Knowledge of pesticide exposure levels in farmers is necessary for epidemiological studies and regulatory purposes. In the European pesticide registration process, operators’ exposure is predicted using the Agricultural Operator Exposure Model (AOEM), created in 2014 by the European Food Safety Authority based on studies conducted by the pesticide industry. We compared operators’ exposures during treatment days in the apple-growing industry under non-controlled working conditions and AOEM-predicted values. The dermal exposure of thirty French apple-growers from the CANEPA study when applying two fungicides was measured using body patches and cotton gloves. For each observation, the corresponding exposure was calculated by means of the AOEM, using data recorded about the operator, spraying equipment and personal protective equipment (PPE) used. A significant linear correlation was observed between calculated and measured daily exposures. The model overestimated the daily exposure approximately 4-fold and the exposure during application 10-fold. However, exposure was underestimated during mixing/loading for 70% of the observations when the operator wore PPE. The AOEM did not overestimate exposures in all circumstances, especially during mixing/loading, when operators handle concentrated products. The protection provided by PPE appeared to be overestimated. This could be due to the optimal working conditions under which the “industrial” studies are conducted, which may not be representative of real working conditions of operators in fruit-growing. Pesticide use for crop protection in agriculture developed in the 1930s and increased worldwide in the second part of the 20th century (2.3 billion tons in 1990 vs. 4.1 billion tons in 2018) (FAOSTAT). Europe is a major agricultural producer and pesticide consumer with 500,000 tons sold in 2018, including 85,000 tons for France alone (FAOSTAT). There are currently more than 1000 active substances on the market used in the control of pests, each with different chemical characteristics, targets and modes of action. They can be classified into three main categories: herbicides, insecticides and fungicides. Fungicides were the best-selling pesticide categories in 2018, representing 40% of total pesticides sold in Europe (FAOSTAT) .Guidance on the Assessment of Exposure for Operators, Workers, Residents and Bystanders in Risk Assessment for Plant Protection Products, in which the Agricultural Operator Exposure Model (AOEM) was described [Since 1993, the approval of pesticides has been regulated by the European Union and includes toxicological and environmental criteria. Toxicity assessments involve the consideration exposure prediction models that were initiated in the 1980s and 1990s based on national initiatives . In 1993, Van Hemmen demonstrated their limitations, namely, that they were based on unpublished and heterogeneous exposure studies with differences in protocols and statistics, and only contained data for some exposure scenarios . He recoescribed . This waescribed ,11. Thesescribed , open-fiescribed ,14, vineescribed ,16 and tescribed . Howeverescribed .The PESTEXPO project was initiated in the 2000s in France to study farmers’ exposure to pesticides under usual conditions of work. The main targeted crops were vine crops , open-fiThe CANEPA study was conducted in four widespread areas in France , over two agricultural seasons (in 2016 and/or 2017), on 24 fruit-growing farms. The study has been described in detail in a previous publication [Farm operators were observed and samples collected in order to estimate dermal and inhalation exposures and to determine factors associated with exposure. We focused here on dermal exposure since inhalation exposure is relatively limited compared to dermal exposure ,21,22,23Dermal exposure was measured using the skin pad method because it was more suitable for the work environment studied. It involved no change in the usual conditions of work as most of the workers did not usually wear a coverall especially during application, no interference with usual working clothes and no thermal discomfort or limitation of movement . This meThe two active substances studied were two fungicides very frequently used in fruit-growing: captan and dithianon. They were both measured in these samples, along with tetrahydrophthalimide (THPI), the major captan degradation product .All information about operators , farms  of crop(s)), weather conditions on observation days , type of personal protective equipment (PPE) used, equipment characteristics  and tasks carried out  were collected by field monitors face to face. Observation notebooks, videos and photos were used to record these auxiliary data. All data have been described previously elsewhere .The AOEM is based on 34 studies, constituting a database of 2900 exposure measurement values from 280 mixing/loading and 344 application phases, including all types of crops. About a quarter of the studies concerned a “high crop tractor/vehicle-mounted or trailed application”, corresponding mainly to fruit-growing and vine-growing. Six hundred and sixty-nine dermal measurements, obtained via whole-body dosimetry, were included in the model for this scenario: 265 for mixing/loading and 404 for application. These 669 dermal measurements corresponded to situations with unprotected and protected hands, body and head .During the development of the AOEM, more than 50 parameters describing the conditions of application were initially studied  . Thirteehttp://www.fao.org/pesticide-registration-toolkit/registration-tools/assessment-methods/method-detail/fr/c/1187029/, accessed on 15 July 2021). The data required to calculate operator exposure are the active substance used , the type of crop treated, the maximum rate of active ingredient applied (kg per hectare), the application scenario (indoor or outdoor application), the spraying method (upward or downward), the spraying equipment  and personal protective equipment (PPE) if worn during mixing/loading and application . During application, the presence of a cab on the tractor must also be specified. It is possible to mention other parameters such as the percentage of oral, inhaled or dermal absorption of the product and dilution, and the vapor pressure of the active substance. These data are then used to calculate the internal dose of pesticides absorbed, which is outside the scope of our analysis.The AOEM is available as an Excel program composed of several spreadsheets  for captan and dithianon and also as liquid in soluble concentrate (SC) for dithianon. The rate of active substance applied varied for each observation day and depended on the active substance used. Pesticide application on apple trees ocurred outdoors, the spray was upward and operators used a vehicle-mounted sprayer. Operators were protected with various forms of PPE: we considered coveralls as long working clothes associated with a hood, and the wearing of protective gloves as efficient.Operator Outdoor Spray AOEM worksheet summarizes the application scenario. A default value of the daily treated area (10 ha for pome fruit) was used to calculate the quantity of active substance used during the day.Adjusting these parameters automatically resulted in the estimation of other parameters. The All this information was used to calculate long-term (75th centile) and acute (95th centile) exposure of hands, body and head (protected or not) and inhalation during mixing/loading and application. The sum of hands, body (chest and back + arms + legs), head and inhalation exposure values during mixing/loading and application gave an exposure value for a treatment day lasting eight hours.Here is an example of the calculation equation used in the AOEM to calculate exposure  as it appears in the Excel cells:This equation can be simplified into:Exposure during mixing/loading and application, and of the different parts of the body, were calculated using this equation. Exposure was calculated using three factors, the values of which depended on the application scenario, the formulation of the active substance, the part of the body considered and the PPE worn: intercept factor , the amount applied factor  and the scenario factor (ranging from −1 to 1.83 for mixing/loading and from −1.64 to 1.89 for application). The values of these factors are detailed in another worksheet named “Operator_exposure_values_AOEM”. The values of these factors for the “pome fruit” scenario are presented in For each treatment day, operator exposure was measured in the CANEPA study and calculated using the AOEM.The variables used to calculate AOEM exposure have been described. We described these variables using the median because they were not normally distributed, according to the Shapiro–Wilk test.t-test). Each point of the scatterplot corresponded to one observation day. Each measured value had a calculated AOEM value.The relationship between measured exposure and calculated exposure was plotted and studied via linear regression , for mixing/loading and application separately, and for the different parts of the body. On some working days, the operator carried out several cycles of mixing/loading and application. In these situations, contamination values for each phase were summed to obtain the daily mixing/loading and application exposure values, respectively.All data analyses were performed using R , R Studio  and Microsoft Excel 2019  software.The amount of captan applied per hectare (ha) (median = 1.52 kg/ha) and per day (median = 10.32 kg/day) was greater than the amount of dithianon WG and SC applied per hectare  and per day (median = 1.4 kg/day for both). The median daily treated area was 5 ha (ranging from 1 ha to 18.3 ha). The AOEM calculated the amount of active substance used on the treatment day from the rate of active substance applied per hectare (kg/ha) multiplied by the treated area, fixed at 10 ha/day for the “pome fruit” scenario. The calculated amount of active substance used in a day was greater for captan (median = 15.2 kg/day) than for dithianon WG or SC  and higher with the model than by observation for 90% of observations .In terms of equipment used, sprayers were pulled (mounted or trailed) by a tractor and only one operator used a self-propelled vehicle. Two tractors did not have a closed cab. The presence of a cab on the tractor reduces the exposure during application, as calculated via the AOEM.