Soil-transmitted helminthiasis is a neglected tropical disease, thriving in environments of poverty and disadvantage. Our objective was to determine the prevalence and intensity of four soil transmitted helminths (STH) among primary school children in the Ngorongoro Conservation Area (NCA), Tanzania.th and June 2nd, 2014. Six of 20 primary schools were chosen, based on elevation, designated low elevation ecozone (LEE) or high elevation ecozone (HEE). A total of 340 children from standards one to four were recruited. Height and weight of each child was determined and body mass index (BMI) was calculated. Stool samples were analyzed using the Kato-Katz, Wisconsin, and Baermann techniques to detect STH eggs and larvae. An interviewer-administered questionnaire on socio-demographic variables was used to capture information from the school’s headmaster and a checklist was used to assess sanitation facilities.A cross-sectional study was performed between May 15Ascaris (presumably lumbricoides), Trichuris (presumably trichiura), hookworms , and Strongyloides . The overall prevalence of STH infection was 29.0% in LEE and 34.0% in HEE. Prevalence was 34.3% and 28.2% in males versus females, respectively. Ascaris sp. were only identified in HEE, prevalence of Trichuris sp. and hookworms were significantly higher in HEE compared to LEE, and Strongyloides spp. prevalence was lower in HEE. Intensity of Trichuris sp. was significantly higher in HEE and lower for hookworms. We did not detect a significant relationship between BMI and helminth intensity; however, BMI was lower in lower elevations and in males vs. females. Sanitation practices are taught at the schools, but challenges were identified when implementing. Latrine facilities were available and latrine-cleaning routines were practiced; however, hand washing practices were challenging due to restricted water availability.STHs identified included Significant differences in prevalence in HEE and LEE exist, and STH infections are still very common among school children suggesting that anthelminthic intervention and education may be necessary in this region. Based on this outcome, the study area in the NCA would be classified as a medium risk area, where periodic treatment recommendations should be based on prevalence estimations in the different ecozones.Ethics approval was obtained from the Catholic University of Health and Allied Sciences ); the Conjoint Health Research Ethics Board (CHREB) at the University of Calgary in Canada (Study ID REB14-0127); the National Institute of Medical Research (NIMR) of Tanzania; and the Tanzania Commission for Science and Technology (COSTEC). Soil-transmitted helminthiasis is recognized as a neglected tropical disease by the World Health Organization (WHO), thriving in environments of poverty and disadvantage . An estiAscaris lumbricoides) and whipworms . Skin penetration of infective larvae is the most common route of transmission for hookworms  and threadworms . These four types of nematodes comprise the majority of STH infections; however, other parasites such as cestodes, trematodes, and protozoa may also be present and cause disease [Ingestion of infective parasite eggs from the environment are principle routes for transmitting roundworms  testing are 12.6% for hookworm, 3.2% A. lumbricoides, and 0.008% for T. trichiura and, in the Magu district, 0% for A. lumbricoides and only 0.2% for T. trichiura [T. trichuris, 6.1% for hookworms, and 4.2% for S. stercoralis [Tanzania is classified in the group of so-called LMICs in Eastern Africa and climate, rural lifestyle, and socio-economic status all contribute to a high risk for school children to contract STH infections . The minrichiura , 14. Tworcoralis , and an rcoralis .The NCA is a remote rural district of the Arusha region in Northern Tanzania, with 21 wards home to an estimated population of 90,000 inhabitants, mainly of the Maasai tribe. They keep their cattle, goats, and sheep in a pastoralist lifestyle, to ensure optimal utilization of land resources aimed at maximizing production . Maasai Due to cultural traditions, e.g., using their hands in eating and walking barefoot, Maasai may be at higher risk of STH exposure , as riskThis study occurred in the NCA in Northern Tanzania. The area has two rainfall periods, short rains from September to December and long rains from March to May/June. The low elevation ecozone (LEE) is 1000 to 1900 m above sea level, with an annual rainfall of 500 to 700 mm and mean monthly temperatures of 17–19 °C. In contrast, the high elevation ecozone (HEE) is characterized by a cool, wet ecozone at > 1950 m above sea level with an annual rainfall of 800–1200 mm, and lower mean monthly temperatures of 12–14 °C .th and June 2nd, 2014, based on two criteria. Firstly, no anthelmintic drug treatment was provided through school-based mass medication, to the students in the 6 months prior to the study. Secondly, schools in LEE had to be ~ 1000 to 1990 m above sea level, and HEE at ~ 2000 and 3000 m above sea level. Sample size estimations to determine the STH prevalence with imperfect tests [The district education officer (DEO), district medical officer (DMO), and NCA dispensary health workers were consulted and asked to prepare a list of all primary schools in the NCA for this study. Six primary schools were chosen and visited between May 15ct tests  were comct tests , as testct tests , 27. AccWe included six primary schools of which three schools were in the LEE, whereas the other three schools were situated in the HEE. Coordinates and elevations for each school were recorded with a hand-held GPS device. The research team visited each school to explain study objectives and procedures with the school headmaster and teachers and to distribute parental consent forms prior to sample collection. Teachers were tasked to explain the study to the parents. The consent form was written in Kiswahili and when necessary, teachers translated it into the local language . The sampling visit was scheduled 1 week later.Each school was visited by a team consisting of one local elder, a minimum of two local translators of both sexes, and members of the Tanzanian and Canadian university research team. Upon arrival at a school, team members provided communal instructions (in Kiswahili and Maa) regarding the objectives of the study and procedures to be followed. They also provided opportunities for children to ask questions. Thereafter, researchers assembled into three teams, with distinct responsibilities. At the registration station, the children’s school, sex, and age were recorded, the latter of which was reported by teachers. At the measurement station, children’s height and weight were measured twice and averaged. Stool sample containers were handed out to each child with a paper plate and wooden scoop for self-sample collection. Children were then directed to the latrine to deposit and collect a fresh sample. At the stool collection station , children returned their stool sample to the team, and sanitized their hands. Samples were stored in bags before transportation.Ascaris spp., Trichuris spp., and hookworms [Strongyloides spp. larvae. We adapted the Baermann method as described by Forrester et al. [Stool samples were brought to the Endulen Hospital laboratory the morning of collection. Samples were processed using modified Wisconsin  and beakookworms . A quantr et al. . Brieflyr et al. , 31. Rhar et al. .For quality-control purposes, ~ 10% of samples for males and females from each school were also processed using the Kato-Katz technique , considered by WHO as a reference test for detecting STH eggs. However, as this test has a reported low sensitivity, it was only included to report prevalence based on this reference test for comparative reasons –35. All The research team conducted interviews on site with the school headmasters to collect information on the student and teacher population, the number of classrooms, water supply, existing food program, the deworming program, as well as sanitation and hygiene education  and interpreted for the age and sex category [2) tests were used to detect statistical differences between categories of explanatory variables and replaced with Fisher’ exact tests if cell counts < 5. A regression model was used to explore associations between sex, ecozone, and BMI of children with helminth intensities, using ecozone as a fixed effect and exploring interactions between ecozone and sex.Data were analyzed using the Statistical Package for Social Science (SPSS) software (Version 26.0). Descriptive statistics, such as frequencies, proportions, means, medians, and standard deviations, were computed. As described by , prevalecategory , 38. ChiA total of 340 NCA-primary school children, from 6 schools were enrolled in the study. One sample was removed as the sex was not indicated on the form. Table P < 0.005).Briefly, there was a significant difference between the number of children per age group enrolled between the LEE and HEE for age 8 vs. 9, 11 and 12 , Trichuris (presumably trichiura), hookworms , and Strongyloides   unspecified trematode  unspecified cestode , and oocysts of Entamoeba spp.  and Isospora spp. .Parasites were identified to the lowest taxonomic classification possible based on morphology. The STH detected included: s) Table . Other pP = 0.384). Overall STH prevalence in males was 34.3% (95% CI = 27–42%) versus 28.2% (95% CI = 20–36%) in females (P = 0.315).The overall prevalence of any STH based on the Wisconsin technique was 31.5% (95% CI = 26–37%). Prevalence in the LEE was 29.0% (95% CI = 21–37%) and in the HEE 34.0%  that were processed using both the Wisconsin and Kato-Katz techniques, prevalence was significantly lower for the KK  compared to the Wisconsin  technique (P = 0.000). The sensitivity of the KK technique was 63% and specificity was 91% relative to the Wisconsin technique , and one female in HEE with 1.0 EPG for unspecified trematode eggs. The univariate linear regression identified no significant correlation between the four STH intensities and either BMI classification or age (y). Ascaris sp. was only observed in the HEE with a significantly higher intensity in male vs female (P = 0.03). However, for Trichuris, a significant difference was observed between males in both ecozones (P = 0.03) and females in both ecozones (P = 0.01). Overall, the intensity of Trichuris sp. and hookworms was significantly different in HEE vs. LEE when combined for both sexes  and larvae per gram (LPG), is summarized in Table Finally, co-infections were compared between the sexes in the two ecozones, and no significant difference were found Table .Table 7Water accessibility was evaluated by asking each headmaster to identify the main source of water for their school during rainy and dry seasons. In the LEE, all three schools collected rainwater during the rainy season; two schools also sent children to retrieve water from the river, whereas one pumped water from the river (when diesel