Toxoplasma gondii (T. gondii), which is difficult to detect in its latent state. We aimed to evaluate the association between toxoplasmosis, the risk of dementia, and the effects of antibiotics in Taiwan.Approximately 25–30% of individuals worldwide are infected with This nationwide, population-based, retrospective cohort study was conducted using the Longitudinal Health Insurance Database containing the records of 2 million individuals retrieved from Taiwan’s National Health Insurance Research Database. Fine–Gray competing risk analysis was used to determine the risk for the development of dementia in the toxoplasmosis cohort relative to the non-toxoplasmosis cohort. A sensitivity analysis was also conducted. The effects of antibiotics (sulfadiazine or clindamycin) on the risk of dementia were also analyzed.P < 0.001]. After adjusting for sex, age, monthly insurance premiums, urbanization level, geographical region, and comorbidities, the adjusted HR was 2.878 . Sensitivity analysis revealed that toxoplasmosis was associated with the risk of dementia even after excluding diagnosis in the first year and the first 5 years. The usage of sulfadiazine or clindamycin in the treatment of toxoplasmosis was associated with a decreased risk of dementia.We enrolled a total of 800 subjects, and identified 200 patients with toxoplasmosis and 600 sex- and age-matched controls without toxoplasmosis infection in a ratio of 1:3, selected between 2000 and 2015. The crude hazard ratio (HR) of the risk of developing dementia was 2.570 [95% confidence interval (CI) = 1.511–4.347, This finding supports the evidence that toxoplasmosis is associated with dementia and that antibiotic treatment against toxoplasmosis is associated with a reduced risk of dementia. Further studies are necessary to explore the underlying mechanisms of these associations.The online version contains supplementary material available at 10.1186/s13071-021-04928-7. Toxoplasma gondii (T. gondii), parasite, affects about 25–30% of the population worldwide [Toxoplasmosis, which is caused by infection with the orldwide . Individorldwide . After iorldwide . In addiorldwide . Elevateorldwide .Chlamydia pneumonia), or parasites (T. gondii) [Dementia is a common neurodegenerative disease characterized by symptoms of worsening cognition, emotional change, difficulties with language expression, and decreased motivation . The mos gondii) , 9.T. gondii antibody titers between an AD group and control group with latent toxoplasmosis [Several previous studies have shown that chronic toxoplasmic infection may be associated with human behavior alterations, obsessive-compulsive disorder, or even schizophrenia , 11. Inflasmosis . No prevThis retrospective cohort study is based on the NHIRD, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW), Taiwan. The National Health Insurance (NHI) scheme was established in 1995, and as of June 2009, it included contracts with 97% of medical providers, with approximately 23 million people enrolled in the program, or more than 99% of the entire population , 22. TheThe NHIRD also records inpatient care, ambulatory care, dental care, and prescription drugs received by the insured and their date of birth. Pursuant to the Personal Information Protection Act, individual identifiers are encrypted before the release of data for research. In the present study, patients diagnosed with toxoplasmosis during the period 2000–2015 were enrolled, and those recorded in the NHI program were coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), as ICD-9 codes of 130.All diagnoses of dementia were made by board-certified psychiatrists or neurologists. Toxoplasmosis was confirmed by serum antibody screening and avidity test or polymerase chain reaction (PCR) . SeveralThis study was approved by the Institutional Review Board of the Tri-Service General Hospital (TSGH IRB No. 2-107-05-026). Because the patient identifiers were encrypted before their data were used for research purposes in order to protect confidentiality, the requirement for written or verbal consent from patients for data linkage was waived.This was a retrospective cohort study. From the Longitudinal Health Insurance Database (LHID) including 2 million individuals, a randomly stratified sub-database retrieved from the NHIRD was used to identify individuals ≥ 50 years of age with a diagnosis of toxoplasmosis during the period between January 1, 2000, and December 31, 2015, according to ICD-9-CM code 130.x. In this 15-year follow-up study, patients were excluded if they were diagnosed with dementia or toxoplasmosis before 2000, were diagnosed with dementia before the first visit for toxoplasmosis, or were aged < 50. The date of toxoplasmosis diagnosis was defined as the index date. Figure The covariates included sex, age group , geographical area of residence , urbanization level of residence (levels 1 to 4), levels of hospitals as medical centers, regional or local hospitals, and monthly income . The urbanization level of residence was defined according to the population, along with various indicators of the level of political, economic, cultural, and metropolitan development. Level 1 was defined as a population of > 1,250,000, and a specific designation of significant political, economic, cultural, and metropolitan development. Level 2 was defined as a population between 500,000 and 1,249,999, and as playing an important role in the political system, economy, and culture. Urbanization levels 3 and 4 were defined as a population between 149,999 and 499,999, and < 149,999, respectively.The comorbidities in this study were diabetes mellitus (DM), hypertension, hyperlipidemia, coronary artery disease (CAD), human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS), and other immune deficiency diseases. All the ICD codes of the comorbidities are as listed in Additional file https://www.whocc.no/), and the duration of antibiotics usage was calculated by dividing the cumulative doses by the DDD of the antibiotics. We analyzed the effects on the risk of dementia between the two subgroups with or without the antibiotics treatment, with the sample divided by the covariates with the references of previous studies using the NHIRD, regarding the treatment effects of medications [Data on the usage of the antibiotics sulfadiazine and clindamycin were collected. The data on the defined daily dose (DDD) were obtained from the WHO Collaborating Centre for Drug Statistics Methodology , vascular dementia (VaD), or other types of dementia. At least three visits in one consecutive year in the NHIRD records would be regarded as a diagnosis of dementia. All the ICD codes of dementia are as listed in Additional file t-tests were used to evaluate the distribution of the categorical and continuous variables, respectively. The Fisher exact test for categorical variables was used to statistically examine the differences between the two cohorts. Fine–Gray survival analysis was used to determine the risk of dementia, and the results are presented as a hazard ratio (HR) with a 95% confidence interval (CI). A sensitivity analysis excluding the diagnosis of dementia both within the first year and the first 5 years was conducted to avoid protopathic bias. The difference in the risk of dementia between the toxoplasmosis subjects and control groups was estimated using the Kaplan–Meier method with the log-rank test. A two-tailed P-value < 0.05 was considered to indicate statistical significance.All analyses were performed using SPSS software version 22 . Chi-square and Table 5 person-years) developed dementia, as compared to 56/600 (323.42 per 105 person-years) in the control group, and the difference was statistically significant in Kaplan–Meier survival analysis  developed dementia, as compared to 1/9 without antibiotic treatment (507.67 per 105 person-years) in the control group, and the difference was statistically significant in the Kaplan–Meier survival analysis . After adjusting for gender, age, monthly insurance premiums, urbanization level, geographical region, and comorbidities, the adjusted HR was 2.878 . Male gender and higher Charlson Comorbidity Index (CCI) were associated with a higher risk of developing dementia. The toxoplasmosis patients aged ≥ 65 years were associated with a higher risk of developing dementia, in comparison to the patients aged 50–64.Table P < 0.001), 6.675 (P < 0.001), and 3.162 (P < 0.001), respectively. Toxoplasmosis was noted as being associated with VaD. Table Table  Antiprotozoal medication usage for toxoplasmosis was associated with a lower risk than that in the comparison group. Both sulfadiazine and clindamycin, either monotherapy or combination treatment, were associated with a lower risk of dementia Table .Table 4FIn this retrospective cohort study, there are several noteworthy findings. First, patients with toxoplasmosis had a nearly 2.8-fold increased risk of developing dementia. After the sensitivity analysis, excluding the diagnosis of dementia for the first year and the first 5 years after toxoplasmosis was diagnosed, patients with toxoplasmosis still had a twofold increased risk for developing dementia. Second, the sensitivity analysis revealed that, after excluding the AD diagnosis in the first year and first 5 years after toxoplasmosis, the association became insignificant, but other types of degenerative dementia were still associated with toxoplasmosis. However, other types of degenerative dementia were found to be proportionately higher than AD and VaD, and most of the community studies revealed that Alzheimer-type dementia is the most common cause of dementia in Taiwan , followed by vascular dementia  and mixed or other dementias (7–15%) –41. One We also discovered that there were no significant differences in the ratios between the two cohorts (21/200 vs. 56/600), or differences between the treatment and non-treatment groups (20/191 vs. 1/9). The difference was only apparent when the duration of follow-up after the exposure to toxoplasmosis was considered, that is, the person-years. This implies that toxoplasmosis might not be the direct cause of dementia, but it could accelerate the process, resulting in early onset of dementia. In addition, antibiotic treatment could attenuate this process. This might indicate that chronic inflammation, instead of the toxoplasmic infection itself, contributes to the process in the development of dementia.T. gondii infection, and may cause life-threatening encephalitis in immunocompromised patients [In previous studies, the brain was found to be the main target organ in patients . In healpatients . In an ipatients . In addipatients . Microglpatients . Althougpatients , the dorpatients . Early apatients .T. gondii-driven cerebral amyloid angiopathy (CAA). In addition, there was also Aβ immunoreactivity co-localized with the T. gondii cysts as early as day 15 post-infection and widespread Aβ immunoreactivity. They were detected in other areas of the brain where they did not co-localize with cysts at days 60 to 90 post-infection [N-methyl-d-aspartate receptor (NMDAR) loss. In the CNS, glutamate plays a role in neuron excitation and could be endocytosed or released at the synapse through NMDAR on neural cells. Therefore, NMDAR plays an important role in the synaptic connection which controls the function of learning and memory. NMDAR dysfunction is strongly associated with AD [T. gondii did not have a higher prevalence of AD. For example, in the 1970s, the seroprevalence in France was 70% [T. gondii-infected mice compared to the non-infected mice [Torres et al. designed another mouse model and argued that the study, by Möhle et al., has not evaluated the advanced signs as nfection . Moreove with AD . There w with AD . However was 70% . Möhle eted mice . The assOur study has several strengths: First, we used Taiwan’s NHIRD, which is a valuable resource to address this issue in a nationwide population. Second, several previous studies have demonstrated the accuracy and validity of several diagnoses of neuropsychiatric disorders in the NHIRD, such as Tourette syndrome , stroke