®, DuPont, Wilmington, NC, USA) over working clothes in only 20%. Other PPE was used, such as aprons.Various forms of PPE were used during mixing/loading and application by operators, with gloves being the most common. Gloves, protective masks or other types of respiratory and head protection were more frequently used during mixing/loading (77% for gloves and 77% for respiratory protection) than during application (13% for gloves and 10% for respiratory protection). Body PPE was the same during mixing/loading and application: long cotton working clothes were worn in 67% of the observations, and chemical protective coveralls   . Overallp-value < 0.0001)  were linearly correlated  . When co 0.0001) a. This u 0.0001) c. Result 0.0001) b.p-value = 0.28) . The seven observations with the highest calculated exposure  were in operators who did not wear long working clothes . Hand exposure was overestimated by the AOEM, except in observations 26 and 28. Exposure values were very heterogeneous in terms of measured exposure, whereas there were two levels of values for calculated exposure: between 0.1 and 1 mg and about 10 mg, corresponding to operators wearing gloves or not, respectively . No linear correlation was observed  a. Body e clothes c. Concerectively b.The daily treated area was fixed at 10 ha/day according to the AOEM in the “pome fruit” scenario, whereas it was often less than 10 ha in CANEPA study. We manually modified the rates of active substance applied (kg/ha) in the AOEM “data entry” worksheet to obtain the actual amount of active substance handled on the observation day, considering the actual treated area. Thus, calculated exposure decreased after this modification, except in three operators who applied fungicides over more than 10 ha . Daily exposure and application exposure were then less overestimated  and mixing/loading exposure was more underestimated after these modifications  .In a context in which few data are available on pesticide exposure in fruit-growers, we produced independent academic results and compared the levels obtained in field observations to those predicted using the regulatory AOEM model. Overall, exposures measured in our study were lower than those calculated by means of the AOEM, although the distribution of the calculated and measured exposures mostly overlapped.However, some inconsistencies were observed when comparing exposure levels according to tasks  and considering PPE; thus, the model does not overestimate exposures in all circumstances. Specifically, the model appears to overestimate the protection provided by gloves and coveralls and underestimates the contaminations that occur during mixing/loading.Since our participants were volunteers, our population was not fully representative of French fruit-growers. Moreover, the average utilized agricultural area of the farms in which our observations were made, i.e., approximately 70 ha in total and 36 ha dedicated to fruit-growing, was higher than that of other French farms  . We therAlthough the participants were advised to proceed as usual, they may have changed their practices due to the presence of observers, a situation that would in fact tend to increase their attention and decrease measured exposure. The actual farming practices we observed were sometimes far from the so-called but not clearly defined “good farming practices”, which constitute the basis for the AOEM ,11. HoweFor body exposure measurement, we used the patch method, one of the OECD-approved techniques . However, over the years, whole-body dosimetry seems to have gained the preference of pesticide companies and regulatory agencies. We chose the patch method for several reasons. The main reason was to respect routine working conditions, including the wearing (or not) of PPE. Moreover, observations took place on days in the warm season where the outside temperature reached 34.5 degrees in the shade. Wearing coveralls would have caused discomfort in terms of movement and temperature due to the extra layer of clothing. The patch technique also requires fewer solvents and is less time-consuming, less expensive and more sustainable than whole-body dosimetry ,32. In fThe AOEM’s calculations are based on the following parameters for the scenario corresponding to the application of pesticide on apple trees: the amount of active substance applied, the formulation, the wearing of PPE and the presence of a cab on the tractor.The amount of active substance applied per day was a crucial parameter in calculating exposure. It was nearly three-fold higher in the AOEM in comparison to field observations, in relation with a 10 ha reference value for an area treated daily in the AOEM . Indeed,In our study, all operators but six used the WG formulation, so we cannot compare exposures according to the formulation. According to the AOEM, the granular formulation was associated with the lowest exposures, followed by the liquid and powder formulations. Several scientific publications also found that the formulation of the active substance impacted exposure and that WG forms were the least exposing ,33,34,35In the CANEPA study, individuals not wearing PPE were among the most contaminated during mixing/loading, whereas this was less obvious during spraying, a task during which the wearing of gloves was rarely observed. However, PPE heavily influenced the values predicted by the model and resulted in a strong divergence between predicted and observed values. Underestimation by the model was particularly observed among operators wearing gloves and long clothes during mixing/loading. However, the PPE proposed in the AOEM poses some problems, as it does not always correspond to the real field situations. In our field study, trousers were sometimes worn with a top covering the arms, and some operators wore coveralls over their working clothes. Exposure was therefore calculated in the same way for operators wearing only long working clothes that were not specific for chemical protection and for those wearing coveralls over them. In the study by Großkopf et al., working clothes reduced body exposure by 85–98% depending on the scenario, and protective gloves reduced it by 89–99% compared to bare hands during mixing/loading and application . In totaRegarding spraying equipment, all but two tractors in our observation were equipped with a cab, so exposure levels could not be compared. However, the proportion of tractors with enclosed cabs in the CANEPA study (93%) was higher than in the studies included in the model for fruit-growing (56%), which could contribute to the model’s overestimation of exposure.Several other parameters may vary during a treatment day and across farming populations in Europe, such as weather, worker status, the type of fruits grown, the size of orchards and the equipment used , and thiThe AOEM is intended to provide conservative exposure estimations, which means increasing protection for operators. Calculated exposure must be higher than actual exposure. To estimate operator exposure, the AOEM used the 75th percentile value, which is assumed to provide a rarely-exceeded estimate of daily exposure . HoweverDetermining the exposure of agricultural operators applying pesticides is a crucial step when approving pesticides for use in Europe. The current method is based on a deterministic exposure model, the AOEM. Exposure calculations are based on a limited number of tests and observations that are conducted and reported only by pesticide companies. Moreover, the number of parameters considered and the scenarios studied are limited, which make the use of the AOEM timely and easy. However, the question of how the parameters are chosen is very important and constitutes a major challenge, since they must accurately cover a range of scenarios and crops. They must ensure the safety of all European workers, regardless of how pesticides are used. As the AOEM is based on studies conducted by the industry under controlled conditions, it is crucial to test whether the predicted values match those observed in usual working conditions. Several academic studies have produced exposure measurements in different countries, for different types of crops and under different working conditions . To our


Cervus elaphus) (RD), roe deer (Capreolus capreolus) (RoD), and wild boar (Sus scrofa) (WB), the effect of time from shot to death on final pH, water-holding capacity (WHC), water content, and colour  was investigated. All analyses were performed on Musculus biceps femoris (BF). After shooting, the animals were divided into two categories . In RD, group B had significantly lower (p < 0.05) water content. In RoD, group B had significantly lower (p < 0.05) values of L* and b*. In WB, group B had significantly lower (p < 0.05) L* value and significantly higher (p < 0.05) pH value. The study proves that in BF of the three studied game species, the time extension from shot to death significantly affects the final water content values in RD, L* and b* in RoD and pH and L * in WB.The specifics of meat production from free-ranging animals include the killing of animals in the wild with firearms. This type of uncontrolled killing sometimes leads to the phenomenon that the game does not die immediately but after a certain time from the shot to death, which may ultimately affect the quality of the meat. During one hunting year on free-ranging red deer ( Recently, much attention has been paid to organic food production, with controlled use of artificially produced nutrients that promote animal growth and reproduction, and the production of larger quantities of meat in a shorter time and in a smaller space. Game raised in open hunting grounds is a prime example of a food source that has minimal human impact and high nutritional value ,2. In thDama dama) suspended by the pelvic bone during evisceration has different characteristics than the meat of deer suspended by the Achilles tendon during processing. In addition, it has been found that the time of day when the game is hunted, the time of evisceration, or the hunting season also have an influence on the quality and maturation process of game meat [Cervus elaphus) (RD), roe deer (Capreolus capreolus) (RoD), and wild boar (Sus scrofa) (WB) live in natural habitats and feed seasonally, there is considerable inter- and intraspecific variability in all qualitative parameters [In addition to genetic inheritance, sex, age, and diet, postmortem treatment of meat also affects the meat quality of certain species of free-ranging animals ,47,48. Same meat . In generameters .As mentioned earlier, one of the peculiarities, i.e., problems in the production/extraction of meat from wild animals is the killing method, which is very different from that used for domestic animals. While domestic animals are killed in slaughterhouses, free-ranging animals are killed in the wild, mainly with the use of firearms. This method of killing, which is usually not instantaneous, may have some effect on certain parameters of meat quality, especially pH, colour, water content, and WHC . The strTo determine the effect of ante-mortem stress on water content, colour, WHC, and pH, shot individuals from RD, RoD, WB were processed within one calendar year for this study. The objective of the study was to compare the above parameters between two groups of animals where the time from shooting to death is different.Canis lupus), European lynx (Lynx lynx), and brown bear (Ursus arctos)) that feed on large herbivores and wild boar to meet their food requirements [A total of 52 WB, 45 RoD, and 51 RD individuals were processed. Although the plan identified an equal number of males (M) and females (F), the field conditions and availability of sampling areas determined the final sex ratio structure, which is shown in irements , which iAbies alba) and spruce (Picea abies) forests are the most widespread. According to the Köppen classification, it is an area with boreal climate. The temperature of the coldest month of the year is between −3 and +18 °C. The driest time of the year is summer, when the average daily temperatures are above 23 °C. The highest amounts of precipitation fall in early spring and autumn. Snow lasts for an average of three months [Quercus roboris) and narrow-leaved ash forests (Fraxinus angustifolia) [During the period of one year, samples of RD, RoD, and WB were collected in the western and central parts of the Republic of Croatia  during te months . The huntifolia) .M. biceps femoris (BF) was taken from each specimen. The BF sample was stored in a portable cooling chamber at +4 °C and taken to the laboratory in a portable cooler. After being shot, each animal was marked using an ear tag and transported for further processing.After shooting, the time elapsed from shooting to death was measured for each individual specimen (respiratory reflex arrest), and the sex was noted (M/F). The time elapsed from shooting to death was measured using a