAA predominantly focus on septic anastomotic complications , 24. AltOur study has some limitations The relatively small cohort is one of the main limitations. Some complications in the sub-classification such as inlet complications or retained rectum were too rare to draw conclusions about surgical success. As high volume centra could provide more patient data on this, classification of surgical treatment of PF remains essential. External validation from high volume centra for the proposed sub-classification for chronic PF and the suggested corresponding therapeutic approach is therefore essential. Adding a significant number of patients with a longer follow-up after surgery for PF will help enable us to draw more robust conclusions with respect to success rates of the management of the various types of chronic PF. Another limitation is that patients can have multiple chronic PF indications as described in the sub-classification. In that case, either an overlapping surgical treatment can be performed or a combination of  surgical treatments can be considered.With the proposed sub-classification, management of the complex problem of chronic PF becomes more comprehensible and makes results comparable. Our series showed that redo pouch procedures for chronic septic problems, outlet problems with or without megapouch, polyposis of the cuff and retained rectum all had favorable success rates, justifying the indication for redo pouch surgery. Conversely, the selected patients that had redo surgery for CD of the pouch, and for refractory cuffitis had unfavorable outcomes. It is, essential to combine good quality data from multiple units in order to draw more robust conclusions.


The aim of this study was to evaluate the quality, content, and demographics of YouTube™ videos about pediatric dentistry for the education of dentistry students.In the era of Covid 19 pandemic, the audio-visual contents of YouTube™ was performed using the keywords "pediatric dentistry”, “pediatric dental treatments”, “primary teeth treatments" in Turkish. The first 50 videos selected for each keyword were evaluated. Parameters of the videos such as the number of views, the days since the upload, the duration of the video, and the number of likes and dislikes were recorded. Videos are categorized by upload source and content categories as an academic, dentist, physician, patient, reporter, and other, and average points are obtained for the Journal of American Medical Association (JAMA) benchmark. The normality of the data was evaluated with the Shapiro-Wilk test. The data were not distributed normally, compared with the Kruskal Wallis test between source and content groups. The Dunn’s Post Hoc was used to determine to find out which group caused the difference. The Spearman Correlation coefficient was calculated to assess a possible correlation between JAMA, GQS, and VPI scores. All significance levels were set at 0.05.A search on YouTubeThe duplicates and non-related ones were removed from 150 videos and remaining 119 videos were evaluated. Most of the videos were uploaded by the dentists and other categories, and mainly the videos were uploaded for patient education. JAMA score was 1 out of 4 for 55 videos, 2 for 63 videos, and 3 for only 1 video. When the video source groups were compared, the difference was statistically significant (p = 0.01). The difference between academic and patient groups (p = 0.007); the dentist and patient groups were statistically significant (p = 0.02).YouTube platform does not contain videos of appropriate quality to support the education of dentistry students in pediatric dentistry in Turkish. COVID-19 disease (or SARS-CoV-2 virus) is a public health problem that emerged towards the end of 2019 and affected the whole world. This disease, which was declared a “Pandemic” by the World Health Organization on March 11, 2020, has adversely affected many sectors and caused serious problems in both practicing medicine and receiving education in the dental field. With the decision of the government, face-to-face training and exams have been suspended for an indefinite period in our country, as in many countries, due to efforts to minimize social contact to prevent the spread of the new coronavirus. On the other hand, the students had to receive digitalized education and were led to educate themselves—even partially—by obtaining information from various platforms on their own means. Web sites and various social media have rushed to the assistance of students in this regard  and video power index (VPI) variables were calculated. The evaluated videos were examined under 6 groups in terms of uploading resources. These are (1) academic (loaders affiliated with research groups and universities); (2) the dentist; (3) physician; (4) the patient; (5) the messenger; (6) other.Videos were evaluated under 5 titles according to content as: (1) information on undergraduate / postgraduate dental education; (2) patient information; (3) inspection experience; (4) entertainment; (5) advertising. The Journal of American Medical Association (JAMA) comparison criteria  were useIn addition, the quality assessment of the videos was made using the Modified Global Quality Score (mGQS)  scaling.Video Power Index is calculated with the formula [like rate * view rate / 100]. The rate of likes is calculated with the formulas [likes * 100 / (likes + dislikes)] and views (number of views/days) .The normality of the data was evaluated with the Shapiro-Wilk test. Since the data were not distributed normally, JAMA, GQS and VPI scores were compared with the Kruskal Wallis test between source groups and content groups. When the difference was statistically significant, the Dunn’s Post Hoc was used to determine to find out which group caused the difference. The Spearman Correlation coefficient was calculated to assess a possible correlation between JAMA, GQS, and VPI scores. The statistical significance level was set at p = 0.05.When duplicates were removed from 150 videos that were reached with keywords, a total of 132 videos were evaluated. Among these videos, 13 videos that are not related to the subject were removed. According to the recorded data of the videos that were evaluated, a total of 44282 seconds of video was examined and the average of these videos was calculated as 372 seconds. It has been determined that the videos were liked 14708 times and 3896 disliked by the users in total. Other recorded and calculated properties of the videos are given in According to the video source classification, it was determined that video uploaders had the most accounts in the categories of dentists (33.61% n = 40) and under the category of ‘other’ (34.45% n = 