Toxoplasma infection in Taiwan was about 10% in 2006 (https://nidss.cdc.gov.tw), but this was with a focus only on pregnant women, and it did not represent the general prevalence in the total population. Therefore, we were not able correlate the current prevalence of dementia with the prevalence of toxoplasmosis in the past. Fourth, there were very few non-treatment patients in our study, and we used a one-sided test to analyze the significance between the treatment and non-treatment groups. This limits the generalizability of the results regarding antibiotic effects and their association with reduced risk of dementia. Further evaluations are needed using randomized clinical trials or observational studies in a larger population.The present study has several limitations that warrant consideration. First, similar to previous studies, not all data were recorded in the NHIRD, and we were unable to evaluate family history, neurological severity, types, laboratory parameters, the availability of rehabilitation, or additional examination findings . Therefore, the lack of data on the clinical and radiological course and treatment of the disease was a limitation. Second, other factors, such as genetic, psychosocial, and environmental factors, were not included in the dataset. However, the present study covers all of Taiwan’s hospitals and > 99% of the Taiwanese population during a 15-year period, thereby increasing the likelihood that our data are valid and representative. Third, the recorded prevalence of To the best of our knowledge, we have provided the first evidence that toxoplasmosis is associated with dementia in Taiwan. The results show that the usage of antibiotics for toxoplasmosis might be beneficial in attenuating the risk of dementia for patients with toxoplasmosis. Clinicians should focus more attention on the risk of dementia in patients with toxoplasmosis.Additional file 1: Figure S1. The flowchart for the comparison of patients with toxoplasmosis with and without antibiotic treatmentAdditional file 2: Figure S2. The Kaplan-Meier survival analysis in toxoplasmosis patients with or without antibiotic treatment. In the comparison of the two groups, the difference was statistically significantAdditional file 3: Table S1. International Classification of Diseases, Ninth Revision, Clinical Modification codes in this study


The AerG, IntG, and ComG participants took part in three different aquatic exercise programs for 28 weeks. The CG participants maintained their usual routines. All participants were evaluated for IMT, blood pressure, lipid profile, and MCP-1 and MIP-1α chemokines, pre- and post-intervention. Significant differences were found in the AerG for diastolic diameter (DD), in the IntG for peak systolic velocity (PSV), and in the ComG for DD and end-diastolic velocity (EDV). Regarding blood pressure, significant differences were found in AerG for systolic blood pressure (SBP) and diastolic blood pressure (DBP); in IntG for DBP; and in ComG for SBP, DBP, and heart rate (HR). Significant differences were found in the AerG and IntG for glucose (GLU). Lower plasma levels of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein (MIP-1α) were found in the AerG and in the ComG for MCP-1 after the intervention. Aquatic physical exercise appears to improve cardiovascular health, regardless of the type of the program adopted. Aerobic programs (combined and continuous aerobic exercises) seemed to have a more beneficial effect in reducing important cardiovascular risk markers.Scientific evidence has shown that physical exercise is an effective way of improving several cardiovascular disease markers. However, few studies have tested its effectiveness when performed in aquatic environments. The purpose of this study was to test the impact of different aquatic exercise programs on the intima-media thickness of carotid arteries (IMT) and hemodynamic and biochemical markers of cardiovascular diseases in community-dwelling older persons. A total of 102 participants were randomly allocated into four groups: an aerobic exercise group (AerG) ( Cardiovascular diseases are a group of heart and blood vessel diseases that are responsible for about 31% of the world’s deaths, 85% of which are caused by heart attacks and strokes .Cardiovascular diseases can be predicted through hemodynamic cardiovascular parameters and cardiovascular risk biomarkers. In relation to hemodynamic parameters, the intima-media thickness of the carotid arteries (IMT) is considered an early marker of coronary artery disease and also a risk factor for other types of cardiovascular disease and stroke . The IMTConcerning cardiovascular parameters, arterial hypertension is considered an early marker of the development of atherosclerotic disease, being considered a high-prevalence cardiovascular risk factor associated with endothelial dysfunction . AtherosRegarding biochemical markers, ageing also leads to a deterioration of the lipid and glucose profile, increasing the levels of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG), and fasting blood glucose (GLU). When those elements are uncontrolled, they are directly related to cardiovascular complications . ChemokiAccording to the literature, physical activity is a very important tool for cardiovascular health. At the hemodynamic and cardiovascular level, physical exercise, mainly exercise with aerobic characteristics, can contribute to the reduction of the luminal diameter of the arteries, since it has a localized effect and/or reflects the increase in blood flow . In addiRegular physical exercise can cause a reduction around −3.5 mmHg in systolic blood pressure and −3 mmHg in diastolic blood pressure . PhysicaRegarding the biochemical markers related to cardiovascular diseases, studies have shown that physical exercise is also an effective tool to improve these factors. In Martins et al. , two exePhysical exercise has shown evidence of being an effective way to improve cardiovascular markers, but there are few studies that test its effectiveness in aquatic environments . The exeA randomized controlled trial was conducted in Beira Interior Region, Portugal. A sample of non-institutionalized older participants were submitted to a 28-week aquatic exercise intervention. The entire study protocol was previously published by Ferreira et al. . Intima-The size and statistical power of the sample were calculated using the G*Power software application  . The foln = 36; IntG, n = 41; ComG, n = 48 and CG, n = 27. According to the experience of the research team and previous studies, the dropout rate from exercise programs among elderly populations is high, so we gathered more participants to fulfil the sample size and compensate for potential dropouts [Initially, 174 individuals from the community were invited to participate in the study. After the application of the inclusion and exclusion criteria, 152 individuals were randomized into the four groups mentioned above: AerG, dropouts ,26,27. AThe following inclusion criteria were applied: (a) participants from both sexes; (b) 65 years or older; (c) non-institutionalized; (d) autonomy to travel from their residence to Sertã municipal swimming pool; (e) filling out the informed consent form; (f) individuals with medical authorization to practice physical exercise in an aquatic environment, in cases they had some type of clinical condition or comorbidity. The following exclusion criteria were also defined: (a) individuals with clinically diagnosed pathologies putting their and others’ health at risk while doing physical exercise in an aquatic environment; (b) individuals that obtained a score of less than 9 points in the Mini-Mental States Examination (indicating severe cognitive impairment) or were clinically diagnosed with a mental illness; (c) an attendance of less than 50% to physical exercise sessions; (d) participants who failed to complete all proposed assessment tests.The AerG, IntG, and ComG groups performed physical exercise in an aquatic environment during a period of 28 weeks. Participants from the CG group were asked to maintain their normal daily activities without performing any type of systematic physical exercise during the same time period. The participants in the control group were age-matched persons who did not perform any type of regular systematic exercise.n = 11); less than 50% of attendance of the exercise sessions (n = 14); not completing all the assessment tests (n = 12); injury not related with the exercise intervention (n = 4); disease (n = 9). Consequently, 102 participants completed the entire process . The cardiometabolic diseases included diabetes, hypertension, and hypercholesterolemia. Fifty participants dropped out from the study for the following reasons: personal reasons  with an accuracy of 0.1 cm. Weight (Wgt), body mass index (BMI), visceral fat (VF), fat mass (FM), and lean body mass (LBM) were evaluated using the TANITA BC-601 impedance scale . Functional fitness was assessed using the following tests from the Senior Fitness Test set, developed by Rickli and Jones [To characterize the sample, values related to anthropometry and physical fitness were collected. Height (Hgt) was assessed using a portable Seca Bodymeternd Jones  and valind Jones : muscle ®) portable ultrasound machine, VIVID model, with a 9 L linear probe (4 to 12 MHz). All examinations were performed by a highly trained technician. The measurements and data reanalysis were interpreted by two independent technicians, with all data being recorded in digital support. All measurements were performed in the space between 10 and 20 mm before the carotid bifurcation (carotid bulb), allowing the measurement of the IMT in the most distal wall, which is the one with the best definition.The intima-media thickness of the carotid arteries (IMT) was evaluated with a General Electric (GEThe participants performed the examination in a temperature-controlled room (22 °C to 24 °C), lying on an examination table, in a supine position, with their heads turned to the side (45°). With the use of the real-time B-mode Echo Doppler ultrasound technique, we obtained an image of the carotid artery in the longitudinal plane and transverse plane in order to confirm the IMT measurements.The images were also used to obtain the systolic diameters (SD) and diastolic diameters (DD). The peak systolic velocity (PSV) and the endo-diastolic velocity (EDV) were measured with the Pulse-Doppler technique in association with the continuous Doppler. For higher accuracy in the velocity calculations, the insonation angle was set at 60°. This allowed us to obtain correct values with respect to the Doppler equation.®, Jungingen, Germany). All the measurements were taken after the participants were at rest for a period of 5 min, sitting and silent, in a room with controlled temperature (22 °C to 24 °C). After this period, participants maintained their comfortable sitting position in a chair, keeping their torsos straight, and the right upper limb stretched and placed on top of a table. Then, a cuff was placed on their right upper limbs, aligned with the brachial artery, at the level of the heart, and adjusted to the perimeter of the arm. Three measurements were taken, with intervals of 1–2 min between them, to check what the average blood pressure was. The mean of the three measurements was considered according to the Guidelines for the Management of Arterial Hypertension [The measurements of heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were performed with the use of a digital automatic sphygmomanometer from Riester  according to the manufacturer’s instructions.Fasting blood samples (15 mL) were collected from the ante cubital vein by a registered nurse. The blood sample was used by the clinic to assess lipidic panel values: cholesterol total (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and glucose (GLU). The atherogenic index (AI) was calculated using the TC/HDL ratio and considered normal for values less than five. Next, the test tubes were centrifuged for 10 min at 3500 rpm, and plasma and serum were retrieved and stored in cryogenic test tubes at −80 °C until further use. Levels of Monocyte Chemoattractant Protein-1 (MCP-1/CCL-2) and Macrophage Inflammatory Protein-1 alfa (MIP-1α/CCL3) were subsequently analysed by ELISA  for the elderly .All exercise programs sessions had a duration of 45 min, twice a week, for 28 weeks and were performed in a water environment (the water level was between 0.80 and 1.20 m with a temperature of approximately 32 °C), using musical rhythm as a tool to control the intensity of the exercise. Sequences of aquatic exercises, previously defined and selected according to the objectives of each program, were applied. Water exercise sessions were organized into three different parts: the initial, main, and final part.The initial part or warm-up lasted between 10 and 15 min, at low intensity (30–40% max HR), and was the same in the three water exercise programs. During this initial part, it is intended that participants will adapt to the aquatic environment, i.e., to the water temperature, and provide muscular and metabolic stimulations to prepare the body for the main part of the session. Thus, simple exercises in water were used, such as displacements and isolated movements, with a progressive increase in complexity and intensity throughout the initial part.