traceable digital stopwatch. Since all animals were shot using a firearm (hunting rifle) from a distance, a certain period of time following the shot was necessary to reach the animal and ascertain its death. In this study, the specimens were classified into group A = time from shot to death < 1 min; and B = time from shot to death ≥ 1 min. A field scale (Kern CH 200 K 100) was used to measure body weight with the precision of 100 g. The Water content was determined using the official method . For pH For the determination of water-holding capacity (WHC), the filter paper press method was used to measure the amount of water expressed from a sample kept under pressure. In short, 2 g of BF muscle tissue was placed on a Whatman no.1 filter paper (which was weighted previously) and pressed between two glass plates by a weight of 200 g for 15 min. The water, which was squeezed out, was absorbed by the filter paper. WHC is obtained by the difference of the weight of the filter papers after and before measurements and is related to the weight of the sample. In this method, the amount of water expressed is inversely proportional to WHC . Each saColour measurements were carried out with a Minolta CM-700d  spectrophotometer . The L* (lightness), a* (redness), and b* (yellowness) colour was measured . Before Statistical analysis was performed by the Statistica 14.0.0.15, TIBCO software Inc. . One-way ANOVA was used to analyse data with normal distribution. The Shapiro–Wilk test was used for variable homogeneity test. A 5% significance level was used for determining significant differences in body mass, colour, and physicochemical meat composition. The Pearson linear correlation coefficients were used for checking the water content, WHC, pH, and colour L*, a*, b* correlation. Only significant correlations are presented in p < 0.05) L* colour value in group B females shot in SH, indicating that the meat was significantly darker in females when the time from shot to death was extended (p = 0.060).A separate analysis of the animals killed in SH and DH was performed for WB. There was a significantly lower (extended . Additiop < 0.05). No regularity was observed with respect to WHC value, colour a*, and water content in both types of hunting. Due to the small sample, in female group B in SH (n = 3) and male group A in DH (n = 2) the differences obtained should be taken conditionally.With WB, some of the animals were killed in DH . In DH, p < 0.05); the animals in group A had higher values.With RD, regularities were observed for pH, WHC, colour indicator L*, and water content . Despitep < 0.05) (p = 0.090) to show lower values in females in group B. The differences of the observed groups were not determined for pH, WHC, and colour indicator a*. Similar to some cases in WB and RD, there are a small number of specimens in group B females (n = 3), so the differences obtained should be taken conditionally.In RoD, a significant difference was found between the observed groups in colour indicators L* and b* in females, whose mean values were significantly lower in group B ( < 0.05) . The abop = 0.032), and a negative correlation for water content and colour parameter b* . In female RD, we found a negative correlation for pH and WHC , and a positive correlation for water content and colour parameter L* . In male RoD, we found a positive correlation for pH value and colour parameter b* .Correlation analyses of the studied parameters were performed within each species separately for each sex. A positive correlation was found in WB females for pH value and colour parameter a*  . HoweverGame in the wild is usually killed with firearms, and this study has shown that in some cases, more or less time elapses from shooting to death, and it highlighted the cumulative effects of this stress on the meat. The stress that occurs during the slaughter of domestic animals or the shooting of wild animals directly affects pH discrepancies, which in turn affect WHC and colour . This isCorrelations between colour parameters and WHC can be explained by variations in pH affecting both colour and WHC. The results of correlation analysis showed a positive correlation for pH and colour indicator a*, and a negative correlation for water content and colour indicator b* in WB females. In RD females, a negative correlation was found for pH and WHC, and a positive one for water content and colour indicator L*, while in male RoD, a positive correlation was found for pH and colour parameter b*.The water content depends on the WHC. Water in muscle is entrapped in the structures of the cell, including the intra- and extra-myofibrillar spaces; therefore, significant changes in the structure of the cell affect the WHC. Protein degradation also plays a role in determining WHC. The pH directly affects the ability of myofibrillar proteins, myofibrils, and muscle cells to trap water. An accelerated pH drop and a low final pH are related to the development of a low WHC. A rapid pH drop while the muscle is still warm, causes denaturation of many proteins, including those involved in binding water .Colour is influenced by the content and physicochemical state of myoglobin and by meat structure. Meat structure is directly related to the ultimate pH: at a high ultimate pH, muscle fibres are more densely packed together due to the increased water-holding capacity of the muscle protein. As a result, light is less scattered on the surface, and the meat appears darker. The relationship between meat colour and pH is generally accepted. L* is a reliable indicator of PSE and/or DFD pork and can be used as a measure of pork quality . In addiFinal meat pH is the result of the amount of glycogen present in muscle prior to killing, which is highly dependent on factors responsible for physical and psychological stress. Exposure to stressors during the killing results in ATP reduction, which leads to depletion of muscle glycogen concentration. Significant depletion of muscle glycogen reserves prior to killing leads to higher final pH, which in turn has profound effects on several important meat quality traits . A fastep < 0.05) in females killed in DH in group B, while in SH, the difference was not significant, although it was higher on average in group B. Studies conducted in WB show different values for the final pH value, as well as an ultimately high pH value. For example, studies [M. semimembranosus (SM) WB give a pH range of 5.45–5.88. The pH values determined in our study for group B in SH and DH are in the middle; however, in both cases, the final pH values are high, especially for female specimens. In animal group A, lower average values were obtained for both sexes, which can be considered normal [p = 0.986. Studies [M. longissimus dorsi (LD) found pH values of 5.48 in females and 5.47 in males. Studies [M. gluteus medius (GM) gave a pH of 5.50 for one region and 5.65 for the other region. Studies [There are a relatively large number of studies that have focused on the study of game meat ,78,79,80 studies ,79 defin studies  define i studies  on WB co studies  for M. sd normal  conducted normal ,52. The d normal . Since Rd normal , in whic Studies  for the  Studies  performe Studies  performe Studies  conducte Studies . In the The WHC value of meat is important to maintain its juiciness, and increasing its value improves its sensory properties. Many factors, such as pH and postmortem proteolysis, influence WHC by altering the amount and location of moisture in muscle. A rapid decrease in pH combined with high muscle temperature in the early postmortem period leads to denaturation of approximately 20% of muscle proteins, resulting in a loss of their functionality and ability to bind water. The WHC value is closely related to the colour of the meat and also influences other physical properties, including meat texture . In our In WB, no significant difference in the water content of the studied groups was found for both observed hunting types. With the exception of DH females, the recorded values are slightly higher in group B. In RD, water contents were consistent with the trend described for WB, and the averages for both sexes were higher in group B. In group B, the determined value for female specimens was significantly higher than the value in group A. For both WB and RD, with the described exception, water contents show some regularity and are on average higher in group B than in group A for both sexes and both hunting types. It can be concluded that as the time interval between shooting and death increases, the percent water content also becomes higher. For RoD, the case is reversed. In group A, higher average water contents were found in both sexes. There are no published studies with which to compare the values obtained by this experiment. Some results, such as Ref , show waThe colour of fresh meat is also significantly affected by postmortem metabolism. An abnormally low pH causes denaturation of muscle proteins, including myoglobin, and reduces their ability to bind water. As a result, large amounts of water migrate from the interior of muscle fibres into the extracellular space, increasing light reflection and resulting in a paler meat colour. In contrast, high pH makes flesh colour appear darker because WHC is higher and light absorption, reflection, and protein denaturation are lower. High pH also promotes the activity of oxygen-depleting enzymes, resulting in less oxygen available to bind myoglobin and more deoxymyoglobin being formed .p < 0.05) compared to group B. In general, WB males had slightly lower L* values than females. In males, there is also a regularity in colour indicators a* (red) and b* (yellow) in DH and SH, with both being lower on average in group B. For females hunted in SH, there is almost no difference in a* value in the observed groups (p = 0.979), while b* value is lower in group B, on average. Studies [M. triceps brachii (MTB) of Ref. [M. longissimus thoracis et lumborum (LTL) of Ref. [p < 0.05) in group B. Of the three species observed, males RD had the lowest L* values, while the highest values were found in WB females hunted in DH. WB meat stands out with the highest average b* values (yellow), which could indicate a higher content of intermuscular fat in contrast to the other two species observed. According to Ref. [For female WB shot at SH, the average L* value for BF in group A was significantly lower ( Studies  in WB, c Studies  conducteps p = 0.9, while  of Ref. . An almo to Ref. , game meA particularly significant influence of the time elapsed from firing to death was found in water content, colour parameters L*, b*, and pH values. Interestingly, the significant differences mentioned above were found in females. Some regularity was observed in pH and colour parameter L* in both sexes. Considering each observed group, higher average pH values were found in group B in WB, while in RD and RoD, the opposite was true, i.e., animals in group B had lower average pH values. The colour parameter L* had lower average values in all three species studied in group B, implying that increasing the time elapsed from shooting to death results in darker meat. This study demonstrates certain regularities and somewhat describes the effects of increased time between shooting and death on pH, meat colour, and water content. However, this study is limited. Future analyses will need to consider a larger number of specimens and add variables, such as outside temperature at the time of shooting, level of residual blood and loss of blood, age, diet, etc., to determine their potential effects on some of the observed indicators related to ante-mortem stress and its cumulative effects on meat quality.


