Colour vision represents a vital aspect of perception that ultimately enables a wide variety of species to thrive in the natural world. However, unified methods for constructing chromatic visual stimuli in a laboratory setting are lacking. Here, we present stimulus design methods and an accompanying programming package to efficiently probe the colour space of any species in which the photoreceptor spectral sensitivities are known. Our hardware-agnostic approach incorporates photoreceptor models within the framework of the principle of univariance. This enables experimenters to identify the most effective way to combine multiple light sources to create desired distributions of light, and thus easily construct relevant stimuli for mapping the colour space of an organism. We include methodology to handle uncertainty of photoreceptor spectral sensitivity as well as to optimally reconstruct hyperspectral images given recent hardware advances. Our methods support broad applications in colour vision science and provide a framework for uniform stimulus designs across experimental systems.This article is part of the theme issue ‘Understanding colour vision: molecular, physiological, neuronal and behavioural studies in arthropods’. Each animal is equipped with an array of photoreceptors expressing various opsin types and optical filters that define the range of wavelengths the animal is sensitive to. But opsin expression alone does not predict how an animal might ‘see’ colours. The downstream neural circuit mechanisms that process photoreceptor signals are critical in shaping colour perception. Interrogating these neural mechanisms in a laboratory setting necessitates experimentalists to construct and present chromatic visual stimuli that are relevant to the animal in question. Outside of trichromatic primates, for which studies in human perception and psychophysics have led the way, there is a lack of unifying methodology to assay colour vision across species using disparate laboratory visual stimulation systems. Here, we describe standardized methods to create chromatic stimuli, using a minimal set of light sources, that can continuously span a wavelength spectrum and be flexibly applied to photoreceptor systems in various species.Light, the input to a photoreceptor, comprises two components: wavelength and intensity. Importantly, a photon of light of any wavelength elicits the same response once absorbed by a photoreceptor. This principle of univariance limits a single photoreceptor from distinguishing between wavelength and intensity, as different wavelength–intensity combinations can elicit the same response, rendering single photoreceptors ‘colour-blind’ ,2. By codrEye, for designing chromatic stimuli, that allow the simulation of arbitrary spectra using only a minimal set of light sources. Our framework is founded on established colour theory [Here, we present a set of algorithms, and accompanying Python software package r theory ,5,6 and . 2As colour scientists, we aim to understand how a given animal processes spectral information and thus perceives colour. A ‘perceptual colour’ space gives an approximation of how physical properties of light are experienced by the viewer. CIE 1931 colour spaces, for instance, are defined mathematical relationships between spectral distributions of light and physiologically perceived colours in human vision . These sa–c; electronic supplementary material, figure S1a,b). Weighting a total light power spectrum by the photoreceptor’s spectral sensitivities renders n effective values of a stimulus—with n being the number of photoreceptor types. The n values compose an n-stimulus specification of the objective colour of the light spectrum for an animal, called the photon capture. This results in an n-dimensional receptor-based ‘capture space’. For dichromats such as New World monkeys and mice, this receptor-based space is two-dimensional (figure 1d). For trichromats, such as humans and bees, it is three-dimensional (figure 1e) and for tetrachromats, such as zebrafish and fruit flies, it is four-dimensional (figure 1f).Can we approximate the perceptual space of animals using available physiological and/or behavioural information? A perceptual colour space is the result of a series of transformations starting from the stimulus itself. The stimulus can be represented in ‘spectral space’, simply describing the spectral distribution of light. This space, however, is high-dimensional, and therefore difficult to work with. Instead, a lower-dimensional colour space can be constructed, by taking into account the photoreceptor spectral sensitivities of the viewer. A photoreceptor’s spectral sensitivity defines the relative likelihood of photon absorption across wavelengths . For dichromats, this visualization simplifies to a line, for trichromats it is a triangle, and for tetrachromats, a tetrahedron. The loci of single wavelengths can be mapped onto these spaces as a one-dimensional manifold, as can theoretical ‘non-spectral’ colour lines. Non-spectral colours result from the predominant excitation of photoreceptor pairs that are not adjacent along the single wavelength manifold [In addition, within this manifold ,10.Although the number of photoreceptors, which determines the dimensionality of the receptor-based space, is not always equal to the effective dimensionality of perceived colours , it provReceptor-based spaces are, however, a good starting point to mathematically approximate the transformations that the brain applies to photoreceptor inputs. They can in particular serve to design relevant chromatic stimuli to interrogate these transformations experimentally. Throughout this paper, we will use receptor-based colour spaces as the foundation for a unified framework for developing such chromatic stimuli.. 3Probing an animal’s colour vision requires measuring behavioural or physiological responses to relevant chromatic stimuli. Among these are artificial stimuli that are constructed to probe specific aspects of visual processing, such as a set of Gaussian spectral distributions to measure spectral tuning, naturalistic stimuli, such as measured natural reflectances, or randomly drawn spectral stimuli, akin to achromatic noise stimuli. Current methods to display such stimuli often do not take into account the visual system of the animal under examination, and instead focus on spectral space, which is often not as relevant functionally. Instead, we have developed a method that allows the reconstruction of a wide range of chromatic stimuli, with only a limited number of light sources, that can be applied across animals for which spectral sensitivities are known. Here, we describe the core method for light spectra reconstruction, followed by highlights of important considerations regarding the stimulus system and aspects of the fitting procedure. An overview of the method is illustrated in  (a)Q elicited by any arbitrary stimulus j is calculated by integrating its spectral distribution Ij(λ) (in units of photon flux: Si(λ) of photoreceptor i across wavelengths (a–c). Even when no photons hit a photoreceptor, it randomly produces dark events [εi to the light-induced capture. By multiplying this sum by the absolute sensitivity of photoreceptor i (Ci), we obtain the total absolute capture n photoreceptor types present in an animal, we get a vector that can be represented as a point in the receptor-based capture space :The light-induced photon capture elengths a–c. Evenk events ,13. Mathre space c,h:3.2QtCi and the baseline capture εi. Unlike the spectral sensitivities of photoreceptors, both Ci and εi are usually unknown (and difficult to estimate) for most model organisms. In many conditions, it is assumed that the photoreceptors adapt to a constant background light according to von Kries adaptation [Ci from the equation, and we obtain the relative light-induced capture qi,j) representing a point in relative receptor-based capture space . Note that equation ( + εi). Thus, the relative photon capture is simply a form of multiplicative scaling that has been shown to approximate adaptational mechanisms within isolated photoreceptors [Equations  and 3.23.2 assumaptation . This rere space d,i. Noteeceptors ,16.η, so that q = qt. However, we will show in a later example why setting a baseline capture value to a specific low value can have practical uses for designing colour stimuli even when we lack knowledge of the exact biophysical quantity ascribed to it.Finally, if we assume that the light-induced capture is much larger than the baseline capture, we can drop e by applying a transformation f that approximates the change in the response in photoreceptors :h–j). If the transfer function is not known for an animal’s photoreceptors, the identity function (i.e. the linear case) can be used or a transfer function can be reasonably assumed given measured transfer functions in other animals or photoreceptor types. Photoreceptor excitation values are the de facto inputs to the visual nervous system of the organism. We will therefore consider spectral stimuli within photoreceptor excitation spaces as a foundation for our subsequent fitting procedures.Receptor-based photon capture spaces do not take into account the neural transformation applied by the photoreceptors themselves once photons are absorbed to give rise to electrical signals. It can therefore be beneficial to further convert our relative capture values to photoreceptor excitations eceptors e,j:3.4e=function ,17–19. A (b)a–e) to adjust the intensities of a set of the light sources in order to map intended spectral distributions onto calculated excitations of each photoreceptor type. Using equations , w, wa–e) tn photoreceptors and m available light sources, we can construct a normalized capture matrix A using equation . Second, an experimenter may want to weight each target photoreceptor excitation differently, if certain photoreceptors are thought to be less involved in colour processing (see e.g. [w) difference between our desired excitations (e) and possible excitations (f(Ax + η)) subject to the intensity bound constraints ℓ and u:x, we use a deterministic two-step fitting procedure. First, we fit the relative capture values—before applying any nonlinear transformation—using constrained convex optimization algorithms. Next, we initialize x to the value found during linear optimization and use nonlinear least-squares fitting  to find an optimal set of intensities that match the desired excitations. This two-step fitting procedure is deterministic and ensures that the nonlinear solution found is the closest to the linear solution, if the nonlinear optimization problem is not convex. If the transformation function is the identity function, the second step is skipped completely as the first step gives the optimal solution. There are a few important points to note regarding this fitting procedure, which we address below.To find the optimal see e.g. ). Thus,  (c)So far, we