Occupational stress, measured both by job strain and ERI, was a moderating factor in this relationship. The relationship between the WOAQ and psychological health, moderated by job strain or ERI, remained highly significant even after adjustment for sex, age, social support, and overcommitment. Regression models explained over 40% of the shared variance of the association between quality of work organization and psychological health. The quality of work organization significantly predicted the risk of sickness absence for musculoskeletal disorders  and for other health problems . A continuous improvement of work organization must consider not only the clients’ or production needs but also the well-being of workers.The quality of work organization may be responsible not only for reduced productivity but also for an increased risk of mental and physical disorders. This study was aimed at testing this hypothesis. Workers of a local health unit in Italy were asked to fill out the Work Organization Assessment Questionnaire (WOAQ) during their periodic medical examinations in the second half of 2018. On the same occasion, they also completed the Demand/Control/Support (DCS) measure of job strain, the Effort/Reward Imbalance (ERI) questionnaire, and the General Health Questionnaire (GHQ12) to assess psychological health. A total of 345 workers (85.8%) completed the survey. Linear regression analysis showed that the quality of work organization was inversely proportional to psychological health problems ( The quality and organization of the work in public health and healthcare organizations is fundamental to maximizing the effectiveness of health services, especially under restricted resources. In Italy, the universal health coverage provided by the national health system has allowed significant improvements in public health, even with a decrease of resources . HoweverA great variety of concepts and tools have been used to solve labor problems in healthcare. Industrial improvement approaches such as benchmarking  or lean Moreover, healthcare facilities are organized in a way that sees modern management based on the care complexity of patients and the intensity of the care that they need . This coThe quality of work organization can be evaluated through two different approaches. The first consists of measuring the organization’s impact on workers’ psychosocial outcomes. For example, organizational justice ,23 is siThere is strong evidence, from meta-analytic research, of the effects of the psychosocial work environment on mental health . Those sIn this study, we aimed to verify the assumption that the organization of work is associated with workers’ mental health status. Furthermore, we expected that perceptions of occupational stress would moderate this relationship. Finally, we studied the relationship between work organization and sickness absence due to musculoskeletal disorders or other diseases. We tested the following hypotheses:H1: Quality of work is positively associated with psychological health;H2: The relationship between quality of work and psychological health is moderated by job strain;H3: The relationship between quality of work and psychological health is moderated by effort/reward imbalance;H4: Quality of work is negatively associated with sickness absenteeism .The study was cross-sectional and descriptive. We followed the STROBE guidelines .European directives state that workers exposed to occupational risk will be assessed by an occupational physician who will verify their suitability for work. All workers of the Local Health Unit Roma 4, Civitavecchia, in the Latium region of Italy, who were called for the periodic visit in the second half of 2018 were asked to complete a questionnaire containing measures of their work experience and psychological health as well as demographic and job-related information . Age was measured in years. Job type was measured as three professional categories: physician, nurse, and support staff. The workers invited to participate were all those who: (1) had been classified as “exposed to occupational risk” by the employer; (2) had undergone a preventive medical examination at least a year earlier; (3) had to undergo a new examination for the expiration of the judgment of suitability at risk. Participation in the survey was voluntary.The Italian version  of the WThe participants were also asked to fill out a questionnaire on job strain: the Italian version  of the DThe participants also were requested to fill in the Effort/Reward Imbalance (ERI) questionnaire by Siegrist ,46,53,54Psychological health was measured using the Italian version  of GoldbThe participants were also asked to indicate with a binary response (yes/no) whether in the year prior to the visit, they had abstained from work due to musculoskeletal problems, and if they had abstained for other diseases.All the workers signed consent to the anonymous processing of their personal data and publication of the results from the analyses, which included their consent related to the present study. The study was conducted in accordance with the Declaration of Helsinki  and apprThe distribution of scores was analyzed by measuring central tendency  and dispersion (standard deviation). We did not need to normalize the data before the statistical analyzes because, as reported by Lumley et al. , the assComparisons between the different professional categories, sexes, and age groups of workers were carried out using one-way ANOVAs, followed by Bonferroni’s post-hoc tests. The relations between these variables were examined using Pearson correlation.Once the presence of a significant correlation between the variables was found, we specified a linear regression model that included interactions in order to test moderation effects. We hypothesized that the work organization could act as a predictor of psychological health (as measured by the GHQ12), with stress as a moderating factor in this relationship. Social support, overcommitment, age, and sex were considered confounding factors.Logistic regression analysis was used to evaluate the association between WOAQ or stress variables and the number of days of absence due to musculoskeletal disorders or other diseases in the year preceding the visit. The estimated effect was presented in terms of odds ratio (OR) and 95% confidence intervals (95%CI). Each of the variables was initially posited as a predictor in univariate models in which the absence of back pain or for other musculoskeletal problems was the response variable. Subsequently, multivariate logistic regression models, adjusted for gender and age, were constructed.The statistical analyses were carried out using SPSS 26.0  integrated by PROCESS version 4.1 .Overall, 345 workers of the 402 who had been invited agreed to participate in the survey (85.8% participation rate). The main reason for non-participation was the lack of time to complete the questionnaire. The sample was mainly composed of females  and nurses  among the professional categories. The average age was 43.44 years (s.d. 8.71). The characteristics of the sample corresponded to those of the employees of the Italian National Health Service . See TabThe comparison between professional categories  indicateWork organization and the variables that measure occupational stress and psychological health were significantly correlated . The quap ≤ 0.05) at levels −0.3008, 0.0001, and 0.3008 . Similarly, the conditional effects of the independent variable WOAQ at values of the moderator ERI were significant (p ≤ 0.05) at levels −0.3827, 0.0001, and 0.3827 . Moderation analysis revealed that both the direct and indirect  had been on sick leave for back pain or other musculoskeletal disorders and 150 workers (44.2%) had been on sickness absence for other causes.Logistic regression was used to examine how work organization was related to absenteeism due to musculoskeletal disorders. In univariate analyses, work organization was significantly and positively associated with the occurrence of sickness absence separately for musculoskeletal disorders  and otheThis study was conducted on a group of healthcare workers in a local health unit in Italy. The findings showed that quality of work organization was significantly associated, in a protective way, with psychological health. Specifically, occupational stress significantly moderated the relationship between work organization and psychological health. Work organization was also negatively associated with sickness absence, both from musculoskeletal problems and other causes. The hypotheses that motivated this study have been confirmed.These results are in line with the literature ,27,28,29The WOAQ has been shown, here and elsewhere, to be a valid and functional measure of the organization of work. The WOAQ asks workers to express the opinion that they and their colleagues share of the organization of work. Objectivity, in this sense, was supported by the lack of significant differences in judgment between the various professional categories, age groups, and sexes. On the contrary, when workers were questioned about their perception of organizational justice, that is, the level of correctness of procedures, distribution of tasks and rewards, information flows, and relationships in the workplace, significant differences were observed between the various subgroups of HCWs, with doctors who complained of poor distributive justice, women who reported poor interpersonal justice, and elderly workers who reported less informative justice than the other subgroups of the healthcare population . This diIn the literature, the organization of healthcare work has also been studied with qualitative methods that demonstrate how staff is able to correctly describe problems and provide useful elements to management to improve a given situation . HoweverHealthcare workplaces are complex and involve many critical elements. A systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent in healthcare . Other wThe two stress models we used have different meanings and, consequently, different relationships with the outcomes. In the vast complex of care activities, each of the two stress models captures some specific aspects: the DCS more linked to physical loads and the ERI to intangible contents. In our sample, which brought together the many activities of a local healthcare unit, the variables deriving from the two models had modest associations with sickness absence. This result is in agreement with what was found in the literature. A German study showed that organizational justice was a significant independent predictor of musculoskeletal pain only among white-collar workers, whereas job strain had additive predictive utility exclusively among blue-collar workers; in reverse, ERI influenced pain-symptom reporting in both occupational groups . In a he©) was initiated [The identification of problems in the organization of work is the basis for the development of workplace health interventions and participatory ergonomics programs. These programs have been applied in different contexts, with encouraging results ,77. It initiated . Throughnitiated . The proThe findings of this research have to be appreciated in light of its limitations. First, the cross-sectional nature of the study prevented us from inferring causality. However, it seems plausible to believe that work organization is a determinant of distress and to believe that reverse causality is unlikely. Second, the survey was carried out in a single health unit, and this requires the utmost caution in extrapolating the results to other work situations. Finally, the sample size was smaller in physicians and support staff compared to nursing. However, it is sensible to observe that there are no great differences between the various health units, and we can therefore believe that by applying the same method in other situations, comparable results can be obtained.The quality of work organization, as measured by the WOAQ, has a significant impact on psychological health and sickness absences, supporting the importance and the need to continuously improve the organization of work to improve workers’ well-being, especially in the demanding healthcare sector.


