Background: Despite the increasing use and acceptance of technology in health care, there is limited evidence on the usefulness and appropriate use of telehealth in home-based palliative care (HBPC). As part of the process evaluation of a pragmatic trial of video visits in HBPC, we assessed clinician experience with video visit implementation.Methods: We assessed clinicians' experiences with and perception of the usefulness and appropriateness of video visits using anonymous surveys and brief qualitative interviews with a subset of survey participants. Qualitative analyses were guided by sociotechnical frameworks that emphasize technology's “value proposition” for its end users as being key to adoption.Results: Clinicians (36 physicians and 48 registered nurses) generally had favorable attitudes toward video visits and telehealth. Respondents felt confident in the skills needed to make their role in video visits successful. Clinicians were neutral on whether video visits were useful for their practice or enhanced the patient–caregiver experience. Clinicians found video visits to be most appropriate for follow-up care (as opposed to start of care). The interviews yielded two themes that complemented the survey findings: (1) factors enhancing the value proposition (positive responses from patients and families and convenience) and (2) factors diminishing the value proposition (issues related to the technology and scheduling).Discussion: Our findings provide insights into clinicians' experiences with implementing remote video physician consultations, facilitated by a nurse in the patient's home in the pre-COVID-19 era. Clinician views about video visits may have shifted with the pandemic, which occurred after our data collection was complete.Clinical Trials Registration No. NCT#03694431. The tech-supported model relied on the nurse who was in the patient's home to facilitate a synchronous video consultation between the patient and family with the remote physician; this approach to video visit use was intended to minimize disparities in access to technology by patients and families. We expected that early video access to the physician for discussion and concurrence on the treatment plan would build trust and confidence with the patient/caregivers, potentially reducing the need for an in-home physician visit. Physicians had the discretion of conducting home visits as needed in the tech-supported model. Half of the teams were randomized to implement the standard HBPC model and the other half, the tech-supported model.This report is a substudy of a larger comparative effectiveness trial  that compared a standard HBPC model with a tech-supported model that included use of nurse to physician video consultation.12,13 .The aim of this analysis was to assess the usefulness and appropriateness  of video visits from the perspective of HBPC physicians and nurses, anchored within the NASSS framework11 All HBPC clinicians  were invited to participate in the survey through e-mail and participation was strictly voluntary. Respondents completed web (REDCap) or paper surveys.We conducted a cross-sectional anonymous survey of HBPC clinicians across 14 study sites to assess the usefulness and appropriateness of video visits and attitudes toward telehealth. The survey was administered approximately eight months after the trial started enrolling participants. The survey was approved by our institutional review board as part of the main study.14–19 and underlying conceptual framework of relevant study-specific domains: quality of physician–patient communication, perceived use and usefulness, satisfaction with the current program, perceptions of telehealth, and perceived effects on patients and caregivers. All questions used a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) with the exception of one question on perceived effects of video visits on patients–family caregivers .A 26-item physician and a 20-item nurse surveys were developed based on a review of the literatureTo supplement the survey data and further assess clinician perspectives and overall experience on the use of video visits, clinicians were invited to participate in 10–15 minutes semistructured interviews over the phone or in-person upon completing the survey. Three qualitative interviewers  used a semistructured guide to probe the clinicians' experiences with video visit implementation, barriers and facilitators, and changes and recommendations. A note-taking template was used to systematically record the interview data.20 In this article, we report on the analysis of one theme, which was heavily represented in the data: the value proposition of video visits to clinicians.We computed descriptive statistics to summarize survey results. Interview notes were imported to NVivo for coding and analysis by T.O. and M.M. and were reviewed with C.M. to further validate the thematic coding.A total of 84 clinicians responded to the survey, which included 36 physicians (45%) and 48 (49%) nurse case managers. At least one physician and one nurse from each of the 14 sites participated in the survey. All physician respondents reported having conducted video visits and half of the nurses reported that they conducted video visits as expected per the HomePal study design .Video visits were used primarily for follow-up visits as opposed to admission/start-of-care. Of the 36 physicians who reported having conducted a video visit, 16 (44%) reporting having conducted video visits for admission/start-of-care, whereas 28 (76%) reported conducing video visits at follow-up. Findings among nurses were similar. We also asked physicians which types of visits were most appropriate for video; the results were consistent with physicians indicating a preference for use of video for follow-up care.Both physicians (4.2 [0.9]) and nurses (4.6 [0.7]) agreed that they had the skills needed to be successful in their respective roles during video visits. Physicians felt competent in their ability to perform key activities in the context of a video visit: discussing treatment options, expressing empathy, understanding patient goals for end of life, discussing transition to hospice, assessing physical, emotional, spiritual, and social needs, and dealing with conflict between team members.In general, clinicians were neutral about video visits being useful for their practice: using video visits increases my productivity ; using video visits makes it easier to do my job .Based on responses rated on a 5-point scale (1 = strongly disagree to 5 = agree), clinicians had generally positive attitudes toward video visits and telehealth. They reported that video visits were a useful addition to HBPC services, that telehealth will be a standard way of health care delivery in the future, and overall satisfaction with the video visits. Physicians and nurses generally disagreed that technology hinders the care experience. Attitudes were more neutral with regard to preference for in-person care among both physicians (3.1 [1.2]) and nurses (3.2 [1.1]).We asked clinicians to rate the extent to which they believe video visits has had a negative (−5 to −1), neutral (0), or positive (+1 to +5) effect on patients and families. Both physicians (2.3 [1.7]) and nurses (2.0 [2.6]) had neutral to positive response to the effect of video visits on patients and families, although the distribution was wide.Seven physicians and seven nurses provided additional feedback on their experience with video visits. Two overarching themes emerged from these interviews :Clinicians shared that patients and families responded positively to video visits. They also noted that video visits offer convenience, especially for physicians.Clinicians noted that issues related to the technology  and scheduling were substantial barriers to conducting video visits. Video visits placed additional burden on the nurses who facilitated the encounters.The survey and interviews provided complementary findings and insights into clinicians' experiences with implementing video visits as part of the HomePal trial. Clinicians experienced both benefits and challenges of delivering care through the video platform. Survey results showed that video visits were primarily used for follow-up visits and that physicians felt competent providing some services through video. This finding may be explained by the scheduling and coordination challenges experienced with video visits. Both survey and interview findings suggest that video visits offer certain conveniences for some clinicians. The interview findings clarified that video visits placed additional burden on the nurse case managers who facilitated the video visits. Survey results indicate that clinicians have generally positive attitudes toward video visits and telehealth. The interview findings further highlight that clinician enthusiasm may be tempered by technology issues.Our study has limitations that are important to consider when interpreting the results. The data are cross-sectional, and as such the findings represent a snapshot of clinicians' views of and experiences with video visits. The survey and interviews included a convenience, volunteer sample of clinicians participating in the trial. Although clinicians represented a range of perspectives from different study sites, respondents may not be representative of all HBPC clinicians. Finally, this study was focused on only one of many use cases for video visits and was conducted before the COVID-19 pandemic.21 Given the unprecedented adoption of virtual care in response to the pandemic, efforts should focus on ensuring more reliable connectivity so clinicians can focus on providing care, not technical troubleshooting. In addition, optimizing physician and nurse schedules through different arrangements, including assigning a pool of dedicated physicians to provide video consultations on demand, may address the flexibility nurses need in the home care setting. Addressing these two issues are critical for streamlining the video consultations for physicians, nurses, patients, and families.Findings from this report further reinforce the lessons learned from the HomePal trial that are reported elsewhere.