have not considered the hardware and the ability of a visual stimulus system to represent colours. In human colour vision, the ‘gamut’ represents the total subset of colours that can be accurately represented by an output device, such as an LED-stimulation system . In ordea–g) which can be combined to create a stimulus system [h–l). Adding more LEDs than this only minimally improves the system . Examining the distribution of all n-sized LED stimulus systems  highlights that different animals allow more or less freedom of LED choice . Interestingly, LED combinations that would be chosen according to the peak of the sensitivities, a commonly used strategy when designing stimulus systems [n-LED combinations . This is due to the fact that our metric takes into account the shape and overlap of the sensitivities and LEDs, in addition to the peak of the sensitivities and LEDs.For illustration purposes, we consider a set of commercially available LEDs  and the gamut of the stimulation system will decrease . At higher intensities of a stimulus, including additional LEDs can enable reconstruction of more colours. This gamut metric is therefore a useful tool for assessing the suitability of an existing visual stimulation system or selecting light sources for de novo assembly.Finally, a desired property of a given stimulus system may be to enable experiments across vastly different intensity regimes. As stimulus intensities are increased, LEDs will reach their maximal intensities h). If the desired captures of a stimulus set are within the gamut of the stimulus system, applying any excitation transformation or changing the weighting factor w will have no effect on the fitted intensities as an ideal solution exists (h–j). In this case, the second step of the fitting procedure (i.e. the nonlinear optimization) will be skipped to improve efficiency. Conversely, the intensities found when fitting captures outside the system’s gamut can vary depending on the chosen nonlinearity and weighting factor w . In these cases, it is especially important to consider the light conditions during experiments . According to various models of photoreceptor noise, the noise of photoreceptors is constant in dark-adapted conditions and becomes proportional to the capture in light-adapted conditions (Weber’s Law) [f chosen for each condition should be the identity or the log, respectively, in order to ensure homogeneity of variance. We have found that using a log transformation and adding a small constant baseline capture ε provide a good prediction of photoreceptor responses across intensities for the fruit fly in the dark-adapted state . This nonlinearity effectively rectifies the calculated captures for small values that are indistinguishable from dark, and smoothly transitions between a linear and logarithmic regime. Furthermore, this transformation approximates the measured responses of other photoreceptors [A desired capture value of light can be within the gamut of the stimulation system or out-of-gamut e.g. h. If then exists h–j. In tr’s Law) ,25. Thuseceptors  and prev (e)For humans, many displays use gamut correction algorithms to adjust how out-of-gamut colours are represented . For exa (f)drEye, we provide alternative options such as maximizing/minimizing the intensity of particular light sources or minimizing the differences between the intensities of particular light sources. An underdetermined system can also be leveraged in other ways, as we discuss in §5.If the stimulus system is underdetermined—i.e. there are more light sources to vary than there are types of photoreceptors—then a space of target excitations can be matched using different combinations of intensities . By default, the intensities that have smallest L2-norm within the intensity constraints are chosen. This will choose a set of light source intensities that generally have a low overall intensity and similar proportions. However, in our package . 4 (a)a,b). The first stimulus is a set of Gaussian spectral distributions. Simulating this set of stimuli is similar to exciting the eye using a monochromator and mapping responses along a one-dimensional manifold in colour space. We have simulated such a set of stimuli previously to map the tuning properties of photoreceptor axons in the fruit fly [a). In both cases, we assume that photoreceptors are adapted to the mean of either stimulus set. We include a small baseline ε of 10−3 μE and a log transformation in our photoreceptor model. Each photoreceptor type is equally weighted. To compare the results for different stimulation systems, we calculated their R2 values as a measure of goodness-of-fit. For the single wavelength stimulus set, a good fit is usually achieved with an n-size LED stimulus system, although for tetrachromatic animals some wavelengths may require more LEDs for a good reconstruction . Furthermore, more LEDs become necessary for high-intensity simulations . For the natural reflectance stimulus set, an n-size LED stimulus system usually gives a perfect fit, if an appropriate LED set is chosen (e–j). However, more LEDs than this improve fits for high-intensity spectra . The naturalistic stimulus set is more correlated across wavelengths. Thus, these types of stimuli are usually easier to simulate given different stimulation systems, as they are covered by a stimulus system’s gamut—especially when adapted to the mean.To illustrate our approach, we have applied our fitting procedure to two sets of targeted stimuli using the five example animals and LED-stimulation systems composed of the LEDs introduced previously a). Photoreceptors are adapted to the sum of 1 μE photon flux of light for both LEDs, and the photoreceptor model incorporates a small ε of 10−3 μE and a log transformation. We sample 121 individual stimuli that equally span a two-dimensional plane from −1 to 1. The samples are drawn either from relative LED intensity space—log(i/i b) with i being the LED intensities and i b being the background intensities—or from photoreceptor excitation space. In the latter case, we fit LED intensities using our fitting procedure to best match the desired excitations. Points outside of the system’s gamut will be clipped as per the fitting procedure. No fitting is required when directly drawing LED intensities. When drawing equally spaced samples in relative LED space, the samples are highly correlated along the achromatic dimension of the excitation space (i.e. eL = eM) and do not span the available gamut in excitation space . Consequently, any neural or behavioural tuning extracted from such a stimulus set can be biased towards specific directions in colour space [d–f). Colours outside the system’s gamut will be clipped, but if the system is chosen to efficiently span colour space, clipping can be reduced significantly. Since photoreceptor sensitivities always have some overlap, the photoreceptor axes are not completely independent as is the case with the spatial dimensions of width and height. Thus, clipping would even occur in a perfect stimulus system. Our drEye Python package includes various ways to efficiently draw samples within the gamut of a stimulation system to avoid clipping.So far, we have assumed we have a set of spectral distributions to simulate. However, this is not necessarily the case. Random sampling of a colour space can be a useful way to probe a chromatic system. Similar to stimulating the eye using artificial achromatic stimuli, such as random square or white noise stimuli ,33, we cur space ,34. On t. 5So far, we have assumed that the spectral sensitivities are uniquely described. However, measured sensitivities can vary depending on the experimental methods used ,36. Furti given the light source j at an intensity of one unit photon flux. We can estimate each variance by drawing samples from the distribution of photoreceptor properties, then determining the light-induced capture for each sample given each light source at one unit photon flux, and finally calculating the empirical variance across samples. Given a particular set of light source intensities x, we can approximate the total variance of the calculated excitations x result in calculated excitations that vary considerably between different samples from the prior distribution of photoreceptor properties. We are less certain that the calculated excitations match the desired target values. Conversely, a smaller value of x from the first step as our initial guess for the second step. In the second step, we minimize x to not deviate significantly from our fit in the first step:δ is the value of the objective function after optimizing x in the first step plus some added small value. δ may even be zero in an underdetermined system as multiple solutions can exist that give an optimal fit but have different values for the overall uncertainty In order to take into account the distribution of photoreceptor properties, we first construct a normalized variance matrix equation . We use a) and an underdetermined stimulus system consisting of a UV, green and orange LED (g). The widths of the sensitivities vary between 30 and 70 nm and between 60 and 100 nm for each photoreceptor, respectively. The peaks of the sensitivities vary between 420 and 460 nm and between 500 and 540 nm for each photoreceptor, respectively. Changing the width and/or peak of the spectral sensitivity of either photoreceptor will affect the calculated capture for each LED differently. As an example of fitting using equation (b). All four values are within the gamut of the stimulation system for the expected spectral sensitivities. As this is an underdetermined system, we can find multiple LED intensities x that fit the desired capture values for the expected sensitivities (c). Using only the standard fitting procedure from §3b, we find a set of intensities that has the smallest L2-norm (X symbols in figure 4c). If we subsequently optimize to minimize the variance x can differ significantly from the first fitting procedure (open squares in figure 4c). However, the overall goodness-of-fit for the expected target excitations is not affected as the solution has simply moved within the space of possible optimal solutions (lines in figure 4c). To get a better idea of how fits differ between the original approach and this variance minimization approach, we drew many random capture values that are inside and outside the system’s gamut (figure 4d). After fitting, we calculated the average R2 scores of the two approaches for all samples from the prior distribution of spectral sensitivities. We find that on average the variance minimization approach improves the R2 score when considering a distribution of possible spectral sensitivities (figure 4e).As an example, we consider two photoreceptors with spectral sensitivities that follow a Gaussian distribution a and an ange LED g. The wiequation , we takeequation b. All fotivities c. Using The variance minimization approach works well when the goal is to fit