We found that caring behavior had a positive correlation with the quality of nursing services and compassion competence. Moreover, there was a positive correlation between the quality of nursing services and compassion competence. Compassion competence had a significant mediating effect on the relationship between caring behaviors and quality of nursing services. This suggests that nurses’ caring behaviors can enable high-quality nursing services influenced by compassion. Therefore, in order to improve the quality of nursing services, repeated and continuous implementation of training programs including education that can improve compassion competence is necessary.This study aimed to investigate the mediating effect of compassion competence on the relationship between caring behaviors and the quality of nursing services. Participants included nurses working in South Korean hospitals. Data collected from 1 November to 31 December 2020 were analyzed using a  With improvements in people’s standard of living, as well as their awareness of health-related quality of life, maintaining the quality of nursing services in medical institutions becomes increasingly crucial ,2. The qQuality of nursing services refers to the quality of nurses’ patient-directed activities. It indicates the consistency of the results achieved, conformity to standards, and the degree of excellence in nursing . The quaCaring behavior refers to the act of caring for the participants of nursing care itself. This is differentiated from the quality of nursing services which prioritizes the satisfaction of patients receiving nursing care, and these aspects ,6. ProviNursing is an act performed through a mutual relationship between the nurse and the patient. Compassion is an important competence for nurses to understand the patients’ situation, accurately perceive their emotions, and encourage them . Nurses’Therefore, this study examines the relationship between nurses’ caring behavior, quality of nursing services, and empathy. Moreover, this study explores the mediating effect of empathic competence on the relationship between caring behavior and quality of nursing services, and thus provides basic data to develop a program to improve the quality of nursing services.This study explores the mediating effect of compassion competence on the relationship between caring behavior and quality of nursing services. The participants were nurses working for more than three months in patient nursing as their main job at South Korean university hospitals. Only those who understood the purpose and necessity of the study and voluntarily agreed to participate were included in this study. The number of participants required for multiple regression analysis was calculated using the G*power 3.1 program. Considering the effect size as 0.15 (moderate), significance level (α) of 0.05, power of 0.95, and 11 general characteristics, the number of participants required, with caring behavior and compassion as independent variables and quality of nursing services as the dependent variable, was calculated as 189. However, considering the fidelity of the survey results, 220 questionnaires were collected, of which 9 were excluded due to insufficient responses; finally, 211 were used for the analysis.The questionnaire consisted of 72 items: 11 items regarding general characteristics and career, 24 items evaluating caring behavior, 20 items measuring the quality of nursing services, and 17 items evaluating compassion competence.For caring behavior, a tool developed by Wolf et al. , modifieA tool developed by Parasuraman et al.  and tranThe compassion competence measurement tool developed by Lee and Seomun  was usedData for this study were collected from 1 November to 31 December 2020. Prior to data collection, we visited the nursing department of two university hospitals located in city D, a nearby population, and explained the necessity and purpose of the study as well as the contents of the questionnaire to the head of the nursing department. We then obtained their consent to proceed with the questionnaire. Then, questionnaires were distributed to the head nurses in the wards. Only those nurses who voluntarily agreed to the survey after understanding the research purpose and necessity from the head nurse were selected as participants. They responded to the survey using a self-reported questionnaire after filling out a written consent form and were provided with a predetermined case. The collected data were analyzed using the SPSS/WIN 24.0 program. Descriptive statistics were used for participants’ general characteristics. Pearson’s correlation coefficients were used to identify the correlation between caring behavior, quality of nursing services, and compassion competence. Before performing Pearson’s correlation coefficient analysis, normality, homoscedasticity, and independence were checked. The normality of the data was evaluated using the skewness and kurtosis, and homoscedasticity was evaluated using Bartlett’s sphericity test. In addition, independence was evaluated using Durbin-Watson’s test, and it was confirmed that all were satisfied. The mediating effect of compassion competence on the relationship between caring behavior and quality of nursing services was analyzed through hierarchical multiple regression. The significance test of the mediating effect of compassion competence on the relationship between caring behavior and quality of nursing service was analyzed by the Sobel test. Reliability was measured through Cronbach’s α.The participants’ general characteristics and differences in caring behavior, quality of nursing services, and compassion competency according to general characteristics are presented in p = 0.018), position , job satisfaction , and salary satisfaction . Caring behavior was higher in those with a spouse than those without, and it was higher in head nurses than in general nurses. Moreover, caring behavior was higher among those with high job satisfaction. Those with average salary satisfaction showed higher caring behavior than those who were dissatisfied.Caring behavior was correlated with the presence of a spouse , job satisfaction , and salary satisfaction . The quality of nursing services was higher among those who were religious, and who had higher satisfaction with their job and salary.Quality of nursing services was correlated with religion , work type , job satisfaction , and salary satisfaction . Religious people and those who worked fixed hours had higher compassion competence. Moreover, those who were satisfied with their jobs and salaries had higher compassion competence than those who were dissatisfied.Differences in compassion competence were correlated with religion  and compassion competence . Additionally, there was a positive correlation between quality of nursing services and compassion competence   .We calculated the Durbin-Watson value to verify the independence of the residuals before testing the mediating effect; the value was found to be within 1.81–2.00, which was close to 2, indicating that the dependent variable had no autocorrelation. To check for multicollinearity, we calculated the tolerance limit, which was 0.62, all below 1.0, and the variance expansion coefficient for all variables, which ranged from 1.00–1.61, all less than 10. Thus, there was no problem of multicollinearity. This finding confirmed that the model was suitable for regression analysis.p < 0.001). In step two of the regression analysis, the influence of the independent variable, caring behavior, on the dependent variable, the quality of nursing services, was confirmed. This result was also confirmed to be statistically significant . In step three, to analyze the influence of compassion competence as a parameter on the quality of nursing services as a dependent variable, regression analysis was performed with caring behavior and compassion competence as independent variables and quality of nursing services as the dependent variable. Both caring behavior  and compassion competence  impacted the quality of nursing services. If both the independent variables and the parameter are significant in step three and the coefficient of the independent variable in step three is smaller than that of the independent variable in step two, it can be said that the parameter has a partial mediating effect on the relationship between the independent and the dependent variables. In other words, the independent variable has a direct influence on the dependent variable, and the independent variable has an indirect influence on the dependent variable by changing the parameter. The regression analysis revealed that both caring behavior and compassion competence were significant in step three, and the coefficient of caring behavior in step three was lesser than the coefficient of caring behavior in step two. Compassion competence was found to have a partial mediating effect, and the explanatory power was 56.6%. We conducted the Sobel test to verify the significance of compassion competence, and it was confirmed as a partial parameter  in the relationship between caring behavior and quality of nursing services.The results of the three-step regression analysis to verify the mediating effect of compassion competence are shown in This study provides fundamental data for the development of a program to improve the quality of nursing services by identifying the level of compassion competence, quality of nursing services, and caring behaviors of nurses, and by confirming the mediating effect of compassion competence in the relationship between caring behavior and nursing service quality.The level of caring behavior of participants in this study was scored at 3.65, which is lower than that reflected in Kim and Choi’s study  targetinThe quality of nursing service score was 3.73, and there was a significant difference according to religion, job satisfaction, and salary satisfaction. The studies conducted by Lee  and YeomIn this study, the compassion competence score was 3.82, which was relatively higher than that in Lee and Seomun  targetinThis study found that nurses’ compassion competence had a significant positive correlation with caring behavior and the quality of nursing services. Additionally, compassion competence was found to have a partial mediating effect on the relationship between caring behavior and quality of nursing services. In other words, compassion can be improved by performing caring actions, which can, in turn, enhance the quality of nursing services. This implies that the compassion competence of nurses is important to improve the quality of nursing services during nurses’ caring behavior. Nurses provide care during interaction with patients by actively identifying patient needs based on professional knowledge and skills ,12. To sThe limitation of this study is its small sample size, which causes issues with generalizability. Therefore, repeated studies with large samples are needed in the future. In addition, since this study used a self-report questionnaire, possible acquiescence tendencies or social desirability biases should not be overlooked. In the future, it is necessary to develop a tool that can objectively measure the compassion competence of nurses and the quality of nursing services from the patient’s point of view. However, the significance of this study is that it is meaningful as it explores the relationship between caring behavior, quality of nursing services, and compassion competence among nurses. The results of this study can be used as fundamental data for developing programs to improve the quality of nursing services in the future.This study tried to provide fundamental data highlighting strategies to improve the quality of nursing services by examining the mediating effect of nurses’ compassion competence on the relationship between caring behavior and the quality of nursing services. It was revealed that there was a positive correlation between caring behavior, quality of nursing services, and compassion competence. In addition, it was confirmed that the compassion competence of nurses had a partial mediating effect on the relationship between caring behavior and the quality of nursing services. On this basis, we propose the following: first, it is necessary to include factors for improving nurses’ compassion competence in educational programs designed to improve the quality of nursing services from a clinical point of view; second, education for nursing students to have the correct knowledge and awareness of caring behavior and compassion competence should be provided at the same time to improve compassion competence; and third, iterative research is needed to expand the scope of the survey, and in-depth research is needed to compare the differences in compassion competence and perception of nursing service quality between nurses and participants.