The molecular structure of copolyurethanes was confirmed by attenuated total reflectance-Fourier transform-infrared spectroscopy (ATR–FTIR), nuclear magnetic resonance spectrometry (NMR), and gel permeation chromatography (GPC). The impact sensitivity, mechanical performance, and thermal behavior of PBFMO-b-GAP were studied by drop weight test, X-ray photoelectron spectroscopic (XPS), tensile test, scanning electron microscopy (SEM), differential scanning calorimetry (DSC), and thermal gravimetric analysis (TGA), respectively. The results demonstrated that the introduction of fluoropolymers could evidently reduce the sensitivity of GAP-based polyurethane and enhance its mechanical behavior (the tensile strength up to 5.75 MPa with a breaking elongation of 1660%). Besides, PBFMO-b-GAP exhibited excellent resistance to thermal decomposition up to 200 °C and good compatibility with Al and cyclotetramethylene tetranitramine (HMX). The thermal performance of the PBFMO-b-GAP/Al complex was investigated by a cook-off test, and the results indicated that the complex has specific reaction energy. Therefore, PBFMO-b-GAP may serve as a promising energetic binder for future propellant formulations.In order to enhance the application performance of glycidyl azide polymer (GAP) in solid propellant, an energetic copolyurethane binder, oxetane] glycol- The chemical structure and molecular weight of copolyurethanes were characterized by attenuated total reflectance-Fourier transform-infrared spectroscopy (ATR-FTIR), nuclear magnetic resonance spectrometry (NMR), and gel permeation −1 and hydroxy value of 0.9% was provided from the Liming Chemical Engineering Research and Design Institute . Butane diol (BDO), BF3-etherate and dibutyltindilaurate (DBTDL) were purchased from J&K scientific Ltd. . Toluene diisocyanate (TDI), N,N-dimethylformamide (DMF), dichloromethane (DCM), and ethanol were supplied by Sinopharm Chemical Reagent Co., Ltd. . 1,2-dichloroethane was obtained from Jinshan Chemical Test Co., Ltd. . BDO and BF3-dimethyl ether were distilled under reduced pressure prior to use. All other solvents for the reactions were of analytical grade and distilled before use.GAP with molecular weight of 3500 g mol3-etherate were dissolved in dried methylene chloride in a round bottom Schlenk flask and stirred for 1 h. BFMO was added into the mixture drop by drop over a period of 8 h, and the reaction mixture was then left under stirring for an additional 24 h. After the polymerization, sodium bicarbonate solution was added to terminate the reaction, and the organic phase was collected, washed by distilled water and dried over anhydrous Na2SO4 overnight. Finally, the solution was dried under 45 °C vacuum to yield a viscous wax PBFMO.The PBFMO was synthesized via cationic ring-opening homopolymerization of  glycol (BFMO), which was synthesized according to the literature procedure . In brieb-GAP copolyurethanes were synthesized through linking of GAP and PBFMO by TDI via a prepolymer process. In a typical synthesis example, GAP, PBFMO, and freshly distilled 1,2-dichloroethane were placed in a 250 mL four-neck flask equipped with a condenser, mechanical stirrer and thermometer under a nitrogen atmosphere, and then heated to 60 °C. TDI and DBTDL were then dissolved in 1,2-dichloroethane and added dropwise into the reaction solution. After stirring for an additional 2 h, the reaction mixture was poured into 400 mL ethanol. The polymer was precipitated and separated out and dried in vacuum at 50 °C for 24 h to obtain PBFMO-b-GAP copolyurethanes .PBFMO-1H-NMR, 13C-NMR, and 19F-NMR were conducted on a 500 MHz Bruker spectrometer using deuterated chloroform as the solvent and tetramethylsilane as the internal standard. GPC was conducted on a Waters GPC, using tetrahydrofuran and polystyrene standards as the mobile phase and for calibration, respectively. The impact sensitivity was tested according to the national military standard GJB772-1997 method , and the characteristic drop height H50  was taken to evaluate the impact sensitivity of samples. XPS analysis was performed using a Sigmaprobe instrument  equipped with a nonmonochromatic Al KR (hv =1486.6 eV) source at a power of 300 W. Mechanical test samples were prepared according to ASTM standard D-412 [−1 at 293 K. The dimensions of testing gels were 20 mm (neck length) × 4 mm (width) × 2 mm (thickness). Tensile tests were conducted five times independently, and results were presented as the mean in values ± standard deviation of quintuplicate measurements for the experiment. Morphology of the gels was investigated through SEM on a Tescan Vega 3 LMU scanning electron microscope . All the elastomers gels were frozen in liquid nitrogen, snapped, and sputtered with gold until the experiment. DSC equipped with a TA instruments DSC Q1000 and TGA measurements of samples were performed in a nitrogen atmosphere using a SDT Q600 TGA instrument in the temperature range from 25 to 500 °C with heating rate of 10 K min−1.ART-FTIR spectra were recorded in a Bruker Tensor 27 spectrometer. rd D-412 . Mechani−1, and temperature ranged from room temperature to 250 °C. In the slow cook-off test, we put PBFMO-b-GAP/Al complex samples in the test set-up, heated by an electric heating cord; meanwhile, the equal heating components of PBFMO-b-GAP were heated with an intelligent temperature controller to adjust the heating rate. Samples were well sealed, and the thermocouples were utilized to obtain their temperature vs time curves. These experimental results were synthetically analyzed to investigate the thermal performance of the PBFMO-b-GAP/Al complex under slow heating stimulation.The special equipment for the slow cook-off test used in the research was designed by the Institute of Chemical Materials; its schematic diagram is shown in b-GAP copolyurethanes was done via a prepolymer process, as illustrated in b-GAP. The peaks that appeared at 1135 and 1276 cm−1 in 3 stretching vibration of PBFMO, respectively [−1 was ascribed to the –N3 from GAP. The appearance of 3320 cm−1 was due to the –NH stretching vibration, the appearance of 1726 cm−1, 1531 cm−1 and 1376 cm−1 were assigned to C=O and –NH stretching bands of the urethane group [b-GAP polyurethane.The synthesis of PBFMO-ectively . The newne group ,30. Thes13C-NMR  of PBFMO-b-GAP was around 3.0~3.3×104 g mol−1, and its density was around 1.273–1.308 g cm−3, which was higher than that of the control group . It is due to the polymers with –CF3 that the group side chain has a higher density [To investigate the different PBFMO- density . H50 towards impact sensitivity was characterized by the drop weight test using standard procedures . It was due to the decomposition process of PBFMO-b-GAP releasing HF; subsequently HF could react with Al and give more exothermal reactions [The cook-off experiment was used to investigate the thermal performance of the PBFMO-f curves ,51,52. Ieactions .b-GAP, was synthesized on GAP as a soft segment and TDI-extended PBFMO as a hard segment. From FT-IR, NMR, and GPC results, the PBFMO-b-GAP was synthesized successfully via a prepolymer process. The drop weight test and XPS results indicated that the introduction of fluoropolymer could evidently reduce the sensitivity of the PBFMO-b-GAP polyurethane. The PBFMO-b-GAP showed an enhanced tensile strength of 5.75 MPa with a breaking elongation of 1660%, and the tensile strength of PBFMO-b-GAP gels was enhanced with an increase in PBFMO content. The DSC and TGA/DTA curves indicated that PBFMO-b-GAP had adequate resistance to thermal decomposition up to 200 °C and began to decompose gradually at about 230 °C; it also had good compatibility with Al and HMX. The PBFMO-b-GAP/Al complex had a significant response temperature peak of 298 °C in the cook-off curves, which indicated that the PBFMO-b-GAP/Al complex has specific reaction energy.An energetic copolyurethane binder, PBFMO-


Research has illustrated potential health benefits from moderate drinking, but also health risks from excessive drinking. Few studies have contrasted drinking effects on health across different periods of the lifespan, and how such contrasts may vary across sociodemographic subpopulations. In this study, we investigated underrepresented racial and ethnic group status as a moderator of drinking effects on health across the lifespan. Analyses used data from two waves of a large U.S.-representative sample. We estimated a series of 3*3 between-persons ANOVAs testing effects of Wave-1 drinking group , age , and drinking-group-by-age interactions in White versus underrepresented status. The outcome variable was Wave-2 hypertension (controlling for Wave-1 hypertension). In the older-adult White group, results reflected the familiar “j-shaped” curve of alcohol effects on health. Specifically, abstainers experienced higher hypertension than moderate drinkers , and excessive drinkers experienced higher hypertension than moderate drinkers (p= .002). In contrast, among underrepresented older adults, hypertension levels did not vary significantly by drinking group. Graphical results clarified that the lack of drinking effects among underrepresented older adults reflected that they had similarly elevated hypertension across all three drinking groups, whereas the White older adults only had comparably elevated hypertension in the excessive-drinker group. These findings suggest that the positive health effects of moderate drinking apply primarily to White older adults. Our poster will discuss potential explanations for the apparent lack of health benefits of safe-drinking practices among underrepresented older adults.