41). It was seen that the least uploaded video source was physicians (1.68% n = 2). The distribution of video sources is given in When the contents of the evaluated videos were examined, it was found that there was a high rate of videos for informing patients (67.22% n = 80) according to the classification made. It was observed that the least uploaded content area was the advertisement (3.36% n = 4) category. The graphic of content classification is given in When all sources and contents were evaluated, the mean JAMA score obtained was 1.54 (SD: 0.5), the mean mGQS score was 1.98 (SD: 0.8) and the mean VPI ratio was 34.2  as calculated. The means and standard deviations (Mean (SD)) of JAMA, mGQS, and VPI values calculated separately for all sources and contents are listed in When an analysis was made based on the JAMA criteria, it was seen that 55 videos got 1, 63 videos got 2 points and only 1 video got 3 points. None of the videos got a score of 4 indicating full reliability. Although the physicians received the highest score when the uploaded sources of the video were evaluated, these values were quite low to conclude that the videos were of high quality in the reliability criteria. The uploaded videos from academic and dentist sources did not exceed 2 points on average based on these criteria. When the video was examined in terms of content, even though the highest quality was in undergraduate/graduate education, again, no category exceeded 2 points on average. When the video source groups were compared, the difference was statistically significant (p = 0.01). The difference between academic and patient groups (p = 0.007); the dentist and patient groups were statistically significant (p = 0.02). The difference between examination experience and graduate/undergraduate education groups were statistically significant (p = 0.029) in terms of video content.When the mGQS score was evaluated, it was seen that academic sources uploaded the highest quality videos in terms of video sources. When the videos uploaded by dentists were considered in terms of educational quality, they have fallen behind the journalist and physician resources. Regarding the video content, the highest score in video quality was obtained in the undergraduate/graduate education category as expected. The lowest score was received by the content of entertainment and advertising videos uploaded by patients as a source. There was a statistically significant difference among video source groups in GQS scores (p<0.001). The difference between patient and academic; dentist and reporter groups were statistically significant . The difference between graduate/undergraduate content and patient disclosure (p = 0.007), examination experience (p<0.001), entertainment (p<0.001), advertisement (p<0.001) were statistically significant.When the popularity of videos was examined over the VPI value, it was seen that the videos uploaded by academic education sources had very low popularity, and the most popular videos were uploaded by patients and for entertainment purposes. The difference between academic and reporter groups were statistically significant (p = 0.043) and, dentist and patient groups were significant (p = 0.039). The correlations between JAMA and GQS (r = 0.426); VPI (r = -0.242) scores were low. The correlation between GQS and VPI scores were -0.208. the difference between patient disclose and examinatişon experience was statistically significant (p = 0.002).™, the well-known social media platform [Because of the extraordinary situations experienced due to COVID-19, education has shifted towards the home environment and internet-based information acquisition has become almost mandatory. Online videos are among the most preferred of these information resources. There are many reasons why students frequently consult online videos to support their education, such as ease of access, more catchy visual data than written ones, more fun, and no time limit [platform . Data inplatform .™, is broadly different from each other in terms of scientific quality, as it is broadcasted directly without any control over the content [™ are people who do not owe academic education and the information they provide is not peer-reviewed and/or validated.However, medical information, including YouTube  content , 24. As ™ platform than other sources and the average JAMA score of these posts is not sufficient to be considered safe. In terms of content, it has been revealed that although the academic group had, naturally, the highest mGQS score, they offered medium-quality content with an average of 3 points out of 5. When video popularity was examined, this group had a very low rate compared to the others. Although variable parameters such as the number of views and likes of the videos provide us some information about the benefits of the videos, it may be considered normal that the popularity of the academic group was lower than the other groups, since this platform was often a medium with a high demand for entertainment content and open to every user.In this study, it has been shown that the sources providing academic education are shared less on the YouTube It was observed that the videos evaluated within the scope of this study, which was conducted subjectively, were not of high quality and reliable to be used as a source of information in pediatric dentistry education, considering the determined criteria. Although there was not any similar study that evaluated this subject specifically in the literature, the findings of our study were in accordance with earlier studies that reported results of YouTube screening on other dentistry-related issues. Knösel et al. observed that the uploaded video content about dentistry on YouTube did not meet the reliability criteria to a large extent . SimilarIt can be predicted that online resources will be used frequently during this period, and academic education resources should do their part in this regard. It is necessary to inform students about how to lead them to sources where they can obtain reliable and qualified information, to make more widespread online information sources for the purpose of providing education, and to develop content, with special attention to student education.™ platform does not contain videos of enough quality and reliability to support the education of dentistry students in pediatric dentistry. The content offered by educators needs to become more widespread and popular. Students should be made aware of which sources to search for and that not all information they obtain from online video sources is completely correct.It has been observed that the YouTube S1 File(DOCX)Click here for additional data file.