Aging hemophiliacs face cardiovascular disease. Lots of evidence has been gathered that hemophiliacs have a more unfavorable cardiovascular profile than the general population does, especially due to the increased prevalence of hypertension (HTN). Among the existing scattered evidence, our study provides the most comprehensive and systematized analysis of the determinants of HTN in hemophiliacs. We discussed the contribution to the HTN substrate of hemophilia-specific factors, such as type, severity and the presence of inhibitors. The complex mechanism of kidney dysfunction in relation to hematuria and viral infections was meticulously addressed. Furthermore, we highlighted the new pathogenic concepts of endothelial dysfunction and the association between HTN and hemophilic arthropathy. The clustering of cardiovascular risk factors is common in hemophiliacs, and it enhances the negative vascular effect of HTN and aggravates HTN. It usually leads to an increased risk for coronary and cerebrovascular events. Our work provides reliable evidence to guide and improve the management of HTN in hemophiliacs. Hemophilia is an X-linked genetic disease with a clinical expression in men. There are 17.1 cases of hemophilia A (factor VIII deficiency) per 100,000 men, which makes it the most frequent congenital bleeding disorder [Atherosclerosis affects all of the arterial territories, and it has been proven that the deficiency of coagulation factors does not have a protective role against its occurrence and progression . Thus, cConsidering the need for antithrombotic therapy arising from the presence of atherosclerotic vascular diseases, managing these patients has proved to be challenging on account of the innate and high hemorrhagic risk. In this context, its prevention was given more thought in an attempt to avoid or at least postpone the onset of cardiovascular disease and its specific treatment with a bleeding potential. Since the coronary, cerebral and peripheral arteries diseases have a commune substrate—atherosclerosis—and they share the same risk factors, early interventions could lower cardiovascular morbidity and mortality.The cardiovascular risk factors identified in the general population were sought in hemophiliacs as well. Their correction is considered to be the best method of intervention for cardiovascular diseases in this particular population category. There are constant reports that hypertension (HTN) is more prevalent in hemophiliacs than it is in the general population. Because in the long term its evolution is linked to numerous complications, such as stroke, myocardial infarction and chronic kidney disease, all of which have a significant clinical, therapeutic and prognostic impact in hemophiliacs, understanding the particularities of the etiological substrate in this population is of great importance. Congenital hemophilia is a condition with low prevalence , therefoThe first reports on the increased prevalence of HTN in hemophiliacs are from the early 1990s. Both the systolic and diastolic blood pressure values were higher among the hemophiliacs than they were in the general population and for the use of antihypertensive treatments as well [Robust data are provided by a large North-European study . The preA high prevalence of HTN in hemophiliacs when they were compared to the general population has also been detected in North American studies ,16,17. IThe increase in the prevalence of HTN in the hemophiliacs, starting at the age of 30, which is at least a decade earlier than in the general population, was noted in several studies across the continents ,11,15,17The data available for comparison are limited because the disease is rare, and hemophilia A (HA) is much more widespread than hemophilia B is (HB). Moreover, the available results are very different, so it is difficult to draw a conclusion. Von Drygalski et al. found that patients with HB had 1.87 times higher risk of being hypertensive when they were compared to those with HA  Figure . This fiAn association between the severity of hemophilia and the prevalence of HTN has been investigated in several studies. Many reports show that the prevalence of HTN is similar across hemophilia severities, and the authors consider that there is no association between the severity of hemophilia and the prevalence of HTN ,28,29,30Inhibitors are usually found in patients with severe hemophilia that require a coagulation factor replacement therapy, and they appear early in life, during childhood. Patients with mild hemophilia rarely require replacement therapy, but nowadays, with the increase in the life span of hemophiliacs, the spectrum of medical or surgical conditions that they develop and which require the administration of coagulation factors has increased . This isSince the patients with inhibitors are more prone to bleeding compared to hemophiliacs without inhibitors, the hypothesis of repeated microbleeds in the kidney leading, over time, to renal failure was considered as a substrate for HTN. Moreover, the inhibitors have the potential to influence vascular health through an immune complex formation.A small Japanese study reported that the prevalence of HTN showed a strong relationship with the presence of inhibitors . Of 29 pSimilar to the general population, HTN in hemophiliacs was independently associated with renal function, which was assessed by both the creatinine and estimated glomerular filtration rate (eGFR) . HematurAn analysis of a North-American database of hospitalized hemophiliacs showed that HTN was strongly associated with both acute and chronic kidney diseases, and it suggested that a connection between the kidney bleeds and HTN might be possible. The prevalence of HTN was 10.1% in the hemophiliacs who were hospitalized for kidney bleeds and only in 4.5% of those who were admitted for other indications . Acute rThe relationship between chronic hematuria, kidney dysfunction and HTN was the main focus of the H3 (Hypertension and Hematuria in Hemophilia) study, which enrolled 532 patients aged over 40 . It has Another issue is whether a microscopic hematuria is as important as a macroscopic hematuria in the occurrence of HTN. Since one in three hemophiliacs has a microscopic hematuria, this issue raised concern. The recent data suggest that a microscopic hematuria is not a risk factor for either renal dysfunction or HTN .A low prevalence of chronic kidney disease (CKD) in hemophiliacs was found in several studies. In a cohort of one hundred and thirty-five hemophiliacs, 34% of them had hematuria and 44% of them had HTN, but only three patients had CKD . These rIt was shown that even in the youngest hemophiliacs with normal serum creatinine values, there are frequent structural and functional renal abnormalities and HTN. In a group of 40 children with severe and moderate HA, renal scintigraphy revealed obstructive uropathy and obstructive nephropathy in 35% and 37.5% of the patients, respectively . The dimA study on 93 hemophiliacs found a prevalence of HTN in 27.9% of them, and urolithiasis and chronic secondary pyelonephritis in 21.5% of them . When onAdditionally, last but not least, the impact of protein load due to frequent coagulation factor replacement therapy should be considered, at least theoretically, as a contributor to renal failure and HTN ,41.A new and interesting concept is that hemophilic arthropathy and increased BP are connected . VasculaIn experimental murine studies, hemophilic arthropathy was characterized by excessive soft tissue proliferation, intensive neoangiogenesis and abnormal vascular architecture . The vasIn the human studies, increased vascularity was identified, and this reflects the intense local vascular remodeling . Barnes The possible contribution of hemophilia-related endothelial dysfunction in the pathogenesis of cardiovascular disease was investigated in a few studies, mainly focusing on endothelium-dependent vasodilation. Brachial flow-mediated dilation (FMD) assessed the degree of vasodilatation which was determined by the release of nitric oxide from the endothelium. FMD was measured in hemophiliacs and controls, with and without obesity. Neither the presence of hemophilia nor the presence of obesity influenced the endothelium-dependent vasodilation, although the amount of atherosclerosis was more significant in the obese individuals when they were compared to the non-obese individuals . AnotherWhile previous studies assessed only the endothelium-dependent vasodilation and found contradictory results, Sun et al. investigated both the macrovascular and microvascular endothelial functions . The stuExtrahepatic conditions caused by an HCV infection must be considered because cardiovascular disease, CKD, obesity, dyslipidemia, insulin resistance and type 2 diabetes mellitus are among them. HCV causes glomerular and tubulointerstitial damage, which can progress to kidney failure. The most common kidney disease is membranoproliferative glomerulonephritis, which often leads to severe and difficult-to-control HTN. Individuals with a chronic HCV infection have a 1.7 times increased risk of developing type 2 diabetes, but they may also develop insulin resistance without diabetes . MoreoveIndividuals living with HIV have an increased risk of HTN due to systemic chronic inflammation, renal disease and blood vessel damage resulting from the long-term exposure to the virus and