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PubMed1999

Enhanced learning of proportional math through music training and spatial-temporal training.

It was predicted, based on a mathematical model of the cortex, that early music training would enhance spatial-temporal reasoning. We have demonstrated that preschool children given six months of piano keyboard lessons improved dramatically on spatial-temporal reasoning while children in appropriate control groups did not improve. It was then predicted that the enhanced spatial-temporal reasoning from piano keyboard training could lead to enhanced learning of specific math concepts, in particular proportional math, which is notoriously difficult to teach using the usual language-analytic methods. We report here the development of Spatial-Temporal Math Video Game software designed to teach fractions and proportional math, and its strikingly successful use in a study involving 237 second-grade children (age range six years eight months-eight years five months). Furthermore, as predicted, children given piano keyboard training along with the Math Video Game training scored significantly higher on proportional math and fractions than children given a control training along with the Math Video Game. These results were readily measured using the companion Math Video Game Evaluation Program. The training time necessary for children on the Math Video Game is very short, and they rapidly reach a high level of performance. This suggests that, as predicted, we are tapping into fundamental cortical processes of spatial-temporal reasoning. This spatial-temporal approach is easily generalized to teach other math and science concepts in a complementary manner to traditional language-analytic methods, and at a younger age. The neural mechanisms involved in thinking through fractions and proportional math during training with the Math Video Game might be investigated in EEG coherence studies along with priming by specific music.

Child↗

PubMed2005

[Excessive computer usage in adolescents--results of a psychometric evaluation].

Excessive computer and video game playing among children is being critically discussed from a pedagogic and public health point of view. To date, no reliable data for this phenomenon in Germany exists. In the present study, the excessive usage of computer and video games is seen as a rewarding behavior which can, due to learning mechanisms, become a prominent and inadequate strategy for children to cope with negative emotions like frustration, uneasiness and fears. In the survey, 323 children ranging in age from 11 to 14 years were asked about their video game playing behavior. Criteria for excessive computer and video game playing were developed in accordance with the criteria for dependency and pathological gambling (DSM-IV, ICD-10). Data show that 9.3% (N = 30) of the children fulfill all criteria for excessive computer and video game playing. Furthermore, these children differ from their class mates with respect to watching television, communication patterns, the ability to concentrate in school lectures and the preferred strategies coping with negative emotions. In accordance with findings in studies about substance-related addiction, data suggest that excessive computer and video game players use their excessive rewarding behavior specifically as an inadequate stress coping strategy.

Adolescent↗

PubMed2005

[Mass media consumption in adolescence].