In developing countries, intimate partner violence is increasing alarmingly, though attention to this issue is rarely given. It has devastating effects on the general wellbeing of women, pregnancy outcomes, and the long-term health of children, and this needs to be addressed. Hence, this study was designed to assess intimate partner violence and associated factors in northwest Ethiopia.st to August 30th, 2021, among 858 postpartum women in Gondar city. A cluster sampling technique was employed to select the study participants. EPI DATA version 4.6 and SPSS 25 were used for data entry, cleaning and analysis, respectively. A bivariable and multivariable logistic regression model was fitted to identify factors associated with intimate partner violence. The level of significant association was declared using the adjusted odds ratio (AOR) with 95 % confidence interval (CI) and a p-value of ≤ 0.05.A community-based cross-sectional study was conducted from July 1In this study, 48.6% of women indicated having experienced intimate partner violence during pregnancy . The odds of intimate partner violence during pregnancy were significantly higher among women who were not able to read and write , were private workers , and had low decision-making power , a poor social support , and unsupported pregnancy by family . Whereas a family size of ≥ 5  appeared to be a protective factor for intimate partner violence.The magnitude of intimate partner violence was unacceptably high in the study area and connected to poor women's empowerment and social determinants of health. Thus, it is important to focus on interventions that improve women's access to social support and allow them to participate in all aspects of household decision-making through community-based structures and networks. It is also important to encourage women to improve their educational status and arrange risk-free employment opportunities. Intimate partner violence (IPV) is a form of violence against a woman by her current or former spouse, leading to pain, psychological threat, and even death . It is oExisting evidence shows that three-quarters of women worldwide have experienced physical violence by their intimate partner; one-third of these women have been physically and/or sexually abused by their intimate partners . About 5Intimate partner violence (IPV) during pregnancy is associated with long-term effects on the physical and mental disorders of women and children , 3, 12. Despite the endorsement of appropriate and effective legal policies to promote women's rights, combating violence against women is a major challenge in developing countries, including Ethiopia . PreviouMost of the previous studies evaluated IPV during pregnancy giving a special focus on physical violence. However, sexual and emotional violence are also considered to be determinants of the wellbeing of women and their children. This study stands in accordance with the recently adopted 2016 global agenda, which is aimed at ensuring women's empowerment and gender equality in every country . Moreovest to August 30th, 2021.A community-based cross-sectional study was conducted in Gondar city from July 1This study was conducted in Gondar city. The city is located in Central Gondar Zone, Amhara national regional state, northwest Ethiopia. It is located 750 km from Addis Ababa, the capital city of Ethiopia. There are 1 governmental referral hospital, 8 governmental health centers, 22 health posts, 1 private primary hospital, and 1 general hospital serving the city and other populations outside of the city. The recent estimated total population of the city is 432,191, of whom 224,508 females about 133, 477 (30.88%) of these females are in the reproductive age group .All women who gave birth in the 6 months prior to data collection were the study population. All women residing for at least 6 months before the data collection period were included in the study.The single population formula was used to calculate the necessary sample size for the current study by considering the following assumptions: the proportion of IPV-44.5% , level oIn Gondar city, there are 22 kebeles , from which 30% of the total kebeles (seven kebeles) were randomly selected by the lottery method. To reach out to the eligible women, a house-to-house visit was carried out in the selected kebeles (clusters). All women found to be eligible for the study were interviewed. Finally, due to the nature of cluster sampling, 858 women were included in the study.Intimate partner violence was the outcome variable, whereas women's age, women's occupation, monthly income, religion, women's educational status, marital status, family size, parity, antenatal care (ANC) visit, the number of ANC visits, whether the pregnancy was supported or not by family, pregnancy was planned or not, husband's educational status, husband's occupation, woman's household decision-making power, media exposure, and social support were the independent variables.Intimate partner is considered as a current spouse, co-habited partner, current boyfriends, or former partner or spouse. If the respondent said “Yes” to any one of the ranges of sexual, psychological, and physical or any combination of the three coercive acts regardless of the legal status of the relationship with current/former intimate partner, it was considered as intimate partner violence .The ability of women to act self-sufficiently about the household activities including their health, children's health, freedom of movement, and control over finance without needing permission from another person . Eight qThe Oslo-3 Social Support Scale (OSSS-3) was used to measure social support. The scale consists of 3 items addressing the number of close intimates to the woman, perceived level of concern from others, and perceived easiness of getting support from neighbors. Accordingly, the level of social support was categorized as “poor” with a score of 3–8; “moderate” with a score of 9–11; and “strong” with a score of 12–14 .Study participants were asked how often they watched television, read a newspaper, or listened to the radio. Respondents who responded at least once a week are considered to be regularly exposed to that form of media .n = 42) of the calculated sample size outside of the study site. The language clarity and validity of the tool were checked and necessary revisions were made after the pretest. The supervisors checked for questionnaire completeness daily.After reviewing related literature and WHO multi country study on women's health and domestic violence , 27, 28 p-value of < 0.25 were included in the multivariable logistic regression analysis to address the possible effect of confounders. In the last model  a p-value of ≤ 0.05 with 95% CI for the AOR was used to decide the level of association. The variance inflation factor (VIF) was used to check the multicollinearity assumption and was acceptable with a value of < 10. The Hosmer Lemeshow goodness-of-fit was performed to check the model fit.Data were checked, coded, and entered into EPI DATA version 4.6 and further cleaning and analysis were done using SPSS version 25. Binary logistic regression analysis was performed to identify candidate predictors. Predictors with a A total of 858 postpartum women were included in the analysis, a response rate of 98.4%. The mean age of the study participants was 29.53 years (±4.79SD) and about 43.2% of them were classified in the age group of 24–29 years old. More than two-fifths (43.2%) of the women had earned a diploma and above education and about 44.4% of women were housewives by occupation .Most (97.3%) of the study participants had ANC follow-up during their last pregnancy. More than four-fifths (86.8%) of the study participants had planned pregnancies. About 28.8% of the women had poor social support .p-value < 0.25. However, woman's education, woman's occupation, woman's decision-making power, woman's social support, family size, and pregnancy supported by families were the factors significantly associated with IPV in multivariable regression.In the present study, about 48.6% of the women indicated having experienced IPV during pregnancy  . On bivaAccordingly, women who were unable to read and write were 4.96 times more likely to report experiencing IPV than women who held a diploma and above education . Likewise, privately -employed women were 1.78 times more likely to report experiencing IPV compared with government employed women .. This study also found that the odds of experiencing IPV among women who had poor social support were two times higher  than women who had strong social support. Moreover, women whose pregnancy was unsupported by their husband or family were 2.32 times more likely to report experiencing IPV during pregnancy as compared to women whose pregnancy was supported by their husband or family  . Similarly, women who had low decision-making power had 1.43 times higher odds of experiencing IPV compared with those women having higher decision-making power 6, 4.24) .Intimate partner violence is a major public health concern that needs urgent policy action and multi-sectorial collaboration. Despite an endeavor made to overcome violence against women globally, it is still very much common in developing countries, including Ethiopia. One of the global goals set to be achieved by 2030 is empowering women and ensuring gender equality everywhere . Hence, In this study, about 48.6% of women reported having experienced IPV during pregnancy. This finding is higher than previous studies conducted in Uganda-40.6% , NigeriaThere are also studies conducted in other African countries mentioning a higher IPV prevalence rate than found in our study. For instance, in Kenya-66.9%  and GambThis study points out that the odds of falling victim of IPV was 1.43 times higher among women with less decision-making power than among women with more decision-making power. This finding contradicts a study conducted in Sub-Saharan Africa, which reported that women who could make decisions were more likely to experience IPV . AfricanThe results of the present study also affirmed that social support during pregnancy was significantly associated with IPV. Accordingly, the odds of experiencing IPV were nearly 2 times higher among women who had poor social support as compared to those women who had strong social support. This finding is in agreement with a previous study done in Vietnam . AccordiIn the present study the odds of experiencing IPV among women who had unsupported pregnancies by families were 2.32 times higher compared with women who were pregnant with support of their families. This finding is consistent with a previous study conducted in Ethiopia . UnplannThe present study revealed that the likelihood of experiencing IPV was nearly 5 times higher among women who were unable to read and write than those women attending diploma and above education. This finding is supported by a previous study conducted in Ethiopia where women who had no formal education were victims of IPV .The odds of experiencing IPV among women having a family size of ≥ 5 were 27% less likely compared with their counterparts. This could be due to the fact that women with a higher family size are expected to be older and therefore get more respect from their husbands and make shared decisions in every aspect of the household. Women with bigger families are expected to have strong social support and social networks, thereby maintaining smooth relationships with their sexual partners/husbands .In the present study, women who were working in the private sector were 1.78 times more likely to experience IPV than those women who were government employees. In the private-sector employees are stimulated to focus on what makes the organization profitable. To do this, the staff can interact with a large number of people in order to attract customers; however, their sexual partners may interpret this in a negative way and this could turn into abusive behaviors.The present study has limitations. Social desirability and recall biases might have been present. However, the study participants had been informed that their participation was crucial for the study, that the information was anonymous, and kept confidential for the study purpose only. Despite these limitations, the findings from study provide important insights for policy action related to violence against women.The magnitude of IPV during pregnancy was high. Being unable to read and write, being a private worker, having low-decision-making power, having poor social support, unsupported pregnancy, and having a bigger family were the factors significantly associated with IPV. Concerned stakeholders need to pay special attention to ensuring women's empowerment and gender equality by establishing social support platforms, engaging women in decision-making matters, and capacitating women financially by arranging risk-free employment.