antiretroviral therapy. An HIV infection itself is responsible for endothelial dysfunction that leads to increased arterial stiffness and premature atherosclerosis, even in patients with undetectable viremia . Up to 3Many hemophiliacs have been infected with HIV and/or HCV through plasma-derived clotting factors before blood product testing became mandatory . These iThe contribution of HCV and HIV to the pathogenesis of HTN in hemophiliacs was evaluated in several studies, and it was shown that HCV/HIV infections were associated with higher BP values and the prevalence of HTN . HCV infSince its introduction in the 1970s, the hemophilia treatment has steadily increased the longevity and improved the quality of life in hemophiliacs. Fresh frozen plasma, frozen cryoprecipitate and plasma-derived concentrates were initially available. However, the donor blood was not tested, and as a result, many hemophiliacs were infected with HIV and/or HCV through plasma-derived clotting factor products. Immunogenicity was also important, as approximately 20% of the patients developed inhibitors .Since then, the treatment has undergone great changes. Not only are the modern blood products tested and free of viral contamination, but the new drugs have been developed and implemented into current practice. Activated factors produced by recombinant DNA technology and factor-free replacement therapy have emerged, and the treatment is now heading towards gene therapy. Thus, the burden of iatrogenic comorbidities decreased. The concern about the viral safety of the recombinant coagulation factors was only temporary, which were related to first-generation factor VIII concentrates, and it was overcome. However, the high risk of inhibitor development remains a major concern even in the era of immunotolerant induction protocols . BypassiThe monoclonal antibody emicizumab is the first factor-free replacement antihemophilic drug, and it has tremendous benefits in preventing bleeding in both of the categories of HA patients, with or without inhibitors. It is a new and modern treatment that aims to overcome all of the shortcomings of the previous therapies. The serious side effects are only related to the rare combination with activated prothrombin complex concentrate in the treatment of breakthrough bleeding .Of interest are also the antifibrinolytics, such as tranexamic acid and ε-aminocaproic acid, which are used to control bleeding in different clinical scenarios. Although they are useful for controlling oral mucosal bleeds, they are currently contraindicated as initial therapies for upper urinary tract hematuria because clots can form and cause obstructive uropathy ,35.The lowest prevalence of HTN in hemophiliacs (of 3.8%) was reported by Kulkarni et al., and their study reflects the large number of young patients who were included, wherein 64.5% of them were younger than 30 years and 79.4% of them were younger than 40 years. At these ages, the prevalence of HTN is generally very low . Even moA low prevalence of HTN was found in Swedish hemophiliacs . AlthougFurthermore, a European study that included hemophiliacs over 60 years of age found a lower prevalence of HTN when they were compared to the general population . The patSimilar results were provided by the large Taiwanese study. Although the prevalence of HTN was low in hemophiliacs, it was similar to that in the general population  Table 1Table 1.There is a high amount of evidence that obesity, insulin resistance and dyslipidemia increase the BP in susceptible individuals in the general population. Therefore, their contribution to HTN and to cardiovascular risk was of interest to hemophiliacs as well. In individuals with hemophilia, obesity is the consequence of sedentary behavior, and several major determinants are recognized. One is hemarthrosis which leads to chronic hemophilic arthropathy and pain. Another is the fear of trauma and bleeding that leads to limited mobility and lack of proper physical exercise. Along with obesity, other metabolic disorders are common in hemophiliacs, such as dyslipidemia and diabetes, which are also as a consequence of a sedentary lifestyle.Body mass index (BMI) and a prevalence of overweight/obesity were assessed in many studies, but the results varied widely and were often contradictory. It was reported that the prevalence of overweight/obesity in European and North-American hemophiliacs reaches 31%. While some studies have reported that there is a lower BMI and prevalence of obesity in patients with hemophilia when they are compared to the general population ,30,58, oMany studies reported that hemophiliacs have a better lipid profile than the men in the general population do ,30,42,67The prevalence of diabetes in hemophiliacs varies widely across studies, from a lower prevalence compared to the general population  to a simThe life expectancy of hemophiliacs has increased due to the wide availability of replacement therapies, and the comorbidities related to aging have become present. By analyzing more than 10,000 hospitalizations of hemophiliacs, it was found that HTN ranked first among the comorbidities, with it being identified in 33.4% of the admitted patients . One stuThe vast majority of studies have shown an increased prevalence of HTN in hemophiliacs, which is higher than that of the general population. It was also highlighted that the prevalence of HTN starts to increase at younger ages than it does in the general population. Therefore, BP measurements should be part of standard care in hemophilia patients and since one in four hemophiliacs aged 30–40 years old had an HTN, the screening should start early in life, at the age of 30 . AnotherSome studies have reported an equal or lower prevalence of HTN in hemophiliacs than in the general population, and the main reason seems to be the studied population. A Swedish study found a low prevalence of HTN in hemophiliacs, at 19.7% . NonetheThe influence of major cardiovascular risk factors on the BP profile was assessed in several studies. Their weight, lipid profile and fasting glucose values were frequently abnormal ,25. One The role of hemophilia-specific factors has been addressed in many studies, but the contribution of the type of hemophilia, its severity or the presence of inhibitors is not supported by consistent results across studies. The bidirectional relationship between renal dysfunction and HTN as well as that between endothelial dysfunction and HTN gathered much evidence that supports their deep involvement in the pathogenesis of HTN in individuals from the general population. Therefore, their potential role as risk factors for NTH in hemophiliacs has been investigated with great interest. Urinary tract bleedings, which are clinically expressed as hematuria, are one of the most common manifestations of hemophilia after hemarthrosis. However, the correlation between hematuria and the incidence and severity of renal dysfunction varied across studies, which did not allow a definitive conclusion to be drawn ,76. Of nHTN is a major contributor to cardiovascular risk, and the studies showed that hemophiliacs seem to have a more unfavorable cardiovascular profile than the general population does, especially due to the increased prevalence of HTN. Hemophiliacs have a 20 to 50 times greater risk of intracranial hemorrhage (ICH) than the general male population does, resulting in a mortality of up to 21.9%. In children and adolescents, 90% of the ICHs are associated with a severe disease, but in those over 50, half of all of the ICH cases occur in patients with the mild and moderate diseases . HTN, anGiven the accumulation of cardiovascular risk factors, we are currently facing an increase in the number of cases of coronary artery disease in hemophiliacs. It was shown that a higher prevalence of cardiovascular risk factors in hemophiliacs, such as HTN, reflects in a significantly higher prevalence of coronary artery disease. Of 2506 American hemophiliacs, 22.6% of them had HTN, 15.9% of them hyperlipidemia and 10.7% of them coronary artery disease compared to 15.5%, 11.9% and 5.8% of the age-matched males in the general population, respectively . Of 35 NOur study has several limitations. Firstly, hemophilia is a rare disease and the data that were analyzed mainly came from small studies which were published by treatment centers dedicated to hemophiliacs. Secondly, there is no consistency across the studies regarding the analyzed parameters, and moreover, the results are sometimes divergent, which increases the difficulty of interpreting the results and reaching a conclusion.Aging hemophiliacs face cardiovascular disease. Arterial hypertension is much more prevalent, and it determines a more unfavorable cardiovascular profile in hemophiliacs than it does in the general population. The mechanism of HTN in hemophiliacs is complex and multifactorial, and it has determinants in direct relation to the disease. Although great progress has been made in the elucidation of the main pathogenic links, there are still elements that require further research. Among the existing evidence, our study is valuable because, as far as we know, it is the most comprehensive and systematized analysis of the determinants of HTN in hemophiliacs. Moreover, it increases the degree of awareness regarding the peculiarities of HTN in hemophiliacs, and we hope it will enhance its management.


