Driven by economic and social benefits, social enterprises create new development models that combine wealth creation, social welfare provision, and environmental improvement through innovative approaches. The social entrepreneurship orientation reflects the behavioral tendency to transplant entrepreneurship orientation into the field of social value creation. It is a strategy to balance and integrate economic interests and social interests, which has a significant impact on social entrepreneurship performance. The purpose of this study is to explore the internal mechanism of the impact of social entrepreneurs’ mindfulness upbringing perception on social entrepreneur orientation. To reveal the internal mechanism, we propose a moderated and mediation model of prosocial motivation and perceived pressure from external stakeholders. In this study, random sampling was conducted among social start-ups in China. In order to improve the accuracy of the scale, a pre-survey was conducted before the formal survey. The data analysis results of the pre-survey showed that the scale in this study was suitable for the Chinese context and had good external validity. Through using survey data from social entrepreneurs in China, hierarchical regression analysis and bootstrapping model are adapted to test and verify mediation and moderation effects. The results show that mindfulness upbringing perception indeed positively influences social entrepreneurship orientation directly and partly through the mediating effect of prosocial motivation. Moreover, findings suggest the perceived pressure from external stakeholders negatively moderates not only the relationship between prosocial motivation and social entrepreneurship orientation but also the overall mediation model. This indicates that social entrepreneurs with low perceived pressure from external stakeholders will improve their social entrepreneurship orientation rapidly when their prosocial level is high. Based on these findings, we conclude that social entrepreneurship orientation may be achieved more effectively through the complex process of mindfulness upbringing perception, prosocial motivation, and perceived pressure from external stakeholders. Finally, the study proposes the theoretical and practical implications and suggestions for follow-up research. Family upbringing refers to a series of activities in which parents create the desired emotional atmosphere around their children in the process of child-rearing, which is embodied in parents’ attitude, behavior, and non-verbal elements towards their children . There aInterestingly, however, children of Chinese descent were more likely than children of European descent to think their parents’ punishment was fair . These rMindfulness parenting was proposed by Kabat-Zinn and other scholars in the 1980s. It extends mindfulness theory and mindfulness therapy in Zen and psychology in family education. It refers to parents’ conscious and non-judgmental attention and awareness of their own and their children’s internal state and the interaction process of parenting in the context of this moment . MindfulSocial entrepreneurship is driven by various social issues  that accompany global economic development . CompareIn entrepreneurial activities, economic goods and social values should shift from “conflict” to “integration” . Self-inMotivation refers to a desire or reason to act, and “prosocial” literally means an intention to help or benefit another person . The proAccording to the emotional contagion theory, entrepreneurs who receive mindfulness training in the early years tend to form organizational ethics and paradoxical leadership within the organization and are good at creating a loose and harmonious environment within the organization, and creating an atmosphere and awareness of social entrepreneurship in the organization . At thisHypothesis1: Mindfulness upbringing perception has a positive impact on social entrepreneurship orientation.H1a: Mindfulness upbringing perception positively influences competitive orientation.H1b: Mindfulness upbringing perception positively influences public-welfare orientation.According to self-determination theory, prosocial motivation is introspective, result-oriented, and future-oriented . Family Hypothesis2: Mindfulness upbringing perception is positively associated with prosocial motivation.According to the resource dependence theory, the prosocial motivation of entrepreneurs brings the harmonious relationship between enterprises and customers, suppliers and competitors, which will undoubtedly trigger enterprises to develop new products and services in a forward-looking manner, so as to perceive market changes in advance and take advanced actions to achieve better market performance . In addiAccording to self-determination theory, when social enterprise entrepreneurs perceive that the enterprise fulfills its social responsibility and attaches importance to external stakeholders, they can improve the public welfare orientation of social entrepreneurship from top to bottom through emotional identification and consistency of values . Unlike Hypothesis3: Prosocial motivation positively influence social entrepreneurship orientation.H3a: Prosocial motivation positively influences competitive orientation.H3b: Prosocial motivation positively influences public-welfare orientation.Mindfulness upbringing perception may facilitate the enhancement process of prosocial motivation, which leads to social entrepreneurship orientation. These arguments suggest the following hypothesis:Hypothesis4: Prosocial motivation mediating between mindfulness upbringing perception and social entrepreneurship orientation.H4a: prosocial motivation mediating between mindfulness upbringing perception and social entrepreneurship competitive orientation.H4b: Prosocial motivation mediating between mindfulness upbringing perception and social entrepreneurship public-welfare orientation.A moderation effect occurs when there is a third variable between the independent and dependent variables . This thThere have been many attempts to confirm the existence of a moderator in fostering and upgrading social entrepreneurship orientation . The relUnder intense pressure from external stakeholders, individuals will constantly monitor the changes in the environment, pay attention to whether their behavior deviates from the goals of stakeholders, adjust their behavior through self-reflection, and take into account various positions and different viewpoints from external stakeholders when solving disputes, adopt a multi-dimensional approach, easy to compromise . In otheBased on this logic, this study assumes that the strength of prosocial motivation could be altered by Perceived pressure from external stakeholders . The resHypothesis5: Perceived pressure from external stakeholders moderates the relationship between prosocial motivation and social entrepreneurship orientation. This positive relationship is much stronger for those with a high degree of Perceived pressure from external stakeholders.H5a: Perceived pressure from external stakeholders moderates the relationship between prosocial motivation and social entrepreneurship competitive orientation.H5b: Perceived pressure from external stakeholders moderates the relationship between prosocial motivation and social entrepreneurship public-welfare orientation.Assuming that Perceived pressure from external stakeholders moderates the relationship between prosocial motivation and social entrepreneurship orientation, it is also plausible that an entrepreneur’s characteristics might conditionally affect the strength of the indirect relationship between mindfulness upbringing perception and social entrepreneurship orientation . In otheHypothesis6: Perceived pressure from external stakeholders moderates the indirect effect of mindfulness upbringing perception on social entrepreneurship orientation . Specifically, prosocial motivation positively mediates the indirect effect when Perceived pressure from external stakeholders is high.H6a: Perceived pressure from external stakeholders moderates the indirect effect of mindfulness upbringing perception on social entrepreneurship competitive orientation .H6b: Perceived pressure from external stakeholders moderates the indirect effect of mindfulness upbringing perception on social entrepreneurship public-welfare orientation .Based on the above-proposed hypotheses and the theoretical foundation, the conceptual association among variables is presented below in The investigation of this study was divided into two parts: pre-investigation and formal investigation. Before the formal survey, the researchers conducted a pre-survey in February 2021, which targeted 500 social start-ups recommended by China Social Enterprise Forum. These social start-ups are representative enterprises. In February 2021, the researchers took the initiative to contact these enterprises and distributed 490 questionnaires. All items were assessed on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The pre-survey was divided into two stages. In the first stage (2021.3–2021.4), researchers interviewed social enterprise founders face-to-face (356) or online (122) and then formed the data of the first round of questionnaire . A total of 478 questionnaires were received in the first round. The recovery rate was 97.6%. The second stage of data recovery  will be carried out about 3 months later, or through a combination of online interview (44) and offline interview (434). The founders of 478 social entrepreneurship enterprises who successfully submitted the questionnaire at the first time point were asked to fill in the questionnaire , and 476 questionnaires were recovered, with a recovery rate of 99.6%. Since the questionnaires administered at both stages included both mindful parenting and prosocial