Background: Cinematherapy and video treatments are artistic therapeutic techniques by which the individuals are exposed to their psycho-physical difficulties through the stories of the characters on the screen who are coping with the same issues that the patients are. Although these techniques are increasingly common within modern art therapies, there are neither comprehensive classifications of the different approaches nor agreement on their effectiveness. We performed a scoping review, describing different methodological approaches and outcome measures in cinematherapy and video treatments.Methodology: We searched articles in PubMed, PsycINFO and Google Scholar. We included: (i) articles in which subjects were treated for their difficulties with videos or films, (ii) articles written in English. Review articles and papers describing a research protocol without data collection were not included.Results: We analyzed 38 studies. Thirty-six reported a positive effect of the treatment. Seven studies used classical cinematherapy, adopting a qualitative approach to measure the therapy outcome. Thirty-one studies used different video treatments, 8 of which were defined as randomized controlled trials with specific objective therapy outcomes. Studies were mainly focused on behavioral and psychological difficulties in Autism Spectrum Disorders and Schizophrenia.Conclusion: Studies using video treatments more often rely upon structured experimental designs; on the contrary, those who used classical cinematherapy produced descriptive results. A more standardized methodological approach in terms of experimental design, procedure, and objective outcome measure is needed to provide evidence on the effectiveness of these techniques, promoting its application in the clinical field. Focusing on the patients’ difficulties, the film or video presentation aims to comprehensively understand them through a “third-person” perspective  Implementation, which means that the therapist assigns a film to the patient to let them understand why the therapist has explicitly chosen that film; and then (iii) Debriefing, the session after viewing the film for understanding the patient’s reactions. At this stage, the therapist and the patient link the film and the patient’s history (making the cinematherapy effective). Brainstorming is also encouraged to make the patient reflect on what can be therapeutic in the film.Over the years, several authors have also proposed different models of functioning with distinct phases for these techniques. For instance, Identification, in which the patient identifies with the character because of the character’s behavior and goals, becoming aware of the character’s feelings and emotions; (ii) Catharsis, the patient tries to learn through the character’s experiences; (iii) Insight, in which the patient internalizes the character’s experience and creates a connection between the character’s and their experience to become aware of their situation. A further stage was also identified  entified  that is rategies . In otherategies .“I was too much like watching my own family […].”Using cinema in clinical practice can allow patients to externalize their problems in a less formal context and discuss their problems in a more detached way to overcome their resistance to the therapy . In suchad hoc created videos or documentaries in which some actors show skills of interest to the patient’s case. This technique, called “video modeling,” originated from Bandura’s work ?•What outcomes have been measured?•Was the application of the technique effective?•What are the major methodological limitations of the available studies?The review was conducted following the PRISMA guidelines for Scoping Review . The revStudies were selected by querying the following keywords in PubMed, PsycINFO and Google Scholar: “Cinematherapy” or “Cinema therapy” and “Mood” and “Emotion” on 18/10/2019, “Cinematherapy” or “Cinema therapy” and “Mood disorders” on 18/10/2019, “Cinematherapy” or “Cinema therapy” and “Psychiatric disorders” on 18/10/2019, “Cinema therapy” or “Cinema therapy” and “Emotions” and “Mood” and “Psychiatric disorders” on 30/10/2019, “Video peer modeling” and “Cinematherapy” and “Psychiatric disorders treatment” on 30/03/2020, “Video peer modeling” and “Psychiatric disorders treatment,” on 30/03/2020, and “Video treatment” and “Video stimuli treatment” and “Psychiatric disease” on 30/03/2020.Studies included in this scoping review met the following inclusion criteria: (i) research article type, (ii) use of complex visual stimuli including video, films, or documentaries; (iii) application of the techniques on psychological or physical difficulties; (iv) English language.To investigate the suitability of the article, we firstly evaluated the title, then the abstract, proceeding to the entire text. ES and GS agreed on the eligibility criteria of the selected studies. Information of interests such as the type of treatment, the treated pathology, study design, characteristics of the participants’ sample and outcome have been extracted and reported in Through databases, 484 articles were identified, and after duplicates were removed, 453 articles were analyzed. After analyzing the content of 186 articles, 148 were excluded because they did not meet the inclusion criteria, such as studies in which cinema or videos were not used for therapeutic aims. Thirty-eight studies published from 1974 to 2018 comprised the final sample included in the review . Among sIn the following paragraphs, we define cinematherapy and video techniques arising from the scoping review of the literature. We also summarized their features, such as the type of film stimuli used, the type of treatments applied, and the populations to which these treatments are administered.In this section, we will summarize the most common ways to use films or videos to treat people , and we will show some examples of video treatment.Shrek 2, a cartoon in which a friend of the two protagonists impedes in their life as a couple, helped a couple become aware that the problems of their relationship were due to their intrusive parents and friends. Another interesting reflection is that viewing specific films can be effective, even when patients accidentally see them . In particular, the therapist chooses some films that, in their opinion, relate to the patient’s difficulties and, after a viewing session, discusses with the patient the main themes that emerged from the movie. For example, see them . The thesee them . With thsee them . Moreovesee them .The video modeling technique exposes patients to videos in which characters manifest specific skills that the patients need to learn . At the end of the video, the patients can practice what they learned from the character. It is also important to note that video modeling techniques are sometimes combined with other treatments  .In a clinical setting, video modeling has mainly been used to improve social skills in individuals affected by ASD, ranging from the appropriate behavior in a workplace environment  to the wAnother application of video modeling exposes patients to videos of people recounting their experiences of a particular event . For exavideo prompting, which provides a step-by-step learning experience. In video modeling, all the skill passages  are usually shown together and followed by the option to attempt the skill. Unlike typical video modeling, video prompting shows each section of the video separately so that the subject can try each step of the skill . The therapist video records every treatment session and follows up by showing these videos to the participant, who then reflects on the target behavior ; researchers simply discuss the movie content with the patients during and after the session, sometimes in combination with qualitative questionnaires .Outcomes are frequently measured using psychological tests. For example, Studies have also assessed physiological parameters according to their aims when participants suffer from an organic illness or when the phenomenon under consideration involves physical parameters. For instance, in a study assessing the effects of viewing humorous films on erectile dysfunction in patients with atopic dermatitis, The authors also measure physiological parameters if it is helpful to understand psychological changes, as is the case with anxiety. For example, Cinematherapy and video modeling can treat various psychological difficulties and particular conditions in healthy and pathological populations. For instance, Other examples of pathologies in which video modeling is applied are ASD , addictiCinematherapy and video treatments can help people manage life challenges. Movies or videos can help develop new skills, increase awareness, and offer new ways of thinking about specific problems in various patient populations. Cinematherapy and video treatments are flexible: they can be applied in several modalities and are adaptable to diverse situations. Nevertheless, there are some critical concerns. In classical cinematherapy, the choice of viewing material is not standardized; it varies according to the therapist’s beliefs and experience. Even if some therapists have proposed lists of films that can be utilized to treat different emotional difficulties , these sThis scoping review found that 38 articles using classical cinematherapy and others employing video modeling (or its subcategories) or other forms of video treatment have been applied to clinical/subclinical populations. In most cases (14 studies), the video technique was applied to treat behavioral difficulties related to ASD. Interestingly, we also found five studies that examined the effect of cinematherapy and video treatments in patients affected by Schizophrenia.Authors who used video treatments or video modeling are more inclined to implement experimental designs; on the contrary, those who used classical cinematherapy produced descriptive studies. Indeed, 8 of the 38 studies were designed as randomized controlled trials and all involved video treatment as a technique. This finding could be intrinsic to the differential nature of cinematherapy and video treatments. On the one hand, cinematherapy uses video material that is strongly characterized by an artistic component and thus challenging to standardize; on the other hand, video treatment involves straightforward video material without artistic intent. When cinematherapists use a film, they manage a complex artistic medium to treat patients. Transforming this approach into a standardized paradigm is far from banal. In some cases, standardizing a specific protocol appears to be more of a limitation than a treatment improvement. Due to these methodological limitations, estimating the objective efficacy for cinematherapy is complex, and the results, therefore, remain mainly descriptive.n = 1,016), an informational film , or an ad hoc documentary (4 Weeks2Freedom) (n = 999). Results showed that there was no detectable effect of the intervention compared with the no-intervention control or informational control film. Among the possible causes of the negative result, the authors suggested that the film may not have been sufficiently engaging to keep participants viewing for long enough to have an effect. Furthermore, they stated that the intervention was unsuccessful as the identification process according to which viewers identify with the people in the ad hoc documentary might not have been effective. We