was available to operate the pump). None of the schools tested water quality or treated water. In the HEE, two of the three schools got their water from the river and the other got it from water sources within the Ngorongoro crater. For all three HEE schools, water was transported by pipes, but only the school that got water from the crater treated the water with chlorine.At all six schools, latrine facilities were available with cleanable cement floors and roofing. Although latrine-cleaning routines were practiced, in three out of six facilities fecal contamination of the environment was observed. Hand-washing facilities were only available close to the latrine in one school in LEE, using a small plastic bucket filled with water. Another school had a washing facility that was broken at the time of the study visit. Soap was only available in one school. In the HEE, one school had a tippy tap (large plastic containers hanging from a tree) and the other had a water bucket.An antiparasitic program  was rolled out in 2012 (2 years prior to the study) at two LEE schools and at one HEE school. For the three other schools, data on deworming were not available. Sanitation and hygiene education were confirmed to be included in science classes at LEE schools.Two schools had “improved traditional pit latrine” and four had a “VIP latrine,” where VIP latrines are defined as cement floor supported by reinforced iron bar or wood, wood and mud plastered or brick or block wall, corrugated iron roof or thatch roof cover, ventilated through installed vent pipes Appendix . No cleaS. stercoralis compared to KK. They also found KK to be equally sensitive as PCR for these same parasites, whereas Verweij et al. [Strongyloides spp. and various versions of the Baermann technique have been used to improve its sensitivity [Strongyloides spp. was 27.4%, higher than reported in studies in Angola (11.3%) and on Zanzibar (10.8%) [This cross-sectional study generated estimates on prevalence and intensity of four STHs among primary school children in six schools in the NCA. School-based anti-parasitic programs had not been implemented within at least 6 months in any of these schools, ensuring that recent treatments would not affect the results. STH prevalence estimations for a subset of samples analyzed using the Kato-Katz, the WHO recommended diagnostic test, was 32.3%. Based on this, the study area in the NCA would be classified as a medium risk area, where periodic treatment recommendations should be based on diagnostic testing in the different ecozones. When prevalence estimations are > 50%, WHO recommends a bi-annual treatment protocol . With thj et al. , reportesitivity . In our  (10.8%) , 41; bot (10.8%) . AdditioStrongyloides spp. may be attributed to the plasticity in its lifecycle that may allow it to persist under adverse conditions. The LEE had the highest prevalence estimations of Strongyloides spp., similar to small-scale studies in rural Côte d'Ivoire also at lower elevation  [The high prevalence of t 400 m) , emphasiStrongloides detection, and also stated that albendazole, which is the common anthelminthic used in school programs in Tanzania, is not the treatment of choice for Strongyloides spp. [Amor et al. also emphasized the Baermann or combined diagnostics for des spp. . This mades spp. . FinallyA. lumbricoides of 4.0%, and only detected it in the HEE. These results are comparable to data from Angola in children (5–14 years) where also a low prevalence of 1.3% was reported [Despite the use of the more sensitive Wisconsin technique, we detected a low prevalence of reported , but lowreported  and in nreported . The reareported , 47.Ascaris sp. and Trichuris sp. compared to LEE.Our main interest in comparing ecozones was motivated from the expected survival of STH eggs and larvae in the more favorable climate of the cooler and more humid HEE. Climate and seasonality can have considerable impacts on transmission dynamics, with significant interannual and within region fluctuations occurring depending on precipitation and temperature , 49. UndTrichuris sp. compared to females in the present study. In other settings, males were also identified at higher risk of infection compared to females, and this may be driven by different behaviors associated with their different roles in society (herding vs doing chores near the home) [Finally, when reflecting on the potential difference of STH infections in sex, behaviors based on roles in the community should be taken into account. Males had a significantly higher prevalence of he home) –52.In our study, we observed evidence of possible low hygiene and sanitation in the schools. For instance, hand washing facilities were present in three schools only, and no soap or ash was available for hand washing at any of the six schools. Another study in the same area in the NCA, including both ecozones, identified low hygiene standards in the same communities ; howeverAs with many field studies, this study has limitations. Only six of 20 public schools were enrolled, and no private schools were included. Only children attending schools participated in the study resulting in a biased sample that may not be representative of all children in this age range in this part of the NCA. Childrens’ ages were self-reported by teachers who based their reporting on incomplete school records. Also, we limited the age range to 8–12, thus results will not be representative of younger or older children. Finally, the study might lack power to find potentially existing differences, as some sex and age groups have lower numbers of participants or observed prevalence and intensities were low. Additionally, the study occurred at a single point in time (following the “short” rains) and did not span different seasons. Given the seasonality of most parasites, our study may have over, or underestimated, depending on the parasite species, the annual parasite burden in this region.We did not inquire about clinical signs consistent with parasitism that children may have experienced. This additional information could inform the knowledge of STH infection symptoms as well as the interference with other common diseases within the list of neglected tropical diseases. Further surveys could include questions on education of parents and older siblings, health, and sanitation routines outside of school .In conclusion, significant differences in prevalence in high and low ecozones exist, and STH infections are still very common among school children suggesting that anthelminthic intervention and education may be necessary in this region.


It is urgent to understand how to effectively communicate public health messages during the COVID-19 pandemic. Previous work has focused on how to formulate messages in terms of style and content, rather than on who should send them. In particular, little is known about the impact of spokesperson selection on message propagation during times of crisis. We report on the effectiveness of different public figures at promoting social distancing among 12,194 respondents from six countries that were severely affected by the COVID-19 pandemic at the time of data collection. Across countries and demographic strata, immunology expert Dr. Anthony Fauci achieved the highest level of respondents’ willingness to reshare a call to social distancing, followed by a government spokesperson. Celebrity spokespersons were least effective. The likelihood of message resharing increased with age and when respondents expressed positive sentiments towards the spokesperson. These results contribute to the development of evidence-based knowledge regarding the effectiveness of prominent official and non-official public figures in communicating public health messaging in times of crisis. Our findings serve as a reminder that scientific experts and governments should not underestimate their power to inform and persuade in times of crisis and underscore the crucial importance of selecting the most effective messenger in propagating messages of lifesaving information during a pandemic. Overcoming public crises may require collective behavior change . Public how to frame public messages in order to maximize their persuasiveness ) and least effective in Spain . Fauci was significantly more effective than the elected government official in South Korea (d = 0.05), Spain (d = 0.14), and the United States (d = 0.14), and on par with the government in Italy and Switzerland. Celebrities were generally least effective. S5 Table in The spokesperson effect on message sharing was moderated by country , and on par with the no-spokesperson condition among the mid- and old-age groups. S6 Table in In addition, the effect of the spokesperson condition on message sharing was moderated by age group , did not reveal important deviations from the observations made from the 2-way interactions described above. S6 Fig in Finally, the 3-way interaction of spokesperson, country, and age group on message sharing, although significant , neutral (d = 0.08 to d = 0.36), and even negative (d = 0.02 to d = 0.12) sentiments towards the spokespersons, although for the latter his effect was only significantly greater than for Kardashian. S9 Table in p < 0.001, d = 0.13, S8 Fig and S8, S10 Tables in Evidence suggests that celebrities who are viewed favorably consistently have positive effects on people’s opinions, attitudes, and behaviors , 19. ThuOverall, the results revealed large differences between the four spokespersons in terms of their effectiveness as advocates for social distancing. Considering that, in the context of a pandemic, even small effects can translate into saving many lives , this coThus, empowering experts during the pandemic could not be more important, particularly when misinformation by high-profile figures can have fatal consequences during the pandemic , and espr = 0.23, p = 3.21x10-146, The results of this study should be considered in the light of its limitations. For example, our study did not measure actual message sharing, but respondents’ stated willingness to do so. Evidence suggests, however, that self-reports of intended behavior during the COVID-19 pandemic do in fact reflect real behavior  and selfWe also observed a heterogeneous spokesperson effect on message sharing across different segments of the population . This suOur study contributes to the development of evidence-based knowledge regarding the effectiveness of prominent official and non-official public figures in communicating public health messaging during the COVD-19 pandemic. The findings presented here can help governments shape effective strategies for communicating behaviors aimed at mitigating the COVID-19 pandemic, including prospective challenges associated with vaccination and proximity-tracing compliance. Numerous celebrities are advocating for social distancing and, maybe partly in response to a general decline in experts’ credibility as perceived by the public , governmS1 File(PDF)Click here for additional data file.