OBJECTIVES: To describe mass media use in teenagers (television, mobile phones, computers, Internet and video games) and to analyze its influence on teenagers' health and development. MATERIAL AND METHODS: We performed a cross sectional study by means of a survey of 884 teenagers aged between 14 and 18 years old who were in the third and fourth years of high school in six towns in Cantabria (Spain) in June 2003. The statistical analysis consisted of uni- and bivariable descriptive statistics. RESULTS: All the teenagers had a television set at home and 24 % of families had four or more television sets. The presence of distinct mass media in teenagers' rooms was 52.5 % for televisions, 57.8 % for computers, 52 % for the Internet and 38.7 % for games consoles. The most frequently found media in teenagers' bedrooms were radio/cassette players and compact disks with 76.8 % and 67.4 %, respectively. Teenagers watched television for an average of 3 hours per day on weekdays and 3.2 hours per day at weekends. They played games consoles for an average of 0.69 hours per day on weekdays (41 min) and an average of 1.09 hours per day (65 min) at weekends and used the Internet on weekdays for an average of 0.83 hours per day (49 min) and an average of 1.15 hours per day (69 min) at weekends. A total of 87.2 % of the teenagers, especially girls, had a mobile phone (91.6 % of girls versus 82.4 % of boys; p < 0.001). The average age at which teenagers had the first mobile phone was 13 years old. Expenditure on mobile phones amounted to 15 3 a month in girls and 10 3 a month in boys, and mobiles were mainly used for sending messages. Nearly half the teenagers (46.4 %) took their mobile phones to high school and reported they had an average of three mobile phones at home. Most (82.1 %) surfed the net but boys preferred surfing and downloading games and girls preferred chatting and sending e-mails. Sixty-two percent of teenagers had been to a cybercafé and 40.8 % has visited a pornographic web site, especially boys (33.1 % of boys versus 7.7 % of girls; p < 0.001). Nearly two-thirds of teenagers (71.5 %) had a video console, especially boys (87 % of boys versus 57.2 % of girls; p < 0.001) and they started playing with them at an average age of 8.8 years. Boys preferred video games with shooting, fights, sports and driving, while girls preferred adventure video games. Nearly a quarter (22.2 %) spent money on video games and cybercafés (an average of 27.06 3 a month in boys and 16.81 3 a month in girls) with no significant differences between sexes. CONCLUSIONS: Society as a whole and especially health professionals should increase health education on mass media consumption, by stimulating reasonable use of mass media and teaching teenagers to be critical. Parents should set a limit of less than 2 hours/day to the use of mass media and should avoid their presence in teenagers' bedrooms. Prepay mobile phone should be used and switched off in inappropriate places. Parents should supervise and educate teenagers about video games, Internet access and e-mail usage in adolescence.

Adolescent↗

PubMed1989

Training of efficient oculomotor strategies enhances skill acquisition.

The present study investigated the hypothesis that efficient oculomotor behaviours can be acquired through practice on a series of simple tasks and can be transferred subsequently to a complex visuomotor task, such as a video game. Each of two groups of subjects were exposed to a different set of simple tasks, or drills. One group, the efficient eye movement experimental group, received training designed to minimize eye movements and optimize scan path behaviours, whereas a second group of subjects, the inefficient eye movement experimental group, received training designed to increase the frequency of eye movements. Oculomotor training was interspersed with practice on the video game. Performance of these two experimental groups in the video game was compared to a control group playing the video game but receiving no specific training and matched for total time in the experiment. The group receiving efficient oculomotor training exhibited significantly superior performance in the video game and fewer foveations than either the inefficient or control groups, which did not differ from each other. Overall there was a significant inverse correlation between the number of foveations in the game and game score. The results of this study are discussed in terms of their implications for the importance of oculomotor training in the acquisition of any complex perceptual motor task.

Adolescent↗

PubMed1998

The effect of attentional load on the breathing pattern in children.

Experiments designed to establish the effects of video games on breathing patterns have led to contradictory results. Several authors reported that video games tended to increase breathing frequency (i.e. to reduce breath duration), whereas others reported the opposite. We postulated that video games contain different psychophysiological components which may have opposite effects on breathing pattern. On the one hand, arousal and emotion may tend to stimulate breathing. On the other, focusing attention on the game may prompt subject to inhibit any movement--including breathing--which might be a potential nuisance variable. The aim of this study was to assess the specific effects of the attentional load in an experimental environment characterized by its low emotional impact. We measured breathing variables, cardiac frequency and cortisol levels in 10 healthy children (mean age = 9.2 +/- 1.5 years) who were familiar with the environment, the experimenter and the video game. Breath duration rose significantly, from 2.56 to 3.16 s, as a function of game difficulty. Cortisol levels, heart rate and the thoracic contribution to breathing displayed no significant changes. Taken together, these data suggest that focusing attention on the game tended to inhibit breathing and that previous contradictory reports in this respect were due to the confounding effects of emotion.

Attention↗

PubMed2003

The difference between playing games with and without the computer: a preliminary view.