particular excitation values . However, if the goal is instead to fit particular spectral distributions, the method can lack accuracy because the corresponding target excitation values are not unique owing to uncertainty of photoreceptor sensitivities. To deal with this problem, we can increase the number of photoreceptors we use to fit artificially by adding different samples of sensitivities to the estimation procedure and weighting them by their prior probability. We can still perform variance minimization as a second step, if the sampled sensitivities cover a range of possible excitation values.c correspond to a range of metameric stimuli that match the four example target captures in figure 4b. In the drEye package, we provide various ways to design metameric stimuli. For another example, we have measured the responses of photoreceptor axons in the fruit fly to stimuli that simulate the spectrum of one LED and then compared this response with the response of the neuron to the actual LED . If the responses match, the sensitivities used are a good approximation within the wavelength range tested. However, care should still be taken as different sensitivities can still produce the same response in a (randomly) chosen neuron or behaviour. Thus, many different types of neurons should be measured and stimuli tested for validation purposes.A final approach to dealing with uncertainty of the spectral sensitivities is to update the prior distribution of the sensitivities with different behavioural and/or physiological data. Besides the more classical approaches to assessing the spectral sensitivity of photoreceptors and the dimensionality of colour vision, sets of metameric stimuli can be designed to probe the responses of various neurons responding to visual inputs. For example, the lines in figure 4. 6So far, we have not explicitly considered the spatial aspect of chromatic stimuli. Our method can be used to display not only full field stimuli but also patterned stimuli, simply by applying it pixel by pixel. However, specific considerations need to be taken into account when it comes to these types of stimuli, which depend both on the animal and on the hardware.at every pixel, a time-consuming and expensive task. In such cases, projectors offer a more flexible and affordable solution, as these only require replacing a single set of light sources by either swapping one or more LEDs or filters or using fibre optics to couple an external light source [Our method can directly be applied to LCD screens and any other screens that pack small LEDs onto single pixels , as longt source ,39. Howea). In most modern video projectors, this mixing occurs independently at each pixel, owing to an array of mirrors that are synced with each subframe and thus allow a patterned image to be formed. This method at its core is equivalent to the algorithm we presented above, mixing in time instead of space.Indeed, the core principle of projector design relies on ‘temporally’ mixing light sources in different ratios in repeating patterns of subframes, and doing so at a higher frequency than the flicker fusion rate of the viewer a. In moseach subframe is dedicated to one light source. Therefore this subframe structure typically limits the experimenter to use only up to a number of independent light sources equal to the number of subframes, to reconstruct a light spectrum at each pixel. If this number is equal to or larger than the number of photoreceptor types of a given animal, and if the refresh rate of the hardware is higher than the flicker fusion rate of the animal, the algorithm detailed above can be applied to reconstruct patterned images. However, when either or both of these conditions are not met, the method is not suitable. If there are fewer subframes than photoreceptor types, the gamut of the system will be too small to properly reconstruct most images. If the flicker fusion rate of the animal is higher than the refresh rate of the hardware, the temporal mixing will not work, and the subframes will be seen as flickering.Importantly, in such systems, For such cases, we have instead developed a different algorithm that can alleviate either problem, by allowing the use of a higher number of light sources than subframes and using the high spatial-spectral correlations existing in natural images, to optimally mix light sources in each subframe. We take advantage of modifications to some projector systems that allow a more flexible use of their subframe structure. This flexibility in practice lifts the requirement of one dedicated light source per subframe, giving the user control over the spectral composition of each subframe ,39.X (sources × subframes) and pixel intensities P (subframes × pixels) for each independent subframe, so that they match the target photoreceptor excitations E (photoreceptors × pixels) of the whole image:ℓ and upper u bound intensities they can reach, whereas the pixel intensities are parameterized, so that 1 allows all light from the light sources to go through and 0 does not allow any light to go through (i.e. luminosity). We fit P and X using an iterative approach similar to common electron microscopy-type algorithms, where we fix either P or X at each iteration while fitting the other using the same nonlinear least-squares approach as previously. To initialize both P and X, we first decompose the relative capture matrix of the image Q (photoreceptors × pixels) using standard non-negative matrix factorization. This returns two non-negative matrices 0P (subframes × pixels) and 0Q (photoreceptors × subframes), whose dot product approximates Q. 0P is normalized so that its maximum is 1 and used as the initial matrix for P. For each column—i.e. each subframe—in 0Q, we apply the nonlinear transformation to obtain excitation values and then fit light source intensities according to our objective function in equation  to obtain a good fit for reconstructing the image.As pixel intensity and light source intensities can be manipulated independently, the aim of our algorithm is to find the best light source intensities equation . Using tR2 value of 0.753. In such cases, hardware limitations may prompt the experimenter to use more subframes at the cost of the projector frame rate.As an example, we fit a hyperspectral image of a calendula flower  given th. 7While studies in trichromatic primates have benefited from the wide adoption of consistent methods for designing chromatic stimuli, studies in other animals have suffered from a lack of uniform methodology. This has resulted in difficulties in comparing experimental results both within and between animals. More generally used chromatic stimuli—e.g. using monochromators or standard RGB displays—also do not take into account the colour space of the animal under investigation and usually give an incomplete description of the properties of a colour vision system. Furthermore, with the currently available techniques, it has been challenging to design more natural stimuli, especially natural images, and thus understand the role of spectral information in processing ecologically relevant scenes.Here, we present a method for designing chromatic stimuli, founded on colour theory, that resolves these issues and can suit any animal where the spectral sensitivities of photoreceptors are known using a minimal visual stimulation system. Specifically, we provide a series of tools to reconstruct a wide range of chromatic stimuli such as targeted and random stimuli as well as hyperspectral images. We offer refinements to our methods to handle various nuances of colour vision, such as uncertainty in spectral sensitivities or handling out-of-gamut colour reconstruction. Even though our methods are hardware agnostic, we provide guidelines for assessing the suitability of a given stimulus system or selecting de novo light sources. Because our methods do not depend on the stimulation device itself, they can serve as a colour management tool to control stimulus systems within and between laboratories and therefore improve reproducibility of experimental results.drEye contains other tools that we have only mentioned briefly or omitted. These include efficient and even sampling of the available gamut, designing metameric pairs in underdetermined stimulation systems, and finding silent substitution pairs [drEye API and have created an accessible web application, which will be easy to use, regardless of coding proficiency.In addition to the tools that we present here, our Python package on pairs  (e.g. elon pairs . With th


Advances in conceptualizing settings in health promotion include understanding settings as complex and interlinked systems with a core commitment to health and related outcomes such as health literacy. Traditional settings for the development of health literacy include health care environments and schools. There is a need to identify and conceptualize non-traditional and emerging settings of twenty-first-century everyday life. The aim of this conceptual review is to inform a conceptual model of a “non-traditional” setting for the development of health literacy. The model uses the example of the public library to propose four equity-focused antecedents required in a setting for the development of health literacy: the setting acknowledges the wider determinants of health, is open access, involves local communities in how it is run, and facilitates informed action for health. The review concludes that a settings approach to the development of health literacy can be conceptualized as part of a coordinated “supersetting approach,” where multiple settings work in synergy with each other. The World Health Organization has long recognized that settings can be health-promoting or health-threatening: “[i]f health is everywhere, every place or setting in society can support or endanger health”  (p. 65).The place or social context where people engage in daily activities, in which environmental, organizational and personal factors interact to affect health and wellbeing.Health literacy is a domain of health promotion and enables people to access, understand, appraise, remember, and use information about health . Health One of the Ottawa Charter's action areas focuses on creating “supportive environments” for health, but the Charter has not formally kept pace with the expansion of everyday settings for health  to incluThe supersetting approach, or “settings approach 2.0” , is one Community-based and informal education settings broadly accessible to people include “extended classrooms” such as “parks, shopping centers, community centers, or libraries”  (p. 146)Despite evidence internationally in support of the potential role of the public library in public health and, to some extent, health literacy , 28, 29,via a conceptual review can foster “revitalization of existing theory,” or even “novel conceptual insights” .A conceptual review of the settings-based approach was conducted using a systematic process of searching