motivation, the researchers compared the responses to the questionnaires received at the two stages for the same social start-up . The questionnaire with the same score of these two variables in the two rounds of answers was retained as one valid questionnaire, and a total of 380 valid questionnaires were collected during the pre-survey.The questionnaire collected from the pre-survey was found to be of good quality after inspection. Therefore, this means that the scale of variables has good external validity, is in line with the Chinese situation, and is reasonable. We can conduct a formal investigation, which was conducted from the end of September 2021 to February 2022.Since 2015, the research team has focused on social entrepreneurship and established cooperative relationships with domestic recognized social entrepreneurship research and service institutions such as EN-pai Public Welfare Platform and China Social Enterprise Forum , accumulating rich case data. These institutions and forums provide communication and service platforms for social entrepreneurship participants across the country, giving great support to the random selection of research objects in this study. The object of the formal survey was 1,000 social start-ups randomly selected from the database of the national recognized social entrepreneurship research and service institutions such as Enpai Public Welfare Platform and China Social Enterprise Forum .To clarify the causal inference and alleviate the problem of standard method variance (CMV), the researchers separated measurement occasions . The datThe first round (T1) survey measured self-reported mindfulness upbringing perception (the level of mindfulness upbringing perception from their parents during childhood and adolescence received) and collected demographic information of the participants. At this stage, 1,000 questionnaires were distributed online (138) and offline (862), and 890 questionnaires were collected (136 online and 754 offline), with an effective recovery rate of 89%.The second round (T2) survey measured prosocial motivation and perceived pressure from external stakeholders. The questionnaire at this stage is for social enterprise founders who successfully submit the questionnaire at the first point in time to fill out. A total of 890 questionnaires were distributed through online distribution (134) and offline distribution (756), and a total of 792 questionnaires were recovered (101 online and 691 offline), and the effective recovery rate was 88.9%.The third round (T3) survey measured social entrepreneurship orientation. No monetary incentive was offered to the participants. The questionnaire at this stage is for social enterprise founders who successfully submit the questionnaire at the second time point to fill out. At this stage, a total of 792 questionnaires were distributed through online distribution (99) and offline distribution (693), and a total of 690 questionnaires were recovered (80 online and 610 offline). The effective recovery rate was 87.1%. After excluding missing data and outliers based on boxplot analyses, 558 responses were analyzed.The detailed process of data collection and the number of questionnaires collected at each time point are shown in the Among these participants, the majority were male (50.7%). The researchers calculated the following statistics based on demographic data. The results of the descriptive statistical analysis of sample enterprises are shown in p values are all greater than the significance level of 0.05, indicating that there is no significant difference in the data, and the mixed use will not have a great impact on the reliability of the research results.Through the F test and T test of the online and offline overall sample data, it is found that the The perception of mindfulness upbringing refers to the respondents’ perception of the extent to which their parents practiced mindfulness upbringing during their childhood family education . ParentsIn essence, prosocial behavior belongs to a broad category of interpersonal interaction , includiPerceived pressure from external stakeholder’s scale was developed by Social entrepreneurship orientation is measured from two dimensions: competition orientation and public welfare orientation. ①The competitive orientation scale is developed by Control variables. The control variables in this study include the industry field of social entrepreneurs, Work experience in the same industry, and the gender, age and education level of social entrepreneurs .To test the hypotheses this study has used a moderated mediation model. It is a statistical method that comprises mathematical and statistical approaches for examining data to identify relationships between variables . SPSS anIt is essential to check the reliability and validity of measurement tools . Reliabip < 0.01), indicating that the relationship between items of user variables is good and factor analysis can be carried out. Explain the eigenvalues of the total variance observation scale and the sum of the squares of the rotating loads as well as the cumulative percentage of the main observation items. More than 50% indicates compliance with factor analysis requirements , and R^2 in model 2 is significantly increased compared with R^2 in model 1, and the change of R^2 is significant at 0.01 level, indicating that mindfulness upbringing perception has a significant effect on competitive orientation compared with control variables. Hypothesis 1A is verified. Similarly, it can be seen from Model 6 that mindfulness upbringing perception has a significant positive effect on public-welfare orientation , and the R^2 of Model 6 is significantly higher than that of model 5, and the change of R^2 is significant at the level of 0.01, indicating that compared with the control variable, mindfulness upbringing perception has a significant impact on public-welfare orientation. Hypothesis 1b is verified. In addition, the age of social entrepreneurs has a positive effect on the competitiveness orientation, which also confirms that older entrepreneurs are more conducive to the competitiveness orientation, which is also consistent with the phenomenon that a large percentage of successful social entrepreneurs are middle-aged. Still, age has no significant positive effect on the improvement of public-welfare exposure.Hierarchical regression was used to test the direct effects of mindfulness upbringing perception on competitive orientation and public welfare exposure. The results are shown in p < 0.001). According to model 3 in p < 0.001). The results show that prosocial motivation has a substantial positive effect on competitive orientation . Still, the effect of mindfulness upbringing perception on competitive orientation is still significant, but the regression coefficient is 0.590  decreased to 0.3748 , suggesting that prosocial motivation plays a partial mediating role in the relationship between mindfulness upbringing perception and competitive orientation. Similarly, according to Models 7 and 8, prosocial motivation plays a partially mediating role in the relationship between mindfulness upbringing perception and public welfare orientation.Then the researchers examine the mediating impact of prosocial motivation on mindfulness upbringing perception and competitive orientation. According to Model 2 in Moreover, the Bootstrap method was then used to examine further the mediating effect of the model . The BooAs shown in To show the moderating effect of perceived pressure from external stakeholders more clearly, the moderating effect chart was drawn. To more clearly show the moderating effect in perceived pressure from external stakeholders on the relationship between mindfulness upbringing perception and social entrepreneurship orientation (competition orientation and public-welfare orientation), the researchers describe the difference of the moderating effect of mindfulness upbringing perception on social entrepreneurship orientation in different levels of perceived pressure from external stakeholders with one standard deviation higher and one standard deviation lower than the mean, respectively. As shown in p < 0.001), and when social entrepreneurs were under lower-level perceived pressure from external stakeholders, the positive effect of mindfulness upbringing perception on competitive orientation was significantly increased . When social entrepreneurs are under different levels of perceived pressure from external stakeholders, the effect of mindful cultivation on competitive orientation is significantly different. Similarly, when social entrepreneurs are under a higher and lower-level perceived pressure from external stakeholders, there are significant differences in the impact of mindfulness upbringing perception on public-service orientation. Therefore, perceived pressure from external stakeholders has a negative moderating effect on the main result.To further verify the significance of the above moderating effect, a simple slope test and slope difference test are conducted, and the results are shown in To further verify the moderated mediating effects. In this study, the PROCESS plug-in was used to test the mediated role according to Wen Zhonglin et al. The researchers adopted the Bootstrapping method to test the significance of the mediating effect of perceived pressure from external stakeholders at different levels. The effective value of the moderating effect was obtained. The results are shown in The possible theoretical contributions of this study are mainly reflected in three aspects:First, it deepens the research on the connotation, impact and effect mechanism of mindfulness upbringing perception. The academic research has not reached a consensus on the connotation definition and functional characteristics of social entrepreneurs’ mindfulness upbringing