Epidemiological studies of insomnia in the Middle East remain scarce. The present study aimed to estimate the prevalence of insomnia and explore its associations in the general population of Qatar. With almost 100 nationalities, Qatar is one of the most culturally diverse, richest, and fastest developing countries in the Arabian Peninsula.A probability sample of community-dwelling adults were surveyed in February of 2019. A total of 1611 respondents completed face-to-face interviews in Arabic or English. Logistic regression modeled associations with insomnia, our dependent variable, as defined by a score of ≤16 on the eight-item Sleep Condition Indicator or according to criteria for insomnia in the Diagnostic & Statistical Manual of Mental Disorders, fifth edition or DSM-5.Approximately, 5.5% of the sample screened positive for insomnia and the 30-day prevalence of those who met all the DSM-5 criteria for insomnia disorder was 3.0%. In addition, 2.0% of the sample screened positive for depression and 3.4% for anxiety in the past 2 weeks. Multivariable analysis showed the following were significantly associated with insomnia: Arab ethnicity, young age, unemployment, being married, having less than high school education, fair or poor health, anxiety, and depression.Insomnia prevalence was in the lower range of previously reported DSM-defined estimates from developed Western countries. Our findings highlight the need for raising awareness and improving sleep hygiene in potential risk groups such as younger adults and those of Arab ethnicity, in addition to incorporating insomnia screening in the provision of mental health services.The online version contains supplementary material available at 10.1186/s12888-020-03035-8. Representative sample of community dwelling adults in Qatar were studied.The 30-day prevalence of insomnia disorder was in the range of 3.0–5.5%.The prevalence of meeting any of the four DSM-5 criteria ranged between 9.4–13.5%.Strong associations between depression, anxiety, and insomnia were observed.Insomnia was associated with ethnicity, unemployment, low-education, poor health, and young age.According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition or DSM-5 , insomniInsomnia adversely affects well-being and quality of life of men and women of all ages and ethnicities . It contTo date, most of the research on the epidemiology of insomnia comes from Western European and North American countries . Even soAdditionally, findings in relation to sociodemographic correlates of insomnia such as gender, age, education, income, and marital status are not always consistent. A study in the United States (US) found that all of these variables were strongly associated with insomnia in the adult population . SimilarFrom a public health perspective, prevalence estimates are important for service planning, policymaking, and in preventing common sleep disorders like insomnia. In addition, measures of insomnia are important indicators of poor mental health such as impaired concentration, disturbed memory, depression, and anxiety , 10, 65.Unlike Western countries, the literature on insomnia in the Middle East and most Muslim countries remains sparse. Large-scale epidemiological studies, of prevalence of insomnia and associated clinical features, are scarce. A comprehensive literature review retrieved only one general population study in Turkey. This reported that 15.3% of adults suffer from insomnia . The stuMost studies conducted in countries of the Arabian Gulf focus on insomnia in specific populations, such as adolescents and students, or primary care patients. In Kuwait, the rates of insomnia varied between 6.0 to 36.0% in adolescents  and betwWith an urban population that continues to grow, Qatar’s context displays a high standard of living and a well-established system of social and healthcare services . The higHence, to aid this effort, the present study aimed to estimate the 30-day prevalence of insomnia using DSM-5 criteria and to explore its socio-demographic correlates and associations with depression and anxiety symptoms in the general population of Qatar.This study was part of a larger annual survey conducted in February of 2019 by the Social and Economic Survey Research Institute (SESRI) at Qatar University, which covered various topics related to social, health, economic, and political issues.As Qatar is divided into eight administrative municipalities, the households in each municipality were stratified according to geographic location and the type of household residents . The target population included residents of Qatar aged 18 and above who were living in residential units during the survey reference period. For this study, the non-residential units such as army barracks, hospitals, dormitories, camps of blue-collar workers and prisons were excluded. A probability-based sample was then drawn from these strata. As Qataris represented the minority group in the population, they were oversampled. A validated adaptation of the Kish method  was utiln = z2(p (1 − p)/e2) deff [For our survey design, the following formula: e2) deff , 38 was “Additional file 1” for details of survey questions asked in both languages.For the interviews, the measures were available in both English and Arabic, enabling participants to select their preferred language. A team formed of four bilingual research members translated and adapted the measures in the following steps: 1) Each measure was independently translated from English to Arabic by the first author and a researcher; 2) Another two researchers who had not seen the original English version of these measures were assigned to back-translate the two Arabic versions to English; 3) Finally, all team members met and reviewed the two Arabic versions of the questionnaire and compared the original and back-translated English versions. Upon their reviews and comparisons, minor discrepancies in translation arose. These were solved by consensus among team members. Please see Qatar University’s Institutional Review Board approved the study (QU-IRB 339-E/14). The survey questionnaire was programmed in BLAISE and administered using CAPI  during face-to-face interviews conducted by trained interviewers in the households of consenting participants who were 18 years old and above. A total of 50 interviewers visited the sampled households and introduced the study. Written informed consent was obtained from all participants after explaining that study participation is voluntary and anonymous. Out of the total sampled households, approximately 4.8% refused to participate. Other reasons for non-participation included language barrier, illness/disability, and vacant housing units. A total of 1611 completed interviews were recorded and the survey response rate was 52.1%. As per household type, the completed interviews included 803 Qataris and 808 non-Qataris. The corresponding maximum sampling error percentage was +/− 3.9 and 3.8 percentage points for Qataris and non-Qataris, respectively.After data collection, all individual interviews were merged and saved in a single BLAISE data file. This dataset was then cleaned, coded, weighted to adjust for probability of selection and non-response, and saved in STATA version 16 for analysis.The eight-item Sleep Condition Indicator (SCI) was used to screen for insomnia disorder in the past month based on the DSM-5 criteria . Each itAs operationalized by the SCI, we measured four main criteria for insomnia disorder as per DSM-5 criteria. The first criterion was difficulty initiating or maintaining sleep. This was based on reports of taking more than 30 min to fall asleep or if waking up during the night, staying awake for greater than 30 min in total; and a rating of sleep quality as average, poor, or very poor. The second criterion was significant distress, which was based on endorsing “somewhat”, “much” or “very much” for the extent that poor sleep in the past month has troubled the respondent in general and endorsing “somewhat”, “much” or “very much” to one of two questions about the extent has poor sleep in the past month affected respondents’ mood, energy, or relationships or affected concentration, productivity, or ability to stay awake. The third criterion was in relation to the frequency of sleep disturbances, which was based on endorsing a minimum of 3 nights per week for the frequency of encountering sleep problems. The fourth criterion was related to the duration of sleep disturbances, based on endorsing a minimum duration of 3 months for having sleep problems.We estimated 30-day prevalence of insomnia disorder using two methods in relation to the SCI data. First, we used a previously validated cut-off score of 16 or less to denote the proportion of our sample that met minimum criteria for putative insomnia disorder . Second,The nine-item Physician Health Questionnaire or PHQ-9 was used to measure the frequency of nine symptoms of depression in the past 2 weeks with a 4-point response including: 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day.” A composite score was calculated based on all nine items and a cut-off score of 10 or higher was used to denote moderate to severe depressive symptoms , 59.The two-item Generalized Anxiety Disorder (GAD-2) scale was used to measure severity of anxiety symptoms. Although not a diagnostic instrument, the GAD-2 captures the frequency of two symptom criteria for GAD in the DSM-5 including feeling anxious, nervous or on edge and not being able to control or stop worrying over the past 2 weeks. The frequency of these symptoms was captured using the same 4-point response options as describe above for the PHQ-9 . The GADA health-based rating question was used to measure self-reported health status with categories including poor, fair, good, and excellent. Respondents were classified into Qataris or non-Qataris based on self-reported nationality. Ethnicity was determined according to respondent’s country of origin and the language selected to complete the interview. We first coded ethnicity into the following main categories: Arab, South Asian, South East Asian, and other . To increase statistical power, we collapsed non-Arab ethnicities into one category to compare with Arab ethnicity. We collected standard socio-demographic information including age, gender, marital status, education level, and employment status.Weighted proportions, corresponding percentages, and 95% Confidence Intervals (CI) along with raw (unweighted) frequencies (N) were generated to describe the distribution of most of the variables in our sample. Mean and standard deviation (SD) was used to describe age of respondents in years.p-values were generated from these models.Bivariate and multivariable logistic regression analyses were conducted to estimate associations between main independent variables (including depression and anxiety) and insomnia, our main dependent variable. For each bivariate model, we adjusted for the association between one independent variable and insomnia. In the adjusted model, we simultaneously controlled for the associations between all variables and insomnia. Unadjusted (bivariate) and adjusted odds ratios (ORs) with corresponding 95% CI and Sample characteristics are shown in Table < 16 (as opposed to > 16 on the SCI) was significantly associated with endorsement on all DSM-5 criteria for insomnia including difficulty initiating or maintaining sleep, significant distress, a