across databases and gray literature, and reading the retrieved literature critically to map and clarify this concept in its historical and social context . While tThe first stage involved defining the settings-based approach in health promotion and distinguishing it from related concepts by formulating and applying eligibility criteria to separate out instances of conceptual conflation and terminological confusion. The second stage used citation analysis of canonical or pertinent sources , 33, 36 The results of the conceptual review are presented as themes that each reveal a tension in the narratives around settings and ways in which the concept has been clarified or developed, such as using complexity theory to represent settings as systems. Overlapping concepts identified from the literature are used to organize the results based on how the public library setting is understood: as a “setting for health,” a “system,” a “health-literate organization,” or part of a supersetting approach. The results inform a conceptual model of the public library as part of a supersetting approach.in a setting , and settings-based health promotion   , 32. In vention) , under aThe emphasis on “traditional” settings for health—“healthy cities; health promoting schools; healthy workplaces; healthy islands; health promoting hospitals; health promoting prisons and health promoting universities”  (p. 30)—The settings-based approach understands settings as complex systems with inputs, throughputs, outputs, and impacts  in relatSocioecological models identified in the conceptual review span theoretical stances and include a model of a non-traditional setting (a sports club) that shows the reciprocal interaction between setting- and individual-based factors for health at macro-, meso-, and micro-levels , and a mA further model identified in the review refers to an “equity-focused settings approach,” or “settings praxis”  that attWork on healthy universities  suggestsAnother concept in the literature is health-literate organizations (HLOs), which by design support people to “systematically orient their daily routines toward HL [health literacy]”  (p. 464)The HLO concept has several related terms, including organizational health literacy, health literacy-friendly organizations , 44, 45,Work side by side (if not together), complementing each other […] Settings that have adopted a health promotion approach can easily become health literate settings and vice versa, because structures and processes have already been reoriented and important changes (including awareness) have already been implemented   recognize and accommodate diverse traditions and health literacy strengths, needs and preferences to create enabling environments that optimize equitable access to and engagement with health information and services, and support for the health and wellbeing of individuals, families, groups and communities  (p. x).To date, the HLO concept has been mainly used with health care environments , and recThe settings-based approach is “explicitly determinants-focused”  (p. 46).Conceptual models provide a reference-point for theorizing settings-based approaches and a reminder to attend to the interconnection between macro-, meso-, and micro-levels of a setting that inform a socioecological, whole-system perspective . The conThe identified antecedents are as follows:A public library…Acknowledges the wider determinants of healthIs open accessInvolves local communities in how it is runFacilitates informed action.in a setting and a comprehensive settings approach: the partner settings depicted here are intended to support a comprehensive approach. Further example settings could include sports clubs and healthy universities, based on their steady emergence in the settings literature as non-traditional settings for health and health literacy  and work intersectorally (with porous boundaries to facilitate partnership work with other settings). In the example of the public library, all four antecedents are in place and position the library as part of a wider network of settings . The model demonstrates the “connectedness”  (p. 10) The supersetting approach is a socioecological approach that builds on local knowledge and resources, is context-sensitive, and emphasizes participation . It is iThe supersetting approach, as an intervention strategy for comprehensive community interventions, works through coordinated engagement of multiple stakeholders in multiple settings to mobilize local resources and support collective community action . It has Sundhed og Lokalsamfund, “Health and Local Community”) marks the entry of the supersetting approach into the literature (biblioteket (library) appears as a label in a figure of the supersetting approach based on the 2014 original The conceptual review highlights how so-called non-traditional settings might support and enable the “project” of health literacy if this project is a collective endeavor, undertaken with support from other settings. It contributes a conceptual model of the public library  operating as part of a supersetting approach. The model theorizes the antecedents that need to be in place for the public library to be an enabling environment for health and health literacy in partnership with other settings, and points toward further areas for investigation.in settings to active “settings for health,” the conceptual review proposes a coordinated supersetting approach. The supersetting approach is increasingly discussed in the literature Many of the settings listed by the World Health Organization as settings for health do not have all the modeled antecedents consistently in place, including Health Promoting Schools (HPS). HPS are frequently represented in the literature as promoting health  and healConsidering that health literacy is a setting-specific social practice , focusinThis review has synthesized research and gray literature on settings from the 1980s to date. The results delineate how, despite the longstanding importance of settings for health and the settings approach in the development of health promotion and World Health Organization strategy, theorizing about settings remains under-developed . The revUnderstandings of the antecedents required so that settings can develop into settings for health and health literacy are advanced by a systems perspective and a supersetting approach that brings together multiple  settings to create and sustain supportive environments for health. This review has used the example of the public library to show the potential for a non-traditional setting for health, when part of a supersetting approach, to promote health and develop health literacy as “a whole-of-society endeavor—at the individual, community, and national level” that works “across sectors, not just health” . The dirConceptualization and writing—review and editing: CJ, SS, and JW. Writing—original draft preparation: CJ. Supervision: SS and JW. All authors have read and agreed to the published version of the manuscript.


The findings from qualitative research (QR) have much to offer medical science.Findings from QR lead to an understanding of the perspectives of those experiencing the event under investigation.It may answer questions around ‘how’ and ‘why’, as well as ‘what’.Learning points Qualitative research plays a valuable role in complementing quantitative research, although traditionally it has been undervalued within the medical sciences. Clinical trials, other experimental evaluations and cohort studies are usually prospective observations of large numbers. In contrast, qualitative research is more in‐depth, exploring small populations that share a common characteristic or attribute, often by suffering from a specific health problem . For example, when embedded in pilot or feasibility studies, pertinent insights into the acceptability of an intervention may be elicited because participants can introduce and reflect upon issues of importance to them. Although not generalisable to the wider population, qualitative research may lead to knowledge that can improve patient experience and outcomes.Qualitative research allows stakeholders to influence research by raising issues that have not have been considered. It can react to the unfolding of events and constant review may lead to the adaptation of research questions or interview guidelines. This is not necessarily a linear process, but may be cyclical. However, to increase rigour it is important that the process is transparent and traceable.Findings from QR lead to an understanding of the social world from the standpoint of those experiencing the social phenomenon or event under investigation. It provides rich, in‐depth data, and can answer ‘how’ and ‘why’ questions, as well as ‘what’. QR explores complexities, nuance and seemingly contradictory positions that people may hold in the context of their lives, and the experience of people who are typically under‐represented in experimental studies, such as clinical trials.never undergone a TOP before,one TOP more than 2 years ago,more than one TOP within the previous 2 years.The quantitative survey revealed that the third group were less likely to own their own homes, and more likely to report both consistent and inconsistent contraceptive use. Qualitative interviews were then conducted with 23 of the women from the third group. It was found that most women from this group were not using TOP as contraception, and had tried various methods to prevent pregnancy. It was also found that women from this group had specific vulnerabilities, including inter‐personal violence, mental health problems, socio‐economic disadvantage and relationship difficulties. Although the experiences and reasons reported by participants are familiar, the women described distinct experiences for each pregnancy, not just a repeating scenario, which highlights the dynamic and complex nature of women’s lives . Contextualising the vulnerabilities highlighted provides an understanding of women’s needs around the time of a TOP that can influence the provision of sensitive healthcare.The following study exemplifies the value of qualitative research. A mixed methods study, combining a quantitative survey with a qualitative interviewing, on experiences of women undergoing termination of pregnancy (TOP) compared those who had: 1BMJ from 76 researchers provides a coherent argument for medical journals to be more receptive to the findings of qualitative research. http://www.bmj.com/content/bmj/352/bmj.i563.full.pdfThis open letter to the editors of the http://www.qualres.org/This website provides a comprehensive guide to designing, reporting and reviewing qualitative research in healthcare settings. None declared. Completed disclosure of interest forms are available to view online as supporting information.Elaine Denny and Annalise Weckesser contributed equally to the paper.Appendix S1Click here for additional data file.Appendix S2Click here for additional data file.