-Continuous aerobic (AerG): exercise aerobic ;-Interval aerobic (IntG): exercise aerobic different intensities . In IntG, the main part of the sessions consisted of several series ;-Combined (ComG): exercise aerobic  and muscle strength .The main part for each one of the three water exercise program sessions had a duration of 20 to 30 min and had the following characteristics :-ContinuThe final part of the water exercise sessions lasted between 5 and 10 min and was the same for each of the three water exercise programs. This part consisted of two phases: return to calm, where relaxation exercises were applied to bring back the participants’ heart rate to values close to the resting state, and stretching exercises stimulating a greater range of motion, used to stretch the main muscle groups used throughout the sessions.For safety and intensity target control reasons, all participants randomly used heart rate monitors   during the exercise sessions, in all three water exercise programs. Depending on the heart rate values obtained, intensity adjustments to the training plan were performed to maintain the intensity target defined for each water exercise program.For safety and intensity target control reasons, the intensity of the different water exercise programs was predicted indirectly using Karvonen’s Formula :Target hAdditionally, and to calculate the maximal heart rate, we used the  followinp-values from the Shapiro–Wilk test; and visual inspection of generated histograms. All longitudinal comparisons were performed using complete case analysis. Parametric data were analysed using the Student’s t-test for independent samples to compare the different moments (M1 and M2) and the one-factor ANOVA test and post hoc Tukey’s test to analyse the differences between groups. Nonparametric data were analysed using the Wilcoxon test to compare the different moments (M1 and M2), and the Kruskal–Wallis and Bonferroni tests were used to analyse differences between groups. Associations between variables were analysed using Pearson’s correlation coefficient values and interpreted as follows [p ≤ 0.05.The collected data were subjected to descriptive statistical analysis where values such as maximum, minimum, mean, and standard deviation were calculated for each variable in each assessment moment. Afterwards, data normality was tested by considering the response to three conditions: z-values from the skewness and kurtosis tests;  follows : r = 0.1p > 0.05). Exercise frequency rate was 75.4% in AerG, 69.3% in IntG and 77.7% in ComG.The base line values characterizing of each group (mean and standard deviation) are shown in Among the different groups of evaluated variables, intima-media thickness of the carotid arteries, blood pressure, lipid profile, fasting glucose, and MCP-1 and MIP-1 markers were analysed for correlations, in the two evaluation phases (M1 and M2) see . Weak anThe variation in the results of the hemodynamic and cardiovascular parameters, which were analysed by type of aquatic exercise program, before and after the intervention, are shown in p > 0.05). As a result of the intervention with the aquatic exercise program, significant differences were found between M1 and M2 in AerG for DD-R , in IntG for PSV-R , and in ComG for DD-L , for EDV-L , and DD-R . In the CG, there was a significant increase for EDV-L , while a significant reduction in the same variable was observed in ComG. In regard to the variables IMT-L, SD-L, PSV-L, IMT-R, SD-L, and EDV-R, no significant changes were observed after the intervention (p > 0.05).The general results of the hemodynamic parameters showed no significant differences between the groups before and after the intervention (p > 0.05). As a result of the intervention with the aquatic exercise programs, significant differences were found in AerG for SBP  and DBP , in IntG for DBP , and in ComG for SBP , DBP  and HR . In the control group, there were no significant changes (p > 0.05).Regarding the blood pressure parameters results, no significant differences were found between the groups before and after the intervention . After the intervention, significant differences were found for AI between IntG and CG (p = 0.008) and between ComG and CG (p = 0.009). In both cases, the CG obtained a less satisfactory result. As a result of the intervention with the aquatic exercise program, significant differences were found in AerG  and IntG  for GLU, and in CG for AI . In regard to the variables TC, HDL, LDL, and TG, there were no significant changes (p > 0.05). As for the chemokines MCP-1 and MIP-1α, statistically significant differences were found between the groups, before and after the intervention (p < 0.05). From M1 to M2, statistically significant differences were found in AerG for MCP-1  and MIP-1α  and in ComG for MCP-1 . For the IntG and CG, no statistically significant differences were found in both chemokines (p > 0.05).The overall lipid profile results revealed that no significant differences were found between the groups before the intervention  on the IMT and hemodynamic and biomarkers of cardiovascular diseases in community dwelling older people. Preliminary systematic research revealed the innovative characteristics of the present study, since there were very few studies that have evaluated similar variables with aquatic exercise interventions in older adults.Although no changes were found in IMT or in the variables related to the hemodynamic parameters, significant reductions were observed for DD-R in AerG and ComG, for PSV-R in IntG, and for DD-L in ComG. In EDV-L, there was a significant reduction in ComG, while in CG a significant increase was observed.A study by Santos  reportedThe results from the present study are in line with those in the existing literature. In IMT-R, although there were no significant statistical differences, a trend towards a reduction was visible in the three exercising groups, whereas in IMT-L only a reduction in IntG was visible, with the value of the mean remaining the same in the other groups. As reported by Santos , our resSignificant reductions were also found for SBP in the AerG and ComG, as well as in the three-exercising groups for DBP, and for HR in the ComG. A study by Park et al.  tested tIn our study, the three exercise groups showed reductions in SBP, DBP, and HR. The aerobic exercise and combined exercise program seem to be the most beneficial. Both showed similar results in SBP and DBP, with the aerobic exercise program leading to a slightly higher decrease in the mean compared to the combined exercise program. In HR, the combined exercise program was the only one where the decrease was statistically significant. We may conclude that the combined exercise program may be more beneficial for cardiovascular parameters, as in addition to having showed similar results to the aerobic program in SBP and DBP, it also led to a significant decrease in HR.In regard to the biochemical markers, significant reductions were noticed for GLU in AerG and IntG, and a significant increase was noticed for the AI in CG (14.3%). After the intervention, significant differences were found in the AI between IntG and CG and between ComG and CG.In a study with participants with type 2 diabetes , after aAs in the study of Cugusi et al. , the preIn the plasma chemokine levels, significant reductions were noticed for MCP-1 and MIP-1α in AerG, and for MCP-1 in ComG.Among long-term intervention studies, the one conducted by Kraemer et al. , which cIn our study, despite the fact that the intervention took place in a different context, the results partly reached the same conclusions. As in the Barry et al. , our resMCP-1 appears to be present in the initial phase of atherosclerotic lesion formation, i.e., in the thickening of the tunica intima and fatty streaks, which suggests that this chemokine may contribute to an early influx of monocytes into blood vessels . In the Exercise in aquatic environments, due to the specific proprieties of water that make the exercise practice safer and more comfortable for the elderly population, reduces the risk of traumatic fractures and joints by giving them less stress and lower impact . The visStudy limitations included the fact that a simple randomization method was used, instead of using a blocked randomization method, which would guarantee a balance in the number of participants in each group, reducing sequence unpredictability. Another limitation was the fact that the level of physical activity of the participants in the control group was not evaluated. Although participants were not involved in regular systematic exercise, this assessment would have contributed to a stronger study. The limited number of publications with interventions in an aquatic environment in older populations was also a limitation for the discussion of results.More intervention exercise studies in aquatic environments are needed in order to reinforce the results found in the present study and better understand the effects and effectiveness of aquatic exercise programs on markers of cardiovascular health.Aquatic physical exercise, regardless of the type of program, seems to lead to benefits in cardiovascular variables, and this type of intervention may be a viable alternative when land-based exercise is not possible and/or desired.In relation to the intima and average thickness of the carotid arteries, we can say that all the aquatic exercise programs studied  can be considered as factors for hemodynamic balance and thus contribute to the reduction of stress on the arterial wall and reduce the risk of cardiovascular diseases. The combined program seems to be slightly more beneficial, compared to the other programs due to the fact that it resulted in significant differences in a higher number of variables.As for blood pressure, the three exercise groups showed reductions in SBP, DBP, and HR. However, the aerobic and combined exercise programs proved to be more beneficial for blood pressure and present statistically significant differences for both variables (with the same mean variation). Additionally, the combined program also showed a statistically significant reduction for HR.Regarding the metabolic profile, our results showed that AerG and IntG are equally beneficial in reducing GLU. Regarding TC, HDL, LDL, and TG, the results did not show significant changes; however, they remain within the reference values. We concluded that aquatic physical exercise may contribute to the balance of the lipid profile.Finally, as for chemokines, the results suggest that aquatic physical exercise, especially that with aerobic characteristics, helps prevent the development of cardiovascular diseases by contributing to the reduction in chemokines MCP-1 and MIP-1α and the subsequent infiltration of monocytes and formation of atherosclerotic plaques.