Primary progressive aphasia is a clinical dementia syndrome secondary to neurodegenerative disease characterized by language-related difficulties. Currently, there is no effective treatment for language impairment in primary progressive aphasia. In the present study, we investigated the feasibility of Internet video-based speech-language activities for this condition.Twenty-three people with primary progressive aphasia (pwPPA) participated in the study and were provided with twelve speech-language activity videos on a dedicated website, with three sessions per week. The group that chose to continue with participation after three months of intervention received Internet activities for one year. Cognitive domains associated with persistence, treatment motivation, and video difficulty settings were statistically analyzed.After three months, 17 out of 23 participants opted to continue with the activities. The ability to follow oral commands which was measured pre intervention was higher in the group that continued compared with those participants who discontinued activity. The scores of two Standard Language Test of Aphasia subtests, sentence repetition and narrative writing–associated with the ability to comprehend and produce sentence structure–were highly correlated with motivation, interest and concentration in activity. Participants with different levels of primary progressive aphasia progression could participate in the same video-based activities when high-frequency words were used in the video.Internet video-based speech-language activity at home has potential as a useful tool for future primary progressive aphasia treatment because it provides a cost-effective approach to intensive intervention and overcomes barriers associated with traditional therapy approaches. Recent clinicopathological and genetic studies have revealed the details of brain changes in neurodegenerative diseases. Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) are neuropathologically defined by the pathological structures and their component proteins that appear in the patient’s brain. Frontotemporal lobar degeneration (FTLD), in contrast, is composed of pathologically and genetically distinct diseases based on a disease concept characterized by degenerative regions of the brain. Thus, neurodegenerative diseases are classified according to pathological findings and/or degenerative areas of the brain.Primary progressive aphasia (PPA), proposed in 2011, is a clinical dementia syndrome secondary to neurodegenerative disease. It is diagnosed according to its clinical manifestations of language-related difficulties and neuroimaging examinations. These gradually progressive impairments affect language production, object nomenclature, syntax, word comprehension, and reading and writing. PPA was first defined by Mesulam et al. in 1982 , 4. naPPPilot studies of PPA show the effectiveness of non-pharmacological therapies, such as speech-language therapy –8. PPA iTherefore, this study investigated the feasibility of home-based speech-language activities for people with PPA (pwPPA) using online videos. There were concerns about the pwPPA maintaining motivation in activities conducted alone at home, and that online videos uploaded from the Internet could not be customized for each individual regarding difficulty level and video speed. Thus, we conducted an autonomous speech-language activity at home using online internet videos with the same content and speed for PPA with varying severities and symptoms, as well as the cognitive domains that influence the realization and discussed whether the content, speed, or difficulty of the video needs to be adjusted for each person. The goal of this study was not to investigate the effectiveness or efficacy of the intervention, but examine the specific uncertainties associated with conducting a larger study, such as the user acceptability or adherence to the intervention.Twenty-three right-handed pwPPA, including 14 people with lvPPA, 6 with non-fluent and/or agrammatic variant PPA, and 3 with svPPA, were recruited from the Departments of Psychiatry at the Tokyo Medical University Ibaraki Medical Center, the University of Tsukuba Hospital and the Memory Clinic Ochanomizu between November 2020 and March 2021. The participants took part in a prospective study of speech activities at home using online videos. Clinical diagnosis of PPA was made by one of three medical doctors  based on clinical symptoms, neurological findings, and neuroimaging examinations after the following neuropsychological examinations by the same speech-language pathologists (YK), following the PPA criteria from Gorno-Tempini et al. [https://vimeo.com/jp/), and one of the 12 videos was made available to participants by embedding it on a dedicated Internet homepage. The uploaded videos were replaced with new videos three times a week and were available for viewing during that time, i.e. only one video was embedded on the homepage, which contained both explanatory and homework sections  and Tokyo Medical University (Registration No.T2020-0421). Participants were those who attended one of the three medical facilities as outpatients during the period described above, were diagnosed with PPA at their first visit, and consented to participate. During the study period, the participants continued to attend outpatient clinics once every one to two months, and if they stopped attending, study participation was stopped. This was because it was not possible to collect the answer/questionnaire booklet described below. Patients with dementia who were not diagnosed with PPA were excluded, but the results of neuropsychological examinations were not part of the inclusion criteria. Although the presence of a collaborator to support speech-language activities was not a criterion for inclusion, 18 of the 23 participants had a collaborator. They gave their informed written consent