The authors address the question of whether associations between video games and cognitive and metacognitive variables depend either on the features of the computer or on the content of the game that the computer allows one to play. An experiment to separate these two kinds of effects was carried out by using a traditional version and a computer-supported version of Pegopolis, a solitaire game. The two versions were exactly the same except that they were played by moving pieces either on a real board or on a virtual computer-presented board. The performance levels and strategies followed during the game by the 40 undergraduates who took part in the experiment were not significantly different in the real and virtual conditions. None of the participants transferred playing strategies or practice from one version of the game to the other. Scores were not affected by gender or by the studies pursued by participants, the habit of playing games in the traditional manner or playing video games, or intelligence. Retrospective reports did not support differences in the subjective experience between the two versions. Results showed that video games, when they do not make much use of the computer's special features, produce effects because of the situations they simulate rather than because of features of the computer itself.

Computers↗

PubMed2005

Relationships between spatial activities and scores on the mental rotation test as a function of sex.

Previous results suggested that female college students' scores on the Mental Rotations Test might be related to their prior experience with spatial tasks. For example, women who played video games scored better on the test than their non-game-playing peers, whereas playing video games was not related to men's scores. The present study examined whether participation in different types of spatial activities would be related to women's performance on the Mental Rotations Test. 31 men and 59 women enrolled at a small, private church-affiliated university and majoring in art or music as well as students who participated in intercollegiate athletics completed the Mental Rotations Test. Women's scores on the Mental Rotations Test benefitted from experience with spatial activities; the more types of experience the women had, the better their scores. Thus women who were athletes, musicians, or artists scored better than those women who had no experience with these activities. The opposite results were found for the men. Efforts are currently underway to assess how length of experience and which types of experience are related to scores.

Adolescent↗

PubMed2005

Adolescent physical activity and sedentary behavior: patterning and long-term maintenance.

BACKGROUND: Little is known about physical activity (PA) and sedentary behavior patterning or its impact on long-term PA sustainability, particularly during the critical transition from adolescence to adulthood. METHODS: Nationally representative self-reported data were collected (National Longitudinal Study of Adolescent Health: Wave I, 1994-1995; Wave II, 1996; Wave III, 2001-2002). Cluster analyses identified homogeneous groups of adolescents with similar PA and sedentary behaviors. Logistic regression predicted odds of meeting national activity recommendations in adolescence and young adulthood. RESULTS: Seven clusters were characterized as follows: C1, high television (TV)/video, video gaming; C2, high skating, video gaming; C3, high sports participation with parents, high overall sports participation; C4, use of neighborhood recreation centers, high sports participation; C5, TV viewing limited by parents, moderate participation in school physical education (PE); C6, low parental TV control, reporting few activities overall; C7, active in school (team/individual sports, academic clubs, and PE). Odds of adolescents meeting PA recommendations were highest in C2 (odds ratio=13.1), C3 (5.8), C4 (4.2), and C7 (4.3) compared to C1. Independent of adolescent PA, absolute odds of meeting recommendations as young adults declined but were still relatively high in these clusters, indicating greater long-term PA sustainability. By young adulthood, however, overall PA declined dramatically in skaters/gamers (C2) and was notably low among those with TV viewing limited by parents (C5). CONCLUSIONS: While odds of meeting PA guidelines in adulthood declined in all clusters, the magnitude of this decline varied by cluster (declining most dramatically in skaters/gamers), providing insights into where to target effective intervention strategies that promote sustainable PA behaviors.

Adolescent↗

PubMed1982

Television computer games: a 'new look' in performance testing.

Work at the Naval Biodynamics Laboratory aims at developing a battery of performance evaluation tests for environmental research (PETER). Because repeated-measures designs are virtually universal in environmental studies, the paradigm focuses on stabilisation with practice; thus far, over 50 tasks have been studied. The present report describes how five computerized video games fare as performance tests. The tasks were performed for 3 weeks each, in the same order, by the same subjects. The results show that four out of the five games meet all criteria satisfactorily and one does not, a favorable showing for the video games in comparison with conventional tests of either the paper-and-pencil or apparatus types. In terms of availability, equipment reliability, expense, and other practical considerations, the video games have many advantages. It is concluded that video games have considerable promise for performance testing and other applied contexts.