minimum of 3 nights per week for frequency of sleep-related disturbances, and a minimum duration of 3 to 6 months for having sleep problem. Also shown in Table Table p = 0.010); for every unit increase in age, the odds of insomnia decreased by roughly 4.0%. For marital status, the association between never married relative to current married respondents and insomnia became more statistically significant in the multivariable model . Having less than excellent or good health rating increased the odds of reporting insomnia by 242% . Furthermore, being unemployed increased the odds of reporting insomnia symptoms by 156% . The adjusted odds ratio for depression and anxiety symptoms was increased by 777%  and 277% , respectively, in those with insomnia relative to those without insomnia.In the multivariable analysis, less than high school education, Arab ethnicity, unemployment, fair or poor health rating, anxiety, and depression were independently and significantly associated with insomnia Table . Arab etTo our knowledge, this is the first report on prevalence of insomnia disorder and associated clinical factors in a representative sample of community dwelling adults in the state of Qatar. Our study makes an important contribution as most of the published studies from the Middle East to date have rarely used a standard set of international diagnostic criteria to estimate the burden of insomnia in the general population. Overall, our prevalence estimates ranged between 3.0% using the DSM-5 diagnostic criteria or 5.5% using the SCI cut-off score to define insomnia. Our estimates were relatively lower than those reported in developed Western countries . HoweverIn our study increase in age was associated with decrease in insomnia symptoms in contrast to most worldwide reports that highlight a higher prevalence of insomnia among older populations , 56, 63.Overall, findings with respect to strong associations between insomnia and depression and between insomnia and anxiety in our study population are in line with findings from around the world , 65, 67.These findings also reinforce our suggestion that there is a need for Public Health consideration to address insomnia symptoms early, particularly due to stigma association with mental disorders. The association between insomnia and mental illness may have important implications in the overall help-seeking and health management of individuals with symptoms of insomnia. Furthermore, considering the potential clinical importance of insomnia, it is worthwhile to include insomnia-related questions in depression and anxiety screening questionnaires.Arab ethnicity was positively associated with insomnia in our study. Arabs reported poorer sleep continuity, severity, quality and daytime impact of poor sleep than non-Arabs. Cultural factors are likely to explain these results. Late bedtimes, interrupted sleep, and daytime napping have been reported in studies investigating sleeping patterns among Middle Eastern populations, factors that may result in suboptimal sleep durations and quality of sleep , 49. ExtInternational guidelines for insomnia management recommend the provision of patient education of healthy sleep habits known as sleep hygiene. Sleep hygiene consists of a combination of behavioral practices and environmental conditions, which improve sleep . The resAnother important finding in our study was that unemployment was positively associated with insomnia. Similar findings were reported in several studies around the world, which showed that people with higher socioeconomic status tend to have less symptoms of insomnia and better quality of sleep , 42. ThiThe survey was cross-sectional and based on self-report. Although survey questionnaires were thoroughly translated and administered in the mother tongue of most respondents, we cannot rule out other sources of response bias in Arab and non-Arab migrants. However, we tried to mitigate the potential risk of response bias  by training all interviewers in and systematically monitoring their adherence to standardized survey interviewing techniques. We collected no information about lifestyle factors that may be associated with insomnia and mental health such as cigarette smoking , 34 and This is the first large epidemiological study conducted in the general population in Qatar about the prevalence of insomnia and associated factors. The study suggests that there is an association between mental illness (particularly depression and anxiety) and insomnia, that needs to be taken into account particularly when screening individuals for mental illness and in the provision of mental health services. We also report important findings with regard to at-risk age groups and ethnicity that highlight the need for raising awareness of sleep hygiene in these groups.This study suggests the need for further research into the socio-cultural and political factors affecting insomnia prevalence in Arab populations. Given the time of this publication, we also suggest conducting a similar study during COVID-19 era, in order to measure its impact on insomnia prevalence. Our study can provide a baseline prevalence of insomnia in the Arabian Gulf Region against which other studies can be compared, and to aid assessment of the impact of natural, political and social crises on insomnia and mental health.Additional file 1. Survey Questionnaire in English and Arabic


Although magnetic resonance imaging (MRI) helps to clearly visualize the disorders in temporomandibular joint (TMJ), the relationship between cross-sectional and clinical findings has not been precisely established. The aim of this study was to evaluate the relationship between clinical symptoms and MRI findings in individuals with TMJ pain.P values < .05 were considered to indicate statistical significance.  This cross-sectional study, conducted on the clinical and MRI findings of the patients, who applied to Uşak University, Oral and Maxillofacial Surgery Clinic with TMJ pain between the years 2016-2019. The primary predictor variables were MRI findings; disc position , disc displacement without reduction (DDWOR)), disc structural distortion , condyle degeneration type  and joint effusion (JE) . The primary outcome variable was pain, recorded on a visual analog scale (VAS) (numbered between 0-10). The other variables were demographic variables (age/gender). The relationship between clinical and MRI findings were statistically evaluated. The data were analysed by Kruskal Wallis and Mann Whitney U test. Chi-square (x2) test was used for categorical variable comparisons.  Clinical and MRI records of 700 TMJ, from 350 patients with the mean age of the 31 (12-65) were evaluated in this study. Statistically significant differences were found between; disc position and pain, disc position and JE; JE and pain; disc structural distortion and pain; and disc structural distortion and disc position. JE was seen more common in DDWOR group. The most common disc distortion, seen in patients with JE, is the folded type. The present study can infer that pain is associated with disc position, JE, disc structural distortion, and DDWOR is associated with JE. Folded type disc is the most common disc type in TMJ with JE.  Key words:Internal derangement, TMJ, MRI evaluation, disc morphology, disc position, condyle degeneration, joint effusion. Temporomandibular Joint (TMJ), which is one of the most complex joint in human body, has been defined as the location where the mandible articulates with temporal bone . DisordeInternal derangement (ID) (intra-articular irregularity) that can be seen even in asymptomatic individuals is the most common pathology in TMJ. The term derangement refers to a change in the normal course of movement of the TMJ, including the function of the articular disc. Since the structure and quality of TMJ do not change, this situation is different from degeneration .The most common cause of internal derangement, also known as disc displacement, is the inadaptability between the condyle, the temporal bone and the articular disc . Disc diDegenerations of the condyle are known as osteophytes, erosion, sclerosis of the condyle, articular eminence or glenoid fossa .MRI is a useful technique to detect internal derangement, as it allows the direct visualization of articular disc in both open and close mouth positions . FurtherJoint effusion, which is also known as the presence of inflammatory changes in retrodiscal tissue, can be detected by magnetic resonance imaging (MRI) evaluation with the presence of inflammatory changes in synovial membrane and retrodiscal tissue .et al. as; biconcave/normal, biplane/flat, thickened, biconvex, fragmented/destroyed  have an important role in the formations of the effusion . The morestroyed .All these disorders may develop in relation to each other in TMJ. Although there have been a few studies ,9,12, whThe purpose of this study was to evaluate the correlation between clinical symptoms and MRI findings in patients with TMJ pain. The investigators hypothesize that there is a correlation between pain and articular disc position/disc distortion type, condyle degeneration type and joint effusion. The specific aim of the study was to evaluate the relationship between pain and the MRI parameters in TMJ.- Method of sample selectionTo address the research purpose, the investigators designed and implemented a cross sectional study with MRI evaluation. The study population was composed of successive patients records who applied for evaluation and management of TMJ pain between 2016 January and 2019 January. To be included in the study sample, patients had to be older than 12 year old and to have TMJ pain. Patients with a history of the presence of benign/malignant cyst/nodula, trauma or surgery in TMJ were excluded from the study.Archived MRI images of the patients were evaluated by a single oral maxillofacial surgeon and confirmed by an oral maxillofacial radiologist over the records of patients. In case of contradiction, a 3-way evaluation was performed in consultation with another oral maxillofacial surgeon and agreement was reached.- Study variablesPrimary predictor variables were determined on MRI findings and grouped as; disc position, disc structural distortion types (disc morphology), condyle degeneration type and Joint effusion.1.Disc position was classified under subheadings such as ,15: Normal: Disc position was deemed as normal if the posterior band in relation to condyle was located between 11 and 12 o´clock.DDWR: The disc is anterior to the condyle in the closed mouth position and returns to its normal position when jaw is opened.DDWOR: The disc is anterior to the condyle in the closed mouth position and does not return to its normal position when the jaw is opened.Posterior displacement: The posterior band of the disc is in apparent contact with the bilaminar zone and its anterior band is at a 2 o’clock or 3 o’clock position.2. Disc structural distortion types (disc morphology): To assess the articular disc morphology, disc were categorised according it’s shape as follows; normal, folded, lengthened, round, biconvex, thick Fig.  16)..16).et al.  or severe degeneration (erosion) .4. Joint Effusion: Articular effusion has been identified as the presence of inflammatory changes in synovial membrane or retrodiscal tissue, and detected by a severe increase in the signal of T2 in MRI evaluation. In the present study, the categories were recorded as present or absent .Primary outcome variable was pain, recorded on visual analog scale (VAS), in this study. The scores on the forms in which the right and left pain values of the patients were recorded using a callibrated scale between 0 and 10 were used .The other variable category was demographic variables (age/gender) were obtained from recorded data.