Background: Stroke-associated pneumonia (SAP) is associated with poor prognosis after acute ischemic stroke (AIS).Purpose: This study aimed to describe the parameters of coagulation function and evaluate the association between the fibrinogen-to-albumin ratio (FAR) and SAP in patients with AIS.Patients and methods: A total of 932 consecutive patients with AIS were included. Coagulation parameters were measured at admission. All patients were classified into two groups according to the optimal cutoff FAR point at which the sum of the specificity and sensitivity was highest. Propensity score matching (PSM) was performed to balance potential confounding factors. Univariate and multivariate logistic regression analyses were applied to identify predictors of SAP.Results: A total of 100 (10.7%) patients were diagnosed with SAP. The data showed that fibrinogen, FAR, and D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT) were higher in patients with SAP, while albumin was much lower. Patients with SAP showed a significantly increased FAR when compared with non-SAP (P < 0.001). Patients were assigned to groups of high FAR (≥0.0977) and low FAR (<0.0977) based on the optimal cut-off value. Propensity score matching analysis further confirmed the association between FAR and SAP. After adjusting for confounding and risk factors, multivariate regression analysis showed that the high FAR (≥0.0977) was an independent variable predicting the occurrence of SAP . In addition, the FAR was higher in the severe pneumonia group when it was assessed by pneumonia severity index (P = 0.008).Conclusions: High FAR is an independent potential risk factor of SAP, which can help clinicians identify high-risk patients with SAP after AIS. Stroke-associated pneumonia (SAP) is one of the most common complications among patients with acute ischemic stroke (AIS), taking place most frequently within the first week of stroke onset –3. The iNumerous studies have discovered various risk factors for SAP such as old age, being male, stroke severity, dysphagia, and diabetes , 9, 13. It has long been known that there exists a wide range of interplay between inflammation and coagulation. For instance, inflammation spikes immediately after injury. Aggregated platelets and neutrophils release factors that stimulate the coagulation cascade in acute lung disease .The fibrinogen-to-albumin ratio (FAR) which combines coagulation with nutritional status, is a new vital inflammatory biomarker for a variety of diseases, such as cervical cancer, oligodendroglial gliomas, acute coronary syndrome, and stroke –25. ZhenHere, we aimed to explore the relationship between SAP and FAR in a retrospective cohort, which might provide an easily available and economical predictor for SAP.Patients were collected from a retrospective clinical database that included consecutive patients admitted to the Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, within 24 h after the onset of ischemic stroke between March 2018 and January 2019 in this retrospective study. This retrospective study obtained the approval of the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University and was conducted according to the ethical standards of the local Research Ethics Committee on human experimentation.2]; and (vi) incomplete medical or laboratory record. Ultimately, a total of 932 patients were enrolled in this study (Included patients diagnosed with AIS were verified with CT or MRI within 24 h at admission. The exclusion criteria were as follows (i) transient ischemic attack; (ii) active infection within 2 weeks before admission or prophylactic use of antibiotics; (iii) a history of central nervous system diseases such as brain trauma, cerebral hemorrhage, or hydrocephalus; (iv) severe liver disease [serum transaminase levels more than twice the upper limit of the normal range or persistent hyperbilirubinemia within 6 months]; (v) severe kidney disease , and blood pressure measurements were conducted within 24 h of hospital admission. Stroke severity, evaluated using the National Institutes of Health Stroke Scale at admission were assessed by well-trained neurologists. Functional outcomes were assessed by the modified Rankin Scale (mRS) at discharge. The same occupational neurologist evaluated swallowing function in all participants at baseline with the modified water swallowing test. The assessment mainly consisted of behavioral airway response, especially coughing, choking, or throat clearing, and/or change in voice . The PSIStroke-associated pneumonia was defined as lower respiratory tract infections within the first 7 days after stroke onset, accordance to the modified Center for Disease Control and Prevention criteria . PatientWe used propensity-score matching to balance confounding factors in baseline characteristics between the low FAR group and high FAR group. The propensity score was estimated using logistic regression of independent variables for each patient that included age, current smoking, drinking, NHISS, previous stroke, diabetes mellitus, AF, thrombolysis, dysphagia, aPTT, D-dimer, PLT, length of hospital stay, and discharge mRS score. If the propensity scores of patients were the same, they had an equal probability of encountering events that we wanted to observe. We adopted 1:1 propensity score-matching to match the low FAR group and high FAR group.t-test, while asymmetrically distributed variables were analyzed by Mann–Whitney U-test, and comparison of proportions were analyzed by the chi-squared test. The relationship between FAR and SAP was analyzed in four steps. First, we conducted a receiver operating characteristic (ROC) curve to determine the optimal value of the area under the curve (AUC), and a significant cutoff point, sensitivity, and specificity. We considered the optimal cutoff point by calculating Youden's index max point giving the highest sum of sensitivity and specificity and maximum diagnostic efficiency. Second, binary logistic regression was performed to explore the relationship between this FAR cutoff point and SAP. Third, all confounding factors (P < 0.05) were included in multiple logistic regression to adjust for potential confounding factors and find out the independent factors for SAP. Finally, we compared FAR levels between the severe SAP group and non-severe SAP group divided by PSI. All statistical analyses were performed with SPSS for Windows, version 25.0 . All the statistics are two-tailed and P < 0.05 was considered statistically significant.Continuous variables were presented as mean with standard deviation or median with interquartile range according to normal or asymmetrical distribution, while discrete variables were shown as frequencies or percentages. Data normality was checked with Kolmogorov–Smirnov test. Continuous variables in normal distribution were compared by Student's P < 0.001), had higher National Institute of Health Stroke Scale (NIHSS) scores at admission (P < 0.001), higher mRS scores at discharged and longer hospital stay, were more likely to acquire dysphagia (P = 0.031). Besides, patients with SAP were more likely to receive anticoagulation treatment and were less likely to undergo antiplatelet therapies.During the research period, 932 patients with AIS were included in the study. The baseline demographic, clinical, and laboratory characteristics of the study population are displayed in P < 0.001, respectively), while albumin was much lower , as shown in It was shown that fibrinogen, FAR, PT, INR, aPTT, and D-dimer were significantly higher in the SAP group than in the non-SAP group  and pointed to an optimal cutoff level of 0.0977 mg/dl of FAR with 69.0% sensitivity and 66.1% specificity for the development of SAP during hospitalization  (ctively) .P = 0.008) had significantly higher FARs than the low scoring groups, showing a close correlation between the FAR and pneumonia severity . The high PSI group  patients were diagnosed with SAP, which was consistent with previous reports . The stuP < 0.001; As fibrinogen and albumin, two critical factors in the coagulation system that care for biomarkers for nutrition state and inflammation, are delivered by the liver, the combined application of two factors (FAR) could be a more powerful predictor than single biomarker fibrinogen or albumin. An elevated FAR level may be a result of increased fibrinogen levels or/and decreased albumin levels. In this study, the FAR levels of patients with SAP were higher than patients with non-SAP , which limited the analysis of the dynamic association between FAR and SAP. It is necessary to conduct a further longitudinal study to verify the predictive value of FAR measured at multiple times for SAP. Third, our study lacked data on the use of the nasogastric tubes and mechanical ventilation, which were related to a high risk of respiratory infections. Finally, other important blood parameters such as antithrombin and leukocyte were not included in this study.Despite the limitations, our findings are very meaningful. Our study revealed that high FAR was an independent predictive factor related to a higher risk of SAP in patients with AIS. It was also related to the severity of pneumonia. The study provides new references for further clinical trials to determine whether the levels of FAR may serve as a new marker to select patients with AIS at a higher risk of SAP and thus, to guide targeted treatment at an early stage.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by the Ethics Committee of First Affiliated Hospital of Wenzhou Medical University. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.GL, MH, JS, ZW, and JH conceived and designed the study. GL and MH interpreted data. GL, MH, and JS wrote the manuscript. GL, JS, and XX prepared figures. GL and JS did the statistical analyses. GL, MH, JS, XX, HL, LQ, HZ, MX, DG, and LY screened and extracted data. ZW, JH, and GH supervised the study. All authors have made an intellectual contribution to the manuscript and approved the submission.This work was supported by the Projects of Provincial Natural Science Foundation of Zhejiang (no. LY19H090013), the Jiaxing Science and Technology Plan Project (no. 2019AD32181) and Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China.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.