Adult↗

PubMed1995

Functional analysis and treatment of eye poking.

In four studies we analyzed the eye poking of a youth with profound disabilities. In Study 1, a functional analysis showed that eye poking occurred during the no-attention condition, but not during demand, attention or recreation conditions. The analysis did not identify socially mediated variables involved in the maintenance of eye poking; rather, eye poking may have been maintained by consequences produced directly by the response. In Study 2 we had the student wear goggles to prevent potential reinforcement from finger-eye contact. The results of Study 2 indicated that eye-poking attempts were reduced when the student wore goggles. We then tested in Study 3 the effects of two alternative topographies of stimulation. Study 3 demonstrated that eye poking was reduced when a video game was provided as a competing source of visual stimulation, and that music was less effective in reducing eye poking. In Study 4, a contingency analysis using the video game was conducted in an attempt to (a) reduce the frequency of eye poking and (b) study whether the video game functioned as a reinforcer. The results of Study 4 demonstrated substantive reductions in the frequency of eye poking, and suggested that the video game served as a reinforcer.

Acoustic Stimulation↗

PubMed2026

Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder: A Randomized Clinical Trial.

IMPORTANCE: Mitigating the harmful effects of digitalization on youth mental health is essential. OBJECTIVES: To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy-based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits. DESIGN, SETTING, AND PARTICIPANTS: PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-Württemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline. INTERVENTIONS: Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols. MAIN OUTCOMES AND MEASURES: The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle. RESULTS: A total of 1793 students were randomized to PROTECTtraining (n = 896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n = 897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen d = -0.91 [95% CI, -1.10 to -0.72] vs Cohen d = -0.61 [95% CI, -0.80 to -0.42]; between-group Cohen d = -0.30 [95% CI, -0.55 to -0.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen d = -0.11 [95% CI, -0.18 to -0.05] vs Cohen d = -0.04 [95% CI, -0.11 to 0.02]; between-group Cohen d = -0.07 [95% CI, -0.16 to 0.01]). Secondary outcomes did not differ significantly between groups. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy-based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) trial registration: DRKS00033989.

Humans↗

PubMed1994

1-year stability and prediction of cardiovascular functioning at rest and during laboratory stressors in youth with family histories of essential hypertension.

Blood pressure (BP). heart rate, cardiac index, and total peripheral resistance index were measured at rest and in response to postural change, forehead cold stimulation, and a video game challenge in a sample of 128 White and 155 African-American normotensive youth with family histories of essential hypertension (EH). These measurements were readministered 1 year later (12.5 +/- 3.2 months). Moderate temporal stability was observed for all resting and absolute stress responses. Reliability estimates for reactivity change scores were lower, although some were within acceptable ranges. African-American youth exhibited greater BP and peripheral resistance index reactivity to forehead cold on both evaluations. After controlling for various anthropometric and demographic parameters and the pertinent previous year's resting cardiovascular (CV) parameter, mean video game systolic blood pressure (SBP) responses were predictive of resting SBP whereas absolute forehead cold and video game diastolic responses predicted resting diastolic blood pressure (DBP) 1 year later. Mean video game DBP responses were also predictive of resting peripheral resistance index after controlling for significant demographic and anthropometric measures. CV reactivity is discussed with regard to possible value in prediction of changes in resting BP and cardiac structure prior lo establishment of EH.

Journal Article↗

PubMed2000

Racial differences in endothelin-1 at rest and in response to acute stress in adolescent males.