also advise caution when using video modeling, as its efficacy may also depend on the choice of material. For instance, in some studies, videos with adult models were shown to children to improve their skills , they more often successfully use video modeling to treat people with ASD (14 studies). As a result, we cannot have a global view of the actual efficacy of this technique for other kinds of pathologies. It would be interesting to apply it to different patient populations and other psychological/physical difficulties to analyze who can best benefit from the treatment.The main criticism of using cinematherapy and video treatment is that they lack a standardized set of stimuli and protocols. Future studies should aim to create standardized protocols, above all in cinematherapy practice, for patient populations. It would be helpful to select a film or some particular scenes of a film and standardize them through an adequate number of healthy subjects who judge the emotional valence of the selected stimuli. Most importantly, the main outcome should be measured objectively. A rigorous methodological approach will allow for the scientific validation of these audiovisual techniques, which are easy to administer and flexible.We have all been to the cinema and have relived the emotions we were experiencing through the characters in the film. This experience is a widespread testimony to the value of the technique. Nevertheless, its justification cannot remain purely anecdotal; further scientific validation is necessary.One of the limitations of this study concerns the detection of published papers on the topic. In fact, in some cases, studies on art therapy are published in journals that are not indexed in major search engines such as PubMed. For this reason, this review may not have taken these papers into account. To deal with this issue, we attempted through cross-searching to include all published works in which cinematherapy and video treatments were applied to clinical and subclinical populations. Lastly, because the review was limited to papers published in the English language, it is possible that other potentially relevant papers were omitted.To conclude, the mapping of the published literature shows that a rigorous and robust methodology is not characteristic of diverse approaches, making the generalization of the results, if anything, more complicated. Cinematherapy and video treatments are flexible, easy-to-use approaches that can be applied to different patient populations. Although the application of stricter rules is complicated due to the complexity of the adopted stimuli, we believe that such an effort is desirable: implementing standard protocols with more precise efficacy indexes will make these treatments objectively valid rehabilitation tools.The art therapy landscape is vast and complex. In recent years, the application of cinematherapy and video modeling to treat psychological difficulties has increased enormously. Nevertheless, the methodological approach is mixed, and the outcome measures are mainly subjective. To our knowledge, this scoping review represents the first attempt to map the available studies on cinematherapy and video treatment, with a twofold implication. First, it organizes what we know so far about cinematherapy and video treatment applied to clinical populations. On the other hand, it represents a starting point from which future research can improve protocols, increasing the efficacy of the use of these techniques at the intersection of art and psychology.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.ES: investigation, data curation, and writing—original draft. GS: conceptualization, writing—original draft, and writing—review and editing. FS and FV: writing—review and editing. GB: conceptualization, writing—review and editing, and supervision. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


N = 5607) was analyzed descriptively, and five focus groups were conducted, applying thematic analysis. Statistics showed that boys from the age of 14 use video games up to 5 times more than girls, while girls are much more on social media. From the focus groups, we found that boys did not view social media as socially significant as gaming and that there is a greater social acceptance of gaming among boys than among girls. Gender differences in video gaming are not necessarily a problem per se, as they may reflect gender-specific motivations and interests. However, the study also finds that girls feel less encouraged than boys to play video games due to different gender-related experiences of video gaming. Therefore, gendered barriers in video gaming must be explored in future research.Gaming is widespread among adolescents and has typically been viewed as an activity for boys. There are however a growing number of female gamers and we need to learn more about how gender affects gaming. The aim of this study is to both quantify gaming among Norwegian adolescents and explore how gender differences are perceived. A mixed method approach was used to capture gaming experiences among boys and girls. Survey data ( Video games have been played for decades, influencing the daily lives of people and relationship to technology. In the last 40 years, video games have moved from amusement arcades 1970s) to home consoles and computers (1980s–1990s), and more recently to mobile devices 2000s) and lastly to sports stadiums due to the popularity of electronic sport, eSports (2010s) [970s to h000s and As pointed out by Lobel et al. most research on video gaming has focused on its potential negative impacts, such as addiction, violence, depression, and other mental health issues . SimilarIn recent years, a significant body of studies has begun to investigate gaming’s potential positive side. Research has shown that gamers can experience considerable benefit, such as pleasure and enjoyment , meaningVideo gaming has long been perceived as mainly a territory for adolescents and males. A systematic review on gender differences in online gaming by Veltri et al.  reports Since video gaming is more prevalent among boys than girls ,16, the In this light, the purpose of this study is to explore gender differences in various aspects of video gaming. We believe that exploring gender disparities is vital because gender is a fundamental characteristic that inspires the behavior and societal roles of men and women. The present study aims to investigate  how gendOur study population was children and adolescents in Norway aged 11–19 years. We used a mixed-method approach, as we believe that using both qualitative and quantitative data would enable an exploration of how the two methodological approaches could complement and nuance each other in understanding adolescents. Quantitative data come from the Ungdata study, a national youth survey covering almost all municipalities in Norway (Ungdata.no). Qualitative data were collected by the author in focus groups conducted in secondary schools in Innlandet County. Both datasets were analyzed separately and then brought together for analysis and comparison.As Granic et al.  point ouUngdata is a standardized and quality assured survey covering various topics, such as school, health, family and friends, substance use, and leisure activities, including digital media use and video gaming. The Norwegian Social Research Institute (NOVA) administers Ungdata. The survey was first implemented in 2010 and is financed by the Norwegian Directorate of Health, Ministry of Children, Equality and Social Inclusion, and the Ministry of Justice and Public Security. Ungdata is available for grades 5–7 in elementary school (Ungdata junior) and for secondary school (Ungdata). The survey may be ordered free of charge every third year by municipalities. It comprises about 150 questions that are similar across all surveys. Schools may also choose an expanded version of the survey, with additional sets of questions on mental health, gaming behavior, and other topics. The students complete the self-reported digital questionnaire during one school lesson with a teacher present. Participation in Ungdata/Ungdata junior is voluntary and based on informed consent .N = 504,553.To show screen activity trends by age, we used the entire Ungdata junior and Ungdata sets used in 2010–2020. The analysis was restricted to participants with non-missing values in the variables of interest, which were gender, age, gaming on PC/console, gaming on smartphone/tablet and use of social media, with a total p-values <0.05 were considered statistically significant. All analyses were conducted in SPSS Statistics for Windows, Version 26.0. .To analyze gender differences in secondary school adolescents regarding screen activity, we used data from 5607 8th to 10th graders (aged 13–16) in Innlandet County who participated in the Ungdata survey in the beginning of March 2020 before the national confinement due to the COVID-19 pandemic. The convenience sample includes 2779 (50.4%) boys and 2731 (49.6%), which represents about 45% of the secondary school students in Innlandet County. Categorical data were presented as counts and percentages. We used Chi-square tests to assess gender differences. The qualitative data were collected using focus group interviews in September and October 2019. We focused on secondary school students aged 13–16 years, as this is the period when many girls lose interest in gaming while boys continue with it . We recrAn interview guide, including gaming-related questions from the Ungdata survey, directed the participants to talk about how they used video games, their experiences of friendship, intimacy, belonging, exclusion, or hate in gaming spaces, how gaming may support or constrain young people’s lives, their parents’ views on their video gaming, and the impact of gaming on their schoolwork, social relations, and mental health. The interview guide was pretested in a 9th grade class of 30 in a school where we did not conduct focus groups. The interview guide was modified after pretesting. Questions were not worded in a manner that directly targeted gender differences. The interview guide ensured consistency and flexibility in the approach to elicit the participants’ stories. Probes were open and specific to their comments.Both researchers were present during all focus group interviews. The second author led the interviews, while the first author took notes and asked some follow-up questions. The interviews lasted 30–45 min and took place in a private room in the school with only participants and interviewers present. Confidentiality was ensured at the outset by informing participants that all identifying information would be removed from the data. All interviews were audiotaped and transcribed verbatim by the first author. The interviewers had the impression that all students spoke freely, but some were less talkative and gave shorter responses.We conducted semistructured group interviews to generate interactive data and access everyday ways of talking about our research topics ,26. FocuQuantitative data were obtained from an established database collected anonymously in the Ungdata surveys, which was approved by the Norwegian Centre for Research Data (NSD). Consequently, separate ethics approval for the present study was unnecessary. Informed consent was obtained from all students and their parents prior to the online survey. Separate informed consent was collected from the students participating in the focus groups