Due to the influence of COVID-19, people pay more attention to the balance between human and nature and pursue more healthy, environmental and nutritional sustainable products (such as organic food). However, the mainstream consumption of organic food is far less, especially in developing countries like China. Therefore, it is urgent to take effective measures to promote the development of China's organic food market. This current study investigated the relationships between consumers' similarity , perceived values  and organic purchasing behavior based on the Stimulus-Organism-Response (S-O-R) theoretical model and information similarity effect. And considering gender differences in consumers' similarity, perceived values and organic purchasing behavior. Meanwhile, the mediating effects of perceived values on the relationship between consumers' similarity and purchasing behavior were also discussed, considering the background of COVID-19. Data were collected using structured questionnaire survey in first-tier cities in China. A total of 344 consumers of organic foods participated in the study. Structural equation modeling was employed for data analysis. The results indicated the significant association of information anxiety, uncertainty and sustainable consumption attitude with perceived values. And perceived values and sustainable consumption attitude had a positively significant influence on purchase behavior. In addition, environmental value played mediating effects in the relationships between organic purchasing behavior and information anxiety, uncertainty and sustainable consumption attitude. And the impact of sustainable consumption attitude and environmental value on organic purchasing behavior differed in gender. The research not only provides novel insights for understanding organic consumption, but also provides reference for organic sellers to develop sales strategies and policy makers to formulate policies to guide organic consumption, which are conducive to promoting China's organic food industry. Global food safety and environmental problems have attracted more and more attention. Thøgersen  believedUnderstanding organic purchasing behavior is the key to predicting organic food consumption  factors into external similarity and internal similarity. In addition, this paper divided external similarity into information anxiety and uncertainty from the perspective of consumers' access to information, which not only considered the similarity of information anxiety, but also considered consumers' similarity to the uncertainty of organic information. This may provide a new perspective for the study of organic consumption, and may provide valuable suggestions for organic sellers. Third, this paper focused on the role of consumer perceived values after the COVID-19 outbreak, divided perceived values into three dimensions of functional value, health value, and environmental value in combination with the realistic background, and explored the relationship between perceived values and organic purchasing behavior. At the same time, the mediating effects of perceived values on the relationship between information anxiety, uncertainty, sustainable consumption attitude, and purchasing behavior were also discussed. The conclusions may provide valuable suggestions for organic retailers, policy makers and even organic producers.The rest of the paper is organized as follows. In Sections Theoretical Background and Hypothesis Development, we review the background literature and develop our hypotheses. Sections Research Methodology and Results provide a detailed introduction of our research methodology and analysis and present our research results. Finally, we discuss some conclusions, significance and limitations of this study, as well as ideas for further research.According to the SOR model from the field of environmental psychology, all aspects of the environment play a stimulating role (S), affecting people's internal states (O), which drives their behavioral responses (R)  has a positive effect on functional value (FV).H1b. Information anxiety (IA) has a positive effect on health value (HV).H1c. Information anxiety (IA) has a positive effect on environmental value (EV).H1d. Information anxiety (IA) has a positive effect on purchase behavior (PB).Uncertainty is a state of holding incomplete information about something Vieira, , and it H2a. Uncertainty (UNC) has a negative effect on functional value (FV).H2b. Uncertainty (UNC) has a negative effect on health value (HV).H2c. Uncertainty (UNC) has a negative effect on environmental value (EV).H2d. Uncertainty (UNC) has a negative effect on purchase behavior (PB).Attitude plays an important role in influencing consumers' perceived values and behavior  has a positive effect on functional value.H3b. Sustainable consumption attitude (SCA) has a positive effect on health value.H3c. Sustainable consumption attitude (SCA) has a positive effect on environmental value.H3d. Sustainable consumption attitude (SCA) has a positive effect on purchase behavior (PB).Perceived values refer to consumers' overall evaluation of the usefulness of relevant products .H5. Health value has a positive effect on purchase behavior (PB).H6. Environmental value has a positive effect on purchase behavior (PB).Perceived values are considered important predictors of consumer decision-making . And in the present study, respondents from Beijing, Shanghai, Guangzhou and Shenzhen were selected as the research objects. There are two main reasons for using online surveys to collect respondents from these cities in the current study. First, face-to-face interviews should be avoided to reduce social distance after the COVID-19 outbreak. Second, the price of organic food is usually 2–4 times higher than that of traditional agricultural products, and China's organic consumers are mainly concentrated in big cities at present , these cities were the top-four-ranked cities for per capita disposable income in China. Therefore, the samples from Beijing, Shanghai, Guangzhou, and Shenzhen are more representative. Moreover, 30 questionnaires were distributed online prior to the formal survey as a presurvey to ensure the comprehensibility of the items in the survey and the appropriateness of data collection procedures. After the preliminary survey, the questionnaire was modified appropriately.Data collection was conducted through the commission of a professional online questionnaire service company, Wenjuanxing . Five items of information anxiety were adapted from Zung  and ShweTo test the proposed model, we adopted the two-stage approach of “structural equation modelling” (SEM) recommended by Anderson and Gerbing . AMOS 24As with all self-reported data, there is a potential for common method variance resulting from multiple sources, such as consistency motif and social desirability  value, degrees of freedom (df), value of χ2/df, comparative fit index (CFI), root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and Tucker-Lewis index (TLI) were used to assess model fit. The model fit is good when χ2/df < 3.0, with RMSEA ≤ 0.08, TLI and CFI ≥ 0.90  were all acceptable.Confirmatory factor analysis (CFA) assesses the fit of the measurement model based on various fit indices. According to the guidelines suggested by Jackson et al. , the chip < 0.001), indicating preliminary evidence for the convergent validity of the measurement model , suggesting that item-factor loadings across males and females were equivalent. In addition, the χ2 difference of 31.81 for 30 degrees of freedom was non-significant (p = 0.376) in the model 7, the χ2 difference of 39.24 for 28 degrees of freedom was non-significant (p = 0.077) in the model 8 and the χ2 difference of 38.53 for 30 degrees of freedom was non-significant (p = 0.137) in the model 9, suggesting that measurement intercepts, covariances and measurement residuals across males and females were all equivalent.In order to test the measurement invariance across males and females, according to the suggestions of Van De Schoot et al.  and Deng2 = 583.87; df = 509; χ2/df = 1.15; CFI = 0.99; GFI = 0.91; TLI = 0.99; RMSEA = 0.02) were all acceptable. The structural model elucidated 44.6% of the variance of purchase behavior . According to the Bollen–Stine bootstrap to correct for bias in the model fit statistic, the resulting fit indices  showed a significant influence on FV, HV, and EV respectively, supporting H1a, H1b, and H1c. And UNC  showed a significant impact on FV, HV and EV respectively, supporting H2a, H2b, and H2c. Meanwhile, SCA had a significant influence on FV, HV and EV respectively. Thus, H3a-H3c were supported. In addition, SCA, FV, HV, and EV had a significant impact on PB at a significant level of 1, 5, 5, 1% respectively, supporting H3d, H4, H5, and H6. However, IA, UNC and Gender had no significant effects on PB. Therefore, H1d, H2d, and H10 were not supported.As shown in 2 difference of 23.808 for 15 degrees of freedom was non-significant (p = 0.068) in the model 5 and the χ2 difference of 4.116 for 4 degrees of freedom was non-significant (p = 0.391) in the model 7, suggesting that path coefficients and structural residuals across males and females were all equivalent. However, the χ2 difference of 18.909 for 6 degrees of freedom was significant (p = 0.004) in the model 6, thus the structural covariances was not equivalent.In order to test the structural invariance across males and females, according to the suggestions of Van De Schoot et al. , we condp < 0.01) showed a significant impact on PB in the male group. However, SCA had no significant effects on PB in female group. Meanwhile, EV  showed a significant impact on PB in female group. However, EV had no significant effects on PB in male group.In order to further test the difference of consumers' gender on organic purchasing behavior, we conducted a group analysis of two subgroups, male and female. As shown in p < 0.05) and indirect effect  of IA on PB, and the total effect  and indirect effect  of UNC on PB were all significant, while the direct effects of those were no longer significant. The above findings indicated that EV played a completely mediating role in the relationships between IA and PB (H9a), and between UNC and PB (H9b). Thus, both H9a and H9b were supported. In addition, the total effect , indirect effect  and direct effect  of SCA on PB were all significant. The above findings indicated that EV played a partially mediating role in the relationships between SCA and PB (H9c). Thus, H9c was supported. However, FV and HV had no mediating effects on the relationships between IA and PB, between UNC and PB, and between SCA and PB. Thus, H7a-H7c and H8a-H8c were not supported.In order to investigate the indirect effects of the independent variable through the mediator, bias-corrected percentile bootstrapping and percentile bootstrapping were performed at a 95% confidence interval with 5,000 bootstrap samples . Our findings are consistent with previous literature. Namely, Ruiz Mafé and Sanz Blas  argued tSecondly, regarding perceived values, the study results found that functional value, health value and environmental value had significant and positive influences on purchase behavior. Our findings are in line with the results of prior literature, which argued perceived values are considered important predictors of consumer decision-making . As we expected, there is a potential relationship among consumers' similarity, environmental value and purchase behavior. However, functional value and health value did not play mediating effects in the relationships between organic purchasing behavior and consumers' similarity . This is not in line with our prediction. One possible reason is that some studies pointed out that COVID-19 is caused by ecological imbalance , perceived values  and organic purchasing behavior based on the SOR theoretical model and information similarity effect. And considering gender differences in consumers' similarity, perceived values, and organic purchasing behavior. Meanwhile, the mediating effects of perceived values on the relationship between consumers' similarity and purchasing behavior were also discussed, considering the background of COVID-19. The results indicated the significant association of information anxiety, uncertainty and sustainable consumption attitude with perceived values. And perceived values and sustainable consumption attitude had a positively significant influence on purchase behavior. In addition, environmental value played mediating effects in the relationships between organic purchasing behavior and information anxiety, uncertainty and sustainable consumption attitude. And the impact of sustainable consumption attitude and environmental value on organic purchasing behavior differed in gender.The results provide valuable findings for the sustainable development of the organic food industry and may enrich the research in this field. The following insights can be obtained from the research results of this paper. First, Perceived values  are important factors affecting consumers' organic purchasing behavior. Therefore, organic sellers and public policy makers can formulate corresponding strategies to drive consumers' organic consumption demand. That is to say, organic sellers should pay attention to specific consumer groups and improve consumers' perceived values of organic food products by maintaining customer satisfaction and pleasure. At the same time, the public policy makers should establish the concept of organic cultivation and breeding which is conducive to ecological civilization and human health through education and publicity, and enhance the correct values of consumers, so as to promote the development of organic industry.Second, the results showed that consumers' uncertainty about organic food hinders consumers' perceived values of organic food, thus hindering organic consumption. Therefore, organic producers, organic sellers, and public policy makers should formulate corresponding strategies to promote consumers' understanding of organic information. Organic producers can show more production details to consumers through media and social platforms, and organic sellers can vigorously promote organic food through media and social platforms. At the same time, public policy makers can also provide more authoritative organic information to consumers through media and social platforms, so as to achieve the goal of promoting organic consumption and sustainable development.Third, the results showed that information anxiety, uncertainty and sustainable consumption attitude have significant effects on organic purchasing behavior through environmental value. In particular, uncertainty positively affects organic buying behavior through environmental values. Therefore, in order to promote the consumption of organic food, the government needs to strengthen the publicity and education of environmental values, so as to promote the people to form values of protecting the environment.Some limitations of this study suggest directions for further research. First, the survey data were collected from organic consumers in China's first-tier cities, which may limit the generalizability of the study findings to other contexts. Future studies may be extended to other cities in China, which might help deepen the understanding of organic purchasing behavior and may further improve the generalizability of the study findings. Secondly, this paper only considered the similarity factors of information anxiety, uncertainty and sustainable consumption attitude, and may ignore other similarity factors , especially in the context of COVID-19. Future studies may consider more other similarity factors and may further enrich the results.The original contributions presented in the study are included in the article/Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.CL shaped the theoretical design. YZ was responsible for the statistical analysis. DC was responsible for the final composition. All authors contributed to the article and approved the submitted version.This paper was supported by the National Natural Science Foundation of China .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.