perception in the Context of Chinese culture, and there are debates on capital, culture, and ethics. Different from previous research, this article follows the evolution history and injection time development characteristics based on social learning theory thoroughly, discusses mindfulness breeding perception of social entrepreneurs to social entrepreneurship orientation (competition orientation and public interest orientation) and the internal mechanism, the influence of this for mindfulness breeding nature has specific theoretical meaning. It also enriches the relevant researches on the mechanism and consequences of social entrepreneurs’ perception of family mindfulness upbringing.Second, it has enriched the research on antecedent variables of social entrepreneurship orientation (competitive orientation and public welfare orientation) from the perspective of individual factors. It is of great significance to explore the antecedent variables of social entrepreneurship orientation (competitive orientation and public welfare orientation) to deeply understand the origin of social entrepreneurship orientation (competitive orientation and public-welfare orientation) and to cultivate social entrepreneurship orientation (competitive orientation and public welfare orientation). Existing researches mainly focus on the influence of individual spiritual traits or personal value such as self-confidence, optimism, and hope, and the resulting psychological resources such as trust and commitment on forming social entrepreneurship orientation (competitive orientation and public-welfare orientation). This study further discusses the influence and internal mechanism of higher individual values, such as the prosocial motivation of social entrepreneurs. And this study which forms an essential supplement to existing relevant research.Thirdly, it finds the “key” connecting the prosocial motivation of social entrepreneurs with the orientation of social entrepreneurship (competition orientation and public-welfare orientation). In this study, the prosocial motivation of social entrepreneurs is defined as a kind of introspective, result-oriented, and future-oriented. It is manifested in the specific entrepreneurial values that inspire and integrate their stakeholders to jointly create social value and meet the social needs that cannot be completed by the existing system, market, and government. Most current studies on the relationship between individual values and entrepreneurial orientation explore the internal relationship between them from the perspective of social capital accumulation. This study, referring to the literature of motivational information processing theory and emotional contagion theory, discusses the mediating effect of prosocial motivation on the relationship between social entrepreneurs’ mindfulness upbringing perception and social entrepreneurship orientation (competitive orientation and public-welfare orientation). This study also builds a new bridge for the study of the relationship between individual values and entrepreneurship orientation.In practice, the results of this study have implications for social entrepreneurs to objectively examine their own internal and external conditions, improve the decision-making level of social entrepreneurship, and strengthen the guarantee conditions of social entrepreneurship orientation.1. Pay attention to the role of mindfulness cultivation perception and attach importance to prosocial motivation. Children’s perception of their parents’ mindful upbringing plays a vital role in developing their prosocial motivation and social adaptability. First, parents should improve their awareness and management of their feelings. Parents should reduce negative emotions or out-of-control emotions caused by children’s destructive behaviors or attitudes in the process of raising children, adjust themselves in time, and avoid negative feelings or ignore them when children express negative emotions. Parents’ conscious choice of appropriate ways to respond to their children is conducive to forming children’s pro-social motivation. It can also strengthen their social entrepreneurship public welfare motivation and competitive motivation. Secondly, parents should not be sensitive to the content of their children’s speech, but should also effectively use nonverbal cues to improve their understanding and sensitivity to their children’s emotional expression and understanding by judging their children’s voice tone, facial expressions, and body language. Parents should not only convey understanding and acceptance to their children, but also provide clear codes of conduct and discipline rules for their children, and set expectations for their children. Finally, mindfulness training or curriculum programs improve the level of mindfulness, promote the formation of positive parent–child interaction, promote pro-social motivation, social entrepreneurship, public-welfare motivation, and competitive motivation.2. Be alert to the intensity of stakeholder pressure on social entrepreneurs. To treat the environmental pressure from stakeholders, social entrepreneurs are encouraged to develop stakeholder-centered policies and corporate strategies, emphasizing communication, to mitigate the negative effect of stress on public-welfare orientation and competition orientation.Inevitably, there are some limitations in this study. First, in terms of sample data, this study collects the data needed for the research through a sample survey of Chinese social entrepreneurship enterprises. However, due to the inherent defects of the sampling survey and the impact of the epidemic, the effective recovery rate in some regions is low, leading to some deviation between the statistical distribution of sample enterprises and the actual situation, which has a particular impact on the representativeness of sample data and may reduce the universality of the research conclusions. In the future, the sampling will be more scientific, and the survey scope will be expanded. Longitudinal multi-point tracking research will be used to more accurately and deeply understand the relationship between mindfulness parenting perception and social entrepreneurship orientation. Second, this study only focuses on prosocial motivation as the “key” to opening the black box of the relationship between mindfulness upbringing perception and social entrepreneurship orientation and fails to comprehensively and systematically reveal the complex mechanism of the relationship between mindfulness upbringing perceptions and social entrepreneurship orientation. There are more transfer factors and complex mechanisms between the perception of mindfulness upbringing and different orientation of social entrepreneurship at the individual level. Future research needs to look for new “keys” from different perspectives.The purpose of this study is to explore the internal mechanism of the impact of mindfulness parenting perception on social entrepreneur orientation. To reveal the internal mechanism, the researchers propose a moderated and mediation model of prosocial motivation and perceived pressure from external stakeholders. Using survey data from social entrepreneurs in China, hierarchical regression analysis and bootstrapping model are adapted to test and verify mediation and moderation effects. (1) The results show that mindfulness upbringing perception indeed positively influences social entrepreneurship orientation directly. (2) Mindfulness upbringing perception indeed positively influence social entrepreneurship orientation partly through the mediating effect of prosocial motivation. (3) Moreover, findings suggest that perceived pressure from external stakeholders negatively moderates not only the relationship between prosocial motivation and social entrepreneurship orientation but also the overall mediation model. This demonstrates that social entrepreneurs with low-level perceived pressure from external stakeholders improve their social entrepreneurship orientation quickly when they have high prosocial levels. Based on these findings, the researchers conclude that social entrepreneurship orientation may be achieved more effectively through the complex process of mindfulness upbringing perception, prosocial motivation and perceived pressure from external stakeholders. (4) External stakeholder pressure has a restraining effect on the positive effect of mindfulness upbringing perception and public welfare orientation. Under a high external stakeholder pressure, the promotion effect of mindfulness upbringing perception on public-welfare orientation will be significantly inhibited. Compared with public-welfare orientation, external stakeholder pressure has a weaker negative moderating effect on the positive relationship between mindfulness upbringing perception and competitive orientation. In other words, external stakeholder pressure has a more significant negative impact on the public-welfare orientation. Under high stakeholder pressure, social entrepreneurs will suffer more significant damage to the public welfare orientation of social entrepreneurship, while competition orientation will be less negatively affected.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.The studies involving human participants were reviewed and approved by the Nanjing University of Posts and Telecommunications. The participants provided their written informed consent to participate in this study.TS contributed to developing the theoretical framework and overall writing of the manuscript. XT contributed to data collection, data analysis, and editing. All authors contributed to the article and approved the submitted version.This article was supported by the following research funds: National Social Science Foundation of China (20CRK004).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.