and their parents. Students were also given verbal information about the study aim and their rights as participants at the beginning of the group interviews. Ethical approval for the qualitative part of the study was granted by NSD (NSD no. 882453).The quantitative analysis shows that more boys than girls in all age groups spend an average of one hour or more per day playing video games on a computer or console. The gender difference varies between 40% and 54%, depending on age. At age 13, video gaming on computers and consoles decreased by about 20% in both genders . Gaming The analysis shows a gendered pattern in the adolescents’ use of social media . Betweenp < 0.001 for all categories).Ungdata participants were also asked about video games, social relations, and friendship . In UngdThe first theme reflected adolescents’ perceptions of how boys and girls were oriented towards different screen activities. In line with the survey findings, the participants associated video gaming with boys and social media with girls. One 9th grade boy said that boys and girls spend about the same amount of time on screen activities, but that boys spend most time on gaming and girls on social media. A girl in the 10th grade described how she and some friends used to text each other so much on social media that their parents had to make a rule forbidding the use of social media after 8.30 pm. She explained how video games and social media play different roles in her life: “I do think it’s fun to play video games, but now that I have Snapchat and stuff, I’ve kind of started talking a lot more with people there”. Both boys and girls mentioned using various social media platforms such as Facebook, Snapchat, and Instagram. Boys, however, did not view social media as socially significant as gaming. One boy in 8th grade stated: “I play a lot. That’s what I do most. I have social media too, but I’m not active there”.Many of the boys used the term “gamer” about themselves. In their perspective, a “gamer” is a person who has video gaming as a passionate hobby. One 9th grade boy, who referred to himself as a gamer, described how gaming was an integral part of his life: “I play every day. Just now, it’s a lot of Minecraft, Grand Theft Auto, CounterStrike. I play with people from my class and sometimes with people I have gotten to know online”. The boys described video gaming as a broad medium, ranging from mobile app games  to large open world games . However, some genres and titles were described as more authentic video games than others. Boys described playing on a console or computer as “real” and “hardcore” gaming and playing on a tablet or a smartphone as “casual” gaming. When one boy mentioned that some girls at school play a horse game (“Howrse”) on tablets, one of the biggest gaming enthusiasts protested loudly: “Hell no, that’s not a real video game!”.All of the girls we interviewed had some experience with video games. Most had one or more games on their smartphone or tablet, such as Candycrush, Roblox, Color Road, and Sims. Despite playing these games occasionally, the girls mainly expressed their relationship to gaming with comments like: “It’s just a pastime for me”; “It’s just something I occasionally do in vacations or when I’m traveling”; “I don’t sit down and do it for its own sake”; “You won’t find me sitting at a computer or Playstation”. Only one girl explicitly mentioned video games as her hobby. However, she expressed ambivalence towards video games and parts of gaming culture.The second theme related to how adolescents associated video gaming with different stages of life. Boys considered video gaming to be a central part of both childhood and youth culture. Many girls associated gaming primarily with childhood and younger children’s lifeworld. One 10th grade girl stated: “Many girls are insecure about themselves and can get affirmation that they’re good enough on social media. Some also think that gaming’s childish. Some games aren’t childish, of course, but on social media, you can talk more with friends”. Several girls reported having played more video games when they were younger, with friends or family members, but that their interest in gaming had gradually faded. One girl felt that video gaming was mostly about playing and having fun, but that social media was better suited to make and cultivate friendships. Some of the boys had noticed that the girls at school were more oriented towards social media and youth culture now than a few years ago. One boy in 9th grade explained: “Many of those typical ‘girl games’ aren’t so popular among the girls any longer. At age 9, or at least that’s what I think, all the girls want to be princesses, cute and stuff. But suddenly that stops, and they all want to be models on social media”.From the boys’ perspective, video gaming belonged to both childhood and youth culture. Unlike the girls, some boys reported spending more time gaming now than when they were younger. Most of them had always enjoyed gaming and they found it hard to visualize a life without video games. One boy in 10th grade said: “A normal day for me is like this: I come home from school, I go to the computer, and I play video games (...) I play lots with friends. I’ve played soccer before, but I’ve become a gamer. I’d probably survive without gaming, but it’s so cool!”. Video gaming was emphasized as fun and entertaining by several of the boys. One boy in 10th grade used to phrase “digital playing” to describe his relationship to gaming and mentioned the popular video game Minecraft, which he described as “Lego on the screen”.Some boys also explained that gaming was more than pure play and fun: they connected gaming to learning, education, and careers. Several boys envisioned a future where video games would be part of their lives, not solely as a passionate pastime but also as a possible career, such as a professional video gamer (eSports athlete), streamer, or game developer. The boys mentioned several schools that offered gaming programs. Some boys were deeply interested in eSports, and they thought it was cool that Fortnite had a Norwegian world champion.The third theme related to video game content and characters. Both boys and girls were critical of gender representation in video games. One 9th grade girl expressed it this way: “The characters in video games are mostly guys. There are lots of war games. I don’t play any video games where the main character is a man”. Although she described gaming as her hobby, she was ambivalent about video games because she felt that there were so few “good female characters”. Another girl commented that female characters are often portrayed as helpless and in need of being rescued, mentioning the princess character in the Super Mario Bros games.Both girls and boys felt that video games were addressed more to males than females. One 10th grade boy explained: “It’s nice to have a choice. Then maybe girls will feel more welcome in video gaming (...) I play a female character in Destiny 2. All the male characters in the game look completely hopeless. They all look like they’re in a midlife crisis.” The interviewees wanted more nuanced and varied game characters. They thought more gender balance would improve the games and that the introduction of more female characters could make girls feel more attached to gaming.The fourth theme concerned the greater social acceptance and higher status of gaming among boys than among girls. The boys described how gaming was an essential setting for experiences of togetherness in free time and school time. One 10th grade boy said: “I play with classmates and sometimes with people I’ve got to know online (…) We have an iPad at school, and it’s tempting to play a game in class. You get a black mark if the teacher catches you, but my friends and I take that risk”. Several boys said that they got to know others better and made friends in online games. Some mentioned that they kept in touch with family members and former neighbors or classmates by playing online together. “In games like Minecraft or Super Mario Maker, you can build something together while talking about other things”, one of the boys explained. Another boy said that he and some classmates used to play Minecraft after school. He added: “I’d have felt left out if I couldn’t play with my friends”.Besides enjoying playing video games themselves, several boys reported often spending time on YouTube and Twitch watching others play video games. They found this just as natural and meaningful as watching soccer or other sports on TV. The most popular games among boys included World of Warcraft Classic, Fortnite, FIFA, Call of Duty, and Counter Strike. When we asked if they sometimes played with or met girls in these games, one boy answered: “I’d be amazed if I met a girl in CounterStrike. There are really not that many girls in those games”. For the girls, social media had greater social significance than video games in the peer community. One girl described how she began to think twice about gaming when she was 12: “When people say gamer, I think mostly of boys really (...) I used to play a boxing game. That was before I got social media. Every time I got a visit, I tried to get them to play, but (...)”. This lack of interest in video gaming from her friends colored her view of video games. Girls found it difficult to find other girls to play with or talk to about games.Our study found pronounced gender differences in the screen activity of adolescence. The statistical analysis showed that boys spent significantly more time than girls in all age groups playing video games on consoles or computers. Regarding online gaming, most boys reported playing at least once in the past week, compared to 23% of girls. This finding concurs with other studies from Norway , GermanyFurther, the analysis showed that the adolescent boys and girls had different views on playing and gaming. Previous studies have reported that teenage girls are often keen  to creatAnother factor that the adolescents eagerly discussed as a gender barrier in gaming was the predominantly male/masculine orientation of many video games. It is well documented that there are far more male than female game characters  and thatFor many young people today, especially boys, gaming occupies most of their waking hours out of school. For many of the boys, video games were a crucial aspect of their social life. They emphasized that gaming was deeply integrated into their friendship and peer groups. Playing video games with friends allowed boys to communicate their thoughts, feelings, and worries in a play-like context. For some boys, video games were also a way to keep in touch with former classmates or distant relatives, as also described in other research .The quantitative analysis supports the interviews in finding that gaming is an essential social tool in male adolescents’ lives. Gaming is a way to connect with friends and find like-minded peers, especially for boys. It is important not to underestimate or condemn virtual friendship as less real and genuine. Although the use of digital tools that mediate our social interactions, such as online gaming and social media, help to maintain communication during breaks in physical presence , researcThis study focused on gaming an understanding of gaming behavior in adolescents in a gender perspective. We applied a mixed methods approach to obtain a broad picture of adolescents’ video gaming practices and experiences. There are several important limitations to the study findings to be addressed. Firstly, one challenge that can emerge when applying a gender perspective is to overemphasize gender differences. Gender and other social identities, such as age, ethnicity, sexuality, religion, and class, form part of a complex interrelationship . Our intBesides these limitations, our study also possesses some strengths. It focused on the gender perspective of gaming behavior in adolescents, which has been absent in much previous research . While tThe present study found significant gender differences in the video gaming of Norwegian 11–19-year-olds. The quantitative part showed a high proportion of gamers among boys regardless of age, but less gaming among girls with increased age. The qualitative part identified four themes that may explain how gender effects adolescents’ practices and gaming experiences. Gender differences in gaming behavior and experiences are not necessarily problematic. However, our study found that adolescent girls have a more limited scope in gaming. The finding of gendered barriers to participation in gaming activities must be explored further in a larger population.