- Data collection methodsAll MRI images were obtained by a 1.5 Tesla Symphony Quantum or Avanto MRI  with a bilateral 80 mm diameter TMJ coil and 3 mm thick sections with a 190 mm field of view and 256 matrix. With the help of localizers; sagittal and coronal oblique plans were obtained. The following sequences were performed:T1-weigheted images (200/11 TR/TE) to access disc position, disc morphology and osseous changesT2- weighted images (1500/20 RTE/TE) to determine fluid and joint effusionBoth sequences were acquired in occlusion and maximum mouth opening. No motion artifacts were tolerated.Reduction of the disc was evaluated by comparing T1 weighted MR images in open and closed mouth position and disc displacement was classified as disc displacement with/without reduction .Articular disc morphology was classified as; normal, folded, lengthened, round, biconvex, thick post and perforation in the T1 sagittal plane ,18.- Data analysisP<0.05 was considered statistically significant.The SPSS 21.0 Package Data Program  was used to evaluate the data. The data were analysed with the Kolmogorov-Smirnov test for conformity to normal distribution. The data were analysed by Kruskal Wallis H and Mann Whitney U test. Chi-square (x2) test was used for categorical variable comparisons. A total of 350 patient’s 700 TMJ data were included in the present cross sectional study with a mean age of 31 [12 – 65]; 179 male and 171 female . Kruskalp> 0.05).Any statistically significant difference was not found between age and other parameters  (p=0.02). Since the posterior disc displacement was seen only in one patient, PD was not included in the statistical analysis. With regard to the condyle degeneration classification, moderate type condyle degeneration was found to be more common in males and severe type found to be more common in females (p=0.003). Any statistically significant relationship was not found between disc structural distortion types and gender; and between joint effusion and gender .p=0.727).There was no statistically significant difference found between pain and gender. (p<0.001).With regard to the condyle degeneration types, the highest pain value was found in the severe type and the lowest pain value was found in the normal type. Pain levels were significantly different between each group .p< 0.05  (p<0.001) .p<0.001). Since disc perforation was seen only in 1 patient, it was not included in the statistical analysis.Normal and round disc were found to be more common in the patients without JE according to patients with JE, and folded type disc found to be more common in patients with JE according to patients without JE (p<0.05).Normal type condyle degeneration was seen more common in normal disc position group, moderate type condyle degeneration was seen more common in DDWR group and severe type condyle degeneration was seen more common in DDWOR group. This difference, between each groups, was found statistically significant (p<0.05).Normal disc form was seen more commonly in the normal disc position group, lengthened type disc was seen more commonly in DDWR group, and the folded type disc was seen more common in DDWOR group (p<0.05).JE was seen more frequently in DDWOR group (53.20%) and the difference was statistically significant (Temporomandibular joint disorders, known as a set of changing involving stomatognathic system especially in the masticatory musculature, TMJ or both. DDWR is one of the most frequent seen internal darangement type among the others, which may associated with/without pain. It has been known that, disc displacement may cause deformation in articular disc due to the mechanical overload, furthermore, this undesirable load causes release of inflammatory mediators in retrodiscal tissue and synovial membrane which is known as joint effusion and causes pain . AlthougAs a result of the study, we obtained results which support our study hypothesis: 1. Statistically higher pain values were found in patients with DDWR and DDWOR according to patients with non-deplased TMJ disc. 2. Pain levels were found higher in patients with folded, lengthened, and round type disc, than in patients with normal type disc. 3. It was found that the pain, felt in TMJ with high condyle degeneration, was significantly higher than the other degeneration groups 4. JE was found to be higher in patients with DDWOR. 5. JE was found to be significantly higher in TMJ with folded type joint disc.et al. in 2018 (et al. in this regard.A study evaluating the correlation between disc dislocation and pain was performed by Akdag  in 2018 . They evIt is known that the disc is located at the anterior of the condyle reversibly/irreversibly in the DDWR/DDWOR, and the extension and tension in the posterior ligaments are higher than the ligament of the disc with normal position. Anterior displacement of the disc results in overloading on the retrodiscal tissue, which, in turn, results in increased degeneration and inflammation of the joint due to the increase of free radical and nitric production in this region . Therefoet al. (There are several descriptions of JE in the literature. The definition of ‘Presence of fluid accumulation in TMJ’ is only one of them . It was et al. . classifet al. ,16, the Koh had reported  that theet al. (et al. (Pinto et al. (In a study by Murakami et al. , bilater (et al.  and Pinto et al. , signifiHosgör  evaluateet al. (et al. (Takahara et al.  evaluate (et al. . The preStatistically, this study infer that there is a strong correlation between JE and DDWOR. Folded type disc degeneration is the most common degeneration type seen in TMJ with joint effusion. Pain is correlated with DDWOR, severe condyle degeneration and JE. In the light of these findings, knowing that the degree of clinical symptoms correlates with internal darangement may provide information about the degree of TMJ disorder. Therefore, clinical symptoms may play a guiding and preventive role in the treatment of TMJ. Results of the study statistically proves the relationship between clinical data and MRI findings. However, more comprehensive, comparative and prospective clinical trials is planned for future studies that will eliminate the limitations of the current study.


Endometriosis is a chronic, inflammatory disease affecting more than 170 million women worldwide and up to 10% of women of reproductive age. As a consequence of inflammatory reaction and infiltration of anatomic structures, endometriosis can cause “pain symptoms” including dysmenorrhea, dyspareunia, dyschezia, dysuria, and chronic pelvic pain. In this review, we summarized the impact of endometriosis on quality of life in all its aspects including sexual life, work, and social relationships. The data research was conducted using web-based search engines and/or various electronic research databases querying for all articles related to endometriosis and quality of life from the inception of the database up to February 2020. Endometriosis has not only physical but also psychological effects, causing depression, anxiety, and compromising social relationships. Furthermore, endometriosis negatively impacts sexual life and social relationships. At last, the economic burden of endometriosis should not be underestimated, both individually and for the community, as this pathology leads to a loss of productivity at work and large use of health resources. Thus, endometriosis-related symptoms control women’s lives compromising the quality of life in all aspects. In this review, we summarized the impact of endometriosis on various aspects of women’s lives.  Endometriosis is a chronic, and often progressive, inflammatory disease defined as the abnormal presence of endometrial tissue outside the uterine cavity . EctopicEndometriosis affects more than 170 million women worldwide  and up tThe main etiopathogenetic theory is the retrograde menstruation theory, which has gained significant ground since it was first described in 1925 ,8. AlongAn area of great interest among etiopathogenetic theories is the relationship between endometriosis and innate immunity. Recently, Karadadaş E et al. have shown that some complement factors are involved in the pathogenesis and probably in the progression of the disease; in particular, this study has highlighted the correlation between the complement protein C6 and endometriosis’s stage, opening the possibility to consider it as a potential biomarker for the diagnosis of endometriosis . There are different types of endometriosis: superficial peritoneal implants, endometriotic ovarian cysts, and deep infiltrating endometriosis (DIE) ,14. The The data research was conducted using the following databases MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library querying for all articles related to endometriosis from the inception of the database up to February 2020. The studies were identified with the use of a combination of the following text words: endometriosis, quality of life, sex, cost, depression, anxiety, emotion, social relationship, economic burden, health care resource, questionnaire. The selection criteria of this narrative review included randomized clinical trials, nonrandomized controlled studies , and review articles. A review of articles also included the abstracts of all references retrieved from the search. Conference papers and reviews and studies with information overlapping another publication were excluded. In the event of overlapping studies, we selected the most recent and/or most comprehensive manuscript. We initially selected 108 studies from different databases: of these, only 88 records were screened. Of these, 57 studies were assessed for eligibility whereas 31 were excluded because of not reporting original data (10) and lacking specific data on quality of life assessment strategies in patients with endometriosis (21) . Titles According to World Health Organization (WHO), quality of life (QoL) is defined as a multidimensional construct of the individual perception of one’s position in life in the context of culture and value systems about goals, expectations, standards, and concerns . PainfulHealth-related quality of life (HRQoL) is a multidimensional concept that includes physical, psychological, and social aspects. Despite the importance of assessing the impact of endometriosis on QoL, there is still little consensus on which method to use. Several types of questionnaires have been proposed and used over the years . A recent review, conducted to assess the health-related QoL burden in women with endometriosis, has shown that the most commonly used QoL tools were the Short Form 36 (SF-36), the Short Form 12 (SF-12), and the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) . The SF-Dyspareunia is the symptom that most of all affects the quality of the sexual life of women with endometriosis: to evaluate it, there is DYSP diary. It is a single item that evaluates the dyspareunia during the last 24 h. The response options vary from Absent—0 , Mild—1 , Moderate—2 (intercourse was interrupted due to pain) to Severe—3  . To assen = 100), peritoneal and/or ovarian