Diagnostics attempted to visualize trigger points and contracture knots with high-definition ultrasound. Based on their findings, the authors reversed the commonly understood meaning of the two terms. However, they did so without providing any convincing evidence. The authors maintained that their sonography images represented trigger points within contracture knots, supporting the multiple loci hypothesis. On review of the paper, both conclusions seem premature and rather speculative.A recent study published in  Diagnostics, Ball et al. [In a recent study published in l et al.  attemptel et al. ) using hl et al. , but theFor the record, prior to preparing this comment, the first author did communicate with the first author of the paper in question to clarify their intentions. We have collaborated previously with the authors in several other publications ,6,7,8,9 contraction knot is more commonly used than the term contracture knot, but since taut bands may be contractures and not contractions, contracture knot may be a more accurate term. The nature of the taut band, however, has not been definitively determined, and there may be alternative explanations to explain the finding of a taut band.There is a general consensus in the myofascial pain literature that “a TrP is a hyperirritable spot in a taut band of a skeletal muscle that is painful on compression, stretch, overload or contraction of the tissue, which usually responds with a referred pain that is perceived distant from the spot . An inteContracture knots are considered to be associated with dysfunctional motor endplates featuring an excessive release of acetylcholine, decreased acetylcholinesterase activity, and increased responsiveness of acetylcholine receptors . The beswithin TrPs [Ball et al. reported that researchers at the US National Institutes of Health identified “ischemia and hypoxia within TrP areas with surrounding hyperperfusion”, which is an inaccurate citation and interpretation of the referenced studies ,16. Whilhin TrPs , unlike hin TrPs .The second paper cited by Ball et al. applied a microanalytic technique with immunocapillary electrophoresis and capillary electrochromatography to investigate the biochemical milieu of the upper trapezius muscle in subjects with active, latent, or absent TrPs compared to the gastrocnemius muscle, and did not include any perfusion studies . Yet, BaNext, Ball et al. maintained that “the terms “contracture knot” and “TrP” have been used interchangeably,” which in their view constituted a “lack of clarity in objective definition of these two terms,” leading “to unnecessary communication difficulties among clinicians and researchers.” Ball et al. referenced a historical review of the field by Shah et al., which mentioned that “a trigger point complex in a taut band of muscle is composed of multiple contraction knots” . A seconBall et al. cited two older papers by Hong  and HongBall et al. included ultrasound images of “TrP speckles” within contracture knots, based on the apparent assumption that contracture knots would present as larger hypoechoic (hyperperfused) areas and TrPs as small hyperechoic (hypoperfused) spots . They mawithin TrPs [It appears that Ball et al. misinterpreted the studies by Sikdar et al., who did not examine the degree of perfusion hin TrPs , which, hin TrPs , e.g., whin TrPs . Ball ethin TrPs . Furtherhin TrPs  citing Lhin TrPs . While Lhin TrPs .Even in the case reports provided by Ball et al., the authors reversed the commonly used terms when they stated that “we visualized that the palpable and hyperperfused contracture knot is actually a collection of much smaller nonpalpable hypoperfused TrPs at motor endplates residing within the palpable contracture knot” . The autIn the discussion section, Ball et al. confirmed their erroneous assumption that the common terminology used in the myofascial pain literature is incorrect and reversed the terms TrP and contracture knot, stating that “previous studies may have mislabeled contracture knots as TrPs” . The autOn the contrary, we continue to maintain that a TrP is a palpable clinical entity of muscle, which may consist of multiple contracture knots, although we recognize that even a region with multiple contracture knots may not be a palpable entity comparable to what clinicians may call a contraction knot. Palpation of a TrP does not assume any knowledge of presumed underlying pathology; it is comparable to identifying an enlarged liver, which offers no details of its underlying pathology either. Biochemical analyses have revealed elevated levels of a variety of inflammatory mediators, neuropeptides, catecholamines, and cytokines in the vicinity of TrPs ,25,26, aWith regard to the observed speckles, Ball et al. assumed these to be hyperechoic TrPs. However, apparently, they did not consider that the observed “speckles” could possibly represent common fibrous densifications associated with perimysial fascia and collagen, which may have no relation to TrPs . FibrousWe agree with Shah and Gilliams that “the pathophysiology is only beginning to be understood due to its enormous complexity”  and a huWhile we welcome innovative studies of the nature of TrPs, we do not recognize that Ball et al. are providing any evidence of “palpable contracture knots with smaller TrPs within.” Based on personal communication (10 May 2022), Ball et al., apparently aimed to work toward clarification and standardization, and redefining the definitions of contracture knots and TrPs may not have been the intended outcome. Nevertheless, labeling hyperechoic speckles on muscle images as TrPs seems premature and rather speculative.


Food is intrinsically linked to culture, identity, and for people with lived refugee experiences, cultural foods are a critical part of settlement into a new country, which is often a time of high stress and dislocation from friends and family. However, cultural foods in settlement countries may be unavailable or inaccessible, adversely impacting on food security. This systematic review aimed to identify facilitators and barriers to accessing foods in high-income countries for people with lived refugee experiences. Sixteen health databases were searched from June 2020 and April 2021 and 22 articles met the inclusion criteria. Bias was assessed using a modified thematic synthesis method and the relevant Joanna Briggs Institute risk assessment checklist. Findings were thematically synthesised and the socio-ecological model and postcolonialism were used as a lens through which the data was viewed. Analysis revealed three themes: “Practicalities and Pragmatism”; “Identity, Belonging and Placemaking”; and “Postcolonial and Societal Influences”. The determinants of food security were present across all levels of the socio-ecological model and people with lived refugee experiences used practical and pragmatic strategies to feed their families. Food was intrinsically linked to identity, belonging and placemaking, and as such, people preferred consuming cultural foods. Societies adversely affected the food security of people from refugee backgrounds by limiting their access to resources and restricting cultural food gathering practices, impacting on their ability to access or afford foods, especially cultural foods. To improve food security for people with lived refugee backgrounds, governments and organisations should collaborate with the cultural communities with lived experiences of accessing cultural foods, appreciate their strengths, and recognise the value of social and cultural capital. For people with lived refugee experiences, the decision to leave their home is generally involuntary, may be unexpected and sudden, and can be a time of high stress and dislocation from family and support networks , 2. On asocial, and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life” (our emphasis)  is hard to get and very expensive. We can buy only in Asian market, Asian grocery store, so all the foods, the Asian food comes from Los Angeles you know, California and some from New York City, so they cost … [a lot]. I mean … the vegetables are very expensive.” (Karen respondent) Given the low incomes prevalent in this population , 41, peoThe perceived safety and quality of foods in high-income countries was a recurring subtheme. People were concerned foods in supermarkets were less fresh, affected by long-term food storage practices, and in cultural stores, were sold without or past their expiry date. Participants were hesitant of ingredients in packaged goods, and importation of cultural foods meant they travelled long distances, possibly impacting on perceived quality , 46, 48.“I like Cambodian food because there is less fat and they use less chemicals. Here in the U.S, the chicken most of the time is injected with hormones; so they don’t grow naturally. I like fish, because it’s from the ocean and they don’t add chemicals to it.” These factors contributed to a mistrust of the quality and safety of foods sold in high-income countries, was quoted as the reason food was perceived as tasteless , 42, 44,Mistrust of legal systems embedded in the host country may leave people with limited options to seek help or uphold their legal rights. People reported concerns over being evicted from of rental properties, not having the same rights as other citizens, feeling they were unable to seek police assistance, and a fear of retaliation if crimes were reported .“Also the worry of [being] kick[ed] out by the landlord make us silent. Feeling that unequal right because we are not citizen[s] when we compete with the other household who are citizen[s]. Landlord doesn’t fix the house problems. Most [in the] Myanmar community like to rent the house with Myanmar landlord[s] in our community. If we see someone using … drug[s], we can’t call the cops because we can’t speak up. We don’t know where we can get … help from.” This may lead to underreporting housing maintenance issues and faulty kitchen facilities, or apprehension when travelling to grocery stores , 47. AddAt the interpersonal level, social support was associated with improved HFI for people from refugee backgrounds , 37, 39.“I ask [my friends], I am preparing this meal, where can I find good quality?