to participate. Speech-language activity took place at home using online videos of approximately 10 minutes duration. Twelve videos were created with different language content to encourage comprehension, reading aloud, dictation and/or vocalization of language components, such as nouns, verbs, sentences and numbers. These language components were changed for each video. The information was presented on the screen with letters, pictures, animations and/or auditory stimuli . Words wParticipants were given an answer/questionnaire booklet and a voice recorder and asked to record themselves during speech-language activity to provide a participation record. Participants wrote the answers in the answer/questionnaire booklet for the two dictation tasks. Questionnaires were completed at the end of each activity session at home to ascertain participants’ subjective impressions of each activity. When undertaking speech-language activities alone at home, it can become increasingly difficult for pwPPA to maintain their motivation, interest, and concentration. Another concerns were that the level of difficulty and the speed of the videos could not be adapted for individuals’ disease progression and that they might not be able to understand the content of the task. Therefore, a questionnaire was administered to determine whether these concerns had arisen in the session. The questionnaire included a seven-point scale with five items, including “Whether or not I would like to do it again,” “Whether or not it was interesting,” “Whether or not I could concentrate on the task,” “Whether or not the task was difficult,” and “Whether the speed of the video was fast or slow.” Considering that pwPPA often have difficulty -answering questionnaires, they were asked to use the 7-point scale by simply circling the appropriate place on the line, which was visually comprehensible . Activitp<0.05 was considered statistically significant [Because of missing values in the questionnaire items due to non-participation, the results of the questionnaire items for the entire study period were averaged for each activity and applied to the statistics. To conduct a time-series analysis of the questionnaire scores, repeated measures analyses of variance (ANOVAs) were conducted for the average questionnaire scores for each course, followed by Bonferroni’s post hoc test for multiple pairwise comparisons when statistically significant. When Mauchly’s sphericity test was significant, the ANOVA results were adjusted for sphericity using Greenhouse-Geisser correction. The dimensions of the five questionnaire items were reduced to two principal components by principal component analysis. Then the correlation between the principal components and the scores of neuropsychological tests was analyzed using Pearson’s correlation coefficient. The results of participants’ neuropsychological tests were examined with the Shapiro-Wilk test to determine if they were derived from a normal distribution. We included neuropsychological test items that followed a normal distribution, such as MMSE, RCPM, FAB, GDS, and ten sub scores of the Standard Language Test of Aphasia (SLTA), including ‘Following verbal commands,’ ‘Speaking object names,’ ‘Explaining a picture story,’ ‘Sentence repetition,’ ‘Word fluency,’ ‘Following written commands,’ ‘Writing kanji words,’ ‘Narrative writing,’ ‘Dictating kanji words’ and ‘Calculation.’ All statistical analysis was carried out using SPSS version 28.0 . As our argument about statistical significance in this study comes from an individual null hypothesis, and not a joint null hypothesis nificant .p = 0.32 and p = 0.58, respectively; p = 0.919, p = 0.919, p = 0.658 and p = 0.354, respectively, p < 0.05. Participants were asked to confirm in writing whether they would continue their participation at the end of the 12 weeks after three courses of speech-language activity. Of the 23 participants, 17 chose to continue and 6 dropped out, giving a persistence rate of 73.9%. One participant with lvPPA declined to complete the dictation task in advance because of dysgraphia, but the others were able to work on all tasks without avoiding specific ones. We examined the factors related to the three-month persistence rate. There were no statistically significant differences between the continued and discontinued groups in the percentage of PPA sub-diagnostic classifications or in the presence or absence of collaborators to support speech-language activity  dropped out because of hospitalization or other reasons. Thus, 13 participants were able to continue the activity for one year. Following the study design, one video was uploaded to the website, and this was changed three times a week. This meant that participants might miss a video, i.e., miss out on participating in some activity sessions. However, the final analysis showed that the monthly participation rate remained relatively high throughout the study period .The average questionnaire scores for each task and course are shown in To make it easier to determine the data characteristics, these subjective impressions were summarized using principal component analysis. Principal component analysis revealed that the five questionnaire items could be reduced to two dimensions: a comprehensive first main component related to motivation, interest and concentration, and a second main component regarding the video speed and difficulty. Eigenvalues exceeded 1.0 for all first principal components, and for the second principal components, except for the ‘Reading aloud current topics’ task. No third principal components with eigenvalues above 1.0 were found for all types of tasks . For eacThe correlations between the first principal component for each task and the scores of cognitive tests and SLTA subtests are shown in We also analyzed the correlation between the second main component for each task and the scores of cognitive tests and