Blacks exhibit greater vasoconstriction-mediated blood pressure (BP) increases in response to stress than do whites. Endothelin-1 (ET-1), a potent vasoconstrictive peptide, has been proposed as having a role in racial differences in stress reactivity. We evaluated the hemodynamic and plasma ET-1 levels of 41 (23 whites, 18 blacks, mean age 18.6 years) normotensive adolescent males at rest and in response to a video game challenge and forehead cold stimulation. Measurements were performed at catheter insertion and before and immediately after the 2 stressors, which were separated by 20-minute rest periods. Blacks exhibited higher absolute levels of diastolic blood pressure, total peripheral resistance index, or both in response to catheter insertion and to the video game challenge and during recovery from video game challenge and cold stimulation (P<0. 05 for all). Blacks exhibited higher absolute levels of ET-1 at every evaluation point (P<0.05 for all) and greater increases in ET-1 in response to both stressors (ps<0.05). These findings suggest that altered endothelial function may be involved in racial differences in hemodynamic reactivity to stress and possibly in the development of essential hypertension.

Acute Disease↗

PubMed1991

Race and blood pressure status influences cardiovascular responses to challenge.

The influence of race and blood pressure status on cardiovascular responses to three challenges (interview, video game and cold pressor) was investigated in 50 healthy normotensive and 30 unmedicated mild-to-moderate hypertensive black and white men, aged 25-44 years old. Group differences were obtained for two tasks. The interview evoked race and blood pressure status differences: higher heart rate responses were elicited from normotensives compared with hypertensives and larger diastolic blood pressure (DBP) responses were elicited from whites compared with blacks. For the video game, black hypertensives displayed larger DBP responses than white hypertensives and greater systolic blood pressure and DBP responses than black normotensives. The video game heart rate response of white normotensives exceeded that of black normotensives and white hypertensives. These findings suggest that cardiovascular responses to challenge are affected by race and blood pressure status. The blood pressure hyperresponsiveness of black hypertensives compared with black normotensives to a psychological challenge (video game) provides generality to previous research conducted only on whites.

Adult↗

PubMed2000

Modulation of attentional inhibition by norepinephrine and cortisol after psychological stress.

Two of the most salient physiological responses to stress are increased norepinephrine (NE) and cortisol (CORT) activities. However, it is unclear how these neurochemical events affect cognition, especially attention. We examined the effects of mild psychological stress on selective attention, as assessed by the negative priming (NP) paradigm. Salivary measures of the stress hormone CORT and alpha-amylase (a correlate of NE) were assayed to probe the relationship between the stress response and attentional inhibition. Healthy subjects (N = 20) engaged in the attention task, which was then followed by 15 min of a stressful video game before a return to the attentional task. Baseline saliva samples were obtained before the experiment began, 1 min after the video-game stressor, and 20 min post-stress. Subjects showed a significant reduction in NP and a decrease in reaction time (RT) after the video game. Moreover, alpha-amylase levels increased significantly after the stressor, indicating the role of NE in the acute stress response. While CORT levels remained unchanged after stress, CORT correlated significantly with both NP scores and RT after the stressor. These results imply that mild psychological stress can significantly alter attentional processes. Given the increase in alpha-amylase and the correlation between attention and CORT after stress, it seems likely that attentional processes are under tight control by brain systems which mediate the fight-or-flight response.

Adolescent↗

PubMed2006

Simulator assessment of innate endovascular aptitude versus empirically correct performance.