Processes for evaluating software architecture (SA) help to investigate problems and potential risks in SA. It is derived from many studies that proposed a plethora of systematic SA evaluation methods, while industrial practitioners currently refrain from applying them since they are heavyweight. Nowadays, heterogeneous software architectures are organized based on the new infrastructure. Hardware and associated software allow different systems, such as embedded, sensor-based, modern AI, and cloud-based systems, to cooperate efficiently. It brings more complexities to SA evaluation. Alternatively, lightweight architectural evaluation methods have been proposed to satisfy the practitioner’s concerns, but practitioners still do not adopt these methods. This study employs a systematic literature review with a text analysis of SA’s definitions to propose a comparison framework for SA. It identifies lightweight features and factors to improve the architectural evaluation methods among industrial practitioners. The features are determined based on the practitioner’s concerns by analyzing the architecture’s definitions from stakeholders and reviewing architectural evaluation methods. The lightweight factors are acquired by studying the five most commonly used lightweight methods and the Architecture-based Tradeoff Analysis Method (ATAM), the most well-known heavyweight method. Subsequently, the research addresses these features and factors. It is essential to detect software architecture (SA) problems before software development, but it is not easy to analyze SA because of software heterogeneity and the arrangement of software components ,2. ConseA successful software project delivers the agreed-upon functionalities in the software within the triangle of a specific time, budget, and acceptable quality . An SA pIn recent years, many researchers have proposed different SA evaluation methods to uncover SA problems systematically. Generally, SA evaluations are beneficial and economical to detect the early stage’s risks or issues, but they are heavyweight and costly to maintain . DespiteThese limitations have triggered another wave of research for lightweight SA evaluation methods such as lightweight ATAM, Pattern-Based Architecture Reviews (PBAR), and Active Reviews for Intermediate Designs (ARID). It also helps to reduce the cost of the assessment process, time, and effort by minimizing the SA documentation, formality, and involved stakeholders. Although researchers took a step towards practitioners’ needs, similar to the non-lightweight methods, the lightweight methods are not being used widely in the industry ,16.The persistence of not using SA evaluation methods brings up the following research questions: Q1: What features and influencing factors encourage the industry to use lightweight SA evaluations? This exploratory research aims to identify the features and characteristics that enable lightweight SA evaluations in the industry. Q2: What are the differences between the aspects of SA’s from industry and academic backgrounds? This study extracts differences between the following two major SA communities: practitioners and researchers, through the comparative text analysis of SA definitions and the systematic literature review of existing methods.Every SA evaluation method consists of the following three main parts: SA design and presentation concepts, SA evaluation procedures, and quality attributes (QA) of SA. This research is aligned to identify features and factors for a solution based on them. Besides, considering that SA is deeply concerned with industrial needs, this research makes an effort to find industrial views of SA to guide the researchers. The history of the SA standards, concepts, and definitions is discussed in the first two sections. The SA design methods section reviews and discusses the most commonly used SA design processes, styles, and presentations. In the SA evaluation section, all the SA evaluation methods are briefly reviewed and examined to identify criteria for comparing SA evaluation methods. Then, comprehensively, the most commonly used lightweight approaches are discussed to identify their strengths and weaknesses. Ultimately, this comprehensive comparison determines the lightweight factors of the SA evaluation methods. Then, there are discussions about the most concerning targeted QAs. In the end, the research discusses the identified features and factors and their relationships. Then, the next section discusses the achievements and results. Lastly, the conclusion section wraps up all the discussion. Research generally offers an added value to SA evaluation by the evaluation approach’s overview. It contrasts the benefits and drawbacks of proposed approaches and presents their constraints. Furthermore, the approaches are closely interrelated and similar. As a result, it is significant to compare existing approaches to help software architects select the most viable option from a set of approaches.Although SA has been used for decades, professionals still cannot refer to a single SA definition as stakeholders recognize “architecture” based on their interests ,18,19,20Moreover, this standard may apply the same methods to a wide range of conditions, so the stakeholders avoid SA standards . As SA sconstraint, limitation), etc. In the end, 127 words are recognized for each group, and the words are ranked based on their occurrences. The most frequent keyword between communities is “design”. Differences between the existing definitions illustrate the real need for SA, which practical stakeholders have perceived. The result indicates “Time”, “Cost”, “Complexity”, and ‘Distributed’ are widespread words that belong to community SA definitions that are not in academic definitions of keyword lists.The Software Engineering Institute of Carnegie Mellon University provides comprehensive online repositories of SA definitions . RetrievMeanwhile, for the academic group’s sake, this study refers to Muccini et al. , which clightweight, which is fast, cheap, and straightforward [The default antonym of “Time”, “Cost”, and “Complexity” means tforward . “Distritforward . It meanIt refers to overall performance and security, two qualities concerned with the system execution. Security may vary radically from one case to another, but performance is broadly the system’s responsiveness and time of interaction between software components. These qualities are discussed in more detail in The lack of standards in SA presentations may cause a mismatch between the SA presented and the actual SA. The Unified Modeling Language (UML) has become an international standard, ISO/IEC 19505: 2012, and has been accepted as an effective industrial standard for SA . HoweverArchitectural patterns are an ideal complement to architectural decisions. An architectural design, interchangeably called architectural style, is specified as a set of principles besides a coarse-grained pattern abstract framework for systems ,37. It iAdditionally, it may have some execution semantics, which can be part of the style definition ,40. For Despite the popularity of domain-driven design, layered architecture, message bus, N-tier/3-tier, and object-oriented modeling, it is challenging to scale them up. Moreover, there is no tool to analyze or measure non-functional properties. The interconnection mechanisms are so basic (method invocation); thus, complex interconnections are so hard in these methods. In a nutshell, there is no clear image of system architecture before component creation . ComponeIn comparison with other SA styles, a component or connector has a higher level of roughness. ISO/IEC/IEEE 42010: 2011 defines this architectural type as an effective standard . Along wThis section examines the existing literature on SA evaluation for the last three decades to answer research questions about SA evaluation . This syAfter more than 30 years of SA evaluations, many research questions remain open about the categorization of SA evaluations. This section determines the criteria for the classification of SA evaluations to identify factors for SA evaluation. In this study, for the systematic review of the literature, the terms of SA “Review”, “Evaluation”, “Analysis”, “Assessment”, and “Validation” are used interchangeably as search keywords.Although SA evaluation is an important activity at any stage of the software life cycle, it is not widely practiced in the industry . Gorton Despite the encouraging number of basic research found (76 approaches), it is evident that only 27-SA evaluation approaches, regardless of their targeted QAs. This table tries to compare the techniques of approaches. Later on, in The first technique focuses on experience, where SA plays a vital role in design and evaluation . This isThe second-most popular technique is the prototype that collects early feedback from the stakeholders based on and enables architecture analysis to look at close-to-real conditions. It may answer questions that cannot be resolved by other approaches .The third technique is a scenario-based evaluation. SAAM is the earliest method using scenarios and multiple SA candidates. Later on, ATAM completed SAAM by trade-off analysis between QAs, where ATAM uses qualitative and quantitative techniques. The Architecture-Level Modifiability Analysis (ALMA) and Performance Assessment of Software Architecture (PASA) have been used to combine scenarios and quantitative methods to boost the results ,70.The fourth technique is checklists, consisting of detailed questions assessing the various requirements of architecture. Software Review Architecture (SAR) uses checklists according to the stakeholder’s criteria and the system’s characteristics. The Framework of Evaluation of Reference Architectures (FERA) exploits the opinions of experts in SA and reference architectures. There is a need for a precise understanding of the requirements to create the checklist ,72.The fifth technique is simulation-based methods, which are very tool-dependent; the Architecture Recovery, Change, and Decay Evaluator/Reference Architecture Representation Environment (ARCADE/RARE) simulates and evaluates architecture by automatic simulation and interpretation of SA . An archThe sixth category is for metrics-based techniques that need to be mixed with other techniques, and they are not intrinsically powerful enough . Here arThe seventh technique, focusing on mathematical-model-based methods, is highlighted in the research areas, but the industry does not attend to them. Software Performance Engineering (SPE) and path and state-based methods are used to increase the reliability performance. These modeling methods exploit mathematical equations resulting in architectural statistics such as the mean execution time of a component and can be mixed with simulation ,81.Concisely, all the above discussion derives is that scenarios-based evaluation techniques are well-investigated and broadly reviewed in research papers. It has been completed by other techniques, such as simulations and mathematical techniques, to perform effectively. Another technique is simulation, focusing on the main components of a planned or implemented architecture to simulate context. While mathematical techniques use static evaluation of architectural designs, some modeling techniques originate from high-performance computing and real-time systems. Experienced-based techniques are different from other techniques. They