SLTA subtests . The secWe studied the feasibility of online video-based speech-language activities at home for outpatients with PPA. In this study, approximately 70% of the pwPPA continued activity for three months and participated in approximately 70.4% of the three weekly sessions . Even inDementia is a disease that requires multifaceted support from medical, nursing, and social services because of the decline in activities of daily living caused by cognitive impairments. Since the COVID-19 pandemic, digital transformation has accelerated in dementia care because face-to-face support is often limited. Examples include the application of the Internet of Things (IoT) and artificial intelligence to medical and nursing care, providing remote consultation , monitorThe assessment of motivation and setting the difficulty level of the video were considered important for the Internet video-based speech-language activity. Therefore, we used a questionnaire after each task session to examine the indicators of activity adherence to identify pwPPA suited to the activity based on the correlation with impairment patterns in cognitive domains. The questionnaire content was dimensionally reduced to two principal components. The first principal component was an index of motivation, interest, and concentration. Two SLTA subtests, sentence repetition and narrative writing, correlated most with the first principal component. In particular, sentence repetition was considered an important cognitive domain because it correlated with many tasks. Repetition tests are commonly used to identify phonological ability, but grammatical competence may also be required when sentences containing many clauses are used. Studies have shown that examination of sentence repetition can provide information about sentence-level abilities, including morphosyntax, verb morphology and functional words , 25. NarThe second principal component was an index of how participants perceived the speed and difficulty of the videos. In the current study, the video playback speed was set to be unchangeable, and it was assumed that pwPPA with more severe aphasia would face more challenges with the speed and difficulty of the videos. However, neither verbal nor nonverbal cognitive domains correlated with the second principal component for most speech therapies. This was probably because the speech rate of our videos was slow enough for many participants, and the familiarity of the words used in this study was higher than average . Thus, In the present study, twelve Internet video-based speech-language activity sessions were created and shared. The current study was performed as a feasibility study because the number of participants recruited at our medical institutions was not sufficient to determine the efficacy of the intervention. Because this study used a blanket approach in which all participants participated in all types of Internet video-based activities, there was concern that some types of video tasks would decrease motivation regarding activities in individuals with certain types of aphasia. Consistent with this, our results suggest that there is some Internet video content that is not appropriate for activity motivation in some pwPPA according to impairment profile. Taylor-Rubin et al. showed that motivation was more important in sustaining lexical retrieval than caregiver availability in pwPPA . TherefoInternet video-based speech-language activities conducted at pwPPA’ homes resulted in a high persistence rate and suggests the possibility of incorporating these activities into a new therapy forPPA. The ability to follow oral commands correlated with pwPPA’ willingness to persist with participation. Furthermore, scores of two SLTA subtests–sentence repetition and narrative writing, likely associated with the ability to comprehend and produce sentence structure–were highly correlated with motivation, interest and concentration in several speech-language activities. People with PPA could participate in activities based on the same video irrespective of their disease progression level because the videos were created using carefully selected high-frequency words. Cognitive training using videos at home holds potential for future dementia treatment.S1 FigNote that the originals were written in Japanese.(TIF)Click here for additional data file.S2 FigNotes: Mini-mental state examination, MMSE; Frontal assessment battery, FAB; Raven’s colored progressive matrices, RCPM; Geriatric depression scale, GDS; n.s., not significant (Mann-Whitney U test).(TIF)Click here for additional data file.S3 FigWe used a seven-point scale with five items, including motivation (A), interest (B), concentration (C), video difficulty (D) and video speed (E) to ascertain participants’ subjective impressions of each activity. Video difficulty and video speed were scored higher when they felt easier and slower, respectively. Mean ± S.D. are shown.(TIF)Click here for additional data file.S4 Figp<0.05), but not in the subsequent multiple pairwise comparisons. n.s., not significant.We used a seven-point scale with five items, motivation (A), interest (B), concentration (C), video difficulty (D) and video speed (E) to ascertain the participants’ subjective impressions of each course. Mean ± S.D. are shown. When we analyzed whether the questionnaire scores differed among the different courses using the repeated Measures ANOVA, a significant difference is found only in the perceived video speed Click here for additional data file.S5 FigNote that only those with significant differences are presented in (TIF)Click here for additional data file.S1 TableNotes: svPPA, semantic variant PPA; naPPA, non-fluent and/or agrammatic variant PPA; lvPPA, logopenic variant PPA.(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 Tablep < 0.05 (Pearson’s correlation coefficient).Note that only neuropsychiatric tests showing statistically significant correlations with the first or second principal components are given. *(DOCX)Click here for additional data file.S1 AppendixAll S1-S12 videos were conceived by SH and YK and created by SH in accordance with the objectives of the task presented in (MP4)Click here for additional data file.S2 Appendix(MP4)Click here for additional data file.S3 Appendix(MP4)Click here for additional data file.S4 Appendix(MP4)Click here for additional data file.S5 Appendix(MP4)Click here for additional data file.S6 Appendix(MP4)Click here for additional data file.S7 Appendix(MP4)Click here for additional data file.S8 Appendix(MP4)Click here for additional data file.S9 Appendix(MP4)Click here for additional data file.S10 Appendix(MP4)Click here for additional data file.S11 Appendix(MP4)Click here for additional data file.S12 Appendix(MP4)Click here for additional data file.


YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain.The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management.A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management–related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video’s relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ≥5 and a DISCERN score of ≥39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted.P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score.Of 73 unique videos, video sources included medical videos , followed by personal video blogs , advertisements , and media . The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos  most frequently addressed overall content regarding pain duration , pain types , return-to-activity instructions , and nonpharmacologic methods for pain control . There were differences in the overall content score (Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. YouTube is a frequently visited website in the United States and a common source of eHealth information ,2. As anRecent studies have evaluated YouTube as a source of health information during pregnancy. Chandrasekaran et al  evaluatePain is a significant concern among postpartum individuals ,8. InadeGiven the unique challenges of the early postpartum period, individuals may use internet resources to address concerns related to their postcesarean birth pain and recovery. While the growing popularity of YouTube has the possibility to improve access to postpartum care and the postpartum pain experience, there are limited data evaluating the quality of available resources for postpartum pain management. Thus, the purpose of this study was to systematically evaluate the quality of YouTube videos on postpartum cesarean recovery.A systematic search of YouTube videos was conducted using postpartum cesarean pain management–related keywords on June 25, 2021. Search terms were identified by expert consensus and expanded using Google Trends to identify related searches. The final terms included 36 iterations of the search “postpartum cesarean pain” .To duplicate a public search, the search was performed in incognito mode in a cache-cleared browser, and no registered account was used. Search results were sorted by relevance, which is the default setting for YouTube searches. The first 60 results from each keyword search were collected, and duplicates were omitted. This sort of strategy and sample size were selected based on data showing that 83% of searchers will not view more than three web pages of results . Videos Descriptive characteristics of each video were gathered, including the date posted, video length, number of comments, likes, dislikes, and channel subscribers. Values that accumulate over time were collected within one day  by a single reviewer to minimize variability. Video source and presenter characteristics were also collected. Video sources were categorized as personal video blogs (vlogs), medical or hospital videos, advertisements, and media. The source was determined based on the affiliation of the video author and the channel description, when applicable. Videos were labeled as vlogs when the video author had an independent channel describing their personal experience and recommendations. Medical or hospital videos were differentiated by a clear affiliation with a hospital or medical service company. Video bloggers who identified as medical professionals on their independent channels were characterized as personal vloggers. Advertisement videos differed from medical videos in that they clearly described the benefits of a single product in the postpartum period. Media videos included news clips and talk show interviews. Videos were labeled as character videos if a specific, identifiable person presented the information. Presenter characteristics were identified when applicable, and reviewers subjectively identified the presenter’s gender, race or ethnicity, and age.Two content scores were developed using the expert opinions of maternal-fetal medicine specialists (NB and LMY) in conjunction with American College of Obstetrician and Gynecologists guidelines regarding pain management . Both scThe DISCERN instrument was used to assess the quality and reliability of the videos as an information source. This tool has been widely used to evaluate web-based sources of health information, including YouTube videos -21. Stud. These criteria were chosen as a DISCERN score of ≥39 indicates at least fair information reliability, and an overall content score of ≥5 indicates that greater than half of the content criteria were met.A combination of the overall content score and the DISCERN score was used to establish video quality as a health education resource that is both comprehensive and reliable. Videos with an overall content score of ≥5 and DISCERN score of ≥39 were classified as high-qualityConsensus regarding the application of scoring criteria was obtained through a collaborative review of 3 videos among 3 authors . Subsequently, the application of the scoring criteria was tested via