endometriosis (n = 100), and a group of healthy controls (n = 100). The authors founded that women with endometriosis experienced more frequent and severe deep dyspareunia and consequent worse sexual functioning compared with controls . Instead, no statistically significant differences were observed between women with different localization of endometriosis  [p < 0.001). There was also a significantly lower frequency in preliminary performance  [p < 0.0001). The average values obtained on the SHOW-Q scales showed poor sexual function . Satisfaction was the most affected dimension (average satisfaction score 55.66–34.55), followed by orgasm (average orgasm score 56.90–33.77). Moreover, in this study, it was highlighted that among women with DIE, only those with vaginal lesions significantly have a significant impact on sexual function [p < 0.05) in pain during intercourse after the surgical excision of endometriotic lesions. A reduction in dyspareunia and an improvement in sexual activity are observed twelve months after complete excision of endometriosis. Besides, sexual satisfaction has increased, and sexual problems have decreased significantly. Surgical excision of endometriosis is a feasible and good treatment option to relieve pain and improve the quality of sexual life in symptomatic women with endometriosis [Endometriosis-related symptoms can affect the sexual life of women with a decrease in the number and quality of coitus and compromising overall sexual activity, self-esteem, and sexual satisfaction . The impovarian) . Howeverovarian) . In addiovarian) . These dovarian) . When coovarian) . Shum etovarian) . As abov= 0.003) . Sexual function . As demofunction . Therefoetriosis . Even meetriosis . The cometriosis . p = 0.004) [There are many pieces of evidence about the negative impact of endometriosis on relationships. An international multicenter survey founded that 50% of 3216 women, invited to participate in the study, reported that endometriosis had affected their relationships, causing a couple split in 10% of cases . The eva= 0.004) . However= 0.004) . The impEndometriosis is a problematic disease in which symptoms control women’s lives also causing important psychological effects . CavaggiDepression negatively affects different aspects of quality of life such as relationships, sex, work, and even sleep quality. Poor sleep quality  can in turn negatively affect the ability to perform daily functional activities in women with endometriosis . MoreoveThe economic burden of endometriosis has been well documented in the literature. A prospective, multicenter survey conducted in 10 European countries (EndoCost study) demonstrated that the average annual total cost per patient with endometriosis in 2008 was almost €10,000, including health care as well as loss of productivity costs . The mosEndometriosis is a chronic disease affecting a large portion of the world’s female population of childbearing age. The quality of life is strongly influenced by this pathology: women suffer from dysmenorrhea as well as chronic pelvic pain and this affects work, leisure, and social and love relationships. Pain-related to endometriosis also affects the psychological aspect, compromising the quality of sleep, making women anxious and depressed. The impact of endometriosis on sexual life is huge: dyspareunia is one of the cardinal symptoms of the pathology. This symptom reduces the frequency of sexual intercourse, worsens the QoL and the SQoL with a negative impact also on the couple’s life. The costs of endometriosis should not be underestimated, both in terms of treatment and loss of productivity of the woman due to the disease. It can be concluded that endometriosis is a pathology that affects all aspects of women’s lives and that thus, it must be treated with a multidisciplinary vision that includes not only a medical approach but also psychological, work, and economic support.


Gyaku-Zuki), front kick (Mae-Geri), roundhouse kick (Mawashi-Geri), and spinning back kick (Ushiro-Mawashi-Geri). Each technique was performed approximately three times per recording , and under three conditions where participants kicked or punched (i) in the air, (ii) a training shield, or (iii) an opponent. Each participant undertook a minimum of two trials per condition. The data presented was captured using a Vicon optical motion capture system with Plug-In Gait software. Three dimensional trajectories of 39 reflective markers were recorded. The resultant dataset contains a total of 1,411 recordings, with 3,229 single kicks and punches. The recordings are available in C3D file format. The dataset provides the opportunity for kinematic analysis of different combat sport techniques in attacking and defensive situations.Human motion capture is commonly used in various fields, including sport, to analyze, understand, and synthesize kinematic and kinetic data. Specialized computer vision and marker-based optical motion capture techniques constitute the gold-standard for accurate and robust human motion capture. The dataset presented consists of recordings of 37 Kyokushin karate athletes of different ages  and skill levels (from 4th dan to 9th kyu) executing the following techniques: reverse lunge punch ( Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.13164848 Human motion capture is commonly used in various fields, including sport, to analyze, understand, and synthesize kinematic and kinetic data.1. Karate requires physical, technical, and tactical skills, and is based on techniques involving striking the opponent with the hand, foot, knee, or elbow. The movement patterns for these striking techniques typically involve flexion, extension, abduction, adduction, and rotation of various joints. Sufficient force must be transferred through the kinetic chain for striking techniques to score points3.The ability to execute the right technique in combat sports plays an important role in scoring points. However, there is no common optimal movement pattern for the performance of individual techniques. The martial art of karate is a method of fighting and defending with an “empty hand” 4. In karate, it is extremely important to be able to execute techniques and changes of direction at speed, and this requires high levels of coordination and balance. Research in martial arts focuses primarily on injuries6, psychology9, biomechanics11, and perception of health12.In recent years, martial arts has increased in popularity, and this has resulted in rule changes. The basic features of sport karate that make it recognizable are point-scoring techniques such as kicks and punches. These techniques can be used in three basic scenarios: (i) to attack, (ii) to intercept an opponent’s strike, and (iii) to counterattack13. An analysis using kinematic methods during karate contests revealed that upper limb techniques achieved a higher score compared to lower limb techniques15. Furthermore, it has been shown that punches are a more dominant technique compared to kicks, which are used less frequently; this is despite rule changes that favor the use of kicks. Punches are less complex, allow greater precision and control, and require less energy expenditure17. Moreover, punches can be executed quickly, and thus have a greater chance of scoring points15. However, taking into account spectators’ perceptions, punches are not as spectacular as kicks.Findings from investigations that have analyzed competitive karate are important for planning the training process, and helping to ensure that training adapts to changes in competition rules. In competition, it has been found that punches and kicks account for 89.09% and 8.36% respectively of all techniques usedMae-Geri), roundhouse kick (Mawashi-Geri), hook kick (Ura-Mawashi-Geri), and sidekick (Yoko-Geri). The roundhouse kick to the opponent’s head (Mawashi-Geri jodan) is the most commonly used kicking technique in karate18. However, a roundhouse kick to the opponent’s torso (Mawashi-Geri chudan) allows more control, and greater protection from the opponent’s strikes, compared to other kicks; therefore, an athlete may opt to use a roundhouse kick to the torso instead of other kicks13.Karate kicking techniques include the front kick  were identified.For example, motion analysis studies of karate have investigated reaction time and anticipation26 was obtained for the reverse lunge punch (Gyaku-Zuki), front kick (Mae-Geri), roundhouse kick (Mawashi-Geri), and spinning back kick (Ushiro-Mawashi-Geri). Every technique was performed three times per recording (resulting in one data file), and under three conditions: (i) kicking or punching the air, (ii) kicking or punching a training shield, and (iii) kicking or punching an opponent. Possible applications of the data obtained are:11, based upon factors such as age, gender, training experience, and karate grade,comparison of movement patterns between individual athletes, or groups of athletes24,kinematic description and analysis of movement patterns used when executing karate techniques27,measure personal and interpersonal repetition of movement29,development of virtual reality environments for virtual training31,training and validation of machine learning techniques for the classification, prediction and synthesis of human movementdevelopment and optimization of methods for teaching karate techniques.Based on the above considerations, we present a comprehensive set of kinematic and kinetic data obtained from recordings of 37 Kyokushin karate athletes. The athletes were of different ages , and of different skill levels as based upon the karate grading system (from 4th dan to 9th kyu). Data34, activities of daily living (ADL)36, and general sport activities37 is publicly available. However, publicly available human movement data regarding the martial arts is limited. In the Physical Activities and Sports category of the Carnegie Mellon University Motion Capture Database (http://mocap.cs.cmu.edu/) the martial arts subcategory contains recordings of only two subjects . In the HDM05 repository38 the only martial arts related category (“kicking and punching”) contains 17 recordings, but without technical descriptions of the techniques depicted, or information about martial arts where the techniques are used, whilst the KIT Whole-Body Human Motion Database40 contains only general recordings described as “kick” and “punch”.Human movement data regarding gaitShorin-ryu, Shotokan, and Oyama styles by inertial sensor based motion capture system41.Consequently, there is little publicly available human movement data concerning specific martial arts, including karate. There has been an attempt to create an open karate motion capture data repository with seven participants, and recordings of 43 contains motion capture data (synchronized with video and audio recordings) of two katas performed by seven participants with different levels of experience.Additionally, a further dataset described44.The goal of collecting the Martial Arts, Dancing and Sports dataset (MADS) was to provide challenging action sequences for human pose estimation from multi-view or depth data. The ground-truth pose data was captured by optical motion capture system with only 60 Hz. As part of the database, the recordings of two martial arts masters in 6 forms in tai-chi and 6 katas in karate are available45.Next available motion capture dataset UMONS-TAICHI contains Taijiquan martial art gestures that includes 13 classes (relative to Taijiquan techniques) executed by 12 participants of various skill levels. The dataset was captured using two motion capture systems simultaneously: optical motion capture system with frequency 179 Hz, and markerless motion capture system based on depth sensorIt is important to address the absence of high quality, well described, and publicly available martial arts motion capture data. Any future repository should contain recordings that depict karate athletes of different levels  executing techniques under various conditions .Mae-Geri) when executed by Kyokushin karate athletes of different levels under three conditions11: (i) a kick in the air, (ii) a kick against a training shield, and (iii) a kick against an opponent.The part of presented dataset was used to investigate the three-dimensional kinematics of the front kick , aged between 10 to 50 years (mean 18 with std 10), took part in the study. Participants trained at the Kyokushin Karate Club . Participant characteristics were: mass 30–118 kg (mean 54.5 with std 19.9), height 142–192 cm (mean 160 with std 12.8), training experience 2–35 years (mean 9.3 with std 8.4), and karate grade (9th kyu - 4th dan)  sampling at 250 Hz. Thirty-nine reflective markers from the Plug-In Gait software full-body marker set were attached to specific anatomical landmarks (according to the Vicon system documentation). In this approach, one marker is placed on each joint . Between adjacent joints there is a further marker placed at different heights on the right and left limbs to distinguish them from each other. Additionally, four markers are used for the pelvis (for the front and back spines), five for the torso , and four for the head. An additional four markers were placed on the training shield. For recordings with an opponent, both the attacker and defender had markers placed on them, resulting in two sets of data . Data acquisition was carried out in the Human Motion Lab (HML) at the Research and Development Center of the Polish-Japanese Academy of Information Technology in Bytom, Poland. The system for data acquisition consisted of ten near-infrared (NIR) Vicon MX-T40 cameras with 4 megapixel resolution and 10-bit grayscale, and 10 Vantage V5 cameras with 5 megapixel resolution. The area used for measurement had the shape of an ellipsoidal cylinder, with a height of 3 m, and a base with axes of 6.47 m and 4.2 m.Before the execution of the technique was recorded, participants performed a standardized individual warm-up. The warm-up was approximately 2 minutes duration, and predominately consisted of stretching exercises. The athletes had to execute the designated technique in the measurement area. After the markers were placed on the participant, and before they executed the technique, calibration of the motion capture system was carried out according to the standard Vicon protocol. For the calibration, the athlete had to stand in a “T” position by joining their legs and raising their arms to the side.kumite no kamae. This position involved standing with one foot in front of the other, and both heels touching the ground. The lateral distance between the two feet corresponded to the width of the participant’s pelvis. The designated technique was executed with the rear leg, and following execution of the technique participants returned to the reference position. Participants were instructed to use their dominant leg to execute the technique, with the exception of the opponent condition , where participants could use either leg to execute the technique in a manner best suited to the combat situation, and their preferred attacking strategy. Participants were instructed to execute the technique with maximum speed, and the intent to achieve maximum force upon impact. No prompt was given to the athletes to start the kick. Participants performed three repetitions of the designated technique, and two trials of each condition were conducted.The reference position (starting stance) for the participants was Mae-Geri) is a basic kick. It is useful for self-defense situations such as kicking the opponent  is also referred to as a round kick. The roundhouse kick is similar to the front kick, the only difference being that the movement pattern for the roundhouse kick is circular, and attacks the opponent from the side. From the fighting stance the kick is executed with the rear leg. The roundhouse kick was recorded at two heights: (i) from knee to hip  begins with the fighting stance, and is generally executed with the rear leg  is executed with the hand contralateral to the front leg ,a kick or punch against an opponent in a combat situation, with both attacker and defender recorded.The following three conditions were specified:Mawashi-Geri) and spinning back kick (Ushiro-Mawashi-Geri) are technically difficult, and some of the less experienced participants were not able to execute these techniques successfully. If a less experienced participant was unable to execute a technique successfully, there is no recording of the technique in the participant’s catalogue. The overall statistics are listed in Table Not all techniques were performed by all participants. For example, the roundhouse kick . The data in the repository is non-normalized giving the broadest possibility of analysis. Available data contains 3D trajectories of all markers (set of 39 markers) and angles of human joints without information about the skeleton. Additional moments, powers and forces in those joints. There are also trajectories of shield markers for determining the position of the target. The additional four trajectory markers used on the training shield are labeled as: Tarcza1, Tarcza2, Tarcza3 and Tarcza4.Plug-In Gait software was used to determine angles, moments, force output, and power output at individual joints, and to estimate virtual markers, such as the center of mass (COM). A description of all variables is available in the system documentation . Catalogues are named as per the participant code number . There are 3–4 repetitions of the same technique in a given trial (T01 and T02). It gives also the possibility of a time and a preparatory movement analysis for the technique. The C3D file format is widely used in the biomechanical field by companies and laboratories to store motion capture system data. The dataset is available at figshare (10.6084/m9.figshare.c.4981073)26.The dataset comprises 1,411 files, with 3,229 single kicks and punches. Data is stored in the C3D file format  anti-aliasing filter was applied. The last step was to downsample the filtered signal to the desired value by discarding the samples. The trajectories obtained in this way had the same length, whilst maintaining their shape. These steps were carried out using the p :μ is the mean value and σ is the standard deviation of p. This method has been used for motion feature normalization in classification tasks47. Figures For joint angles, moments, force outputs, and power outputs, this normalization was sufficient. However, for the trajectory of joint markers spatial normalization was necessary. The participant’s position within the scene affected the marker position . Therefore, all trajectories had be normalized in some way. A basic method to standardize trajectories is to use the z-score of entclass1pt{minimaWhilst this method works well for simple visualization, it is too simple to evaluate individual trajectories. For example, this method of normalizing would not show the difference in kick height. To obtain such information, other normalization methods that take into consideration factors such as participants’ limb length and height can be used.When analyzing movement anatomical axis and planes are used. The x-axis is the frontal axis (representing movement from the left to right side of the body), the y-axis is the sagittal axis (representing front and back movements), and the z-axis is the vertical axis (representing up and down movements).To automatically detect the kick, and the kicking leg (right or left), the value of the z coordinate and basic peak analysis can be used. If the peak value exceeds a specified limit, it means a kick has occurred. To standardize the kicking leg data , the value of the x coordinate should be changed to the opposite side .The trajectories of the ankle marker on the kicking leg are presented on the charts. Each condition has been drawn using a different color: (i) a kick in the air (green), (ii) a kick at the training shield (red), and (iii) a kick at the opponent (blue). Kicking leg hip joint angles, punching upper limb finger marker trajectories, and punching upper limb shoulder angles are presented in the same manner.In Figs. Mae-Geri kick . For analyses in Matlab, the external MoCap Toolbox can be used to open C3D files. Data normalization and synchronization appropriate to the planned analysis are required49.The dataset can be used for kinematic analyses. The Biomechanical ToolKit (BTK)


Rupornis magnirostris), broad-snouted caiman (Caiman latirostris) and loggerhead sea turtle (Caretta caretta) tears. Tears were collected from healthy animals, their spectral profiles were obtained with an LTQ Orbitrap XL mass spectrometer, and the dataset was analyzed against reference taxa.Tears play an important role in ocular surface protection, and help wild animals maintain visual acuity in the face of air and water friction. The proteomics of tears has only been described for mammals. The knowledge of the proteomics of wild animal tears can aid not only in the setting of normal standards for ocular disease studies in these animals, but also to base the search for new molecules to be used in ophthalmology therapeutics. We therefore set out to describe the proteomic profile of roadside hawk (For roadside hawk, 446 proteins were identified, the most abundant being albumin, transferrin, globulin and actin. For broad-snouted caiman and loggerhead sea turtle, 1358 and 163 proteins were identified, respectively. Uncharacterized proteins and transferrin were highly abundant in both species. The roadside hawk tear components and their properties were similar to those described for humans, but with a higher albumin concentration. Broad-snouted caiman tears presented a wide diversity of ontological functions, with an abundant presence of enzymatic compounds. In loggerhead sea turtle tears, the predominance of proteins with ion-transport functions was consistent with possible osmolality-maintenance mechanisms.These data enhance our understanding of birds and reptiles’ tears microcomposition and may be used to base the discovery of new molecules with high biotechnological potential. Biotechnological advances have contributed to the description of microcomponents present in fluids, their properties, and the presence of health and disease biomarkers –3. AmongNumerous organic components can provide information on biological pathways and activities, or even clinical applications , 7. AmonNon-human mammals’ tear studies have been conducted for the establishment of experimental or clinically relevant models –15. HoweRupornis magnirostris), broad-snouted caiman (Caiman latirostris) and loggerhead sea turtle (Caretta caretta). The composition of these wild animals’ tears can provide information on modifications due to the environment or the evolutionary process, serve as a base for studies on biomarkers of ophthalmic diseases, and reveal molecules of potential biotechnological importance.Vision