The brain is the most energetically demanding organ and relies on a continuous supply of nutrients and oxygen from the blood. To maintain energy supply and remove unwanted proteins and metabolites continuously, the cerebrovascular function of the brain relies on the normal functioning of the macrocirculation in cerebral arteries and the microcirculation in cerebral microvessels including capillaries , angiographic irregular plaque, and white thrombus detected by optical coherence tomography (OCT) imaging using logistic regression. They achieved a satisfactory result with 59.4% sensitivity and 84.5% specificity. The developed three-item scale shows promise to determine symptomatic carotid artery plaque. Future large-scale studies to validate the three-item scale, and further refine the model to improve sensitivity and specificity are clearly warranted.Identification of symptomatic carotid artery plaque may be clinically valuable in recognizing vulnerable and high-risk carotid atherosclerosis, providing important information for treatment. Stefan et al. have presented a deep learning and simulation-based method to measure cortical capillary red blood cell (RBC) flux in a high-throughput way using OCT as input data with simultaneously acquired two-photon excitation fluorescence microscopy acting as the ground truth of training data. The training data are learned to uncover the distribution of parameters governing the height, width, and inter-peak time of peaks in OCT intensity associated with the passage of RBCs. This can simulate thousands of time-series examples for different flux values and signal-to-noise ratios to train a 1D convolutional neural network (CNN). The trained CNN is applied to 4D data of the murine cortical vasculature to estimate RBC flux across the entire network of hundreds of capillaries. Repeating this prediction and averaging for every vessel in a capillary network produced a map of RBC fluxes that allow for the study of capillary network dynamics with greatly improved statistical power.Currently, studying blood flow in the capillary network to understand how microvascular flow is regulated in the brain in health and disease is still a challenging problem. Xu et al. recently studied five patients with RICS to evaluate the morphological features of RICS and stent-vessel interactions by intravascular OCT. They found that the morphological features of RICS were heterogeneous by OCT evaluation upon the carotid stent implantation, and one patient developed in-stent neointimal hyperplasia on follow-up OCT examination. The preliminary study demonstrates that OCT can be applied to reveal the features of RICS. Future studies on RICS by OCT will shed light on the understanding of RICS, thus improving its prognosis and treatment.Radiotherapy is effective treatment strategy for head and neck cancer, however may induce cerebrovascular stenosis or occlusion during the follow-up. The mechanism of radiation-induced carotid stenosis (RICS) has been underdetermined. Further, carotid artery stenting is performed in patients with RICS to reduce the risk of stroke. Hence, studies to elucidate the mechanism of RICS are needed. Brunner et al. has been exploited to extract reliable RBCv information without the need of contrast agent or special acquisition requirement. With an angiographic scan of rat brain, the blood Doppler signal was filtered from slower movements or tissue part through 20Hz high-pass filter to be segmented as directional cortical microvessels with enough computed total signal intensity, which is split as positive and negative frequencies for the different flow directions in each angiographic image position. A sliding window Fourier transform of the segmented Doppler signal correctly quantified the Doppler spectrum in the blood flow direction for extracting the average spectrum and average RBCv in individual vessels via a simplified model of laminar flow and standard formula that links the velocity with the Doppler frequency. Then, the authors provided quantitative hemodynamic measurements of the absolute RBCv and relative CBF changes of individual cortical vessels under resting-state and evoked conditions. Hopefully, the functional ultrasound imaging modality will act as part of the toolkit for studying the neurovascular coupling at the brain-wide scale and new insights into neurological diseases.Although optical neuroimaging techniques including laser speckle contrast imaging, two-photon microscopy, and OCT have been widely used to measure blood hemodynamics in the brain vessels such as red blood cell velocity (RBCv) and/or cerebral blood flow (CBF), they are mostly restricted in brain surface for a limited coverage of a few individual cortical vessels. Due to the advent of ultrafast imaging at thousands of frames per second vastly enhancing slow blood flow sensitivity in smaller vessels, functional ultrasound imaging , the National Natural Science Foundation of China (61271320 and 61775134), and Interdisciplinary Program of Shanghai Jiao Tong University .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.


Political campaign activities are increasingly digital. A crucial part of digital campaigning is communication efforts on social media platforms. As a forum for political discourse and political communication, parties and candidates on Twitter share public messages and aim to attract media attention and persuade voters. Party or prominent candidate hashtags are a central element of the campaign communication strategy since journalists and citizens search for these hashtags to follow the current debate concerning the hashed party or political candidate. Political elites and partisans use social media strategically, e.g., to link their messages to a broader debate, increase the visibility of messages, criticize other parties, or take over their hashtags (hashjacking). This study investigates the cases of the most recent 2017 and 2021 German federal elections called 'Bundestagswahlen'. The investigation (1) identifies communities of partisans in retweet networks in order to analyze the polarization of the most prominent hashtags of parties, 2) assesses the political behavior by partisan groups that amplify messages by political elites in these party networks, and 3) examines the polarization and strategic behavior of the identified partisan groups in the broader election hashtag debates using #BTW17 and #BTW21 as the prominent hashtags of the 2017 and 2021 elections. While in 2017, the far-right party 'Alternative für Deutschland' (AfD) and its partisans are in an isolated community, in 2021, they are part of the same community as the official party accounts of established conservative and liberal parties. This broader polarization may indicate changes in the political ideology of these actors. While the overall activity of political elites and partisans increased between 2017 and 2021, AfD politicians and partisans are more likely to use other party hashtags, which resulted in the polarization of the observed parts of the German political twitter sphere. While in 2017, the AfD polarized German Twitter, 2021 shows a broader division along the classical left–right divide. Social media communication as digital campaigning is essential to political election campaigns  organizational structures and work routines, (2) presence in online information spaces, (3) support in resource collection and allocation, and (4) symbolic uses in the sense of political marketing Jungherr . SymboliFurthermore, social media also provides an opportunity for top-down leadership claims for populist parties and politicians. Social media provided additional channels for communication with and between political elites, partisans, and the electorate. Hashjacking of political adversaries and the strategic hashtags use of broader discourses increase the representation of populist messages on social media : Did AfD partisans aim to hashjack other parties' hashtags during the election campaigns in 2017 and 2021?(RQ2): Was the average activity of partisan communities around the party and election hashtags higher in 2021 than during the 2017 federal election campaigns?(RQ3a): Do AfD partisans appear as an isolated community in the #BTW17 retweet networks?(RQ3b): Do AfD partisans appear as an isolated community in the #BTW21 retweet network?(RQ4): Are right-wing partisans of the AfD more likely to engage in the macro-debate #BTW17 and #BTW21 hashtags than partisans of other parties?While prior work investigated the role of strategic hashtag use and 'hashjacking' as a strategy used predominantly by far-right actors in the German Twittersphere, this study explores the use of party, chancellor candidate, and broader election debate hashtags during the election campaigns. During campaign times, political debates intensify, which may result in hashtag debates that are more polarized in contrast to periods outside election cycles. Besides, political elites, such as parties, members of parliament or election candidates, and political partisans have higher incentives to behave actively on social media and criticize political adversaries for gaining media attention or persuading undecided voters. Revisiting prior work on 'hashjacking'  for academics.The observation period is the final week before the elections in 2017 and 2021, in which we expect intensified campaigning efforts by parties, candidates, and supporters. The study first identifies partisan communities and hashjacking efforts using party hashtags during the two observation periods and, second, investigates the role of these partisan groups within the broader political debate on the elections represented by the #BTW17 and #BTW21.Political networks may represent many different relations, such as parliamentary co-sponsorship Fowler , coalitiThe analysis assumes that the network consists of two major partisan clusters. The more significant the proportion of accounts in these clusters, the more polarized is the network. In prior work on the German context, partisans of the far-right AfD constituted an isolated community in several political party hashtags . In prior studies, a closely connected far-right partisan community, whose activity was much higher than that of other communities, formed around official AfD accounts and amplified their political messages by retweeting . The analysis measures the average activity of partisan groups (RQ2) by the weighted outdegree retweet network of nodes in the pro-party partisan community within each party hashtag. The weighted outdegree, also accounting for the number of reciprocated edges, signifies the number of times an account retweeted another account. In order to examine (RQ3a) and (RQ3b), the study assesses the assumed isolation of the AfD partisan cluster in two steps. At first, the investigation of the retweet network topology indicates the networks' potential polarization between partisan communities, and second, a qualitative content analysis of the most retweeted accounts (with the highest indegree) indicates the political ideology of the communities.The analysis proceeds with logistic regression models to test each partisan group's binary likelihood of co-occurrence in one of