an independent review of 10 videos. The average DISCERN scoring disparity was 0.18 points. Intraclass correlation was 0.76 and interclass correlation was 0.81, indicating good interrater reliability. Areas of discordance were resolved by team discussion. The remaining videos were divided and scored by authors NS or ES. Data were extracted and stored using REDCap  software.P value of less than .05 was considered significant.All statistical analysis was performed using Excel software . Interrater agreement was analyzed by intraclass correlation coefficients and a single-factor ANOVA. Video characteristics were analyzed via descriptive statistics. Associations among video source, quality, and descriptive characteristics were evaluated using nonparametric correlations. A This study does not involve human subject research and was deemed exempt by Northwestern University’s institutional review board (reference number: STU00214706).A total of 233 unique videos were identified. Following the application of inclusion and exclusion criteria, 73 videos remained for analysis . Most viP=.02). Personal vlog videos had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 , different types of pain , and return to activity , whereas information on when to use medication  and risks to the newborn  were less frequently included . The mea SD 2.0; .P=.77; Most videos  did not specifically address opioids and, therefore, had an opioid content score of 0. For those videos that did address opioids , videos most often covered maternal risks , limitations of opioids , and when to use opioids . Videos rarely discuss the risk of addiction , the recommended duration of use , or proper opioid disposal . For videos that addressed opioids, the mean opioid content score was 3.1 (SD 1.6) out of 9. There was no difference in opioid content score by video source P=.77; .P=.45; The DISCERN scores ranged from 22 (very poor reliability) to 59 (good reliability), with a mean DISCERN score of 39.2 (SD 8.1), consistent with fair reliability. No videos met the criteria for excellent reliability. The overall DISCERN score did not significantly differ by video source P=.45; . Videos r=0.38; P<.01), the number of comments , and the number of likes  were significantly correlated with the overall content score. The number of comments was inversely correlated with the DISCERN score . No video characteristics were significantly correlated with the opioid content score , number of comments , and number of likes  met the criteria for high quality. High-quality videos most frequently addressed overall content regarding pain duration  and pain types  was limited by the fact that YouTube presenters rarely provide self-identifying information. Though our assessment was subjective, we felt that it was important to note representation, as this may influence viewership. Finally, our assessment of video quality was subjective. While we recognize the possibility that YouTube videos may be purposefully narrow in scope with high reliability, we purposefully defined high-quality videos as those that presented both comprehensive and reliable health information to the public.Studies have evaluated eHealth information on pain management outside of the obstetrical population. In one study, the average DISCERN score for chronic pain websites was 55.9 out of a possible 80 points , suggestSeveral studies have evaluated the reliability of YouTube videos as a source of health information during pregnancy. Studies regarding COVID-19 during pregnancy, gestational diabetes, and epidural analgesia for labor pain identified DISCERN scores of low to moderate information reliability ,30,31. LUncontrolled postoperative pain may delay hospital discharge and prolong recovery . For birWhile YouTube provides an opportunity to supplement patient education regarding recovery after cesarean birth, current content, including opioid content, is inadequate. Few videos address safe opioid use in the postoperative, outpatient setting, despite campaigns for judicious use. Opioids are known to be prescribed at high rates following cesarean delivery . FulfillYouTube videos provide an opportunity to share quality information on postpartum pain management with a large audience; however, it is essential that clinicians and patients be aware of the limitations of the available videos. This is particularly relevant, as many patients may not discuss the content of electronic sources with their clinicians. A review examining patterns of electronic health use during pregnancy in an underserved, racially diverse population found that while the majority of patients used electronic health sources, approximately 70% of patients discussed their searches with their clinician . TherefoFurther research is required to understand how obstetric patients are using YouTube during pregnancy and postpartum. The availability of videos and associated subscribers indicates public interest, but further studies are required to understand the needs of postcesarean individuals as they generate their own YouTube searches. Further work is required to evaluate the information available regarding recovery from vaginal birth as well as pain control in the antepartum, intraoperative, and immediate postoperative periods. This study highlights the need for pain management videos that combine medical expertise with consumer needs. While clinicians should caution patients about the reliability of YouTube videos as a health resource, they should also take an interest in what information their patients are looking for on the internet.Patients seeking information from YouTube regarding postcesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. YouTube is an easily accessible resource and an increasingly common source of health information; however, clinicians should counsel patients to use caution when using current YouTube videos as a resource in the postpartum period.