is the main sense in birds and is essential for many basic habits, such as flying, mate selection, predator avoidance and prey –18. WithWe identified 446 proteins , cytoplasm (13.5%), cell fraction (10.9%), cytosol (4.8%), integral membrane components (4.3%), cytoskeleton (actin – 3.0%); other associations, with lower frequency, were with the endoplasmic reticulum, hemoglobin complex, and nucleus , cell wall component and structural process (10.1%), catabolic processes (8.1%), regulation 7.3%), transport (6.5%), homeostasis regulation (5.3%), immune response (4.2%) and, less frequently, biosynthesis, redox processes, microtubule-based processes, protein folding, cellular response, oxidative stress and glucogenesis  associated with the amino acids serine, cysteine and threonine. Other functions were detected at lower frequency, such as actin binding (7.8%), ATP binding (6.1%), calcium-ion binding 4.6%), oxidoreductase activity (4.3%), and metal-ion binding (3.2%)  and the age (intrinsic factor) can change the tear composition , 32. ForAlthough the application of MS in this research provided some important results, the absence of a database including the specific species, or taxonomically close species’ genomes could present an obstacle to result interpretation. Comparing our MS data for roadside hawk tears to prior descriptions of Aves taxa, for broad-snouted caiman tears to prior descriptions of Alligatoridae, and for loggerhead sea turtle tears to prior descriptions of Testudines, may reduce the accuracy of some findings, and may have influenced the information obtained for ontology categories, but these were the only data available for consideration.Zhou and Beuerman  classifiComparing the protein profiles of the two reptile species’ tears in this study, we observed a greater abundance of proteins in the broad-snouted caiman and a higher frequency of transferrin in the loggerhead sea turtle. Therefore, transferrin may be key to the mechanism of ionic balance in the corneal epithelium of loggerhead sea turtles, since the high salinity in their environment can result in osmotic stress at the ocular surface . SimilarTransferrin and other proteins associated with ion transport are described as an immunological barrier in tears. Together with the abundance of globulin, these proteins might serve as a defense mechanism for ocular surface protection in birds and sea turtles, as has been previously shown in mammals , 26, 35.Actin has also been observed in the tears of other species. It is a major component of the ocular surface epithelium microprojections, and an important component of the cytoskeleton , 15, 26.The freshwater broad-snouted caiman’s tear proteins were most frequently associated with the cytoplasm, extracellular space, ribosomes, intracellular space, membrane components and nucleus, making up about 55.6% of this ontology classification. Taking into consideration the particularities of this species, the high protein presence may promote a stable tear film, despite wide intervals between palpebral incursions  and the The concentrations of microcomponents in organic fluids, including tears, are correlated to homeostatic and metabolic processes. As an example, studies in humans showed differences in the tears of healthy patients and those with systemic diseases, such as kidney disease and diabetes , 39. HowAlbumin is an important serum component among vertebrates, presenting a role in ion transport and osmolarity maintenance , 40. It Some proteins that were identified in the tears studied herein were previoulsy detected only in specific tissues, such as vitelline, described in birds and reptile eggs and with a possible antimicrobial function, and olfaIn proteomics studies of humans and dogs tears, the ontology classification of biological processes acts as a guide for tear function, with an emphasis on processes correlated to the immune system , 15, 26.In relation to the molecular functions of the proteins, Winiarczyk et al.  identifiCalcium-ion binding was the most frequent molecular function in loggerhead sea turtle tears. The strong presence of functions correlated to ion transport associated with transferrin frequency reinforces the notion that the main function of the tear in loggerhead sea turtles is maintenance of stability against the osmotic pressure exerted by the medium . AnotherThis study offers the first description of bird and reptile tear proteomics, with a focus on species inhabiting different ecosystems . A total of 446, 1358 and 163 proteins were identified in roadside hawk, broad-snouted caiman and loggerhead sea turtle tears, respectively. The proteomic profiles of these fluids differed from those of mammalian tears, suggesting that adaptative processes directly influence the composition of tear polypeptides. In reptiles, there was a large number of uncharacterized proteins. The components of roadside hawk tears were primarily destined to molecules and ion transport, indicating the constant need for maintenance of osmolarity and stability. The protein profile of the broad-snouted caiman tears was diverse, with a high abundance of enzymes, a situation that can be related to a close contact with a hypotonic freshwater environment or even to a specific defense role. The ontological classification of proteins in loggerhead sea turtle tears revealed a strong mechanism of osmotic-pressure maintenance.This study was approved by and registered at the System of Authorization and Information on Biodiversity (protocol no. 27489) and by the National System of Management of Genetic Heritage (protocol no. A1F8C27), both part of the Brazilian Ministry of the Environment, and by the Ethics Committee on Animal Experimentation of the School of Veterinary Medicine and Zootechnology of UFBA (protocol no. 72/2016) who allowed to use the animals.. All procedures were conducted in compliance with the Association for Vision and Ophthalmology Research (ARVO) and the National Institutes of Health (NIH) for the use of animals in eye and ophthalmic research. In addition, at all stages involving contact with the animal, minimally invasive maneuvers were performed to reduce stress and pain.The following materials were obtained from Sigma-Aldrich : ACN, TFA, ammonium bicarbonate, DTT, IAA, and trypsin (0.1 μg/μL). Nanopure water was used throughout.Rupornis magnirostris) is a hawk with a wide geographical distribution in the America s[Caiman latirostris) is a medium-sized crocodile, bred for commercial purposes, which lives in freshwater environments and can be found in eastern and central South America. The loggerhead sea turtle (Caretta caretta) is considered a vulnerable species according to the current IUCN  Red List Criteria; it is globally distributed throughout the subtropical and temperate regions of the Mediterranean Sea and Pacific, Indian, and Atlantic Ocean s[The roadside hawk  and housed in an outdoor enclosure, with an environmental enrichment like that found in the Atlantic Rainforest. The birds’ diet was based on meat and chicken or slaughtered prey (mice). We screened 70 healthy adult broad-snouted caimans, males and females, kept in a commercial breeding center . The animals were kept in freshwater tanks with a water supply without pollutants, and a supervised diet based on chicken and meat. A total of 10 healthy juvenile loggerhead sea turtles of unknown sex were also screened. These animals were kept at a wild animal conservation center , and the tank water supply was originated directly from the sea and filtered using sand filters. The pH of water tanks was around 7.5–8.5. The diet of the sea turtles were based on fish, algae and vegetables. The choice of captive animals was based in the fact that they are used to human handling, making the tear collection ease and with less chances of contamination. All animals were submitted to periodical hematologic exams and had no history of disease. In addition, it complies with national regulations (SISBIO law requirements) and these institutions allowed to use the captive animals.The collection procedures were conducted under manual restraint, without the use of anesthetics, and with previous cleaning of the eye with sterile water to avoid contamination. Before sample collection, the institute staff and veterinarian ophthalmologists performed a routine physical examination, and evaluated the eyes and periocular regions using light and a magnifying lens. Other ophthalmic evaluations (such as biomicroscopy and fluorescein test) were performed after acquisition of the samples, as these techniques can influence tear production. If diseases or morphological changes were found, the sample was excluded from the evaluation. Stress factors, such as intense sounds and light stimuli or physical restraints for a long time, and procedures that can induce pain, such as an excessive manipulation of the eyelids and eyelashes, were prevented and reduced with the objective to preserve animal welfare during the sampling process.All collections were performed in the morning (0800–1130 h), in both eyes. For birds and caimans, the collection was performed by Schirmer strip , as previously describe d. The vis2/g, Agilent, Santa Clara, CA, USA) to separate and collect the peptides. The column was washed and activated with 0.1% (v/v) TFA solution in water, and then ACN solution (80% v/v) and 0.1% TFA were added sequentially. After this step, the sample was reintroduced into the column and washing was performed with 0.1% TFA solution and water; then the sample was eluted with 80% ACN solution and 0.1% TFA in water. The collected peptides were concentrated under vacuum (− 26 °C) for 18 h prior to performing MS.The protein concentration of each of the tear pools was determined, and then they were eluted in buffer solution  and incubated in trypsin at 37 °C for 18 h (overnight). HPLC was performed on a C18 column  operated in positive mode. Samples were introduced to the source by direct infusion at 10 μL/min and MS was performed through collision-induced dissociation. The precursor ions were isolated from 3 Da, activated from 25 to 35% of the normalized collision energy per 100 ms, and the The MS results were evaluated using Byonic Protein Metrics software ; polypeptides with a score above log 2 were included, and those below this score were considered foreign proteins. The data were evaluated using the UniProtKB database, with the research criterion set to the taxa Aves (class), Alligatoridae (family) and Testudines (order) for roadside hawk, broad-snouted caiman and loggerhead sea turtle, respectively. The total abundance was obtained, and protein frequencies were described as percentages (relative abundance). The results were organized into clusters, based on the frequency of the protein and it gene ontology category , as previously describe d.Additional file 1 Table 1. Proteins identified in roadside hawk (Rupornis magnirostris) tears. An Orbitrap platform was used to identify the peptides, and the results were analyzed using the taxum Aves databaseAdditional file 2 Table 2. Proteins identified in caiman (Caiman latirostris) tears. An Orbitrap platform was used to identify the peptides, and the results were analyzed using the Alligatoridae family database .Additional file 3 Table 2. Proteins identified in caiman (Caiman latirostris) tears. An Orbitrap platform was used to identify the peptides, and the results were analyzed using the Alligatoridae family database .