the two main clusters on the broader #BTW17 and #BTW21 debates. The response (independent variable) of being in one of the two largest communities in #BTW17 and #BTW21 is binary since most nodes are assigned to these two communities . The resulting odds as outputs of the logistic regression models indicate how likely partisan groups from the party networks co-occur in the more extensive retweet networks of #BTW17 and #BTW21. A high likelihood of partisan co-occurrence in clusters of the broader electoral debate indicates the ideological closeness of these groups. Similar directions of the odds indicate membership in the same significant clusters. If partisans of one party are isolated in one community, as hypothesized for AfD partisans in (RQ3a) and (RQ3b), they should have the opposite odds direction as all other parties.This section presents the results of the analysis. The first part compares German political party hashtags polarization between the two election periods in 2017 and 2021. The community detection identifies a pro-partisan cluster and a contra cluster as the largest community with highly retweeted members of other parties. Then, the analysis compares the activity of different partisan groups. After that, the focus lies on the structural assessment of the large-scale hashtags #BTW17 and #BTW21 and investigates the likelihood of (strategic) hashtag use of different partisan communities. The main finding is a differently polarized electoral debate on Twitter between 2017 and 2021. While the far-right party AfD was a segregated community in 2017, in 2021, the AfD is in the same cluster as the center-right, conservative parties (CDU and CSU) or the liberal party (FDP). Section  further Political hashtag debates often polarize into two or more communities. Prior research has shown that a far-right cluster led by official accounts of the AfD polarized German party hashtags  and their partisan community's growth in the Greens case. Except for the slight decrease in bi-polar polarization for #CSU and #FDP, there is an overall tendency of higher polarization between the two largest partisan communities, which relates to RQ1. The results indicate a higher level of bi-polar polarization for party hashtags in 2021.While RQ1 concerned the distribution of accounts in two partisan communities, it does not account for the activity of partisan clusters. The activity of the partisan cluster is subject to RQ2, which raises the question of whether the average activity of partisan communities was higher in the 2021 elections than in the 2017 elections. Figure The distribution shows differences between 2017 and 2021. At first, AfD partisans are much more active than partisans of other parties. Besides, the retweets are more unequally distributed than for other communities. AfD network elites have much higher values of weighted indegree as the number of being retweeted than the elites in other party networks. Additionally, the activity of other party supporters increased notably between 2017 and 2021, especially for the AfD, FDP, and CDU, as indicated by the means in the box-candle plots in Fig. 3.After analyzing the use of party hashtags and identifying partisan communities within the retweet networks, the analysis proceeds with analyzing the co-occurrence of these communities in the broader debate on the elections. This co-occurrence is an indicator of strategic hashtag use. Additionally, the co-occurrence of partisans from different parties indicates ideological closeness between groups Fig. .Fig. 3ABundestagswahlen as #BTW17 and #BTW21 are common hashtags to refer to the upcoming elections on Twitter. Figure The acronym hashtags of the The analysis investigates the likelihood of co-occurrence in partisan communities and the communities in the broader discourses as an indication of strategic hashtag use. The qualitative assessment implied that the #BTW21 debate is more broadly polarized than #BTW17. The logistic regression output as the odds of co-occurrence confirms the first observation of the network analysis in Sect.  that indHowever, it is unclear what caused these differences in partisan retweeting behaviors. Possible explanations could be, (1) political elites retweet different accounts such as media sources, (2) retweeting users/partisans retweet more closely along classical right-left divides, (3) the AfD may have become part of the conservative mainstream and is retweeted by similar users that also retweet the other parties, or the other parties have moved toward the AfD, and AfD partisans tend to be more likely to retweet CDU, CSU and FDP accounts. The following section will discuss these potential explanations and summarize the findings and limitations of the study.This study investigates the structure of the German political party and candidate hashtags during the final week of the campaigns before the election. The analysis focuses on online political behavior such as strategic hashtag use and hashjacking, a politically motivated networked communication strategy. The term refers to a coordinated use of hashtags commonly used by or referring to a politically opposed group. While using other parties' hashtags is not per se strategic, the analyses confirm the hypotheses that partisans and politicians of the German far-right party AfD are more likely to use other parties' hashtags and appear as a partisan group in all other party hashtags displayed by the contra bars in Fig. In contrast to the 2017 elections, however, AfD partisans in 2021 do not appear as an isolated group but in a joined community with CDU politicians and partisans. This joined community shows the higher likelihood of co-occurrence in Fig. The analysis showed that the Twittersphere, represented by essential political hashtags during the German Federal election, has polarized into a so-called left–right divide between party supporters. While in 2017, AfD partisans were located in an isolated cluster and effectively polarized the hashtag discourse on the elections, the 2021 #BTW21 shows a broader polarization, especially between the AfD and CDU on the one hand and Greens, SPD, and LINKE on the other side. Partisan clusters of the FDP and CSU are also in the right-wing cluster, with a lower likelihood of partisan co-occurrence as measured by the odd ratios in Fig. Moreover, the broader left–right polarization and higher closeness of CDU partisans and AfD partisans may indicate an increasing online polarization of social media and online news sharing and consumption that was visible in the US media system during the Trump campaign in 2016 (Benkler et al. The study design and methodology also come with some limitations. First, choosing hashtags as selectors also limits the analysis to the streams of debate and information (Burgess and Bruns Another limitation of the study is the focus on retweeting behavior, which leaves out quote tweets and mentions. The focus on retweeting has been chosen for two reasons. Firstly, the network structures and mechanisms differ between tweet types Conover . Secondl[1] to allow for a replication of the approach. This data allows colleagues a comparative assessment of the results, e.g., by applying various community detection algorithms to test the limits of modularity maximization for community detection (Lancichinetti and Fortunato Additionally, modularity-based community detection has some limitations. Modularity values and respective cluster detection vary slightly when repeated. Due to this variation, the reproducibility of the research has its limitations. However, the edge lists of the analyzed retweet networks and Gephi output data on measures like centrality values and community memberships are published on the authors' GitHub accountThe study finds a broader level of polarization during the election campaigns in 2021, indicating an ideological shift of the CDU. Thus, it is vital to continuously investigate the political Twitter sphere, e.g., as a potential indicator of ideological shifts in the political spectrum. Due to this visualization and analysis of political behavior, Twitter constitutes something like a political big data microscope. With regards to the findings of this study, further research needs to assess whether the level of polarization into a clear left–right divide was only a side-effect of higher politicization, activity, and, thus polarization, during the campaign period or whether it marks a lasting shift of the German political sphere. The findings align with a move toward more conservative CDU leader Merz after the elections and may have had an indicator function for ideological shifts of political parties and represent individual and party positions Ceron .Further research should also investigate whether membership in partisan communities varies over time and, if so, precisely for what proportion of its members. Moreover, it remains under-researched to what extent community memberships in retweet networks represent differences in political beliefs or offline political behavior. The association between online and offline political behavior can be further investigated by linking social media and survey data (Beuthner et al. Networked and digital campaigning has become a crucial part of election campaigning. Concerning networked digital campaigning, this study  assesses strategic communication and ideological polarization on Twitter during election campaigns. While politicians and partisans of all parties use hashtags strategically to link their tweets to broader While politicians and partisans of all parties use hashtags strategically to link their tweets to broader discourses, AfD partisans use other parties' hashtags much more frequently. This higher frequency is a sign of a purposeful hashjacking strategy that reflects the party's anti-establishment character. From the network perspective, these AfD partisans built an isolated community due to strategic retweeting behavior and ideological differences. While this was the case during the 2017 federal elections, this study finds a much broader left–right polarization of the electoral debate on Twitter during the 2021 German federal elections. On the right-leaning side of the political spectrum, partisans of the AfD, CDU, FDP, and CSU are more likely to appear within the same community, whereas politicians and partisans of the SPD, GRUENE, and LINKE are more likely to appear in the broader community with major news outlets. While the AfD intended to hashjack other party hashtags in both elections, they did not hashjack the broader electoral debate on #BTW17 and #BTW21. However, the AfD and CDU have become ideologically more similar, as indicated in a shared community membership on Twitter. This online polarization and closeness to AfD partisans resonate with or might even foreshadow a right shift of the party leadership in the months after the elections when CDU members elected Friedrich Merz as the new party leader for times in opposition. Concludingly, the study contributes to research on online political behavior during election campaigns and calls for further development of measurement methods of online discourses as measures of ideology, opinion dynamics, and political polarization.