DEAR EDITOR,We have read with interest the article published by Martins JRM, which that tells us about the side effects of anti-thyroid medications in hyperthyroidism and the possibility of definitive treatment once this has occurred . The SAAgranulocytosis is an infrequent 0.2%) but serious adverse effect of thiamazole (% but serLithium is actively concentrated in thyroid follicular cells, 3-4 times more than in plasma, which main mechanism of action is decrease in the release of thyroid hormones through the inhibition of colloidal pinocytosis .The American Thyroid Association does not recommend plasmapheresis as a preoperative preparation in the definitive treatment of hyperthyroidism . The AmIn conclusion, although the health emergency has brought many setbacks, it is also an opportunity to direct attention to the use of alternative treatments that, in situations like this, can be useful.


Patients with type 2 diabetes mellitus (T2DM) face significant challenges in the treatment process, which can have a negative impact on disease management. Proper management of the disease can reduce symptoms and complications, improve glycemic indices, and reduce mortality and readmission.Given the influential role of patients in prevention and self-care, this study was conducted to explore the challenges of diabetes management from the perspective of patients.Two rounds of focus group discussions with T2DM patients were conducted. The principal investigator of the study and a research assistant compiled a list of volunteer patients with names and contact information and selected participants based on their medical information. Participants were chosen via a purposive sampling technique. The questions were designed to encourage patients to share their views on how the treatment team communicates and participates in treatment, how they are trained, and the health care system. The discussion continued until data saturation. During 2 rounds of focus group discussions, the voices of the participants were recorded by 2 voice recorders, and one of the team members was a transcriber. After discussion, participant views were transcribed, and common issues were identified, sorted, and reported as categories and subcategories.According to the conventional content analysis, 88 primary codes were extracted from the detailed and in-depth description of the participants. The codes were summarized after repeated readings and classified based on their similarities and semantic relevance. Through analysis and comparison, 4 categories and 7 subcategories were identified: communication challenges , challenges to participation in treatment (lack of patient participation), educational challenges , and challenges of the health care system .This study showed that the treatment team members should pay more attention to the challenges of care and treatment from the perspective of patients with T2DM. Therefore, recommendations for future policies to overcome these obstacles include establishing a multidisciplinary health care team; using trained health care workers to provide organized treatment and care services; holding individual counseling sessions with patients in need of counseling; and providing counseling services, involving patients in the treatment and self-care process, and designing a comprehensive diabetes education program with an emphasis on education. Necessary information should be provided to the patients, and effective communicate should address patient concerns. Type 2 diabetes mellitus (T2DM), with all its complications and consequences, constitutes the most critical problem for health systems worldwide. It is estimated that in 2014, 422 million adults lived with diabetes compared to 108 million in 1980 .The prevalence of T2DM has affected all areas of the world, but the prevalence of T2DM is higher in low- and middle-income countries. It is estimated that about 12% of the total health expenditure in the world is spent on treatment of T2DM and related complications, and most countries spend 5% to 20% of their national health budgets on this disease . In IranManagement of diabetes is one of the most important priorities of the World Health Organization . DiabeteIn other words, diabetes control requires a multidisciplinary care approach with a focus on self-management, in which the patient and family are at the center and the activity of all members of the treatment team is necessary to identify and cover the treatment and care needs of the patient and family . MedicalOne of the most important factors in controlling chronic disease is the participation of patients in disease management. Therefore, patients with diabetes and their families should learn about measures such as monitoring blood glucose, choosing an appropriate diet, and increasing physical activity . Most ofIn this study, a qualitative methodology was selected and focus group discussion (FGD) was used as the study method. FGD is a qualitative research method in which the facilitator asks questions and participants volunteer their opinions, creating opportunities to extract information on a topic through group discussion. This also encourages participants to interact and exchange information about their experiences and perspectives -22. Due Patients with T2DM were included in the study. Inclusion criteria were the ability to participate in the FGD without assistance . Patients suffering from mental or physical disability were excluded from the study. After coordinating with the clinic supervisor, patients were simultaneously invited to participate in the FGD. Sampling was purposive. Two investigators  selected study participants based on medical information. Background disease, disease duration, marital status, education level, type of drugs , and history of diabetes complications including retinopathy, nephropathy, diabetic foot ulcer, neuropathy, and cardiovascular diseases were recorded by the researchers. The researchers determined the time and place of the meetings in the clinic. The researchers had no previous relationship with any of the study participants, and they did not work at the clinic where this study was conducted.This study was performed at the Diabetes and Metabolic Diseases Clinic affiliated with Tehran University of Medical Sciences . After providing written informed consent, participants were invited to participate in the FGDs. We arranged the patients in a circle position to improve group interactions and accurately record their voices. Each round of FGDs took less than 2 hours. At the beginning of each session, the principal investigator explained the objectives of the study to the participants and described their participation and activities in detail. The research assistant helped record the interviews, observe group interactions, take notes, and facilitate the discussion with probing questions.One researcher  was as facilitator during the 2 rounds of FGDs, while another researcher took notes on the topics discussed and recorded participant reactions. Participants were asked to follow instructions explained to them at the beginning of each round of FGDs: each participant should introduce themself at the beginning, and they should not interrupt each other. Thus, the FGDs began with open-ended questions about challenges from the perspective of patients with T2DM.The following questions were asked during the FGDs:What is your experience with how health care providers communicate?How do you feel about your participation in the management (both care and treatment) of your disease?What are your health care providers’ views on diabetes education?What are your main challenges in dealing with the health care system?The facilitator encouraged the participants to express their opinions and experiences on related topics. The next questions were asked based on the answers of the participants. General promotional questions were asked to enrich the data: “What do you mean?” “Can you explain more?” “Can you give an example?” and “Would you like to mention anything else?”The responses of the participants were recorded through 2 voice recorders and note-taking. We held 2 FGD rounds, with each round lasting less than 2 hours. First, 12 patients were selected. Two patients did not participate due to lack of time; 10 patients participated in the first round, and the same 10 patients participated in the second round. At the end of each FGD round, participants were asked to state what else they thought was important in the process of diabetes management and care.The FGDs were ended when data saturation was reached. In other words, we continued the discussion until no new ideas were expressed or when the responses were similar or repetitive . ConceptIn the preparation phase, all recorded FGDs were transcribed. In case of any doubts on understanding the responses or any disagreement, the third researcher was consulted or a member check was applied. The transcribed FGDs were then read several times, and codes were identified. In the next step, similar open codes were classified into subcategories. Based on similarity and semantic relevance, subcategories were then divided into categories, and finally, categories, subcategories, open source, and key phrases were extracted from transcripts. In the final step, the analysis was reported.Trustworthiness is one of the most important dimensions of qualitative studies. According to Bowen , 4 reliaTo ensure credibility, researchers tried to communicate well, spend enough time, and gain participants’ trust in data collection process. In order to do a member check, the results were returned to the participants to check the opinion of members and ensure the accuracy of the collected data. The research team also had a considerable conflict with qualitative data. In order to maintain transferability, we tried to avoid homogeneous participation by having the maximum variety in terms of age, sex, type of medication, disease duration, and history of diabetes complications, including retinopathy, nephropathy, neuropathy, cardiovascular diseases, and diabetic foot ulcer. To ensure consistency, all stages and research process were recorded and reported as thoroughly as possible.This study was approved by the research ethics committee of Tehran University of Medical Sciences in 2019 . All participants signed the written informed consent forms. Participants agreed to having their voices recorded, and the researchers made sure the data were anonymous and confidential at all times. The researchers promised that the information would remain confidential and the files and transcripts of interviews and voice records would be deleted at the end of the investigation.According to the conventional content analysis, 88 codes were extracted from the rich and in-depth descriptions of the participants. The codes were summarized after repeated readings and classified on the basis of their similarities and semantic relevance. Through analysis and comparison, 4 categories and 7 subcategories were identified as shown in Poor communication by medical staff included insufficient understanding and empathy, unkindness and disrespect, lack of face-to-face communication, and inflexibility of health workers. Patients expressed their