[…] Where is the quality that I can trust? Did you try it? We have a group, us Syrians in Canada on “whats” [referring to Whatsapp] and “face” [referring to Facebook] so anybody who has a question, messages in the group and others answer, like almost 50 women in Canada” Utilisation was increased by community members teaching new arrivals about adapted cooking methods, equipment or sharing household goods . AvailabThere were many factors which affected FS at and above the intrapersonal level of the SEM. During the initial resettlement phase, it was found that people had competing priorities, such as learning the local language, attending orientation programs, caring for children, and finding housing and employment , 46. SomAt the interpersonal level, some had an important social responsibility to provide for extended family who may have resided in another country , 40, 48."I have to help when my mother calls, because my mother she has eight children, and they are little children in Africa, and I was the firstborn for my mom. So they call and say, “A dog bit your little brother and they take the flesh off,” and the money I was having, I send it on the same spot. So no food…” Additionally, institutional racism may have impacted on access to employment , 44, 47.The initial resettlement period was identified as a time of high stress, culture shock, and mental health disturbances . Some fo“[…] they have all this stress coming on them that […] from the society’s expectations of them to learn English, to access […] to get jobs and um, have their children in school and take good care of them. There’s a lot of, like, pressure on the families that’s kind of goes on top of everything that has to do with the food.” The level of formal education received prior to arrival by people with lived refugee experiences was found to be associated with improved HFS , 37, 38.This client has eight children and a wife back in ‘identified nation’–he feels too ‘guilty’ to eat food .These factors illustrate the bi-directional relationship between mental health and FI, where FI may lead to anxiety over obtaining enough food with insufficient financial resources, and guilt may lead to FI when people send funds overseas. Consequently, one study found a strong association between HFI and depression for people from refugee backgrounds .On arrival, people with lived refugee experiences are connected to resettlement services and agencies designed to facilitate settlement. Typically, these services provide an orientation, which is seen as an important part of the resettlement process providing valuable information and potentially facilitating FS . SupportThe settlement worker went on holiday and left this couple without skills to shop and manage money. They bought all food from a local deli and ran out of money. Their stove broke down and they had no way of cooking and did not know who to ask to get it fixed .This may indicate that agencies are under-funded, do not understand the needs of their clients or are unable to provide culturally appropriate services.Having access to personal transport was associated with increased HFS for people with lived refugee experiences and, when unavailable was cited as a major barrier to FS , 47, 48.Orientation and resettlement services may not necessarily understand the cultural significance of foods and may instead focus on informing their clients on where to find cheap and affordable foods, which may not be culturally appropriate , 18, 46.“We [her family] had issues with food stamps [Supplemental Nutrition Assistance Program (SNAP)] because we couldn’t remember how to swipe or use the pin number. Sometimes we would go to the grocery store and couldn’t remember our pin number and we would have to call our caseworker to remind us what the pin number was.” Food procurement can be difficult when the community and environment is not inclusive to the needs of residents. Difficulties navigating the food environment were associated with increased HFI for people with lived refugee experiences , 38. Pub“Sometimes since I don’t know the language my heart gets tired. My mind is not happy either since I don’t know the language. Sometimes, it like my mind is just so done with it.” Having a supermarket in the neighbourhood was associated with increased availability of cultural vegetables . HoweverThe role of food in building and maintaining identity, belonging to culture and community, and placemaking emerged as a theme.Foods was embodied in culture and cultural identity, and provided a connection to home, people, places and between the past and present , 43, 46.“When we are eating our foods we feel like we are in our country again” This was especially important when people with lived refugee experiences arrived in high-income countries where aspects of their culture, such as language, dress and food, were not necessarily understood in the broader community . Consequ“We have done this for a long time. We do not want to change our culture. We want to keep our culture, eating the same stuff we were eating before” Mealtimes were identified as an important opportunity to share culture and connect with family and friends, and people often preferred in-home and family orientated meals , 40. In The intrinsic nature of food and culture extended to procuring, preparing, and consuming food. Where food could be acquired using cultural ways, settlement was positively impacted . Gardeni“When we live back there [Burma] we cultivate, and when we come here, if we don’t cultivate, it is uncomfortable for us. Cultivating is like living in our house, our country. It seems like that and it enjoyable for us.” In contrast, some participants described their disappointment and distress at being unable to obtain foods in culturally appropriate ways , 45, 46.The following subthemes explore some of the factors which impacted on the meaning of cultural foods and affected the identity, belonging and placemaking of people with lived refugee experiences who arrived in high-income countries.When cultural foods were not easily available or accessible, people from refugee backgrounds experienced anxiety over obtaining sufficient cultural foods , 45, 49.One participant stated that food shopping was “very scary and that it made her worry”, so only her husband went shopping for the first year These feelings of distress and anxiety may be exacerbated when religion prescribes fundamental rules around food, and substitutions are not permissible. For example, people following Islam consume only halal meat products and other foods are strictly prohibited (haram), however, in high-income countries these may be difficult to find and expensive , 44, 45.“When I buy canned food I have to read the ingredients and this is a challenge. I don’t buy anything that I don’t know. If I don’t know the ingredients or if it has gelatin or preservatives, I don’t buy it. I have to know it and this is a big challenge” This may lead to anxiety over finding religiously sanctioned foods, and mistrust of foods and their labels sold in settings where halal identified products were not commonplace, such as supermarkets and restaurants., 40, 44 “Even in the vegetables, they say ham flavour, so we have to check everything.” On arrival, people were often physically distanced from friends and family, and felt isolated with less opportunities to socialise , 45, 47.“Like the most important thing is social life. I noticed that it is not available here. Like you are now in Syria, you are in a neighborhood, like: “good morning, my neighbor! Come for coffee. Come for tea.” You find yourself happy every day. Here, nothing. No social life. No interaction between people here. It is difficult how they’re living here.” Cultural foods helped to re-establish community, family, social networks, and identity by bringing people together to share a meal , 40, 43.“Yes, I am happy, so I want other people to eat our food too … other people are interested in Burmese food, I encourage them to eat our food.” Showcasing foods at significant celebrations and ceremonies with the wider community created a greater connection to the new country and allow people to feel pride in their culture and cultural foods , 43. ShaThe intrinsic connection between food and placemaking positively altered foodways and improved FS . As commFurthermore, private gardens in homes are rapidly expanding and are providing for their community, as well as supplementing incomes by sending specialised produce, such as rosella leaves, off to market locally and interstate. Sought after seeds are exchanged amongst the community and horticultural knowledge is highly valued and passed on .A mix of reshaping the food environment and dietary acculturation influenced those who had resettled but also other residents as they began consuming new foods . PlacemaAt the community and environment level, people may be food literate in their home country, but not necessarily in the arrival country because the range of foods available, and their nutritional value and meaning can be different depending on the context. Some people who regularly experienced food shortages, strived to consume enough food for their energy needs , 42, 48.In further discussion, participants mentioned that people in their villages often experienced food shortages and worked hard to afford 2 meals. Hence, it was difficult for them to comprehend that certain food elements could also lead to poor health .Additionally, some cultural foods were sought after for nutritional properties that were rare in the home country. For example, Henderson et al.  reportedThis review identified many of the challenges to FS for people with lived refugee experiences were caused by societal expectations and norms, and political structures which were infiltrated by colonial ideas.Changes to social networks, living environments, and school and work commitments impacted on the ability of people with lived refugee experiences to consume cultural meals in a cultural way , 43, 46.In Somalia this is typically taken at lunchtime and involves the whole family. Women reported ongoing difficulties in shaping an alternative arrangement that met the dual objectives of bringing the family together and ensuring an appropriate food intake .Societies which valued self-sufficiency meant extended family members, who previously cooked together to prepare family meals, were sometimes working in the new country and unable to help prepare these meals . Food prOne participant had a preference for a very time consuming ‘hot soup’ made from beef or goat bones. In Myanmar such a soup would be purchased from a neighbourhood stall, or would be cooked up for a whole family by a mother, grandmother or aunty. In Coffs Harbour this participant now has Weet-bix for breakfast .Societal expectations and norms in the working environment and school setting also influenced food choices away from cultural foods. In some cultures, it was typical for family members to return home at noon for a family meal . In the [Newcomers will say] “show me how to make a lasagna, a vegetarian lasagna, show me how to do, you know, more Canadian stuff.” You know, because if they take it to work, you know it doesn’t smell as much, right? Children were particularly influenced by the pressure to fit into the social environment, and consequently, pressured parents to provide non-cultural foods which were similar to their peers , 46, 47.Gender roles were often viewed differently in the new country, which impacted on cultural belonging, mental health and FS. In some cultures, it is typical for women to be responsible for childcare, household management or food preparation, shared among extended family members , 45. How“I found that trauma is more evident in the men because they come from a culture where the man is the breadwinner and the decision-maker and the new situation emasculates them. The women come here they already didn’t know anything so they are more eager to learn and more receptive to learning and so the man has to act as capable and wants to be seen in her eyes as relevant. The child tax benefit plays a major role in conflict because it comes in the name of the woman. So for the first time this woman, who never had anything and it comes in her name. So the man feels emasculated.” At the political level, neoliberal influences were seen in the welfare system as it provided insufficient entitlements, late payments, and eligibility criteria set too high for people with cultural needs , 44–46, “they [nutrition assistance program representative] sent me paperwork for reviewing, and I didn’t know what to do with this paperwork. After that I found no more money in the account.” This also applied to other forms of income, such as establishing a business which required registration paperwork to be filed .