Pleomorphic adenoma (PA) is one of the most common benign lesions of the salivary glands, with a majority of them occurring in the parotid gland. PA has origin from the epithelial and mesenchymal elements and can arise from both major and minor salivary glands. Among minor salivary glands, the palate is the most commonly affected site, followed by lips, cheeks, gingiva, the floor of the mouth, and tongue. PA of the upper lip without intraoral mucosal involvement is a rare entity. In this article, we report a case of PA of the upper lip in a middle-aged female patient and its surgical management with a novel technique. During six months’ postoperative review, the patient showed excellent wound healing with very minimal scar formation. Pleomorphic adenoma (PA) is a benign mixed tumor of the salivary gland that has origin from both the epithelial and mesenchymal elements. PA constitutes 45-75% of all salivary gland tumors and 70-80% of benign salivary gland tumors . It mostA 46-year-old female presented to the Department of Oral and Maxillofacial Surgery with a chief complaint of painless swelling in the upper lip for the past five years. History revealed that the growth was initially small in size and gradually increased to attain the present size. The patient gave no relevant past medical or surgical history. On examination, the lesion was located in the extra-oral aspect of the upper lip on the right side, and there was no intraoral swelling Figure . It was Differential diagnoses of the lesion included PA, epidermoid cyst, sebaceous cyst, and lipoma. The patient was advised ultrasonography (USG), which was suggestive of a sebaceous cyst measuring 1.4 x 0.7 cm on the right upper lip. Surgical excision of the lesion and reconstruction of the upper lip based on the principles of modified Millard’s rotation advancement flap was planned under general anesthesia.Local anesthesia was infiltrated at surgical sites on the upper lip. Markings were made around the lesion and involved the philtral column on the non-lesion side also Figure . The lesThe underneath muscle, orbicularis oris, was resected. Closure of the oral mucosal layer was performed with resorbable sutures Figure . Re-apprHistopathological examination of the specimen showed a non-encapsulated neoplasm of glandular epithelium admixed with myxoid connective tissue stroma. The epithelial component was composed of tumor cells arranged in the form of duct areas of varying sizes and shapes, with a central lumen containing an eosinophilic coagulum lined by cuboidal cells. These duct-like areas were surrounded by angular, spindle cells merging into the myxoid connective tissue stroma. There were sheets of numerous rounded to oval cells with an eccentrically placed nucleus and eosinophilic cytoplasm suggestive of plasmacytoid cells. Several areas showed hyalinization with squamous and adipocytic metaplasia. The connective tissue stroma showed myxoid-like areas along with moderate vascularity and areas of hemorrhage. The overlying epithelium showed ortho-keratinized stratified squamous epithelium of variable thickness suggestive of dermal epithelium with dermal appendages. Thus, the findings confirmed the diagnosis of PA of the salivary gland Figure . During PA is one of the most common benign lesions of the salivary glands, with a majority of them occurring in the parotid gland. PA also arises from the intraoral minor salivary glands mostly involving the hard palate and soft palate. PA of the lip is common compared to other regions such as the cheek, floor of the mouth, retromolar trigone, and the gingiva . In our The upper lip is the second most common site for the occurrence of PA in the intraoral minor salivary glands -10. PA iThe treatment plan was in toto surgical excision of the lesion followed by histopathological examination. The lesion was excised along with the overlying skin, providing a clearance of 5 mm and maintaining the integrity of the capsule. Surgical excision is the primary treatment for salivary gland neoplasms. For malignant lesions, a margin of 1-2 cm should be excised along with the lesion . Minor sIn our case, the residual defect after excision was large, and primary closure would lead to gaping of the wound or result in an unsightly scar. To overcome this shortcoming and to achieve a tension-free closure, the rotation and advancement of Millard’s technique were adopted and modified to suit our case. Millard’s technique was followed and an intentional through and through incision of the upper lip was made, and back cuts were created to accommodate the C-flap . This tePA arising from the minor salivary glands of the upper lip and not manifesting intraorally is a rare entity. Clinical diagnosis of salivary gland tumors related to oral mucosa is quite challenging. PA of the upper lip resembles several benign lesions, and final confirmation of the pathology is always based on the histopathological report. Proper surgical planning and execution are important in the management of PA in salivary glands, and long-term follow-up is recommended as they tend to recur. After surgical excision of the PA of the upper lip, Millard’s rotation advancement philosophy of cleft lip surgery can be utilized in the reconstruction of upper lip defects.


The COVID-19 pandemic has deepened issues of health inequity and social injustice against people with dementia. Despite having one of the highest mortality rates, little research focuses on the COVID-19 impact of people with dementia. This presentation aims to: 1) explore the COVID-19 experiences and key factors of health inequity among people with dementia during the pandemic; and 2) identify actions to improve the health equity of people with dementia in the pandemic. We collected 6,243 relevant tweets using the Twint application in Python from September 8, 2020, to December 8, 2021. Tweets were divided among eleven coders and analyzed using thematic analysis. Analysis identified three primary themes: structural inequities ; frustration and despair due to loss ; and resiliency and hope for the future . There is an urgent need for policymakers to improve the health equity of people with dementia in the pandemic. Tackling COVID-19 inequities requires revisiting infection control policies to improve access to health and support services, recognizing the essential role of family care partners, and providing resources to help support people with dementia during the pandemic. Moreover, it is essential that COVID-19 policy responses are informed by evidence-informed research and authentic partnerships that embrace the insight and lived experiences of people with dementia.


Whether physical or psychological, the individual determinants of work or athletic performance are the subject of a large body of literature aimed at better understanding what makes an individual perform and how their work can be made safer and more productive . While a first study measured the impact of a constraining thermal condition  on the cognitive functioning of individuals, the other three studies focused on possible interventions  to help individuals perform under environmental stress conditions .Schultz Martins et al. investigated the role of skin and core temperature and partial pressure of end-tidal carbon dioxide on cognitive function in a series of domains. Indeed, while increased body temperature due to heat stress generally impairs cognitive function, the relative contribution of changes in skin temperature to core temperature requires more clarity. The different manipulations performed on the 11 participants lead the authors to conclude that neither skin temperature nor the maintenance partial pressure of end-tidal carbon dioxide significantly impaired cognitive function during passive hyperthermia.Specifically, in the first study, O'Keeffe et al. asked 13 men to participate in a study designed to test whether self-selected motivational music could buffer the performance decrements observed in hypoxia. To do this, the authors tested the effects of subjective, physiological and physical performance measures in four experimental trials crossing self-selected motivational music (vs. no music) and normobaric hypoxia (vs. normoxia). Their results show positive effects in several of the measures tested indicating that preferential motivational music plays a beneficial role in mitigating the negative impact of hypoxic conditions.In the other three studies, authors focused on possible interventions to help individuals perform under environmentally-stressful conditions. The first of these studies focused on music as a tool for mitigating the performance decrements observed in hypoxia. People exposed to hypoxia may suffer from physiological and psychological consequences. At the same time, it is known that music has ergogenic effects to improve psychological factors such as mood, emotion and cognition. For this reason, Riera et al. tested the effect of face cooling with cold water  during high-intensity swimming training on both the core temperature and thermal perceptions in internationally ranked long-distance swimmers during 2 randomized swimming sessions. Among the results, thermal comfort was higher with cold cooling than neutral cooling and thermal sensation was lower with cold cooling compared with neutral cooling. In general, the authors suggest that brain integration of signals from physiological and psychological sources is involved in the changes obtained by per-cooling.In the second study on possible interventions to reduce the negative impact of environmental conditions, Coudevylle et al. conducted a mini-review in which they refer to how the tropical climate impacts motivational factors during aerobic performance and the strategies to maintain the motivation of athletes in such conditions. For this purpose, they proposed a theoretical model integrating several theoretical frameworks that need to be tested by empirical studies. The authors nevertheless remind us of the importance of being cautious because under the cover of an increase in motivation and performance, the risk is to push athletes beyond their physiological limits with all the potentially serious consequences on their health.Finally, Although these four studies focused on students and athletes, the ultimate goal is also to investigate other populations whose professional activities are subject to particularly difficult environmental conditions . Thus, other high-level athletes such as GP motorcycle or Formula 1 drivers, but also construction workers, firefighters, police and army special intervention forces, and fighter pilots would need to be investigated in order to help optimize their performance and health in different environments.GC is responsible for the production of this special issue, including this editorial. GC proposed a first version of this editorial to NG, TM, and SC. Each co-author then amended the document on both substantive and editorial issues. The GC then compiled all comments and changes and inserted them into the final submitted version. All authors contributed to the article and approved the submitted version.