are less explicit, and they are based on subjective factors, namely, intuition and experience. This technique is based on reviewer perception, objective argumentation, and logical reasoning. For example, an expert might recognize an availability problem, and then they convince others through scenarios that depict the situation.There is no distinctive categorization in technique-based classifications because hybrid architecture evaluation methods that use multiple architecture evaluation techniques belong to different categories . The selThis study proposes a comparison framework to present and compare the analysis methods to elaborate on these fundamental criteria. It has been proposed by the combination of three software evaluation comparison frameworks ,84. In TC1:The main goal of the method.C2:The evaluation technique(s).C3:Covered QAs.C4:Stakeholder’s engagement.C5:How applied techniques are arranged and are performed to achieve the method goal.C6:How user experience interferes with the methodC7:Method validationNiemela et al.  introductools, and techniques, and the SA description and outcomes of the methods are also explored. Moreover, C4, C5, and C6 are replied during the review of the SA evaluation “process”. These criteria are used to compare the existing solution to identify factors that increase the evaluation framework’s use.Other than these criteria, Architecture evaluations are usually performed manually based on informal/semiformal architecture documentation and the reviewer’s knowledge . The comATAM is the most mature, sophisticated, and well-known method that various researchers have devised. ATAM-based methods are flexibly used for evaluation purposes, such as the following: seeking SA improvement opportunities, risk analysis, SA comparison, but generally, finding out whether the candidate SA supports business goals adequately. ATAM-based methods engage various stakeholders with various techniques for prioritizing requirements by cumulative voting and utility tree, then identify trade-offs to resolve conflicts.C1 : identifying SA patterns and tactics suit business derives.C3 (Covered QAs): All QAs or any property that can affect the business goals.C4, C5, and C6 (Process): C2 : Based on scenario and experience.C7 : It has been extensively validated.Outcomes: A list of risks, non-risks, risk-themes, sensitivity points, and trade-off points.SA description: SA styles and tactics, as well as ATAM-based methods, define a precise template for documenting the quality scenarios.Tools and techniques: Brainstorming and voting.Discussion: Although it exploits a scenario-based paradigm, it engages various stakeholders for up to six weeks and is costly. The quality scenarios and ATAM templates represent the requirements in detail, but they are often confusing. Cumulative voting can induce stakeholders into excessive rivalry. Moreover, its reliance on SA documentation and the ignorance of project management paradigms makes ATAM impossible to run for agile projects.Costs of the ATAM-based method derived from Lightweight ATAM requires less than 6 h running. The technique is used by a development team that is familiar with ATAM, SA, and goals.C4, C5, and C6 (Process): The evaluation process was created by eliminating or constraining the scope of ATAM’s activities, which is shown in Steps 1, 7, and 8 are omitted, and steps 2, 3, 4, 5, and 6 should be completed in 15 min. Step 9 should be completed in 30 min.C7 : No validation, and the method features generally are as same as ATAM.Discussion: The method reduces the stakeholder’s engagement, and the evaluation process steps, but architecture evaluation still needs more formality. It relies on the stakeholder’s familiarity and tactical knowledge, which is achieved because of the full ATAM implementation. It is evident that by constraining the scope and depth of evaluation, a lower effort is needed.C1 : Detecting of SAs issues to assess the appropriateness of the chosen SA.C3 (Covered QAs): Applicable for any QA originated from the quality scenarios.Step 1: Appointing of reviewers.Step 2: Presenting of SA’s designs.Step 3: Prepare seed scenarios.Step 4: Arranging the meeting.Phase 1: Meeting for preparation.Step 5: Presenting ARID.Step 6: Presenting designed SA.Step 7: Brainstorming and prioritizing the scenarios.Step 8: Conducting of SA evaluation.Step 9: Results.Phase 2: Review meeting.C4, C5, and C6 (Process):C7 : One pilot experience in the industry.C2 : Based on scenario and expertise.SA description: There is no specific form of SA designs or documents.Tools and techniques: Brainstorming and voting.Outcomes: List of the given SA issues.Discussion: It is a simple method to seek flaws and weaknesses in QAs of the given SA. ARID does not explicitly state the QAs and SA styles during the analysis. The analysis focuses on a set of properties represented by a group of quality scenarios. It has nine steps, which are not compatible with the lightweight concept. It emphasizes an expert informal review with no particular form of SA style. As a result, it is difficult to repeat.ATAM is the most mature, sophisticated, and well-known method that various researchers have devised. ATAM-based methods are flexibly used for evaluation purposes, such as the following: seeking SA improvement opportunities, risk analysis, SA comparison, but generally, finding out whether the candidate SA supports business goals adequately. ATAM-based methods engage various stakeholders with various techniques for prioritizing requirements by cumulative voting and utility tree, then identifying trade-offs to resolve conflicts.C1 : Detecting quality attribute issues.C3 (Covered QAs): Potential risks influencing QAs.Elicitation of essential quality requirements from user stories with the assistance of developers.Establishing SA’s structure by a discussion with developers.Nominating architectural styles.Analyzing the nominated architectural effects on the qualities.Recognizing and discussing the final results.C4, C5, and C6 (Process):C2 : It is based on scenario and experience.C7 : Nine student small-size projects for industrial use.SA description: There is no specific form of SA designs or documents, but SA styles are included during the evaluation.Tool and techniques: Informally requirement elicitation during the development team meeting.Outcomes: It has the QAs issues, which are mismatches between QAs and SA styles.Discussion: PBAR contains all the criteria of the lightweights. It reduces the process into five steps that occur once in face-to-face meetings with the development team. It omits the prioritizing requirements to help the method. PBAR requires a negligible amount of time to run in comparison with the traditional methods. It focuses on the production step in agile projects. It is operational in the software industry rather than the conventional methods for companies that use agile and lean software development methodologies. It also confines the use of this method comprehensively. The evaluation uses SA styles and tries to find mismatches between SA styles and QAs of candidate SAs. However, it ignores formalizing the assessment technique and merely relies on tacit knowledge of SA styles and their impacts on QAs. Moreover, the influence of styles on QAs is not conclusive in most cases since other factors should be taken into account.C1 : Indicating the proper SA of crucial requirements.C3 (Covered QAs): QAs and even functional requirements.The evaluator elicits essential requirements and system context.The evaluator designed SA based on the previous.The implementation techniques are assessed.The results of the previous step should link to the requirements. Expert judgment techniques are applied in this step.The evaluation’s results should be collected and related based on the predefined forms.Present findings and recommendations.C4, C5, and C6 (Process):C2 : Metric-based.C7 : TARA has been validated in the industry.SA description: There is no specific form of SA designs or documents, but the evaluator should understand functional/deployment structures and system context.Tool and techniques: The method involves automated code analysis techniques . For implemented software exploits information on software execution .Outcome: a list of crucial requirements with its relevant SA.Discussion: TARA is a lightweight permissive method that does not exclude requirements specification documents. It allows an evaluator to consult with the stakeholders to prioritize the requirements. TARA suits the implemented software since it uses code analysis techniques with operational data. Evaluation methods mainly rely on explicit scenarios and the architect’s knowledge, but TARA relies on the reviewer’s judgment associated with the SA analysis evidence. Consequently, it just works well for implemented software in the maintenance phase when it is hard to correct the flaws.C1 : Suitability of architectural decisions.C3 (Covered QAs): A set of architectural decisions.Preparation: The SA styles and related technologies are presented for management and customer representatives.DCAR Introduction.Management presentation: The management/customer representative will be exposed to a brief presentation to elicit the potential decision forces .Architecture presentation: The lead architect will present potential decision forces and potential design decisions to all participants in a very brief and interactive session to revise the list of architectural choices.Forces and decision completion: The decision forces and design decisions will be verified based on the same terminologies for all stakeholders.Decision prioritization: The decisions will be prioritized based on participant’s votes.Decision documentation: The most important decisions will be documented in applied architectural solutions, the addressed problem, the alternative solutions, and the forces that must be considered to evaluate the decision.Decision evaluation: By discussion among all stakeholders, the potential risks and issues are selected, the decisions are revised based on decision approval.Retrospective and reporting: Review team will scrutinize all the artifacts and produce the final report.C4, C5, and C6 (Process):C3 : Experience-based and expert reasoning.C7 : It has been verified in five large industrial projects.SA Description: SA design, informal requirements, and business drivers.Output: Issues and risks.Tools and technique: Templates, wiki, and UML tools.Discussion: DCAR originated from SA evaluation experiences in the industry. It is a lightweight method that allows users to analyze and record the rationale behind architectural decisions systematically. In comparison, scenario-based methods test SAs against scenarios to find flaws and issues in a specific QA. For the sake of being lightweight, brainstorming and prioritizing steps are omitted. The reviewers should know SA and rely on the standard UML tool to make the evaluation understandable for stakeholders. Although it provides comprehensive templates for assessment, it considers several factors that originated from managerial views. This consideration leads to the nine steps, which are not compatible with lightweights.The five lightweight methods plus ATAM are compared in SA has been evaluated at various points in the software life cycle. It can happen at the early and late stages of the development life cycle. Early methods evaluate SA candidates before the implementation, while late methods