LincRNA-p21) through a p53-dependent mechanism. Kidney tubule cell-specific deletion of LincRNA-p21 attenuated oxidative stress, inflammation, apoptosis, and endoplasmic reticulum stress, leading to reduction of histological and functional kidney injury despite persistent obesity and hyperlipidemia. Mechanistically, HFD- or PA-initiated lipotoxicity suppressed the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR)/murine double minute 2 homolog (MDM2) signaling cascade to activate p53 and enhance the transcriptional activity of LincRNA-p21. Collectively, our findings suggest that the p53/LincRNA-p21 axis is the downstream effector in lipotoxic kidney injury and that targeting this axis particularly in the kidney tubule could be a novel therapeutic strategy.Lipotoxicity has been implicated in the pathogenesis of obesity-related kidney damage and propagates chronic kidney injury like diabetic kidney disease; however, the underlying mechanisms have not yet been fully elucidated. To date, reduction of lipid acquisition and enhancement of lipid metabolism are the major, albeit non-specific, approaches to improve lipotoxic kidney damage. In the kidneys of high-fat diet (HFD)-fed mice and tubule cells cultured with palmitic acid (PA), we observed a dramatic upregulation of the long intergenic non-coding RNA-p21 (  LincRNA-p21 through a p53-dependent mechanism in kidney tubule cells exposed to palmitic acid. Tubule cell-specific deletion of LincRNA-p21 prevented histological and functional kidney injury induced by high-fat diet. These findings suggest p53/LincRNA-p21 signaling axis as a potential therapeutic target for lipotoxic kidney injury.Our study observed a dramatic upregulation of  Obesity has been considered as a major risk factor for the development of chronic kidney disease, independent of its association with hypertension, diabetes, and dyslipidemia.,,In addition to the well-known role of tumor protein 53 (p53) in tumor suppression, a plethora of evidence suggests the extensive involvement of p53 in the regulation of energy metabolism and numerous metabolic processes like aging, obesity, and diabetesLincRNA-p21) is one of the most-studied lncRNAs due to its ability to fine-tune p53-dependent transcriptional responses.LincRNA-p21 comes from its genetic location lying approximately 15 kb upstream from the Cyclin Dependent Kinase Inhibitor 1A  gene on chromosome 17. Previous studies documented an integrative role of LincRNA-p21 in a variety of cellular functions, including modulation of cellular proliferation, inflammation, apoptosis, cell-cycle arrest, ER stress, gene expression, and protein stability.,LincRNA-p21 alleviated pathological changes in diabetic kidney.LincRNA-p21 participates in obesity-related kidney injury.Long intergenic non-coding RNAs (lncRNAs), a class of non-coding RNAs over 200 nucleotides in length, have been a center of intense research in recent years and recognized as important regulators involved in diverse obesity-associated biological and cellular processes.LincRNA-p21 signaling axis in the pathogenesis of lipotoxic injury arising from the chronic metabolic stress of excessive dietary fat consumption.The current study aims to dissect the role and mechanism of the p53/LincRNA-p21 was found in kidney tissue from obese db/db mice and HFD-fed obese mice (LincRNA-p21 in diet-induced obesity (DIO) and associated metabolic disorders, tubule-specific LincRNA-p21 knockout (KO) mice and their control (CTL) littermates were generated  (Elevated expression of ese mice A and 1B.enerated  and fed enerated C. Gene Kenerated D. Tubulen (FISH) D and 1E.LincRNA-p21 does not affect the metabolic profile in HFD-induced obesity.HFD markedly increased BW in both KO and CTL mice from week 12 onward A, and noLincRNA-p21 deletion  and tubular injury score (LincRNA-p21 deletion (LincRNA-p21 deficiency enhanced the kidney's resilience to HFD-elicited injury.HFD-induced increase in serum creatinine (sCr), blood urea nitrogen (BUN), and urinary albumin levels in HFD-fed CTL mice were improved after tubular deletion F–2H. Perdeletion A demonstry score B and 3C.deletion D–3F. TheLincRNA-p21 deletion , a marker of ER-stress-elicited apoptosis, was upregulated in CTL-HFD mice and reduced by LincRNA-p21 deletion (Bax) and downregulation of anti-apoptosis mediator B-cell lymphoma 2 (Bcl2) were observed in CTL-HFD mice, and these alterations were partially reversed by LincRNA-p21 deletion (Bip) was enhanced in CTL-HFD mice and reduced after LincRNA-p21 deletion  stimulation in HK-2 cells but partially reduced by silencing LINCRNA-p21  is highly expressed in tubular epithelial cells of HFD-fed mice and was ameliorated by tubular deletion A and 4B.pression C–4F and pression G–4J of pHFD mice A and 5B.deletion C. Likewideletion D–5F. In deletion G. In vitCRNA-p21 H. TranscCRNA-p21 I–5K.FiguLincRNA-p21 deletion reversed the suppression of the PI3K/AKT/mTOR signaling cascade by HFD, reinstating MDM2 and reducing p53 expression  induced elevation in both p53 activity (LINCRNA-p21 transcripts (BAX and suppressed anti-apoptosis mediator BCL2 in HK-2 cells exposed to PA and p53 activators (RITA and Nutlin-3) were partially reversed by PFT-α .Western blot analysis demonstrated HFD suppressed the activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mechanistic target of rapamycin (mTOR) signaling cascade, a well-known upstream signaling pathway of p53, which resulted in reduced protein expression of murine double minute 2 homolog (MDM2), an endogenous inhibitor of p53, and eventually enhanced expression of p53 in obese kidney A–6F. Intpression A–6F. In activity G and LINnscripts H in HK-2by PFT-α I and 6J.LincRNA-p21, a key mediator of multiple biological processes, in lipotoxicity-induced kidney damage. We show for the first time that lipotoxicity-induced kidney lesions were suppressed by deletion of LincRNA-p21 in both cell culture and mouse models of DIO. Our findings provide convincing evidence that LincRNA-p21 deficiency in kidney tubule cells protects the kidney from multiple HFD-induced pathological responses, including oxidative stress, inflammation and apoptosis, and ER stress. Mechanistically, our data demonstrate that lipotoxicity suppressed the PI3K/AKT/mTOR/MDM2 signaling cascade to enhance p53 transcriptional activity, which subsequently contributed to upregulation of LincRNA-p21 in kidney tubule cells. Taken together, these results highlight a connection between LincRNA-p21 and lipotoxicity-induced metabolic perturbation in tubule cells, corroborating a permissive role of LincRNA-p21 in metabolic disease.The present study sheds light on the role of ,Accumulating evidence proposes lncRNA to be a possible cellular hub for the coordination of cellular processes involved in multifarious kidney disease progression, and strategies targeting multiple individual lncRNAs have received attention as potential treatments for kidney diseases such as diabetic kidney disease (DKD). Podocyte-specific lncRNA taurine-upregulated 1 overexpressing DKD mouse models improved glomerular phenotype in terms of albuminuria and histological changes through protecting podocytes from apoptosis and ER stress and alleviating extracellular matrix (ECM) accumulation.LincRNA-p21 in numerous cellular functions, including modulation of cellular proliferation,,,LincRNA-p21 as a promising diagnostic and prognostic biomarker, as well as a therapeutic target, in human diseases. More importantly, it was found that LincRNA-p21 silencing alleviated pathological changes in diabetic kidney, and reduced ECM in mouse mesangial cells stimulated by high glucose,LincRNA-p21 in kidney disease. Mechanistically, LincRNA-p21 acted as a molecular sponge for miR-18b that had inhibitory effects on connective tissue growth factor (CTGF) expression via interaction with the 3′-UTR of CTGF, ultimately enhancing expression of collagen I, collagen II, and fibronectin in mesangial cells.LincRNA-p21 in obesity-related kidney injury. Our findings for the first time highlighted a prominent role of LincRNA-p21 in obese kidneys and PA-stimulated tubular epithelial cell pathological processes.Emerging evidence unveils an integrative role of ,LincRNA-p21, we generated a tubule-specific LincRNA-p21 KO mouse to unravel the potential of LincRNA-p21 to become an early tubular damage marker as well as a therapeutic target in lipotoxic kidney injury. LincRNA-p21 plays no regulatory role in lipid metabolism as its deletion did not affect serum lipid profile or BW in HFD-fed mice.Tubular damage is an early predictor of future functional decline in type 2 diabetes, and initial stages of kidney damage in obesity or pre-diabetes are characterized by the presence of serum lipid abnormalities and ectopic renal lipid accumulation.LincRNA-p21 mediates obesity-related kidney lesion, we assessed cell oxidative stress, inflammation, apoptosis and ER stress in kidney tissue from HFD-induced obese mice and cultured tubular cells under PA treatment. Lipotoxicity-elicited oxidative stress, inflammation, apoptosis, and ER stress were blunted in the absence of LincRNA-p21, and alleviated the associated kidney dysfunction. Intriguingly, we found that tubule-specific LincRNA-p21 not only attenuated tubule injury but also contributed to reduced glomerular tuft area in HFD-induced obese mice. This finding reinforced the potential role of tubular injury in initiating loss of renal function with secondary sequelae that lead to glomerulosclerosis. The mostly accepted hypothesis of this phenomenon is that the overwhelming tubular glucose load due to increased plasma glucose levels during diabetes or pre-diabetes results in elevated proximal tubular sodium reabsorption through tubuloglomerular feedback, thus leading to a reduced afferent arteriolar vasoconstriction and subsequently glomerular hyperfiltration.,To elucidate the biological mechanisms through which LincRNA-p21 in mediating various pathological responses.,LincRNA-p21 resulted in a similar protective impact on a streptozotocin-induced DKD mouse model by reducing ECM in mesangial cells, alleviating kidney lesions, and hence improving renal function.LincRNA-p21 regulates both lipotoxic and glycemic kidney injury, albeit through different functional mechanisms in different resident kidney