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical approval for the study was obtained from the Institutional Review Board (IRB) of the University of Gondar (Reference No: V/P/RCS/05/2710/2021). The patients/participants provided their written informed consent to participate in this study.AK conceived and designed the experiments. DG, NTs, MAk, WT, MAb, TA, NTi, HA, TH, AS, AT, AY, MM, GN, KW, and BT investigation, analyzed and interpreted the data, and wrote the article. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


There is no summative quantitative study that report the difference in BMI in high screen user children and adolescents or give a difference in screen time in children and adolescents with obesity vs. children and adolescents without obesity. In the current meta-analysis we systematically summarized the association between obesity and screen time and meta-analyzed the results.A systematic search from Scopus, PubMed and Embase electronic databases. Studies that evaluated the association between screen time and obesity up to June 2021.2 higher BMI . Moreover, children and adolescents with obesity had a mean value of 0.313 h higher screen time compared with children and adolescents without obesity . The results of subgrouping showed that study quality, continent and sample size could reduce the heterogeneity values. No evidence of publication bias was reported according to visual asymmetry of funnel plots and the results of Begg’s and Egger’s tests.Results revealed that those at the highest screen time category had 0.7 kg/mFor the first time, the current systematic review and meta-analysis revealed a positive association between screen time and obesity among children and adolescents. Due to the cross-sectional design of the included studies, causal inference is impossible, therefore, further studies in separate analysis of both genders are suggested to better elucidate gender-specific results.www.ClinicalTrials.gov], identifier [CRD4202123 3899].[ The prevalence of overweight and obesity among children and adolescents is a growing pandemic health issue and is increasing rapidly worldwide; according to the estimates of world health organization (WHO), roughly, 39 million children under the age of 5 were overweight or obese in 2020 , 2. ChilFrom the above introduction, it is clear that there are great between-study differences and their obtained results about the association between obesity and screen time. So, it is difficult to elucidate an accurate conclusion about it. Therefore, we conducted the current systematic review and meta-analysis to classify the association between BMI and screen time according to different parameters like the type of screen device, age, geographical distribution, and setting of different studies in children and adolescents. The patient/population; intervention; comparator; outcome (PICO) question in the current study was as follows: in children and adolescents (P), does high screen time (I) compared to low screen time (C), is in more strong association with body mass index (O)?We reported the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)  32). Th. Th32). The following inclusion criteria were applied in our research: (1) studies with observational designs ; (2) studies that evaluated the relationship between screen time and BMI (3) the studies that were conducted among children and adolescents (≤18 years); (4) studies that provided the mean ± standard deviation (SD) of BMI among highest vs. lowest screen users or those which reported screen time among children and adolescents with obesity vs. children and adolescents without obesity or the studies that reported screen time or odds of internet addiction among children and adolescents with obesity vs. children and adolescents without obesity. The excluded studies were clinical trials, systematic reviews, meta-analysis, case-reports, and case-series, experimental studies, short communication, letter to editors, and studies that examined the relations other than the relationship between screen time and obesity.According to our search results obtained from the Scopus, PubMed and Embase electronic databases through July 2021, a total of 6,291 articles were retrieved . A combiAfter duplicate removal and exclusion of articles according to title/abstract, 2,156 articles were remained. All articles were checked independently by 2 investigators. Thereafter, 2,101 manuscripts were removed because of their irrelevant subject, design, involving other age groups, other languages, being reviews conferences and seminars, and not evaluating the association of studied parameters. Any discrepancies between reviewers were resolved by discussion. Consequently, 54 manuscripts were included in the meta-synthesis.Data extraction was performed independently by two authors, using a standard Excel extraction datasheet. First author and journal name, country, year of publication, age range of participants, study design, total number, and the number of participants in each category of screen time or BMI, adjusted covariate, gender, setting, obesity, and screen time definition, weight, height and screen time measurement tools, and main results of the studies were extracted from all of the selected articles. Any disagreements between reviewers were resolved by discussion.The methodological quality of included studies were assessed using the Agency for Healthcare Research and Quality (AHRQ) checklist  Supplem. The AHRP-values less than 0.05 were considered as statistically significant. The studies that reported the comparison between BMI [mean (SD)] in those with highest vs. lowest screen time and the studies that evaluated the comparison of screen time [mean (SD)] in children and adolescents with obesity vs. children and adolescents without obesity were included in two separate meta-analysis. Moreover, the studies that reported the odds of internet addiction in children and adolescents with obesity vs. children and adolescents without obesity were also analyzed. Therefore, the weighted mean difference (WMD) with 95% confidence interval (CI) was reported. Hozo et al. (SD = (b-a)/4 , was used for data analysis and o et al.  method w (b-a)/4 , 37. If Some of the expressions that were used in the current study needs to be defined: Scree time, is defined as “time spent using a device such as a computer, or games console” as the Oxford English Dictionary . In the P = 0.011) and not girls (P = 0.34). All of the remained studies reported significantly higher BMI in highest vs. lowest screen users . The two-class meta-analyses of the comparison of screen time between children and adolescents with overweight/obesity vs. children and adolescents without overweight/obesity is presented in P < 0.001; I2 = 96%). P = 0.659; I2 = 0.0). For finding the source of heterogeneity, subgrouping were performed and the results are available in P = 0.916) and Begg’s test (P = 0.78); comparison of ST and odds of screen addiction in children and adolescents with obesity vs. children and adolescents without obesity: Egger’s test (P = 0.228) and Begg’s test (P = 0.25) and Egger’s test (P = 0.253) and Begg’s test (P = 0.34), respectively.Meta-analysis of the comparison of BMI between highest vs. lowest screen time categories  revealed2 higher BMI among 45,638 children and adolescents with high screen use. In another analysis of 44,549 children and adolescents, we also revealed that screen time was 0.313 h higher children and adolescents with obesity vs. children and adolescents without obesity. This is the first meta-analysis with a relatively appropriate number of included studies that quantifies the association between BMI and screen time among children and adolescents and this is independent of obesity definitions; previous meta-analysis that was performed by Fang et al. (2 increase in BMI by increased screen time; this amount of increase in BMI has clinical importance; a previous study revealed that for every one point increase in childhood BMI, there are 24 and 11% increased diabetes and CVD risk in adulthood (In the current meta-analysis, we reported 0.703 kg/mg et al. , increasg et al. . In the g et al. , for evedulthood . Other sdulthood –61. Perfdulthood , the sigdulthood , childredulthood . Accordidulthood . Howeverdulthood . Differedulthood , 16, 63.dulthood , 65. Incdulthood , 67, incdulthood –71; and dulthood –74. Moredulthood , 76. Incdulthood , 78. TheAs mentioned before, the current meta-analysis is the first study that provided a quantitative result for the association between different screen times with obesity among children and adolescents and reported a difference for screen time among children and adolescents with obesity vs. children and adolescents without obesity were limited and could not be generalized. Since the results were not separable for boys and girls, therefore, further studies with separate results for males and females and different screen devices are needed to better explain the obtained results.The raw data supporting the conclusions of this article will be made available with reasonable request from corresponding author.YW was involved in general hypothesis generation, data extraction, and writing the manuscript. AA and FE were involved in extraction of data, quality assessment, and writing the related parts in the manuscript. LJ was involved in manuscript revision and data analysis. MA-F supervised the project, was involved in generation of the study’s hypothesis and was involved in manuscript writing and revision. All authors read and agreed with final submission of manuscript.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.