Attention‐deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children and adolescents. Recent studies show that video games have great potential for the treatment and rehabilitation of ADHD patients.The aim of the present review is to systematically review the scientific literature on the relationship between video games and ADHD, focusing on adherence to treatment, frequency of the intervention, and the long‐term follow‐up of video games in children and adolescents with ADHD.The preferred reporting items for systematic reviews and meta‐analyses guidelines were adopted. The review protocol was registered in PROSPERO database. We searched in three databases, PubMed, Medline, and Web of Science to identify studies examining the association between video game interventions in ADHD patients.A total of 18 empirical studies met the established inclusion criteria. The results showed that video games‐based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long‐term effects in patients with ADHD.Video games are useful and effective interventions that can complement traditional treatments in patients with ADHD. This article reviews the scientific literature on the relationship between video game‐based treatments and ADHD. The results showed that video games‐based interventions can be used to improve ADHD symptoms and display high adherence to treatment. In addition, in the studies reviewed, the most common intervention frequency is 30 min three to five times per week. However, there is little evidence from studies with video games showing long‐term effects on patients with ADHD.  An assessment of the quality of the studies was performed using the Newcastle–Ottawa‐scale , with a median and mode of 7. Figure Indicate that all studies obtained one star for adequate case definition and for the ascertainment of exposure. On the other hand, the definition of controls was the item with the lowest number of stars, with 44% of the studies having low bias. This is due to the fact that most of the studies divide the control and intervention groups from a single group of patients diagnosed with ADHD. Finally, the nonresponse rate had a low number of stars. Moreover, we calculated ICC among reviewers, that was 0.923 (95% CI .864–.956) for all articles.4.1.1Table Video games for ADHD treatment may also improve adherence to intervention , which have shown efficacy in the short term (Catalá‐López et al., As it has been possible to verify, video game‐based treatments are generally effective. Gamification and cognitive training could be the main mechanisms underlying the usefulness and effectiveness of videogame‐based tools (Peñuelas‐Calvo et al., Men seem to be the most affected by video game addiction (Mathews et al., In future lines of research, it would be interesting to consider the potential of video games to improve the quality of life of children with ADHD. Healthcare professionals and computer engineers should collaborate with each other to develop video games that achieve the required therapeutic quality and are adapted to healthcare environments. Furthermore, most of the video games mentioned in this study work on a computer, tablet, or game console, and it would therefore be interesting if they could be adapted for use on smartphones, as these devices could be a good opportunity to implement more effective e‐health.6This systematic review has highlighted the importance of video game‐based treatments as an adjunct to traditional treatments. The treatment of ADHD requires specialized clinical, pharmacological, and cognitive behavioral therapy intervention. However, access to those treatments is sometimes limited in some populations, and video games could facilitate this access for patients.The use of video games for the treatment of ADHD allows for constant training over time and a level of difficulty and motivation adjusted to the patient, which therefore allows for a decrease in ADHD symptoms and an increase in adherence to treatment. Advances in artificial intelligence will help achieve this goal. Additionally, this review offers an estimated frequency of the intervention with video games for children and adolescents with ADHD that can serve as a reference to avoid possible addictions to video games.Finally, it is considered necessary to continue investigating the possible long‐term beneficial effects of the use of video games as a treatment for ADHD. Although there is very little information to date on this subject, there is some evidence that suggests that improvements in attention, hyperactivity and impulsivity, and executive functions, among others, can be maintained over time with the use of these tools. It will also be necessary to study how to create video games that are adapted to the age of the patient, so that they can effectively support the treatment of ADHD in children and adolescents.Conceptualization; methodology: Lucía Caselles‐Pina and Aaron Sújar. Investigation: Lucía Caselles‐Pina and Alejandro Quesada‐López. Writing—original draft preparation: Lucía Caselles‐Pina, Aaron Sújar, and David Delgado‐Gómez. Writing—review and editing: Lucía Caselles‐Pina, Aaron Sújar, Alejandro Quesada‐López, and David Delgado‐Gómez. Project administration: David Delgado‐Gómez. Funding acquisition: David Delgado‐Gómez. All authors have read and agreed to the published version of the manuscript.The authors declare no conflicts of interest.https://publons.com/publon/10.1002/brb3.3265.The peer review history for this article is available at