cells. Therefore, LincRNA-p21 may target multiple genes to regulate renal pathophysiology.Others also reported an integrative functional role of LincRNA-p21 induction in obesity-related kidney lesions, proposing a novel mechanism by which p53 participates in the progression of metabolic disease.LincRNA-p21 expression and preserved its anti-apoptotic capability in PA-exposed renal tubule cells, consistent with previous findings.,LincRNA-p21 through in vitro and in vivo studies, while upregulated LincRNA-p21 possibly further inhibits PI3K/AKT/mTOR/MDM2 signaling to enhance p53 activity to result in a positive feedback loop of injury. Although we did not highlight the likely downstream molecular mechanism mediated by LincRNA-p21 during lipotoxic kidney injury, prior studies showed that the binding of LincRNA-p21 with MDM2 enhanced p53 transcriptional activity in vascular smooth muscle cells from atherosclerotic mice,,LincRNA-p21 inhibited Wnt/β-catenin signaling in hepatic stellate cells,LincRNA-p21, PI3K/AKT/mTOR, and MDM2/p53 signaling cascades. Recent data recognized LincRNA-p21 as a molecular sponge to sequester microRNA-18b or microRNA-17-5p and promote the proliferation of mesangial cells exposed to high glucose or prevent activation of hepatic stellate cells,,LincRNA-p21 to reduce lipotoxic kidney injury. We and others observed the potential of LincRNA-p21 to mediate p53 activity in a feedback manner,,LincRNA-p21 as an effective upstream regulator of p53 to regulate its function under lipotoxic kidney injury. This hypothesis merits future research for a better understanding of the metabolic functions and molecular mechanisms of p53 family members.Our current data indicate that p53 is the upstream transcription factor that leads to LincRNA-p21, which trigger subsequent kidney injury. Tubule-specific ablation of LincRNA-p21 in kidney protected HFD-induced kidney injury structurally and functionally through ameliorating oxidative stress, inflammation, apoptosis, and ER stress. Our findings unraveled the potential of the tubular p53/LincRNA-p21 signaling axis in the regulation lipotoxicity-induced pathological cellular events, and opens a new avenue for developing treatment of lipotoxicity-elicited kidney injury.Collectively, lipotoxicity suppressed the PI3K/AKT/mTOR/MDM2 signaling pathway to activate the downstream effectors p53/LincRNA-p21 (LNA-LincRNA-p21) and corresponding negative CTL (LNA-CTL) were purchased from Qiagen , and Opti-MEM Reduced serum medium was obtained from Applied Biosystems . MDM2 inhibitor Nutlin-3, p53 inhibitor PFT-α, and p53 activator RITA (NSC 652287) were obtained from Selleckchem . Fatty-acid-free BSA and PA were obtained from Sigma-Aldrich . PA was conjugated with BSA before being added into culture medium. In brief, 10% fatty-acid-free BSA solution dissolved in phosphate-buffered saline (PBS) was heated to 37°C before the addition of a 200 mM PA stock solution dissolved in absolute ethanol to gain a 10 mM working concentration, while a comparable concentration of 0.475% BSA was used as vehicle CTL for PA. All the other chemicals and reagents utilized in this study, unless otherwise specified, were obtained from Sigma-Aldrich.Dulbecco's modified Eagle’s medium/Nutrient Mixture F-12 (DMEM/F12), GlutaMAX, 100 IU/mL penicillin, 100 μg/mL streptomycin, fetal bovine serum (FBS), and RNAiMAX reagent were purchased from Invitrogen . Custom-made locked nucleic acid (LNA) GapmeR antisense oligonucleotides targeting db/db mice and the lean CTL db/m mice were obtained from The Jackson Laboratory . The Ksp-CreERT2 mice were obtained from Professor Peter Igarashi  and the heterozygous LincRNA-p21fl/wt mice were bought from the Jackson Laboratory . For the Ksp-CreERT2 mice, CreERT2 fusion protein expression is regulated exclusively under the kidney specific Ksp-Cadherin (Cadherin 16) gene promoter, thus the Ksp-CreERT2 fusion protein would specifically be found in the renal tubular epithelial cells upon activation by 4-hydroxytamoxifen. The LincRNA-p21fl/fl mouse carries two loxP sites sandwiching the LincRNA-p21 sequence. By cross-breeding Ksp-CreERT2 and LincRNA-p21fl/fl mice, we successfully generated the tubule-specific LincRNA-p21 KO, which carried both the Ksp-CreERT2 and LincRNA-p21fl/fl alleles  was administrated to all experimental mice  by daily intraperitoneal injection for five consecutive days to induce the Cre/loxP recombination in kidney tubules. qRT-PCR and FISH using Stellaris RNA FISH probe and reagents  were used to confirm the successful deletion of LincRNA-p21  for 8 weeks, whereas mice fed with ND  served as CTL. BW was monitored biweekly. Blood was collected from tail vein following overnight fasting for renal function and biochemical analyses. Serum glucose levels were determined by Accu-Check Aviva glucometer . Serum sCr, urinary creatinine, BUN, serum triglycerides, and cholesterol levels of mice were measured by enzymatic method . Urinary albumin was determined using an ELISA quantification kit . All mice were sacrificed at the end of experiments and kidneys were removed for histological analyses. Markers of oxidative stress, inflammation, apoptosis, and ER stress were evaluated by qRT-PCR, western blot analysis, and immunohistochemical (IHC) staining.Total RNA was isolated from HK-2 cells using NucleoSpin RNA II total RNA Isolation Kit . NucleoSpin TriPrep Kit (Macherey-Nagel) was used to extract total RNA from mouse renal cortex. Isolated RNA (2 μg) was utilized for synthesizing cDNA by High-Capacity cDNA Reverse Transcription Kit (Applied Biosystems). qRT-PCR analyses were conducted in the StepOnePlus Real-time PCR Systems (Applied Biosystems) using SYBR Green Master Mix (Applied Biosystems) and specific primers . RelativHK-2 cells were collected and washed with cold PBS after experiments and solubilized with lysis buffer  containing protease inhibitor cocktail . Total protein from mouse kidney cortex was isolated by NucleoSpin TriPrep Kit (Macherey-Nagel). Protein concentrations from the cultured cells or cortical lysates were detected by the BCA Protein Assay Reagent (Thermo Scientific). Equal amounts of proteins were separated on 4%–12% precast Bis-Tris gel  and then transferred from the gel to a 0.45-μm polyvinylidene difluoride membrane  using standard electroblotting procedures. After blocking with 5% non-fat milk in Tris-buffered saline with Tween 20 , the blots were incubated with primary antibody overnight, washed with Tris-buffered saline with Tween 20, and then incubated with horseradish peroxidase-conjugated secondary antibody for 2 h and subsequently processed for incubation with enhanced chemiluminescence (ECL) prime chemiluminescence  and visualized by ChemiDoc XRS+ system (Bio-Rad). Intensity of the protein bands was measured via Image Lab software (Bio-Rad).Kidney samples were fixed in 10% formalin, embedded in paraffin, and sectioned to 4-μm thickness. Morphologic analyses of the kidney sections were carried out after PAS staining (Sigma). Injured tubules in the renal cortex were assessed by the presence of necrosis, loss of brush borders, vacuolation, cast formation, and tubular dilatation. Tubular injury was scored from 0 to 5 according to the percentage of injured tubules  from 10 randomly chosen, nonoverlapping fields at 400× magnification under a microscope. Glomerular tuft area was quantified by ImageJ software  from 20 randomly selected cortical glomeruli at 400× magnification and data were expressed as average μm2 per glomerulus. Only glomeruli containing a visible vascular or urinary pole were considered for area measurements.In situ detection of apoptosis was performed using the ApopTag Peroxidase Kit  based on TUNEL staining, and data were expressed as number of apoptotic cells per high-power field. For IHC staining, paraffin-embedded kidney sections were deparaffinized and rehydrated, followed by microwave-based antigen retrieval in citrate buffer (10 mM), pH 6.0, or protease K solution (20 μg/mL) in Tris-EDTA buffer, pH 8.0. Sections were quenched by 3% hydrogen peroxide and blocked with 2% BSA. Primary antibodies against NGAL and NOX4  were applied on the sections overnight, followed by incubation with peroxidase-conjugated second antibodies . Sections were developed using 3,3′diaminobenzidine substrate (Dako) and counterstained with hematoxylin. Ten images per section were captured in a blinded manner. Quantification of staining was performed using ImageJ analysis software. Data were expressed as percentage of positively stained area.Pro-inflammatory cytokines including IL-1β, IL-6, TNF-α, and MCP-1 in serum from all mice were measured in a single batch by Milliplex multiplex assays (EMD Millipore) according to the manufacturer's instructions and using a Luminex 200 multiplex detection system (EMD Millipore).2. Cells were growth arrested in culture medium containing 0.5% FBS for 12 h before the initiation of all experiments.The human proximal tubular cell line, human kidney 2 (HK-2) cells, was purchased from American Type Culture Collection  and cultured in DMEM/F12 fermented with 10% FBS, 1% penicillin/streptomycin at 37°C in 5% COIn vitro knockdown experiments were performed by using specific LNA GapmeR antisense oligonucleotides (ASOs). Three custom LNA GapmeR ASOs targeting LINCRNA-p21  and one LNA GapmeR ASO targeting negative CTL (LNA-CTL: 5′-AACACGTCTATACGC-3′) were used. One day before transfection, cells were plated in medium without antibiotics and FBS in a 12-well plate at a density that resulted in 60%–70% cell confluence. LNA-LINCRNA-p21 and LNA-CTL were diluted to the required concentration in Opti-MEM and mixed with Lipofectamine RNAiMAX, followed by incubation for 10 min at room temperature and then added to each well. Knockdown efficiency was determined 24 h after transfection by qRT-PCR, and cells with knockdown efficiency >70% were used for subsequent experiments.p53 activity in HK-2 cells with different treatments was measured using a p53 Transcription Factor Activity Assay Kit  according to the manufacturer's specifications. This kit is a non-radioactive assay for the quantitative measurement of specific transcription factor DNA binding activity of active p53, and a biotin-labeled p53 response element DNA binds specifically to active p53 in nuclear extract and forms a complex that could be detected by the p53 specific monoclonal antibody. In brief, 5 μg of nuclear extract samples from HK-2 cells subjected to different culture conditions and CTLs were pipetted into wells precoated with a biotin-labeled p53 response element DNA that captures specifically active p53 to form a complex, which was then detected by adding anti-p53 monoclonal antibody that is conjugated to horseradish peroxidase streptavidin after removing unbound material by washing with washing buffer. Horseradish peroxidase catalyzed the conversion of a chromogenic substrate (tetramethylbenzidine) to a colored solution with color intensity proportional to the amount of protein present in the sample. Spectrophotometric data were expressed by measuring the absorbance at 450 nm using a microplate reader. Quantitative results were calculated from at least three independent biological experiments.Statistical analysis was performed using Prism software version 7.0 . All data were expressed as mean ± SEM. Two-tailed Student's t test or one-way ANOVA followed by a post hoc multiple comparison (Tukey) test was carried out where applicable. p < 0.05 was considered statistically significant.