Significant increases in microbial concentrations was found only in the MRW subgroup, among non-smoking workers only. The results showed increased bacterial concentration in WIP nasal samples for as many as 12 bacterial species, including, e.g., Streptococcus constellatus, Peptostreptococcus spp., E. coli, and P. mirabilis. These preliminary data confirmed that the nasal swab method was helpful for assessment of the workers’ real-time exposure to airborne bacteria.The aim of this pilot study was to assess the time-related changes in viable nasal bacteria concentrations among waste-incineration plant (WIP) workers compared to a group of office building (OB) workers outside the plant. In total, 20 volunteers participated in the study, including 14 WIP and 6 OB workers. WIP workers were divided into two sub-groups: supervisory staff (SVS) and maintenance and repair workers (MRW). Nasal swabs were collected before and after the morning work shift. Airborne bacteria were sampled with a six-stage impactor to assess the bioaerosol size distribution. The analysis showed that a significant, almost three-fold increase in nasal bacterial concentration was found only among WIP workers, and this referred mainly to anaerobic species. The load of anaerobic bacteria at the beginning of work was 12,988 CFU/mL, and after work shift 36,979 CFU/mL ( The use of quantitative and qualitative analyses of the bioaerosols in different occupational settings has important practical value; however, as recent research reports show, this may be inadequate to accurately assess the impact of microbial exposure on workers’ health ,2,3. SciStaphylococcus aureus (MRSA) among pig farm workers [Bacillus determined in the nasal mucosa of postal workers in the U.S. [Previous studies in this field showed that researchers have been focused mostly on the transmission of antibiotic-resistant bacterial strains in relation to the work performed. These studies referred mainly to the methicillin-resistant  workers ,7, food  workers , health  workers , and vet workers . Anotherthe U.S. . The nasthe U.S. , health the U.S. , fuel wothe U.S. , and pigthe U.S. . It has the U.S. ,17,18,19Currently, the most popular waste-recycling methods include composting, mechanical sorting, and recovery of waste as well as its incineration . In PolaThe development of new plants has resulted in the creation of new workplaces, which makes it necessary to carry out a comprehensive assessment of exposure to occupational hazards, including biological agents such as bacteria, fungi, and their toxins. The hygienic assessment of working conditions in the municipal waste incineration plants is complicated due to the complexity and variability of chemical  and biolThe aim of this preliminary study was to assess across-shift changes in the content of viable nasal bacteria among waste-incineration plant workers exposed to bioaerosols (study group) and a group of office workers (control group) outside the plant. The analysis included quantitative and qualitative determination of isolated strains and the size distribution of bacterial aerosols.The study was conducted in 2018 among workers at two different facilities: the waste incineration plant (WIP) and office building (OB). WIP combusted mixed municipal waste from an agglomeration with over 300,000 inhabitants. At the time of the study, the number of the plant’s employees totaled 56, including 37 maintenance and repair workers. Out of this staff, 14 workers expressed interest in participating in the project. The OB employed a total of 40 workers, and only 6 of them agreed to take part in the study.The volunteers provided a written consent to participate, and the study protocol was approved by the Bioethics Committee of the Institute of Rural Medicine in Lublin, Poland (resolution No. 3 of 28 May 2018)Depending on the activities performed during the work, WIP workers were divided into two sub-groups: supervisory staff (SVS), usually doing computer work, and maintenance and repair workers (MRW), including mechanics, electricians, and heavy equipment operators. The workers who were enrolled for the study worked in the morning shifts, from 7:00 a.m. to 3:00 p.m., and the measurements were taken in the middle of the working week (Wednesday). A brief description of the study population is presented in The study participants were instructed about the swabbing procedure. Nasal swabs were collected before and after the morning work shift. The sampling was performed by trained medical personnel, using sterile eSwab™ swabs  with a nylon fiber tip, and 1 ml of liquid Amies medium, according to WHO recommendations . The swaThe air-quality assessment in WIP covered three workplaces where the technological process takes place, i.e., the waste delivery hall, the vibrating screen for metal residues, and the crane control room. In OB, the sampling points were located in two office rooms.3. In the intervals between the sampling sessions, the impactor was disinfected and cleansed with isopropyl alcohol and then dried with a stream of hot air.Airborne bacteria were sampled with a 6-stage Andersen impactor , which can separate particles sized > 7/4.7/3.3/2.1/1.1/0.65 µm in diameter, in order to assess the size distribution of the bioaerosols. During the measurements, the impactor was set at a height of approx. 1.5 m above the ground. The sampling time was 5 min, the air flow rate 28.3 L/min, and the volume of the collected air sample was equal to 0.1415 mFor bioaerosol sampling, the impactor was loaded with Petri plates containing the following media , according to Atlas : tryptic−1–10−4 was prepared based on a normal saline. In the next step, 200 μL of the suspension was picked and plated by surface swabbing on Petri plates with microbiological media, the same as for bioaerosol sampling.In the laboratory, the tubes with swabs were vigorously shaken for 5 min, and then, a series of 10-fold dilutions in the range of 103 of the sampled air (CFU/m3).The incubation conditions for aerobic bacteria were: 1 day (37 °C) + 3 days (22 °C) + 3 days (4 °C) and for anaerobic bacteria: 2 days (37 °C) + 2 days (30 °C). The extended incubation period for microbial samples was applied to facilitate the growth of the slow-growing strains at low temperatures . MicrobiAll isolated microorganisms were identified to the genus or species level. Such taxonomic analysis was based on their capability for enzymatic degradation of organic substrates through detection of the appropriate metabolites generated by the reaction. For this purpose, a set of API test kits, i.e., 20 Staph, 20 Strep, 20 NE, 20 E, 50 CHB/E, Coryne, and 20 A (bioMérieux), was applied to detect clinically important genera/species.p < 0.05 as statistically significant.To evaluate the findings regarding bioaerosol exposure, descriptive statistics were calculated, namely the arithmetic means (AM) with standard deviation (SD), median (Me), and the min–max range. Since the Shapiro–Wilk test revealed non-normal distribution of independent variables, the non-parametric Mann–Whitney (M-W) and Wilcoxon matched-pairs signed rank (WT) tests as well as Spearman’s rank correlation coefficient were used to confirm the statistical significance of the observed relationships. Chi-square test was used to investigate the diversity of identified microorganisms. All calculations were performed using “STATISTICA data analysis system”, version 10. , adopting p < 0.01) and related mainly to the presence of anaerobic bacteria. The median value of bacterial load before the beginning of work for all the WIP workers under study was close to 13,000 CFU/mL and after work increased to as much as 36,979 CFU/mL (p < 0.01). As regards the aerobic bacteria, the increase in their concentration was much smaller and statistically insignificant. However, the performed analysis showed that the type of work was the factor affecting nasal bacteria concentration among WIP workers. Significant increases in microbial concentrations could be only found in MRW subgroup. On the other hand, among SVS, these increases were either lower than among MRW, or, as in the case of aerobic bacteria, their concentrations in the nasal mucosa were even found to decrease during the work shift. The analysis also showed that the concentrations of total and anaerobic bacteria increased significantly among non-smoking workers (p < 0.05).The quantitative analysis of total (understand here as culturable) bacteria in nasal swabs from WIP workers  showed aThe findings obtained for the six-person group of OB workers were quite different from those noted for WIP workers. The study did not show that bacterial concentrations in the upper respiratory tract of OB workers had changed significantly as a result of work shift. However, the comparison of the median bacterial concentrations in this group revealed a trend indicating a decrease in the degree of nasal colonization by both the aerobic and anaerobic bacteria .3) was found in the waste-delivery hall and the lowest (757 CFU/m3) in the vibrating screen for metal residues. In the office rooms, the bacterial aerosol concentrations were more homogeneous and did not exceed the value of 163 CFU/m3. What distinguishes the OB environment from plant work places was the lack of anaerobic bacteria in the air of the tested office rooms.The results of the quantitative analysis of bioaerosols  showed tClostridium, Porphyromonas, and Streptococcus genera) and four Gram-negative rods . The study showed that the Gram-negative bacteria were more frequently found in MRW group (42.8%) than among SVS (21.4%); however, this difference was not statistically significant. Additionally, the presence of pathogenic Staphylococcus aureus was detected in 64% of samples from WIP workers. The comparison of data obtained before and after the work shift showed increased bacterial concentration in nasal samples for as many as 12 bacterial species, with the highest levels found for S. epidermidis, Streptococcus constellatus, Peptostreptococcus spp., Porphyromonas asaccharolytica, and Clostridium beijerinckii. Increased concentrations were also found for E. coli and P. mirabilis. The highest decreases in bacterial concentrations after work were recorded for Actionomyces naeslundii, S. aureus, and S. hominis.The study identified a total of 52 bacterial species belonging to 29 genera . The anap < 0.05). Of the identified strains, 60% belonged to Staphylococcus genus, including the anaerobic species of S. saccharolyticus, which was present in all subjects, and S. aureus, which was found to be carried by half of the workers. Moreover, non-sporing Gram-positive rods of Corynebacterium and Brevibacterium genera as well as rods of Bacillus genus were also determined. In turn, no Gram-negative rods were found in nasal swab samples. The highest concentration increase during work shift was observed for S. epidermidis, S. hominis, and S. aureus.The nasal microbiota among OB workers after the work shift comprised a total of 10 bacterial species, which was significantly less than among WIP workers . The taxonomic diversity of bacterial aerosols partially resembled the variety of species in the nasal mucosa of workers after work shift, but there were also numerous bacteria of Cellulomonas, Bacillus, and Micrococcus genera as well as mesophilic actinomycetes of Streptomyces genus present in high concentrations in the air only. The analysis of particle size distribution  prevailed in the air of the studied rooms, but bacteria of Bacillus, Micrococcus, Aerococcus, and Rothia genera were also present there. The analysis of particle size distribution , bacterial concentration increased more than in those from the supervisory staff. The workers controlling the technological process “from a distance”, were found to be less exposed to bioaerosols than the technological line workers. These findings relate to the period of one work shift in the middle of the week. Therefore, it is not known whether the changes in bacterial colonization of workers’ noses were permanent. To assess this, a measurement period of up to several days, including the weekends, would be required. The available data from pig farms suggest that these concentrations will probably decrease for a period of several hours after the end of work and then increase again the next day . HoweverThe analysis of the data obtained in the present study showed that bioaerosol exposure was related to the worker’s smoking habit. Although tobacco is a well-recognized source of bacteria , due to S. aureus bacteria in the noses of selected volunteers as a consequence of exposure in this work environment [As previously mentioned, similar studies have so far been carried out only among pig farmers. However, most of them have focused on analyzing the prevalence of MRSA strains. These used mostly qualitative analyses (“present vs. absent”), examining the presence of ironment ,19.S. aureus before and after work shift over one working week. This study showed that, as a consequence of occupational exposure, the median concentration of MRSA strains in the nasal mucosa at the end of work  was about 60% higher than the concentrations measured in the morning (9800 CFU per swab). In contrast to those findings, Angen et al. [A different approach was presented in the report by Islam et al. , which aS. aureus was not present in workplace air, but according to Hossain et