OBJECTIVE: Prior work has established that performance on an endovascular simulator incorporating tactile feedback (haptics) correlates with previous endovascular experience and can be improved by training. This study was designed to test the ability to define and measure innate endovascular aptitude and empirically correct performance and to determine whether these are two different things. METHODS: Subjects ranging in endovascular skill level from novice to expert were surveyed to determine video game experience and skill, endovascular level of training, and endovascular experience. They were then tested by using a standard protocol requiring timed advancement of a catheter and wire sequentially into each of three vessels arising from a simulated type I arch. Recorded trials were independently and blindly scored by two experienced endovascular faculty members by using a modification of a previously validated scale (Modified Reznick Scale; MRS). Summed scores were analyzed by frequency analysis and categorized as satisfactory and unsatisfactory on the basis of a clear bimodal distribution. Categorical outcome, time to task completion, and other variables were analyzed by means of linear regression, analysis of variance, and Welch modified two-sample t tests, as indicated. RESULTS: A total of 61 subjects were enrolled: 42% students, 8% technicians, 19% surgeons, 13% cardiologists, and 18% radiologists. Of these, 62% were considered novices and 30% experts on the basis of previous experience; 56% of subjects worked in an endovascular-related occupation. MRS scores were highly correlated between raters (P < .0001) and showed a clear bimodal distribution, with subjects in any endovascular occupation (including technicians) scoring significantly better than all others (P < .0001). Hours of video games played per week were correlated highly with completion times (P < .001) and MRS scores (P < .001). Measures of formal training (number of endovascular cases and occupation) correlated highly with completion times (all P < .03) and MRS scores (all P < .008). In comparing completion times vs MRS scores, three groups were apparent: unskilled-inexperienced, skilled-inexperienced, and skilled-experienced, corresponding primarily to senior subjects without endovascular experience, younger subjects without endovascular experience, and formally trained endovascular physicians, respectively. Those judged intermediate in aptitude reduced times to the lowest possible level before improving their MRS scores. CONCLUSIONS: Although inherently subjective, the MRS yields reproducible scores that correlate with endovascular experience and formal training. Experts and novices with extensive video game experience achieve short completion times, whereas high MRS scores are achieved only by formally trained subjects. Innate endovascular aptitude and empirically correct performance may be two separate things, and aptitude may be acquirable through (or identified by) extensive nonmedical video game experience.

Adult↗

PubMed2006

Screenieboppers and extreme screenies: the place of screen time in the time budgets of 10-13 year-old Australian children.

OBJECTIVES: Excessive 'screen time' has been associated with a range of psychosocial disturbances and increasing pediatric obesity. This study describes the magnitude, distribution, composition and time-distribution of children's screen use; examines correlates of screen use; and characterises 'extreme' screen users (top quartile). METHODS: 1,039 South Australian children aged 10-13 years old completed a multimedia 24-hour activity recall diary on 2-4 occasions in 2002, including at least one school day and one non-school day. RESULTS: The median screen time was 229 minutes.d(-1). This was higher in boys (264 vs. 196 minutes; p<0.001) and on non-school days (260 vs. 190 minutes; p<0.001), increased with age (p=0.003), and decreased with socio-economic status (SES; p=0.003). Television consumed 73% of all screen time, video games 19%, non-game computer use 6%, and cinema 2%. The top quartile of screen users were more likely to be boys (OR=3.8), have low physical activity (OR=4.3), spend >25% of screen time playing video games (OR=1.8), sleep less, and be of lower SES. CONCLUSIONS AND IMPLICATIONS: Interventions to reduce screen time should target inactive, low-SES boys, encourage earlier bedtimes, and limit video game use.

Adolescent↗

PubMed1991

[Prediction of goal-directed behavior: attitude, subjective behavioral competence and emotions].

Ajzen's (1985) theory of planned behavior explaining and predicting goal-directed behavior is extended by an emotional component. The extended theory of planned behavior is tested experimentally. N = 64 subjects play with two video games (a speed- and a problem-oriented game) under an achievement-motivational orientation. One half of the subjects plays both games in an easy version, the other half in a difficult version. The verbal emotional reactions to playing video games are grouped factor-analytically into an "activity emotion" and a "security emotion". Subjects playing video games in the difficult condition feel significantly more insecure, and perceive their behavioral control as significantly lower than subjects playing in the easy condition. Tests of the extended theory of planned behavior lead to significant squared multiple correlations for the dependent variables within the range of R2 = .20 to .58. The activity emotion accounts predominantly for a significant part of the variance of the attitude and the security emotion accounts for a significant part of the variance of the perceived behavioral control. No predictive power was found for the intention to play the games successfully.

Achievement↗