assess the system’s implemented versions compared to the planned/previous versions. Early methods are based on SA descriptions and other sources of information. These methods lead to a better understanding of SA and the identification of problems with the architecture. At the same time, late processes utilize data obtained from the actual software implementation. Hence, the existing architecture can be reconstructed to compare with early evaluated SA. Early methods mostly contain scenario-based, mathematical-model-based, and simulation-based, while late ones are mostly metrics-based and tool-based. Early methods emphasize designing and modeling while late ones try to catch code violations and module inconsistencies. Sometimes, early methods can evaluate the implemented software ,90. WhilAlthough SA evaluation is beneficial, it is not broadly applied in the industry nowadays. Even agile development approaches do not encourage using architecture evaluation methods since they usually take a considerable amount of time and resources ,92. ExceAd hoc analysis ties architecture analysis to architecture design and implementation activities employing experience, expertise, and argumentation . InformaBased on “software architecture definition differences” in this research, performance and security are selected as the targeted QAs. These QAs will be discussed in the following subsections. The QAs belong to the methods represented in Predicting the system’s performance in the early stages of the software life cycle.Testing performance goals.Comparing the performance of architectural designs.Finding bottleneck, possible timing problems.Mostly, the performance is estimated based on the approximate model of the runtime view. These methods need appropriate descriptions of the dynamic behaviors of SA to show the characteristics of the components, frequency, and nature of inter-component communication. Mathematical formalism such as Petri net and simulation boost this estimation . Figure Some of the essential methods are discussed in the following: CF is a mathematical model-based method that integrates performance analysis into the software development cycle. It presents software execution behaviors through a graph, including arcs and nodes, with timing information. This model works based on the Queuing Networks Model (QNM) performance model. The simulation evaluates the model to estimate performance attributes. The approach has been enriched by using Kruchten’s 4 + 1 views and using use case scenarios depicted by a message sequence chart as the dynamic behavior of SA. Later on, the approaches combine UML diagram information to create a performance model of SA more formally. However, the methods do not consider the concurrent/non-deterministic behaviors of the components during QNM modeling. In order to address these problems, the labeled transition system (LTS) graph and ADL were added to the approaches ,98. The PASA boosts SPE by adding performance anti-patterns and architectural styles. It tries to adapt the concept of ATAM and SAAM into SPE. PASA formally states the scenarios with a descriptive architecture language such as the UML sequence diagram .Nevertheless, none of these approaches has yet been applied to a complete environment for performance analysis, specification, and providing feedback to the designer. The unsolved problem is automating completely derived performance models from the software specification and assimilating the supporting tools in a comprehensive environment . MoreoveJava Authentication and Authorization Service(JAAS), and without any significant problems [Security is a complex technical topic that can only be treated superficially at architectural levels. Although scenario-based methods are typically used for SA security analysis, security differs from other quality attributes. The security requirements are not enough for constructing a “security scenario” by themselves . At the problems . These tThe most important problem is that distributed SA has multiple layers of abstraction. Once each service abstracts the lower layer’s business functionality, it is needed to abstract the underlying application’s user identity context. Combining with the individual backends, heterogeneous security concepts beget a long way from the first request for a business procedure to the systems. Therefore, it also comprises monitoring, logging, and tracing all data flows related to security . SecuritOmission flaws are born in the aftermath of decisions that have never been made . Experience and prototype-based or even scenario-based methods can help the architect to detect this type of flaw. Still, they are mainly concerned with the requirement elicitation step, which is outside the scope of this research.Commission flaws refer to the design decisions that were made and could lead to undesirable consequences. An example of such flaws is “using a weak cryptography for passwords” to achieve better performance while maintaining data confidentiality. DCAR is devised to support such a problem.Realization flaws are the correct design decisions , but their implementation suffers from coding mistakes. It can lead to many consequences, such as crashes or bypass mechanisms. TARA and SA evaluation methods can mitigate these problems.In the industry, commission and omission flaws happen due to inexperienced decisions. The realization flaws are mostly ignored due to the cost of the detective methods. As a result, this current research highlights the realization flaws.An SA model has properties such as performance or security. Regularly, these properties are emergent, and it is more feasible to reason about emergent properties in simpler models than complex ones. So, it is needed to simplify your model to leverage the problem and prove your knowledge about the emergent properties .The study was devised to identify the features and lightweight factors to boost an evaluation framework. Concerning this fact, the study sought the practitioner’s needs and the tendencies that researchers have paid attention to. First of all, two categories of SA definition were elicited from the online repository. In the next step, the keywords in practitioners’ reports differed from the keywords of researchers. The top keywords are “time, cost, distributed, and complexity”, which means the practitioners needed a lightweight solution. “Distributed” refers to the scope of the evaluation. Secondly, based on the 811 published studies from 1999 to 2016 in SA’s topics, “security and performance analysis, heterogeneity and distributed, and agility” were the most popular research topics. Similar to a practitioner’s concerns, heterogeneity and distribution refer to the scope. Security and performance were selected as the targeted quality attributes (TQA) for evaluation. Agility was the same as one of the identified factors for lightweights.Component-Based architecture, SOA, and pipe and filter styles were selected as the identified scope’s proper SA styles. As mentioned in For the sake of research concerns, 76 articles with SA evaluation topics were selected out of 811 articles. Next, 27 SA evaluation methods were chosen for the review. These methods were reviewed based on the following two aspects: the technique and popularity in the industry. The comparison framework was defined to compare the evaluation methods. Then five lightweight methods were selected and compared with ATAM. Consequently, three lightweight factors were identified. Moreover, (TQA1) performance and (TQA2) security were reviewed throughout 27 evaluation methods. As mentioned many times in this study, the SA evaluation approaches are devised to help software architects make a proper decision. Obviously, the architects are interfering in many steps to heighten the evaluation process, so the SA evaluation tends to be more manual rather than automated. Architects’ skills may impact the design and decision-making parts that are outside the scope of this research.Based on identified features, factors, and comparison framework, the overall profile of a lightweight evaluation framework is described below as follows:This study replied to research question two by distinguishing the differences between practitioners’ and researchers’ perspectives on SA via the comparative text analysis of SA definitions and the systematic literature review of existing methods. Then, for the sake of the first research question, this exploratory research identified the features and characteristics that enable lightweight SA evaluations in the industry. An evaluation framework can boost its usage by detecting flaws and issues in SA’s performance and security. An informal description of requirements, UML diagrams, and source code is the input of the framework. The framework works within the specific scope of distributed software with the mentioned SA styles. The procedure for stakeholders is the minimal process, which was elicited from reviewing the lightweight solutions. The procedure is a face-to-face meeting between the architect and internal/external reviewers who know SA. The tools and techniques should be investigated to ease the integration of features and factors.The existing literature was reviewed to remind us of the past research on using SA evaluation methods to identify the proposed framework’s main features in the first stage. In the second stage, the factors affecting lightweights are identified. These factors improve the SA evaluation framework used in the industry.In the first stage, the SA evaluation framework’s features were identified based on the text analysis of researchers’ and practitioners’ SA definitions and all published studies for the last three decades on SA’s topics. This analysis concluded that a lightweight SA evaluation solution was needed to uncover distributed and heterogeneous software’s security and performance problems. Consequently, the security and performance analysis of SA were reviewed, and the proper SA presentation and styles for the distributed and heterogeneous software were identified.In the second stage, lightweights were identified from the weaknesses of the current state of the art in the lightweight SA analysis methods. Indeed, the study tried to bridge the gap of less usage of systematic SA evaluations in the industry. First, it should be clear why the industry refrains from SA evaluation methods proposed by academics. As a result, this study followed two strands of academic and practitioner concerns. The practitioners need the SA evaluation framework with specific industrial features to solve their current problems, while academics focus primarily on scientific issues and possible issues in the future. This mindset led us to analyze the online web repository of SA definitions. As a result of that, the main extracted features that are in demand for both sides were a lightweight framework that can evaluate heterogeneous software systems from a performance and security perspective.Moreover, the study conducted a systematic literature review on SA evaluation methods. As a result, the SA evaluation comparison framework was proposed as a basis for the SA evolution comparison. Then, it narrowed down the literature to the lightweight SA evaluation methods. A total of six SA evaluation methods were studied deeply to identify the factors influencing the SA evaluation method.Although SA evaluation methods are beneficial, they are not broadly applied in the industry ,109. The