al. [In our study, the MRSA strains were not particularly notable in the waste-incineration plant. Nonetheless, as much as 60% of waste plant workers were found to be the carriers of this pathogen. A similar level (50%) in this respect was found when the office workers were examined. Available literature data indicate that this bacterial species is present in the upper respiratory tract in people of different ages and occupations. In a Dutch study , around n et al. , this paClostridium and Peptostreptococcus genera) indicates that the transported waste was contaminated with organic matter, most likely with food residues that have started to undergo the fermentation processes [The stationary measurements carried out in two different occupational settings as well as the qualitative analysis of bacterial aerosols along with the analysis of their size distributions indicate a possible aspiration of the bacteria released during the waste-incineration process. The characteristics of the bacterial groups revealed that the changes in their load in the workers’ nasal mucosa were mainly dependent on to the prevalence of anaerobic bacteria. This discovery sheds a new light on the problem of microbiological contamination in this work environment since this group of bacteria has not yet been detected in thermal waste disposal. Given the conditions of the combustion process, most studies have focused on the bacterial contamination in relation to their growth at different temperatures rather than on their oxygen requirements ,35,36. Trocesses . SeveralStaphylococcus saccharolyticus was found in the noses of office workers, which, according to latest research, should be treated as a permanent element of the human skin microbiota [Staphylococcus epidermidis or Streptococcus constellatus, which together accounted for over 30% of all bacteria in the noses of WIP workers. According to available reports, they can produce bacteriocins that inhibit the growth of other bacterial species [Only the anaerobic species of crobiota . It can crobiota , in partcrobiota . However species . HoweverBacteroides [Escherichia, Proteus [Porphyromonas [Municipal waste delivered for thermal treatment was characterized by fecal contamination, as evidenced by the presence of the following genera of Gram-negative rods: teroides , Escheri Proteus , and Poryromonas . Nasal sClostridium genus, whose representatives may be responsible for skin wound infections; S. aureus, E. coli, and P. mirabilis, which are opportunistic pathogens that can cause infections of the digestive, urinary, and respiratory systems as well as the skin; and mesophilic actinomycetes (from Actinomyces and Streptomyces genera), which show strong allergenic properties. As regards the exposure of OB workers, only two potentially harmful bacterial strains, namely S. aureus and Corynebacterium spp., were determined. Both of them may slow down wound healing. It should be also mentioned that all Gram-negative rods, which are the source of endotoxins, can pose a health threat to the incinerator workers.Based on the classification of harmful biological agents in workplace , we concClostridium and Bacillus genera) may have reached as far as the pulmonary bronchioles. Thus, we can assume that they may have experienced irritation of the nose and throat as well as cough and various allergic reactions.The negative impact of bioaerosols on workers’ health, which is associated with the infectious or allergenic properties of bacteria, may be enhanced due to the deposition of these particles in different parts of the respiratory system. To the best of our knowledge, the size distribution analysis of the bacterial aerosols in the waste-incineration plant in our study was the second attempt of this kind after that carried out by Heo et al. . In thisP. aeruginosa, S. pneumoniae, and S. aureus as well as anaerobic bacteria. Ibironke et al. [1, FEF50, and FEF75, which was confirmed for incinerator workers in other studies [The nasal swab analysis after work shift, especially for the anaerobic bacteria, showed that the detected bacterial groups were similar to those identified at the first impactor stage, i.e., with an aerodynamic diameter bigger than 7 µm. One of the recent clinical studies of people with COPD (chronic obstructive pulmonary disease)  showed te et al.  estimatee et al. . As a co studies .Clostridium genus, play a special role in the occupational exposure of waste-management workers. The analysis of bioaerosol particle size distribution showed that they can effectively colonize all parts of the workers’ respiratory tract.As evidenced by the findings of this pilot study, the colonization degree of the upper respiratory tract of waste-incineration plant workers increased significantly during the work shift comparing to office workers and the changes depended on the type of occupational tasks. The nasal swab method appeared to be helpful for assessment of the workers’ real-time exposure to airborne bacteria. However, one should note that the outcomes of this preliminary research require further confirmation in a larger-scale study, with a large population of exposed workers and an extended observation time in order to investigate the persistence of detected changes. This study confirmed the previous reports that anaerobic bacteria, including those of


Functional dyspepsia and digestive disorders are common, debilitating and costly. Little information is available about the role of stress management in terms of cognitive-behavioral treatment of dyspepsia. We performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia.A comprehensive search of several databases from 1966 to March 2022 will be conducted. The databases include Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The primary outcome for this study was the rate of successful treatment (presence of no more than mild pain or discomfort after treatment). The secondary outcomes were improvement of dyspepsia at short-term (<1 year) and long-term (≥1 year) follow up, improvement in quality of life, and development of treatment-related adverse events. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The Review Manager 5.3  will be used to analyze the data.We will synthesize the current studies to evaluate the effectiveness and safety of cognitive behavior stress management on functional dyspepsia.The result of this review will provide more reliable references to help clinicians make decisions when dealing with functional dyspepsia. Functional dyspepsia is a clinical syndrome comprising chronic symptoms arising from the gastroduodenal region.,8 On the other hand, functional dyspepsia is a kind of psychosomatic disorder and some researchers have confirmed stable somatization in these patients. Somatization functional gastrointestinal disorders are accompanied with psychiatric disorders. Thus, considering the role of psychological and social factors and the accompanied symptoms of psychological disorders in patients with functional dyspepsia, researchers have become interested in the use of complementary therapies, that is, alternative and psychological.Although the course of functional dyspepsia is not associated with mortality, ultimately an important issue is that this disease typically affects the lives of patients and the associated economic costs of care in the community. Elements of cognitive-behavior therapy include cognitive restructuring, raising awareness about stress, relaxation training, problem-solving training, self-management, and adequate social support. Stress is an important factor affecting the symptoms of patients with functional dyspepsia; on the other hand, stress management increases the ability of people to reduce stress and appropriate compatibility with stressful situations. Currently, little information is available about the role of stress management in terms of cognitive behavioral treatment of functional dyspepsia. Thus, we performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia.Cognitive behavior stress management refers to a family of stress management therapy which focuses on cognitive-behavioral approach.2 We have registered this study at Open Science Framework . The registration DOI of this study is 10.17605/OSF.IO/RPWK8. Ethical approval is not required for this study since it relies on secondary data.This protocol is reported following the preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P) statement guidelines.2.12.1.1In this work, we will include randomized controlled trials (RCTs) of cognitive behavior stress management on functional dyspepsia in adult populations (≥18 years). Non-RCTs and observational study will be excluded. Studies published in English and Chinese will be included.2.1.2This study will include patients diagnosed with functional dyspepsia after biochemical, endoscopy, and ultrasound reviews. Included patients had no restrictions on age, sex, economic status, severity of the disease, or education.2.1.3The control group received placebo or conventional pharmacotherapies recommended by guidelines, and the intervention group received additional cognitive-behavioral stress management.2.1.4The primary outcome for this study was the rate of successful treatment (presence of no more than mild pain or discomfort after treatment). The secondary outcomes were improvement of dyspepsia at short-term (<1 year) and long-term (≥1 year) follow up, improvement in quality of life, and development of treatment-related adverse events.2.2A comprehensive search of several databases from 1966 to March 2022 will be conducted. The database includes Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Two authors will independently draft and carry out the search strategy. In addition, we manually retrieve other resources, including the reference lists of identified publications, conference articles, and gray literature. The key terms used for the search are “functional dyspepsia,” “cognitive behavior stress management,” and “randomized controlled trial”.2.3We will extract and record the first author's name, year of publication, study design, group information, age, gender, dropouts, sample size, duration of intervention, outcomes, and adverse effects from the studies that met the inclusion criteria. We will contact the corresponding authors for additional information if necessary.2.4 Two researchers will independently evaluate the bias based on the following items: random sequence generation, allocation concealment, blinding of the participants and personnel, blinding of the outcome assessments, incomplete outcome data, selective reporting, and other sources of bias. The studies will be evaluated as low risk, high risk, and unclear risk. Inconsistencies will be resolved by discussion with other reviewers.The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool.2.5χ2 and I2 tests. If P ≥ .05 and I2 ≤ 50%, no statistical heterogeneity is observed, the data will be calculated with a fixed-effect model. If P < .05 and I2 > 50%, the random effect model will be used. If there is significant heterogeneity, subgroup analysis will be conducted based on different interventions, controls, durations of treatment, and outcome measures. We will carry out sensitivity analyses to investigate the robustness of the study conclusions. In this way, we will be able to assess the impact of low-quality studies on the overall results and whether the results are robust.The Review Manager 5.3  will be used to analyze the data. For outcomes, we will use relative risk and 95% confidence interval to evaluate dichotomous outcomes, while using standardized mean difference with 95% confidence interval to assess continuous variables. The heterogeneity between RCTs will be calculated by Cochrane 2.6A funnel plot analysis will be drawn to assess the publication bias and Egger test in Stata 14.0  will be conducted for statistical investigation.2.7 to assess the results. In the Grading of Recommendations Assessment, Development, and Evaluation system, the quality of evidence will be categorized into 4 levels: high, moderate, low, and very low quality.We will use the Grading of Recommendations Assessment, Development, and Evaluation3 Psychological factors have also been associated with functional dyspepsia.,17 Clinical observations suggested a higher anxiety level and stress experienced in functional dyspepsia patients with a positive correlation to the disease severity.,19 Cognitive-behavioral stress management has been applied successfully in many physical and emotional conditions. It includes 2 goals:Functional dyspepsia is common and recent studies indicated a heterogeneity of this disorder whose specific clinical symptom patterns could be related to varied gastric pathophysiological mechanisms.(1)to accept the existence of stress events, as well as its harm to health, and(2)to provide effective methods to relieve stress. But it has not yet been fully applied to functional dyspepsia. Therefore, there is a need to clarify and illustrate the function and action modes.To the best of our knowledge, this is the first meta-analysis of RCTs to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia. We hope that the result of this review will provide more reliable references to help clinicians make decisions when dealing with functional dyspepsia.Data analysis: Xiu-E. Zhou.Data collection: Yu-Chen Xu.Study design: Hong-Mei Dou.Writing: Min Cheng.