“It’s really hard to open a shop because it requires certificate II or III, not like in India [her transition country].” These requirements were not inclusive of people with lived refugee experiences that may have minimal formal education, poor literacy levels, lacked important documents or were still learning the local language, and therefore often struggled to complete the required forms , 47, 48.In the United States there are two important food safety nets provided by the government, Supplementary Nutrition Assistance Program (SNAP) and special supplementary program for women, infants and children (WIC). These programs are designed to supplement other government welfare entitlements to provide additional access to food and are considered reliable food safety nets , 41, 47.Institutions may be structured in ways that are not inclusive to the needs of people with lived refugee experiences. Orientation services include courses, such as English as a Second Language, which can improve employability and therefore income and FS status. However, these courses were found to be inflexible to competing priorities, such as childcare, and when employment was gained before the course was completed, some people found they had to choose between completing the course or losing their job , 37. ThiHousing and neighbourhoods can affect FS and was also influenced by postcolonial political and social ideologies. At the public policy level, town planning was not inclusive for people with lived refugee experiences, who were overlooked in community consultations, resulting in cultural stores being located at a distance from where people live and poor public transport connections to cultural food environments , 47.“I am not able to go to the Sunday market (farmers’ market) as it is in (name of neighborhood) and I do not have a car. It is very difficult to travel on the train with food and children. Even when I go with the train, the market is far from the train station.” Landlords often displayed stereotyping, discrimination, and racism towards people from refugee backgrounds. Some people reported homeowners were unwilling to carry out basic maintenance, leaving residents living in unacceptable and unsanitary conditions, affecting their food safety , 47. Oth“In Australia we have difficulty finding a place to rent for several reasons. First, we are a big family and second, our family relies on Centrelink payment and landlords are not trusting us that we can afford their rent.” Some found alternative housing were difficult to locate or deposits were forfeited if they left, suggesting limited choices regarding housing options , 47. SomUsing a postcolonial lens, dietary acculturation, that is, encouraging people to adopt the diet of the host country, was a reason behind the lack of success of interventions aimed to address FI. Programs which focused on improved access to local foods, such as foodbanks and community gardens, or knowledge and skills development about local cuisine using nutritional education programs were often culturally inappropriate and did not meet the needs of people with lived refugee experiences , 45, 46.“The school will pick and choose kids that have difficulty in having enough food to eat. So, they send the food home with the kid, and I get the food. It’s basically the surplus of the food that school has” Where interventions met the needs of people with lived refugee experiences and considered the significance of providing cultural foods, their value may not have been recognised and they struggled to obtain ongoing funding and were subsequently shut down , 46. PeoCultural food gathering practices such as foraging, fishing and growing foods provide people from refugee backgrounds agency over their foodways , 47. HowOne respondent noted, for example, that she would forage for plants in the urbanscape but was threatened by a police officer with a ticket for removing the plant .The rules, regulations and policies described were implemented without consideration of the needs of people with lived refugee experiences or local Indigenous populations that may have similar practices, and consequently reduced access to food and worsened FS.This review has highlighted that individuals and communities displayed remarkable strength and resourcefulness when accessing food, and cultural skills were protective against FI. Individuals drew on food skills and knowledge, dedicated extraordinary effort to navigate the food environment, and supplemented their food supply by using culturally appropriate and sometimes cost-free methods , 47, 48.The resilience of people and communities with lived refugee experiences was identified by using a strengths-based approach. Two studies by the same author investigated the social and cultural role of food in placemaking, which is a strengths-based approach , 43 and Some selected articles explored the healthiness of cultural foods , 46, 48,A deficit-based approach is not uncommon in research, with academia historically overlooking the impact of discrimination and other upstream factors on health . PreviouThis review was underpinned by a rigorous search strategy and methodology approach. It does, however, have some limitations. The selected articles were all conducted in three countries  and therefore the findings may not be generalisable to other high-income countries. All articles were included in the review regardless of their quality assessment. However, the contribution from those of lower quality were supported by higher quality articles, and therefore were relevant.The findings from this review highlight the complex and interrelated factors at all levels of the socio-ecological model that affect FS for people with lived refugee experiences. Governments, organisations and institutions need to acknowledge the fundamental influence of prevailing political and social structures and the limitations they place on the agency of people and communities from refugee backgrounds to integrate their cultural foods into their diets. Cultural foods are instrumental to the identity, culture, and spiritual and physical health of people with lived refugee experiences. Policy makers should strive for policy changes that actively work to embrace cultivate inclusivity and remove bureaucracy across all levels of government and government action. Additionally, public health workers, clinicians, community support workers, case workers, and all organisations and institutions should endeavour to work in collaboration with cultural communities, appreciate their strengths, and recognise the role of social and cultural capital and the importance of accessing cultural foods.S1 Checklist(DOCX)Click here for additional data file.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.S3 TableAvg = Average, Yrs = Years, Mths = Months.(DOCX)Click here for additional data file.


Behavioral diversity is sometimes used by animal scientists to better understand and compare how animals behave. The methods used in behavioral diversity research have not been investigated across the entire research sector. This paper aims to identify which methods are being used in behavioral diversity research and find some novel methods from other areas of science that could be used in new research. To investigate the techniques and species investigated in behavioral diversity literature, a literature search was conducted. Two methods: behavioral richness and the Shannon–Wiener index, were the most often used methods, whereas the Behavioral Variability index featured rarely. While a range of species appeared in the behavioral literature, mammals were the most frequently studied animal group, whereas amphibians did not feature in any papers. There are several diversity indices which did not feature in behavioral diversity including Simpson’s index, and Chao. These methods could be used to better understand animal behavioral study outputs or be used to estimate the number of ‘unobserved’ behaviors that an animal may express. Future studies could therefore make use of these unused tools.Behavioral diversity is a commonly used tool used to quantify the richness and evenness of animal behaviors and assess the effect of variables that may impact an animal’s quality of life. The indices used in behavioral diversity research, and the study subjects, have not been formally reviewed. This paper aims to identify which indices are being used in behavioral diversity research, and under which scenarios, and uncover novel indices from other disciplines that could be applied to behavioral diversity. To investigate the techniques and species investigated in behavioral diversity literature, a Web of Science literature search was conducted. Two methods: behavioral richness and the Shannon–Wiener index, were the most frequently used indices, whereas the Behavioral Variability index featured rarely. While a range of species appeared in the behavioral literature, mammals were the most frequently studied Class, whereas amphibians did not feature in any papers. There are several diversity indices which did not feature in behavioral diversity including Simpson’s index, and Chao. Such indices could be used to better understand animal behavioral study outputs or be used to estimate the number of ‘unobserved’ behaviors that an animal may express. Future studies could therefore extend beyond the Shannon–Wiener and richness indices. Behavioral diversity indices are frequently used in animal behavioral research . The indWhile also used for other research types, behavioral diversity is sometimes used to measure animal welfare. The theory here is that enriched animals have the opportunity to engage in a much wider range of behaviors that those in impoverished environments. Similarly, an animal that is experiencing poor welfare due to chronic pain or stress may choose to remain inactive for long periods, even when opportunities are available. Some animals in similar positions engage in stereotypy; long bouts of repetitive, functionless behavior that also result in low diversity scores on account of their invariant nature ,7. An anSeveral cautionary notes have arisen regarding the application of behavioral diversity to animal studies . There aBehavioral diversity is a measure in that it can be applied alongside other welfare tools. In addition to behavior, this measure has been previously applied alongside other welfare-related metrics such as enclosure use indices ,13,14 orBehavioral diversity has potential as an objective comparative measure in carefully planned behavior studies. Behavioral diversity