opinions that health personnel do not care about patients and the disease, and members of the diabetes treatment team did not have a close relationship with and did not listen to patients.Disrespect by the medical staff was expressed from the patient’s point of view.The patient who cried while talking and said I live alone and I’m nervous. I would like them to talk to me and support me.Participant 6Patients wanted the doctor to pay attention and make eye contact when talking to them.The doctor is also working on his computer while talking to me and this behavior bothers me.Participant 5Lack of psychological support was another subcategory. Patients were worried about their symptoms and illness, and the health care staff did not address their complaints or spend enough time to listen to them , lack of provider team work, and duplicate record making for the patient.The duration of the doctor’s visit is very short. The doctor’s visit time is very short. The doctor quickly examines and prescribes medicine, and this makes me very uncomfortable in every visit. Whenever I protest, he says that he should visit other patients as well.Participant 1Patients also complained that sometimes they paid for a doctor’s visit but were not visited by a doctor.Although we pay for a doctor’s visit, and sometimes we even pay for two doctor visits, but we do not see the doctor, and then the survey form is texted that you are satisfied with the doctor? And they expect me to fill in the evaluation form.Participant 5In addition, the patients were upset that things were not done by the team in an organized manner, and they had to visit several times to get services.Things are not done as a team. I have to visit a doctor once and another day for nutrition counseling.Participant 2Patients were dissatisfied with the medical record filing system, and the system was not working well. Each new group that comes to the clinic creates a new file for the patient.I have a record in this diabetes clinic for 18-17 years. The new people who came filed a record for me again.Participant 4Another challenge was caregiver insufficiency. The most important issue raised by patients regarding caregiver efficiency was follow-up.The first time my blood sugar was high, the doctor told me to get rid of stress and adjust my diet and walk for an hour a day. The next time I went, he said my blood sugar was low and I did not take any further action because the doctor did not insist on taking medication. He did not follow up and the next time I went; my blood sugar was so high that I had to inject insulin.Participant 9Due to the important and effective role of patients in better prevention and self-care, focus group meetings were held to review the challenges of patients with diabetes for disease management. The results showed their challenges in 4 main categories including communication challenges, challenges to participation in treatment, educational challenges, and challenges of the health care system.Communication problems in the treatment staff and training program indicate ineffective communication and inadequate patient education. The results of a study investigated the barriers to diabetes care in a developing country. This study showed that patients need more time to understand the content of the educational program provided by the treatment team, and the treatment team needs to allocate more time to patients . AnotherOne of the most important factors in controlling this disease is the participation of patients in the treatment . The resOur study showed that patients face educational challenges in the management of diabetes. In a study on barriers to self-care, diabetics requested more time for visits and counseling. They also needed to continue their education in different ways and update their information on diabetes care . AnotherThe results of this study showed that obstacles in the management of diabetes from the patients’ view are problems related to the care system and health system. Lack of support for patients was one of the most important problems mentioned in previous studies ,43,45. FThe most important limitation of this study was related to the nature of the study methodology. The generalizability of the qualitative study is limited. Another limitation was that only 2 rounds of FGDs were held, fewer than the researcher expected. In qualitative studies, data saturation is a definite determinant of ending the study. In this study, due to the similarity in patients’ opinions and the lack of a new opinions and ideas after 2 rounds of FGDs, this factor may not affect the findings.The results showed that patients pay more attention to nontherapeutic issues than therapeutic issues. Communication with the patient, patient education, proper support from the health system, and adequate participation in treatment were challenges that made the process of treatment and self-management difficult for patients. Therefore, it is necessary to pay attention and check these cases in the management of the patient. A comprehensive training program should be designed to address these patient concerns.


Child and Adolescent Psychiatry and mental health services in the twenty-first century are facing major challenges that require multiple competences and a strong trans-disciplinary and interprofessional input. Epidemiological data now clearly show that mental health care for children and adolescents should be a public health priority in most countries of the world , 2. GlobGiven the complexity of these issues and the multiplicity of challenges, the objectives of this Research Topic were broad, potentially integrating contributions of scientific knowledge from various fields  in order to better understand the problems of children and adolescents with psychiatric disorders, and to advance treatment modalities and innovative approaches, in a biopsychosocial, multicultural, inter- and intra-professional and multimodal perspective.A series of four surveys were conducted to explore the experience of new and collaborative approaches to training and treatment in children's mental health services, summarized below.You et al. retrospectively studied the effectiveness of acupuncture treatment of tic disorder in children over a 12-week period. This work showed that, compared with the control group, the reduction in the Yale Global Tic Severity Scale (YGTSS) total score after 12 weeks of treatment was greater for the acupuncture group , and this association was stronger for subjects who had significant vocal tics . The authors of this work have thus provided preliminary evidence supporting the therapeutic effect of acupuncture for tic disorder in children, which could therefore be an effective and well-supported adjuvant treatment in children with this indication, particularly for vocal tics.Kilicel et al. focused on the transition in psychiatry, that refers to the period when young people move from child and adolescent mental health services to adult mental health services. This period is marked by a strong discontinuity with a potential impact on the young adult's disorders and subsequent follow-up, in both psychiatric  showed improvements in prevention knowledge compared to the control group (n = 39), they did less so in prevention behavior, and field tests with realistic seduction situations showed no improvement. This last point is important because, as the authors emphasize, naturalistic contexts are essential to provide evidence of the effectiveness of preventive interventions for children with intellectual disabilities.Lincke et al. studied attitudes toward innovative therapeutic approaches  in the German health care system. Less than one in five participants preferred online treatment approaches, while more than half could imagine being treated at home. Younger subjects were more open to online therapy approaches, while people with a low level of education often preferred traditional treatment. Interestingly, the level of acceptance of online therapy did not increase significantly during the first months of the COVID-19 pandemic. The results of this study therefore highlight the need to inform about and promote these innovative treatments, whose diffusion and level of acceptance still seem moderate.Finally, In sum, this Research Topic provides new evidence on: (i) acupuncture treatment of tic disorder in children; (ii) factors that can ensure a quality transition in psychiatry; (iii) an innovative behavioral prevention program on sexual abuse for children with intellectual disabilities; (iv) attitudes of the general population toward innovative therapeutic approaches.In conclusion, we believe it is important to encourage local and global networks of cooperation and collaboration and the aim of this Research Topic, coordinated by two clinician-scientists, one American and one French, is to contribute—in a modest way—to the advocacy on the ground of these crucial issues, in order to encourage stakeholders to demand socially justifiable and equitable resources. As we have stated several times before , 10, proAR and CK are the two topic editors of this Research Topic and take responsibility for the views expressed in this editorial. AR wrote the first version of this editorial. CK extensively reworked the editorial. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This study expects to solve the network delay in college English online teaching, prevent disrupting the normal teaching order of college English classroom caused by network problems, increase college students' interest in learning English, and improve the time spent by college students in English learning. First, the study investigates and analyzes the current needs and situation of college English online learning and puts forward the improvement standards for college English online classroom. Second, the study applies edge computing (EC) technology to improve online teaching system and designs an online learning system for college specific English based on EC. Finally, the improvement effect is tested, and it is concluded that the effect of using EC to improve the online classroom system for college English is better than that of the unmodified online teaching system. The results reveal that the online classroom system for college English based on EC designed can effectively reduce the network delay of the traditional teaching system, ensure a high reliability, and increase the time for students to learn English, so it is helpful to improve the teaching quality. The results provide a new direction for applying emerging computer technology in online teaching in colleges and universities, a guarantee for improving college students' English level, and set an example for the relevant research in the future. With the popularization and rapid development of emerging network technology in China, online teaching has been widely used in various education industries. Due to the current environment, it is impossible to carry out offline teaching at some time, so it is necessary to develop applied online teaching systems. English has always been one of the most important subjects. In the process of English teaching, it is necessary to pay attention to the training of listening and speaking and