The circulatory system is critical for the development of the vertebrate organism and is comprised of an intricate network of blood and lymphatic vessels. Vessels consist of an inner lining of endothelial cells (EC or ECs) that are in contact with the blood or lymph and an outer lining of smooth muscle cells that surrounds the endothelium. In this specialty Grand Challenge article, I will discuss the past, present and future in the field of EC biology, a topic of my interest and expertise. The intent here is to provide my perspective of how the EC biology field has progressed in the last 40–50 years. My discussion here is restricted to EC biology and interaction of ECs with other cell types in a contextual manner. The purpose of this Grand Challenge article is to inform the reader of the exciting developments that have come and yet to come in the EC biology field, and to invite fellow scientists to contribute their innovative work to the Molecular and Cellular Pathology Section of the Frontiers in Cell and Developmental Biology journal.de novo angioblast differentiation into arteries and veins is also referred to as artery vein specification and occurs through vasculogenesis, a process involving assembly of cells to form a tube-like structure called a vessel. This vessel has a central hollow cavity called a lumen, which carries fluid such as blood or lymph. In contrast to vasculogenesis, angiogenesis is the process of sprouting blood vessels from an established vasculature and is often associated with remodeling. We have gained immense insight in the last century or so on how vessels are patterned, which has largely built upon the initial careful descriptions of vessel architecture in various organs noted by the Belgian physician Andreas Vesalius among others. The discovery of growth factors in particular vascular endothelial growth factor (VEGF) or vascular permeability factor (VPF) by Dvorak   , other lGF-A121) , PDGF, FGF-A121) . These tGF-A121)  demonstrGF-A121) . At presAs developmental biologists continued to unravel how these molecules worked together to generate new EC types and eventually pattern the vasculature, some of this knowledge helped gain better understanding of vascular anomalies, a condition that is thought to result from deregulated mechanisms underlying embryonic vascular patterning process. Classification of vascular anomalies into two classes: hemangiomas and vascular malformations occurred, and the genetic basis for vascular anomalies gained steam . MeanwhiOver the last decade or so, basic ECs biology has seen some remarkable progress. We now have a great understanding of the various types of junctions that exist between ECs. VE-cadherin plays a prominent role in stabilizing the vascular junctions . We alsovia glycolysis even though glycolysis only yields two molecules of ATP per molecule of glucose. This behavior is reminiscent of cancer cells displaying Warburg effect, the concept of metabolizing glucose in anerobic rather than aerobic conditions. This anerobic glucose metabolism offers an advantage to ECs in their function in that they do not use the oxygen but allow it to diffuse into the needy avascular anoxic tissue. This evolutionary adaptation and possible implications in disease are beginning to emerge  , that reo emerge .in vivo to low shear stress and release calcium in vivo in a zebrafish model (via p38. These studies begin to suggest that ECs respond to the same ligand from two different sides (tissue-derived versus blood-derived) and have vastly different outcomes in terms of their responses.ECs are also the first line of contact with blood flowing in the lumen. Thus, the role of flow in regulating endothelial cell morphology emerged. ECs experience fluid shear stress, which is the tangential force (blood flow) exerted on the endothelium. In response to shear stress in culture, some ECs such as human umbilical vein ECs align to the direction of flow while others such as brain ECs do not . Fluid ssh model . Furthersh model . We and sh model  have repsh model . More resh model , which ssh model . In bothsh model . From a sh model  vessel bDLL4 and TIE1 gene loci (The emergence of single cell RNA (scRNA) sequencing has revolutionized the field of ECs heterogeneity. It is now increasingly clear that ECs from distinct vascular beds are different and contain sub-sets of cells expressing unique gene expression patterns. For example, 15 distinct cell sub-types have been identified in mouse brain ECs, and similarly, 17 distinct cell types have been identified in mouse lung ECs . Furtherene loci . The lisThe future for EC biology is full of interesting questions and we have the technology to explore them. I think we are entering the golden era of vascular biology from an endothelial cell perspective. The interaction of ECs with resident cells in a tissue is likely to gain steam. With advent of organoid model systems , such qu


Patient engagement in patient safety is aimed at increasing the awareness and participation of patients in error-prevention strategies. The aim of this project was to improve the patient safety with the patient engagement within the local context of a maternity hospital by implementing best practice.A clinical audit was conducted using the JBI Practical Application of Clinical Evidence System tool. The current project was conducted in surgical ward of Shahid-Beheshti maternity hospital, Iran. The sample size was 46 patients and 46 healthcare practitioners for both the baseline and follow-up. In phase 1, four audit criteria were used and a baseline audit was conducted for this project. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted.The results showed varying levels of compliance with the four criteria used in this project. The criterion 1, which was related to training of healthcare practitioners on how they can support patients, has the highest compliance at 87% in baseline and follow up data collection. Furthermore, compared with the baseline data , compliance with criteria 2, 3, and 4 notably improved at 85, 76, and 92%, respectively.The present project successfully implements patient engagement in Iran and reveals varying results on compliance and the increasing knowledge of healthcare practitioners and patients on evidence-based patient engagement in order to improve the patient safety. The used strategies can facilitate implementation of evidence based procedures in clinical practice. Patient safety is the prevention of errors and adverse events associated with provision of medical care . PatientThe evidence has shown that significant numbers of harmful incidents, many of which are preventable, occur in hospitals . PatientPatient engagement in patient safety is aimed at increasing the awareness and participation of patients in error-prevention strategies. Patient engagement in healthcare planning, service development and research is a key policy component in many countries . PatientHowever, whilst the concept of “patient engagement” is recognized, unanimous definition of patient engagement exists, rather a variety of terms, including “patient involvement,” “patient collaboration,” “patient empowerment,” “partnership” and “patient-centred care,” have been used to describe a partnership with patients , 13.The WHO Eastern Mediterranean Regional Office (EMRO) developed the patient safety friendly hospital initiative (PSFHI) in 2007. At first, six countries were chosen as candidate to perform the programme and later it was implemented in all other countries in the region . Iran, aPatients who were aware of the need for their engagement and knowledgeable about patient safety were likely to engage in patient safety initiatives . ProvisiWhilst research shows that patients are willing and capable of engaging in patient safety initiatives , 20, theNumerous studies have been conducted on the effect of patient engagement in improving patient safety. In the majority of studies, research evidence was produced and translated, but the present study tried to implement the translated evidence , 20, 22.The aim of this project was to improve the patient safety with the patient engagement within the local context of a maternity hospital at Maragheh in Iran by implementing best practice recommendations.Through the audit process, the specific objectives of the project were as follows:To determine current compliance with evidence-based practice regarding patient engagement in patient safety by carrying out an initial audit.To identify barriers and facilitators to achieving compliance and develop strategies to address areas of non-compliance.To improve knowledge regarding best practice regarding patient engagement in patient safety in Shahid-Beheshti hospital.To implement strategies for obtaining patient engagement in patient safety in order to address non-compliance with criteria.To conduct a follow-up audit to determine improvements in compliance with evidence-based criteria regarding obtaining patient engagement in patient safety.The current project is a quality improvement project using the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool. The JBI PACES and GRiP framework for promoting evidence-based practice involves three phases of activity such as (1) establishing a team for the project and undertaking a baseline audit based on the criteria informed by the evidence; (2) reflecting on the results of the baseline audit and designing and implementing strategies to address noncompliance observed in the baseline audit by following the JBI and GRiP framework; and (3) conducting a follow-up audit to assess the results of the interventions implemented to improve practice and to identify future practical issues to be addressed in subsequent audits. This project was implemented in three stages, from May 2020 to October 2020.This project was considered a quality improvement project within the Shahid-Beheshti hospital in Maragheh, Iran. The study was approved by ethical committee of Maragheh University of Medical Sciences . An approval from the hospital ethics committee was acquired. All participants entering in this study gave an informed consent. A verbal consent form was completed by all participants.A project team was established to engage key stakeholders to support the work during the process. The team included the senior research fellow, gynecologist, head nurse (HN), chief executive officer (CEO), chief nursing officer (CNO), chief quality officer (CQO), public relations manager and the patient safety improvement expert of the hospital. The team identified a senior nurse, clinician and a nurse educator as additional key stakeholders to support and endorse this project. Involvement of the project team was based on their roles in support, data collection, data entry and/or participation. The members of the team were invited to participate in the project based on their positive approach and ability to influence staff and to engage patients. The team leaders highlighted the importance of the recommended practice, conducted pre- and post-implementation audits based on the timeline chart. The team members and stakeholders used formal letter, phone and social media for meetings.The current project was conducted in surgical ward of Shahid-Beheshti maternity hospital. This hospital is a maternity health facility with a 112-bed capacity, located in the city of Maragheh. The surgical ward has 26-beds and receives approximately 2400 patients annually. The sample size included all healthcare practitioners working on this unit. There were 46 healthcare practitioners and 46 patients involved in the baseline audit, with a similar number involved in the follow-up audit.The baseline audit was conducted from May 03 to 21, 2020. The baseline audit was conducted by the project team members using the JBI PACES program. To collect the baseline data; we designed a questionnaire, consisted of demographic characteristics of the respondents  and audit criteria. Methods used to measure percentage compliance with best practice included documentation audit and semi-structured interview. The interviewers included three researchers from the research team. The researchers have previous experience conducting semi-structured interviews of patients and healthcare professionals. Additionally, they had been trained to conduct the semi-structured interviews for improving the quality of interviews. After the project team completed the audit form by reviewing of documents and interviews with participants, the investigator reviewed the participant’s chart according to criteria.This phase of the study focused on gaining an understanding of the barriers or gaps between the current practice and best practice in patient engagement in order to improve the patient safety. In first, the team presented baseline audit results to the healthcare practitioners. Based on these results, the team and the surgical ward identified barriers to the low compliance of the identified criteria. The team encouraged the healthcare practitioners to ask questions and suggest strategies to improve the audit results. In addition, the JBI GRiP tool was used and strategies and resources were formulated to facilitate our discussion. Then, a GRiP report was generated by outlining the implementation plan on patient engagement, and each member of surgical ward was informed.This phase assessed whether the post-implementation resulted in the improvement of compliance with the best practice patient engagement that must be enhanced. The follow-up audit used the same criteria utilized to the baseline audit. A total of 46 patients and 46 healthcare practitioners were audited during this phase. The follow-up data were analyzed into the PACES. Results were subsequently compared with the baseline audit to determine any change in the compliance rate. This follow-up audit was conducted in late October 2020.The ward staff identified four main barriers through interviewing the participants  and then specified strategies to improve their outcomes. The project team entered the specified barriers into GRiP. The barriers and developed strategies are shown in Subsequently, patients were encouraged to engage and communicate with their health care team. Other strategies were getting feedback from patient, attend to patients’ complaints, using the suggestion box and implementing specific guideline.This project was the first attempt to examine the current practice and implement evidence-based patient engagement in patient safety in a maternity hospital in Maragheh, Iran. Baseline and follow-up data were collected, and barriers, strategies, and resources were identified using the JBI PACES and GRiP tools. The project team and hospital leadership provided the resources in order to implement the identified strategies. The importance and practices of facilitators of patient engagement in patient safety were included in the educational programs of healthcare practitioners in the surgical ward. In addition, educational content were provided in unit and meetings were conducted to review patient engagement in patient safety.The results showed that after implementation of the strategies, highest mean scores of criterion were found in relation to training of healthcare practitioners on how they can support patients (100%). The compliance rate for the criterion 2 on patients have received information and education on how to detect and report changes in their clinical condition, communicate errors, and how they can best participate in patient safety initiatives increased from 52% to 85%. The compliance rate of criterion 3 in relation to patients have received specific instructions from their healthcare practitioners to improve safety increased from 37% to 76% in the post implementation period. Finally, the compliance rate for the criterion 4 on preparation of the visual aids such as brochures to remind patients and healthcare practitioners to perform safety behaviors increased from 61% to 92%.Despite the successful implementation of the project, several limitations exist. The first was inability to implement the face-to-face training to healthcare practitioners because of the outbreak of coronavirus disease (COVID-19). The project was conducted during this outbreak, which is a less busy time for healthcare practitioners. Therefore, the workload has increased that can influence the strategies. Additionally, due to the time limitations and funding, the strategies were only implemented in one ward and in one hospital. Therefore, the sample size was small and composed patients and healthcare practitioners from one maternity hospital so may not be generalisable to other hospitals.This project has several strengths. One of the strengths of this study is to implement the best translated research evidence related to patient safety improvement using the patient engagement. We tried to change the behaviour of healthcare practitioners and patients in order to improve the patient safety and engagement in hospital. Also, our method of study was unique compared to other previous studies. We established a project team to support the work during clinical audit process in medical practice. The team included the key stakeholders. Then, the evidence-based audit criteria used in the project (baseline and follow-up audit). Next, we implemented evidence-based strategies to improve performance using JBI GRiP tool. Finally, we assessed post-implementation resulted in the improvement of compliance with the best practice patient engagement. In fact, we modified and improved the performance of patients and healthcare practitioners using the best available research evidence.A challenge for the implementation of the project was that some of the healthcare practitioners did not think it was necessary to conduct the assessment, because patient safety standards are implemented in the hospital. In order to overcome the challenge and improve the beliefs of healthcare practitioners of the importance of conducting a project, a webinar about patient engagement in patient safety and practice improvement of clinicians were conducted and then, strategies were provided by considering their perspectives.The main success of the project was including the full support of the hospital management team. Hospital leadership has important responsibility to oversee the safety and quality of care provided . The stuIn this project, barriers to the engagement of patients in the delivery of safe care in Shahid-Beheshti hospital were identified. The results highlighted that low level of health literacy and insufficient training in patient participation are disproportionate to the number of patients and that this decreases patients’ ability to take an active role in safety. A systematic review also showed the insufficiency of health literacy amongst the Iranian population . In ordeThis project was successful to an important evidence for improving healthcare practitioners’ skill and knowledge about evidence-based patient engagement in patient safety in Shahid-Beheshti hospital. The results of this project provide the positive direction into implementing evidence-based patient engagement in other hospitals. This project has the potential to raise awareness amongst healthcare practitioners and managers on the barriers to patient engagement in patient safety and improvement strategies in Iranian hospitals.In the future, follow-up audits engaging other clinicians from the hospital units should be conducted. Thus, healthcare practitioners and patients will be empowered to improve performance and patient safety. This project is a critical point in patient safety improvement with the patient engagement in Maragheh. We must try to provide the formal educational and practical strategies for sustainability.


International comparisons of population indicators of maternal and newborn health are valuable for guiding health policy and practice. The Covid-19 pandemic revealed the difficulties of compiling comparable, timely data in Europe. As part of the PHIRI  project, we developed a protocol to facilitate the exchange and analysis of population birth data in Europe.https://zenodo.org/record/5148032#.YmlUttpBxPY). These tables were used to compile comparable perinatal health indicators from routine population-based sources for the years 2015 to 2020. We assessed the feasibility of this approach and the availability, quality and comparability of the data.The Euro-Peristat network, which includes experts from 31 European countries, developed a common data model and R scripts to facilitate rapid exchange of anonymised aggregate tables . The protocol requires the active participation of each country to ensure it is correctly applied.We illustrated the feasibility of using a common data model with open source scripts to facilitate rapid production of data and analysis on key perinatal health indicators in European countries