The context, such as scenes and objects, plays an important role in video emotion recognition. The emotion recognition accuracy can be further improved when the context information is incorporated. Although previous research has considered the context information, the emotional clues contained in different images may be different, which is often ignored. To address the problem of emotion difference between different modes and different images, this paper proposes a hierarchical attention-based multimodal fusion network for video emotion recognition, which consists of a multimodal feature extraction module and a multimodal feature fusion module. The multimodal feature extraction module has three subnetworks used to extract features of facial, scene, and global images. Each subnetwork consists of two branches, where the first branch extracts the features of different modes, and the other branch generates the emotion score for each image. Features and emotion scores of all images in a modal are aggregated to generate the emotion feature of the modal. The other module takes multimodal features as input and generates the emotion score for each modal. Finally, features and emotion scores of multiple modes are aggregated, and the final emotion representation of the video will be produced. Experimental results show that our proposed method is effective on the emotion recognition dataset. Emotion recognition is an important content of a comprehensive understanding of video scenes. It can help us understand humans emotions shown in a video clip. Particularly, understanding such emotions has a wide range of applications . For exaPrevious research on video emotion recognition has mainly focused on exploring facial features. The facial action coding system (FACS)  encodes Scene Complexity. Because of the complexity of the scene in the video, such as the difference of angle and distance of cameras, there will be a difference in pose and sharpness of humans in the video, which will lead to the difference of emotion discrimination. As an example, take a look at the images in Differences in Emotional Expressions of Different Modes in the Video. Different modes contain different amounts of emotional information in different videos. For example, some videos contain more human images and fewer context images. Meanwhile, the face of the human has a rich emotional expression, such as the image sequences in Psychological researches  have beeThis paper addresses the problem of video emotion recognition considering the emotion difference between different modes and different images. The first contribution of our work is a multimodal human emotion dataset (MHED), which is described in Using the MHED dataset, a hierarchical attention-based multimodal fusion network (HAMF) for video emotion recognition is trained, which is inspired by the quality-aware network  and atteMultimodal Feature Extraction Module. It has three CNN subnetworks, and each subnetwork consists of two branches. The first branch of the three CNN subnetworks takes the face, scene, and global images as input for extracting face features, scene features, and global context features. The other branch of the three subnetwork takes the middle representation of the face, scene, and global context features as input and generates an emotion score for each image. This branch is called a local attention network because it is used to generate the emotion score for each image of a modal approach. This is for the purpose of distinguishing global attention networks.Multimodal Feature Fusion Module. Features of each modal are fed to the global attention network, which is used to generate emotion scores for different modes. The scores and features of multiple modes will be aggregated, and the final emotional representation of the video will be produced. Then, the final emotion representation of the video passes through a tiny fully connected network and is supervised by a softmax loss.The main contributions of the paper are summarized as follows. Firstly, we constructed an MHED dataset, which mainly focuses on multimodal fusion for video emotion recognition in the wild. Secondly, the local attention network solves the problem of emotion difference of video frames, and the global attention network solves the problem of emotion difference of different modes.The remainder of this paper is organized as follows. In Most recent emotion recognition methods focus on exploring facial features based on deep neural networks . In psycMultimodality image fusion can not only enhance visibility to human eyes but also mutually complement the limitations of each image. Zhu et al.  proposedBecause the sparsity of emotion expression in video and human emotion can only be recognized in some specific moments during a long utterance, attention mechanism is used to aware of which time-frequency region of speech spectrogram is more emotion-relevant in the paper . Lee et The MHED dataset is constructed from videos that we manually downloaded from the Web, which mainly focuses on human emotion in the video. Six emotion categories are considered according to the well-known psychologists Ekman and Friesen , includiThe MHED dataset was manually annotated by 16 annotators. In order to ensure the quality of the annotations, annotators first need to learn the definition of the emotional categories, given by psychologists Ekman and Friesen. Secondly, some video clips with emotion labels coming from the existing video emotion recognition dataset are exercised by annotators. After learning and practicing, annotators are asked to annotate our MHED dataset. In the case of emotion categories, we show a video clip and ask the annotators to select an emotion category that applies to that video. Each annotator independently annotates emotions, and the emotion catalog of a video marked by the most annotators is selected as the emotion label of the video. Furthermore, annotators also annotated the gender and age of humans in the video.Of the 1066 annotated videos, 37.15% are males and 62.85% are females. Their ages are distributed as follows: 5.9% children, 6.47% teenagers, and 87.63% adults. The dataset has a minimum number of 137 videos per category and an average duration of 15.76 seconds. In this section, the hierarchical attention-based multimodal fusion network (HAMF) will be described in detail. Specifically, our proposed framework is first introduced. Then, the local attention mechanism to extract the emotional score of each image is given. Finally, the multimodal fusion method based on the global attention mechanism is described.Context information including scene, body, pose, and surrounding environment can also provide different emotional pieces of information, which can help to improve the accuracy of emotion recognition. However, as discussed in Speciﬁcally, our proposed HAMF network fuses multimodal features of a video to recognize video emotion. HAMF consists of two attention-based modules. The first module is a multimodal feature extraction module for generating emotion features of each modal. It has three CNN subnetworks, and each subnetwork consists of two branches. The first branch of the first CNN network takes images as input and extracts scene features for providing surrounding environment support. The first branch of the second CNN network takes images of the face as input and extracts face features for providing human feeling. The first branch of the third CNN network takes global images as input and extracts global context features, such as body and pose, for providing contextual support. The scene CNN and image CNN use the same input, but they use different networks and generate different features. The other branch of the three subnetworks takes the middle representation of the face, scene, and global features as input and generates an emotion score for each image. This branch is called a local attention network because it is used to generate the emotion score for each image of a modal approach. This is for the purpose of distinguishing global attention network which is used to generate emotion scores for different modes. Then, the emotion scores and image features of each modal will be aggregated, and the feature of each modal is produced. The other module is a multimodal feature fusion module for fusing multimodal features and generating the emotional representation of the video. Each modal's features pass through a global attention network and generate an emotion score for each modal. The features of multiple modes and their emotion scores will be aggregated, and the final emotion representation of the video will be produced. It will pass through a tiny fully connected network and is supervised by softmax loss.sa is anchor, positive sample sequence sp where its emotion is consistent with sa, and negative sample sequence sn where its emotion is different from sa. Three video frame sequences propagate forward through the same CNN network and output the corresponding features R(sa), R(sp), R(sn). A set's representation R(sa) is supervised by triplet loss [Lt, which is formulated asδ is a very small positive number.The local attention network and the global attention network are trained separately. A training sample includes three video frame sequences: let loss  Lt, whicS of video V, faces are first extracted by faster-R-CNN [n be the number of faces of the video V, and face sequences can be expressed as F={f1, f2,…, fn}. For convenience, in the experimental stage, we also selected n images from image sequences. Therefore, image sequences can be expressed as S={I1, I2,…, In}. The features of each modal are extracted by an independent CNN network. VGG-face model [L1):Si denotes the emotion score of the ith modal, Mi is the middle representation of a feature of the ith modal, and W0L, W1L, b1, and b2 are parameters which can be learned through training. σ is an active function. Here, we choose the rectified linear function for σ. Similarly, we can also use two or three successive convolution layers and one fully connected layer that has only one cell, annotated by L2 and L3, respectively:W0L, W1L, W2L, W3L, b0, b1, b2, and b3 are parameters which can be learned through training. In the experiments, the effect of the above different weighting functions will be compared.Multimodal feature extraction module is used to extract face, scene, and global image features by three parallel CNN networks. Given an image sequence er-R-CNN  trained er-R-CNN , and thece model  which isce model  as initice model . It takeXi={xij|j=1,2,…, n}which denotes the fc6 features of the ith modal and Si={sij|j=1,2,…, n} which denotes the emotion scores of the ith modal. The final emotion representation of the ith modal is a linear combination of emotion features and its emotion score.Then, the fc6 layer emotion features and scores of all images are extracted. We use The final emotion representation is supervised by triplet loss , which mThe different modes can be efficiently combined to improve emotion recognition performance. The contribution of each modal is different in different videos. Thus, a global attention mechanism is used to combine these modes according to their contribution. Its responsibility is to evaluate the importance of each modal and then assign an emotion score for each modal. Multimodal features and their emotion scores will be aggregated together, and the final emotion representation of the video is produced.m be the number of modes, and let Xi be the features of the ith modal. This paper uses three modes: face, scene, and global feature, and Xi is a 4096-dimensional vector, which is got by aggregating the fc6 feature and emotion score of all images of the ith modal. We can use a matrix X to represent a feature set containing m modes:Let αi is the weight of the ith modal. It can be acquired through learning a linear mapping Wig and can use a single fully connected layer that has only one cell (G1):Wig and b are parameters which can be learned through training with standard backpropagation.It should be noted here that the modes are unordered, and permuting the rows of the matrix cannot affect the results. The global attention results can essentially be expressed byAlgorithms. Similarly, we can also use two or three successive fully connected layers, annotated by G2 and G3, respectively:Wi1g, Wi2g, b1, and b2 are parameters which can be learned through training, and σ is an active function. In the experiments, the effect of the above different weighting functions will be compared.F:X is a feature set containing m modes and G(•) is used to generate emotion scores, which is described in formula . Image features of the face, scene, and context are extracted separately by three CNN networks without an attention mechanism. Then, these image features of each modal are aggregated by average pooling, and emotion features of the face modal, scene modal, and global modal of the video are obtained.Multimodal Fusion (MF). The fc6 layer features of face modal, scene modal, and global modal are first extracted. Then, these features are fused by the concatenation method which is described in the paper [he paper . These fFirstly, the local attention mechanism is evaluated. In this experiment, the global attention network does not use the attention mechanism, and the local attention network uses and does not use attention mechanisms, respectively. In order to visualize the hierarchical attention mechanism, some image sequences in the test set and their corresponding emotional scores are shown in In this subsection, we compare the state-of-the-art performance in recent literature. To validate the effectiveness of our HAMF method, we compare the following state-of-the-art approaches.Quality-Aware Network (QAN) [rk (QAN) . It is mAttention Clusters [Clusters . The fc6Emotion Recognition in Context (ERC) [xt (ERC) . ERC conEmotion in Context (EC) [ext (EC) . Images'Temporal Multimodal Fusion (TMF) [on (TMF) . Face feIn this section, we conduct experiments on Ekman-6  and VideThe ekman-6 dataset contains 1637 videos, and it uses a training set of 819 videos and a testing set of 818 videos. There is no overlap between the training set and the test set. It was manually annotated by 10 annotators according to Ekman's theory  on six bThe videoEmotion-8 dataset contains 1101 videos collected from YouTube and Flickr. The average duration of videos is 107 seconds. It uses a training set of 734 videos and a testing set of 367 videos. There is no overlap between the training set and the test set. The experiments were conducted 10 times according to train/test splits provided by [In this paper, we first build a dataset for human emotion recognition in video, named multimodal human emotion dataset (MHED). With the MHED dataset, a hierarchical attention-based multimodal fusion network (HAMF) for human emotion recognition in video is trained. HAMF uses a hierarchical attention mechanism to solve the difference of contained emotion information in different modes and different images. Firstly, the middle representation of each modal is fed to the local attention network and generates an emotion score for each image, and features of each modal will be aggregated according to their emotion scores. Secondly, features of each modal are fed to the global attention network and generate an emotion score for each modal, and the score and feature of multiple modes will be aggregated and the final emotion representation of the video will be produced. The performance of the HAMF network is evaluated and it can achieve excellent results on our MHED dataset.Although our HAMF method obtains a promising performance in human emotion recognition in the video, because of the sparseness of emotional expression in the video, most videos contribute little to emotional recognition. Video emotion recognition mainly depends on some key video frames or clips. In the next, we will focus on extract and study videos containing rich emotions.