make full use of computer equipment. At present, the online English teaching system has received extensive attention in the Corona Virus Disease 2019 (COVID-19) pandemic environment. Teachers can use the system to upload English courses, publish learning tasks, and conduct online teaching operations through the online teaching platform. Students can download course information and watch videos to learn. Fitria showed through research that online English learning systems had the potential to help lecturers and students more effectively in the teaching and learning process . These sOn the one hand, the current actual online teaching cannot reasonably apply and manage the teaching resources because of the limitation of various hardware facilities. On the other hand, the gradually popular cloud computing usually adopts centralized management, so it is unable to ensure the low delay and reliability of online classroom, or even causing some data security problems . In thisThe application of EC technology in all walks of life has been studied by many domestic and foreign scholars. Wu and Song realized a content distribution framework for teaching monitoring videos through network, storage, and EC capabilities. Besides, they utilized Long Short-Term Memory (LSTM) to provide edge cache architecture and cache update strategy . Sun proTo sum up, at present, the research of EC technology is mainly concentrated in the fields of industrial production and traffic photography and seldom applied in education. This work innovatively uses EC technology to optimize the college English online teaching system, improve the online teaching system's stability, and help build a new teaching order and teaching model in the current epidemic environment. The integration of EC technology with IoT technology is utilized here to improve the online system of college English. Firstly, under the foundation of current teaching requirements analysis, EC is combined with the IoT technology for the online classroom to improve the network situation. The video stream frame filtering method is proposed to filter gibberish, and a corresponding algorithm is written for an online classroom system. Consequently, a teaching video transmission system with high real-time performance is obtained, which reduces the network delay and improves the reliability. The research results are of great significance to the education development in China and the promotion of online teaching technology.The IoT technology was born in 1999 at Massachusetts Institute of Technology in the United States. It is an emerging information service architecture based on the Internet and radio frequency identification technology. This architecture aims to enable the information technology infrastructure to provide safe and reliable “goods” information through the Internet and to create an intelligent environment to identify and confirm “goods” to facilitate information exchange within the supply chain. IoT is developing rapidly today and is reforming human life mode, which permeates all aspects of human life, but also causes some problems. The IoT needs to verify the user before operation, providing an inherent leak difficult to solve from the technical perspective, and users can only be informed in advance in privacy policies , 13.Cloud computing is a service related to information technology, software, and the Internet, which can provide dynamically scalable and cheap computing services on demand through the network. It is also a computing model that provides dynamically scalable virtualized resources through the Internet in a service manner. Cloud computing has the following characteristics: large-scale, distributed, virtualization technology, high availability and scalability, and on-demand services. However, cloud computing still has the problems of low security, high cost, difficulty in governance, legal risks, lack of resources and expertise, immature technology, and high requirements for network quality. Cloud computing gathers all data on the edge of the network and processes data on the main server. Cloud architecture is famous because most devices, such as smartphones, are near the edge without sufficient storage capacity and computing power, which cannot process or analyze the collected data. Although people can use WiFi or other high-speed networks on most devices, their hardware capabilities remain limited. Therefore, ordinary devices are inadequate for data processing or analysis –16.  FigGenerally accepted cloud architecture usually consists of three layers: the infrastructure layer, the platform layer, and the software service layer. The corresponding names are Infrastructure as a service (IaaS), Platform as a Service (PaaS), and Software as a Service (SaaS). IaaS mainly includes computer servers, communication devices, and storage devices to provide users with information technology infrastructure services such as computing capacity, storage capacity, or on-demand network capacity, which are provided at the infrastructure level. The core of IaaS's mature application lies in virtualization technology. Through virtualization technology, it can virtualize all kinds of computing devices into computing resources in the virtual resource pool, virtualize storage devices into storage resources in the virtual resource pool, and virtualize network devices into network resources in the virtual resource pool. When users order these resources, the data center manager directly packages the ordered shares and provides them to users, thus realizing IaaS.The College English Teaching Guide (2020 edition) points out that college English should give full play to the important role of modern information technology in English teaching and vigorously promote the deep integration of modern information technology and English teaching.College English is a compulsory public basic course for most non-English majors. It mainly cultivates college students' foreign language ability, humanistic quality, and cross-cultural communication ability. College English teaching objectives can be divided into three levels: foundation, improvement, and development. College English teaching can adopt task-based, cooperative, project-based, inquiry, and other teaching methods. the Guide, college English teachers should make full use of network teaching platform, make rational use of information technology elements, innovate, and practice online teaching mode and online and offline mixed teaching mode. Colleges and universities should make full use of information technology and actively create a diversified teaching and learning environment. The Guide pays special attention to promoting the modernization of college English teaching means. The construction of a new education and teaching model based on information technology has become a national strategy [According to strategy .During the novel coronavirus pneumonia epidemic prevention and control, online teaching provided an important opportunity to consolidate English teaching concept and innovate teaching methods and means. The development of Internet plus, intelligence + technology online, and offline education has become an important development direction of higher education in China and the world. Our English online teaching system mostly adopts cloud computing technology and online teaching platforms in colleges and universities and relies on courseware made by teachers and a few application systems. Although online teaching has been achieved, there is a serious shortage of teaching resources. The new educational intelligent cloud classroom today can support online real-time learning or lecturer video playback. In particular, online real-time learning requires good network conditions and cloud processors with extremely large memory space , 19.The test of the learning module of online real-time classroom proves frequent network delays or lags. Moreover, when more than half of the students watch the learning videos recorded by the lecturers synchronously, the buffer time of the videos will be greatly prolonged. This is because the online teaching student terminals frequently send requests and uploads or downloads data to the cloud server, which gradually accumulates the amount of data needed to be processed by the cloud server. The excessive mass of data will reduce processing speed. Besides, these behaviours will occupy a large network bandwidth, further reducing the speed of data transmission, and seriously limiting functions of the cloud computing system.EC is a kind of cloud computing technology. Since it processes data near the data source rather than in the external data center or cloud, it can reduce the network delay time. Besides, it requires a low cost, so users spend less on data management solutions of local equipment than on cloud and data center networks. As the number of IoT devices increases, data generation continues to increase at a record rate. Correspondingly, the network bandwidth becomes limited, making the cloud overwhelmed and causing greater data bottlenecks. EC has higher application running efficiency, because with the decrease of lag the application can run faster and more efficiently. Since MEC (mobile edge computing) technology has an independent server and strong computing and storage capabilities, with the server extremely close to the network terminal equipment on the physical layer, it also greatly improves the user's service experience. Moreover, through EC, the network model can be adjusted according to individual needs based on constant learning, bringing personalized interactive experience. Furthermore, EC is concentrated, effectively avoiding personal privacy leakage –22.  FigThe cloud edge nodes in Users are trying to utilize IoT devices to optimize the network, hoping to locate the processing function at the edge of the network and accomplish real-time data processing and analysis. The EC system does not need to return data to the server, which reduces network delay and improves processing performance. In addition, EC is conducive to optimize the data-driven function of the network by collecting, analyzing, and processing data close to the end user .  