Several studies have demonstrated that environmental factors, such as meteorological factors and air pollutants, are closely associated with epistaxis. However, age-specific associations between environmental factors and epistaxis have not yet been evaluated. This study aimed to evaluate the associations between individual meteorological factors and air pollutants and epistaxis, by age.A retrospective cohort study.Records of patients covered by the Korean National Health Insurance Service who visited our hospital for epistaxis between January 1, 2002, and December 31, 2015, were retrospectively reviewed.N = 19,580); age group 1 ; age group 2 ; and age group 3 . Cases of epistaxis and data on environmental factors were analyzed according to the day, month, and year. Stepwise logistic regression was performed to identify the environmental risk factors for epistaxis in each age group.The 46,628 enrolled patients were divided into four age groups: age group 0  and sulfur dioxide, sunshine duration, and wind speed were significantly associated with the occurrence of epistaxis in the study population. However, analysis according to age group showed that the meteorological factors and air pollutants associated with epistaxis were different in each age group.We suggest that the environmental risk factors for epistaxis should be differentially analyzed according to age. Epistaxis is a frequent complaint and the leading cause of visits to the otorhinolaryngology department , 2. MultEpistaxis has a bimodal peak incidence. Additionally, the mechanisms of epistaxis and its risk factors could vary with age . To evalThis study was approved by the Institutional Review Board of Chung-Ang University Hospital (2005-015-19314) and the review board waived the requirement for informed consent. The South Korean NHIS approved the use of its database for this study (NHIS-2020-2-178).The study population was selected from the NHIS national sample cohort (NHIS-NSC), an administrative nationwide cohort established by the National Health Informational Database (NHID) in South Korea. The NHIS is a single health insurer covering ~97% of all Koreans and is managed by the Korean government. NHID, created by NHIS, is a public database of the entire South Korean population. It contains information and records pertaining to health care utilization, health screening, sociodemographic, and mortality data between 2002 and 2015. NHID was first established using the data of approximately one million national health insurance subscribers and medical aid beneficiaries in the system as of 2002, as well as their follow-up data from 2002 to 2013. The second version of NHIS-NSC, which has been available since 2017, comprises 14 years of follow-up data, including 2015.N = 82,969). Patients with the following conditions were excluded: (1) possible posterior epistaxis defined as ICD-10 code R04.0 with the procedural code for general anesthesia (L1211 or L1212) (N = 963); and (2) possible causes of secondary epistaxis, including bleeding disorders, presence of a foreign body in the nose, history of trauma, tumors, cardiovascular system diseases, or other systemic diseases  . We only included patients who had records of their domicile in Seoul, from where we obtained meteorological, and air pollution data to avoid any undue influence from meteorological and air pollution differences between districts.Patients with a history of epistaxis  were initially reviewed in this study (https://web.kma.go.kr/eng/index.jsp). Data on the daily concentrations of PM10 (μg/m3), carbon monoxide (CO) (ppm), O3 (ppm), SO2 (ppm), and nitrogen dioxide (NO2) (ppm), and the average ground temperature (°C), lowest temperature (°C), highest temperature (°C), highest wind speed (hhmi), average wind speed (m/s), sunshine duration (h), average relative humidity (%), average air pressure (hPa), average temperature (°C), and maximum wind speed (m/s) were analyzed for the period between January 1, 2002, and December 31, 2015. Concurrent presentation of sinonasal diseases, such as chronic sinusitis (ICD-10 code J32), acute sinusitis (ICD-10 code J01), rhinitis (ICD-10 code J31), and septal deviation (ICD-10 code J342), was also reviewed.We obtained and analyzed data on the following patient characteristics: sex, age, domicile, and date of the hospital visit. Meteorological and air pollution data were obtained from the Korea Meteorological Administration . Continuous variables are presented as median (range), and comparisons between groups were performed using the Mann–Whitney N = 19,580); age group 1 ; age group 2 ; and age group 3 . Among the 46,628 eligible patients with epistaxis, only 10,476 who had a domicile in Seoul were included in the study. The final number of cases that were chosen for the study and their group-wise distribution was as follows: age group 0 ; age group 1 ; age group 2 ; and age group 3  (The selection of the study cohort is summarized in N = 503) . ChildreN = 503) , we defiN = 503) , 15.N = 19,580, 41.99%) and lowest in age group 3  , followed by May , and lowest in July . In age group 1, the number of epistaxis cases was the highest in January  and lowest in July  and August . In age group 2 (41–70 years old), the number of epistaxis cases was the highest in January  and lowest in August  and July . In age group 3, the number of epistaxis cases was the highest in January  and lowest in July , and August .The annual and monthly numbers of epistaxis cases according to the age groups are shown in , 5.74%) . The mea, 5.74%) . The numThe mean monthly values of meteorological factors and air pollutants are described in P < 0.05) (P < 0.05) (P < 0.05). In age group 2, the lowest and highest temperature, maximum wind speed, and average atmospheric pressure were significantly associated with epistaxis (P < 0.05). In age group 3, the lowest temperature, maximum wind speed, and highest temperature were related to epistaxis (P < 0.05).Stepwise regression analysis showed that average relative humidity, both the lowest and the average air temperature, PM10 and SO2 concentrations, sunshine duration, and average wind speed were significantly associated with epistaxis ( < 0.05) . Analysi < 0.05) . In age In this study, we evaluated the prevalence of epistaxis and its association with meteorological factors and air pollutants in different age groups. In general, we found that the number of epistaxis cases was higher in younger individuals than in older ones and that the relationship between meteorological factors and air pollutants and epistaxis differed according to age. Additionally, we found that the monthly pattern of the incidence of epistaxis in the older population differed from that of children and adults, suggesting that seasonal variations have different effects on the incidence of epistaxis in each age group. The main strength of this study is that we excluded cases of secondary epistaxis and minimized the effect of hypertension. We enrolled primary epistaxis cases only to ensure direct evaluation of the association between meteorological factors and air pollutants, and epistaxis.In a previous study, Mohamad et al. reported that emergency department visits for epistaxis increase with age . PatientP < 0.05) were significantly associated with epistaxis in the study population. We found that average relative humidity, lowest air temperature, sunshine duration, concentration of SO2 and average wind speed negatively correlated with the epistaxis, and concentration of PM10, average air temperature, and average ground temperature positively correlated with the epistaxis (data not shown). Similarly, a previous study performed in Korea indicated that temperature, wind speed, and relative humidity were associated with epistaxis; however, age was not considered in that study , the concentration of PM10, the duration of sunshine, the levels of SO2, and average wind speed (at study . In the P < 0.05)  . In that < 0.05) . In the  < 0.05) . HoweverSeveral studies have proven that allergic rhinitis is closely associated with epistaxis , 20. OthSince the outbreak of Coronavirus disease 2019 (COVID-19), wearing a facial mask has been a usual topic, and wearing a facial mask could result in a reduction of exposure to airborne pollutants and nasal rhinitis symptoms, with fewer allergic symptoms in the general population . TherefoThis study has some limitations. First, this study was conducted using health insurance claims, and owing to the nature of the study data, there is a possibility that enrolled cases in the current study do not completely reflect all true cases of epistaxis. It has not captured the data of patients who had episodes of epistaxis but were not registered in the national portal. Therefore, the results may be underestimated or overestimated compared to the actual number of patients. Second, we only evaluated meteorological and air pollutant factors that are regularly monitored in Korea; other potential environmental risk factors that could affect the occurrence of epistaxis were not considered in this study . Third, To conclude, this study has served to highlight the association between environmental factors and epistaxis, and more importantly, it has shown that the effects are more pronounced in the younger age group.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Institutional Review Board of Chung-Ang Hospital (2005-015-19314) and the review board waived the requirement for informed consent. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.HM: concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and supervision. E-JA: acquisition, analysis, or interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and statistical analysis. All authors contributed to the article and approved the submitted version.This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (2022R1F1A1063720 to HM).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.