could be used to measure the impact of an intervention such as an enclosure move, novel environmental enrichment, or training effectiveness ,17,18,19While an excellent review of behavioral diversity literature is available in the literature , there i™ database. The search period was set for a 71-year window (from 1 January 1951 to 31 December 2021). The search terms used were “behavioral diversity” or “behavioural diversity” followed by “animal”. Papers were counted if they were original research papers and had behavioral diversity outputs for named animal species. Papers were excluded if they were reviews, did not state the species under investigation, or did not provide any behavioral diversity outputs. Papers that did not investigate living organisms explicitly  were similarly excluded. For all included papers, the species being studied and behavioral diversity index that was used was recorded.Relevant papers were identified using a search of the Web of Science To identify other potential diversity indices, an ad hoc sample of studies from ecology and microbiology were identified, because both fields commonly investigate the diversity of species in their respective areas. Papers were identified by using the search term ‘species diversity’ plus ‘microbiome’ or ‘ecology’ using the database and timeframes detailed above. A convenience sample of papers were collected from these searches, but it was beyond the scope of this paper to summarize all papers. The species diversity indices from these papers were noted along with their equations.A total of 52 papers were identified from the literature search, with a total of 112 species investigated in these papers. Here, the term ‘paper’ is used to describe a published manuscript, whereas the term ‘study’ is used to define specific experiments/observations. Therefore, a paper could contain more than one study, particularly on occasions where multiple species were observed. The most common method of behavioral diversity assessment was the Shannon–Wiener index with 79 individual species studied using this method, with behavioral richness (the number of behaviors observed) also appearing commonly (31 species studied) . The BehWhile the Shannon–Wiener index and behavioral richness are regularly used, many potential indices have not yet been applied to behavioral diversity studies. These potential tools include Simpson’s, Menhinick’s and Chao indices . These tBehavioral richness is the simplest measure available. Behavioral richness is defined as a measure of the number of behaviors observed during a set period . For exaAs behavioral richness considers only the number of behaviors seen, it does not take into account the evenness with which these behaviors occur. For example, animals will receive identical scores if they perform the same number of behaviors, regardless of how evenly they perform them .Another challenge faced by behavioral richness is it cannot control for sampling effort. This challenge emerges in situations where one animal is observed more frequently than another . Here, the researcher is intrinsically more likely to identify higher behavioral richness to the visible animal, despite the fact that the two may actually be similar in behavioral diversity . While tThere are also challenges in that detailed ethograms are not always available, even for some commonly housed species. To address this, further basic behavioral science is needed to better standardize how behaviors are measured. Simply stated, richness will vary based on the use of different ethograms or behavior types observed, which makes interpreting different richness results across different settings and studies difficult.The Shannon–Wiener index appears to be the most commonly used behavioral diversity index ,31,32. Wip refers to the proportion of time the animal spent engaged in the ith behavior [H′ value per number of behaviors seen: this occurs when all behaviors are equally represented  and 0 (highest diversity). Many researchers find these numbers counterintuitive, with the lowest diversity resulting in the highest value. As such, the second index, Simpson’s index of Diversity, was produced. This index can be calculated by simply deducting the Simpson’s index from 1, (1—Simpson’s index), and results in inverted values, where 1 demonstrates highest diversity and 0 the lowest. The final index, Simpson’s Reciprocal index, can be calculated as 1/Simpson’s index, where 1 is the lowest value and the upper limit is infinite  could be used to investigate differences in index values between conditions, but this depends on the questions being asked alongside test assumptions.Much like the Shannon–Wiener index, Simpson’s index is sensitive to both behavioral richness and evenness . HoweverPractitioners should note, however, that there is one potential shortfall to the three Simpson’s indices. Unlike the Shannon–Wiener index, which runs on proportional data, Simpson’s indices run on actual, observed values. This means that different values are generated when the number of observations made are larger. For example, two behaviors may occur equally commonly in two observations, but a different value will be generated if, for example, the animal was out of sight for a period of time see . This shR1) is:Menhinick’s index is a very simple index that has been widely practiced in ecology . The equS refers to the number of behavior categories, and N denotes the total number of observations. Values vary, with a minimum value of 0  and maximum values extending beyond 1 (lots of behaviors seen with only a few observations). The value of 1 essentially indicates that the number of behavioral observations is equivalent to the square root of the number of behaviors seen. Thus, a value of 1 can be generated if four observations are conducted and two behaviors are seen, or nine observations are conducted and three behaviors are seen.Here, Unlike the Shannon–Wiener index, Menhinick’s index is not sensitive to evenness. An observation where all behaviors are seen equally, and an observation where only one behavior dominates, would therefore produce the same Menhinick’s value, so long as both observations were of the same length and the number of behaviors seen was identical. This, therefore, is a potential limitation to the index, as behavioral richness features much more prominently.The index, unlike the Shannon–Wiener index, is also much more sensitive to sample size (number of observations made). As a result, Menhinick’s index scores tend to become lower when more observations are undertaken .2R) is regularly applied in ecology [S refers to the number of categories of behavior, and N denotes the total number of observations. Unlike Menhinick’s index, this index uses a natural logarithm to generate index values. Values of 0 indicate lower behavioral diversity, with higher values indicating a higher number of behavior categories observed. As per Menhinick’s index, these values are reduced by N, with higher numbers of observations resulting in lower behavior scores  works by estimating the true number of species in an ecosystem or sample. The equation is as follows:The Chao index is well applied in the field in microbiology, where there is a need to assess large numbers of microbial species, often with many unobserved taxa . At currSobs refers to the number of species observed . F1 refers to the number of behaviors where only a single incidence of the behavior was observed across the observation period (singleton), and F2 refers to the number of behavior categories that were seen only twice (doubletons). From these data, Chao generates an estimate value for the true number of behavior categories the animal may express.Here, Chao index values are identical to the number of behaviors actually observed, unless single observations of a behavior category occur. The more single observations of behaviors that appear, the higher the estimates of the ‘true’ number of behaviors .In terms of value to researchers, the Chao index has great potential as a tool for pilot studies. The index could be applied to estimate the ‘true’ number of behaviors that an animal may express. For example, a researcher might observe a previously unstudied species for a short observation period using a standardized observation technique . The index can, however, provide excellent comparisons between habitats and provide some informed feedback in opportunities for animals to express natural behaviors. Finally, it is also worth noting that this index does not take into account aspects of behavioral evenness; only presence or absence of behaviors are recorded.The Behavioral Variety index (BVI) features in some animal behavior literature e.g., 20,21), and has some potential in investigating animal welfare. BVI requires a full ethogram of an animal its ‘natural’ state to determine the range of behaviors it may express [,21, and Overall, this study revealed that the majority of animal research papers that used the term ‘behavioral diversity’ made use of the Shannon–Wiener index ,41. The The Shannon–Wiener index is likely to be prevalent in the literature because it considers both behavioral richness and evenness ,43. It iIt is surprising that the second most common index of behavioral diversity was richness. While richness has value as a diversity indicator, it has several limitations . BehavioThe ability to estimate the true number of behaviors an animal may express is particularly novel, and achievable through the Chao index . This coIn future behavioral diversity studies, researchers could avoid some of the shortfalls associated with any single index by applying a combination of several indices. Such methods are commonly used in ecology and microbiology, where combinations in Simpson’s and/or Shannon–Wiener index, plus Chao, are commonplace ,26.Pan troglodytes) [Not all taxonomic groups were equally well represented in behavioral diversity literature. For example, mammals were the subject species for 75% (84/112) of the identified literature ,50. Of tlodytes) ,59,60,61lodytes) ,63,64, blodytes)  and invelodytes) ,67 speciSimilar trends in species bias have been identified in the animal literature, in which a few mammalian orders have been exceptionally well-studied, while and other taxa, such as reptiles, amphibians, and invertebrates, have not . Much oOther than a simple measure of the number of behaviors , the most commonly used measure of behavioral diversity in the animal behavior literature was the Shannon–Wiener index. While a straightforward and valuable animal welfare tool, there remain many unused indices in the behavioral diversity toolkit. Use of further measures, such as the Chao and Simpson’s indices, could allow researchers to make more informed decisions regarding the length of their studies, the frequency of their observations, and the number of behaviors that have not yet been observed. Diversification of index use, therefore, has great potential in providing a more holistic understanding of animal welfare for scientists. While taking heed of the limitations of the diversity indices, researchers should develop their use of these tools for a wider array of study subjects, taxa, and settings.