Table EC technology can transfer cloud computing to the edge side of the network, to meet the real-time requirements of the network, providing more efficient data processing, more intelligent application functions, and more guaranteed data security. The network video live broadcast and recording system based on EC technology can transfer the main processing steps of video information to EC devices instead of transmitting data to the cloud for processing. Besides, the EC video live broadcast framework can remove background noise and redundant data information in the image and make better judgment and decision on image content. When the complex processing is transferred to the EC center for calculation and storage, the requirements for bandwidth and network speed decrease. Moreover, since the EC platform has the function of user information security protection and early warning, it can better protect the security and privacy of users. The edge side of the video live broadcast and recording framework uses cameras for initial video data collection. When the edge side transmits data to its edge cloud server, it also manages and schedules the front edge devices in all paths, thus monitoring the information security and transmission capacity of the front edge devices. The front-end edge device and server will preprocess the received data information and filter out the unnecessary data information, to reduce the space occupied by video information and improve the overall efficiency of video information storage. This also provides a solution to the insufficient storage space in the EC system and the network delay problem, alleviating the network pressure and eliminating the security problem caused by network bandwidth , 25.In general, it is necessary to connect numerous front edge devices and server vectors for the bidirectional information transmission. Besides, the data transmission between front edge devices and servers and between the servers and the cloud centers must adopt the bidirectional transmission technology. This system includes hardware layer and software layer. The hardware layer needs to use the computing hardware unit, wireless communication module, and video terminal equipment to communicate with the outside. The software layer involves some image processing algorithms. The preprocessing steps are completed by the front edge device, while information fusion and state estimation are operated by the server. Finally, the result report is transmitted to the cloud center, and the service management is carried out by the cloud center .  FigureVideo stream is used to describe the bidirectional transmission of data. If a video stream becomes stable and continuous after the processing of network and video compression algorithm, it is called a coding stream. The compression coding algorithm used here is H. 264. The original unprocessed video stream is called YUV stream (Y), which is almost used for the compression of all the transmission streams in the network. When the data stream reaches the terminal, it will be decoded and converted to the decoded video stream called RGB , 28. TheIn The categories of video TP are mainly Hypertext Transfer Protocol (HTTP) and Real-time Transport Protocol (RTP). RTP is divided into Real-Time Controlling Protocol (RTCP) and Real-Time Streaming Protocol (RTSP). RTSP is adopted here because it is suitable for transmitting large files , 30.The transmission process of RTSP is composed of the following sections. (a) The user terminal device is connected with the server, which communicates in the form of command description characters. (b) After receiving the communication command, the server returns a series of corresponding characters as a response. (c) After receiving the response string sent by the server, the user terminal establishes the corresponding commands for the individual flow in the response content according to the response type, to inform the server with the actual port collecting the data. (d) After the establishment of the basic connection condition, the user terminal transmits the corresponding request to guide the server to run, so the server will send the media flow data packet required by the client terminal. In this step, the user terminal can send different requests to adjust the process of server running. (e) This step corresponds to the end stage of the communication between the client terminal and the server. In this stage, the client terminal needs to send a request to guide the end of the whole communication. T, to attain many video frame sequences with different contents and form a group. Then, the system identifies the video frame sequences to find the required part. Frames per Second (FPS) represents the number of frames transmitted in each second or the number of RGB format images transmitted in each second, and FPS is related to the fluency of the display picture. The higher the FPS is, the smoother the picture is. 24 FPS is generally used currently. Denote the result amount included by the main frame i in the total video stream S by Oi, the broadband transmission experiment by De, the complexity of the algorithm by O(T ∗ X), the frame length by T, and FPS by F [The effect of video frame filtering is to cut the video stream according to time FPS by F .Collaborative computing contains two core parts: symmetric processing and parallel processing. However, due to the delay of network response, the current technology cannot complete the symmetric processing. Therefore, the parallel processing mode is adopted here; that is, multiple different tasks are processed simultaneously. Collaborative computing is a kind of optimization algorithm, which uses edge server to allocate data processing tasks and sends the task to the terminal with computing components, such as intelligent cameras and intelligent sensors. This method can greatly improve the speed of data processing and reduce the delay and system load .  FigureThe data to be processed is distinguished by complexity, as shown inW represents the total workload of data to be processed; knwn denotes the workload of a single data with difficulty n; Kn stands for the processing times required for data with difficulty n; v represents the total workload of processing data with difficulty n [In , W repreiculty n .It is necessary to select the location for the placement of EC center and user terminal. The first following equation describes the data on the location of EC center, and the second following equation represents the location of user terminal:d represents the linear distance between the terminal and the server, while B denotes the data transmission bandwidth. In addition, c refers to the data processing capacity, and v signifies the data processing speed.Among  and 3),,3), d reX as a reasonable allocation scheme, and the matrix model for data processing can be expressed asTtotal represents the sum of time required for data processing and arg min denotes the corresponding value of X when Ttotal is the smallest. Then, set the server's initial processing capacity to c0, the initial processing speed to vo, and the light speed is s. Then, there areI of 1 × (n + 1) and define the matrix X as the optimal allocation strategy of function arg min, and the matrix X is n × (m + 1)-dimensional matrix of the content adjusted with the strategy.Mark X, the total processing quantity W is quantified into three parts. Denote the processing quantity of the server by WEdge, the processing quantity of the terminal by Wdevices, and the processing quantity of the jth terminal by Wjdevicese, which can be written as According to the complexity of data processing and matrix S1 and S2 are selected for the experiment, which are processed by video filtering technology as the following steps. (a) Calculate the average recognition result Oi, s of the video stream S within the T period, and perform frame filtering for the video stream path with large Os. Repeat the operation until the number of target recognitions is not less than the average recognition result. (b) Select and reserve the frame with changes in Oi, s. (c) Sort the frames obtained in the previous step according to the size of Oi, s, and generate the obtained result into a sequence group. The filtering of video frames with a large number of target recognitions is stopped first.The processing results of 10 frames in the same time period of two video streams Four kinds of data resolution are selected for network delay comparison experiment, namely, 320P, 480P, 720P, and 1080P.The actual availability of broadband is detected when the bandwidth is 5 Mbps, 10 Mbps, 15 Mbps, 20 Mbps, and 25 Mbps, respectively.The textbook of New Horizon College English is taken as an example for the experiments to verify the practical application effect of the online English learning system proposed here. First, the teacher randomly selects a unit of content in the textbook, makes network courseware, and initiates a collective video to start online teaching. The timing starts until the teacher finishes explaining all the contents. In this process, the times of video jamming and blurring are recorded and compared with the system without EC optimization.As shown in Figures When the network bandwidth is between 5 Mbps and 5 Mbps, the frame filtering algorithm is used to filter the frames under different network bandwidths, which ensures real-time video data transmission. After video frame filtering algorithm processing, the filtered FPS is mainly distributed in the range of 15 to 22. The edge node task scheduling optimization algorithm improves network utilization compared with the ordinary video frame filtering algorithm. Under good network bandwidth, the node task scheduling optimization can be efficiently and effectively executed, so network utilization can be maintained at more than 99%. When the network bandwidth is poor, the network utilization rate remains above 80%.As shown in The original college English online learning system is improved based on EC and IoT technology. Firstly, the current online learning needs and status of college English are analyzed. Then, the advantages of EC and IoT technology for online teaching system improvement are analyzed. Subsequently, an online learning system for college English based on EC technology is designed. Finally, the improvement effect is tested, and it is concluded that the EC technology can effectively improve the online learning system. The results demonstrate that the online learning model of college English based on EC can effectively reduce the network delay of general technology, ensure high reliability, and solve the current network problems of online teaching. Thus, an excellent online teaching system can be obtained, which is conducive to improve the learning efficiency of college students' English.This work optimizes the online English learning system using EC, which dramatically improves the speed and stability of network data transmission. However, the function design of the system in practical teaching application and the maintenance of students' classroom discipline were not comprehensively considered. The future study will combine the Deep Learning technology with the online English learning system and refine the system to improve the practicability and help lecturers monitor students' daily attendance, maintain classroom discipline, and improve the online English classroom mode.


The presence of sub-fertile or infertile males in farms or artificial insemination (AI) centres has a great impact on the reproductive and economic performance of the livestock industry. Assessment of the field fertility of males or ejaculates  with a large number of AI procedures can take a long time and involves high costs. The early detection of these males or semen samples with low-potential fertility by means of in vitro analysis is extremely valuable. While infertile male detection may be more or less evident, the detection of sub-fertile males requires procedures of in vitro evaluation of sperm quality to be as optimized. Moreover, to evaluate the effect of cooled storage or cryopreservation, it is essential to have adequate procedures for in vitro evaluation, to know the real impact of these techniques and to improve them. Most published papers reporting optimizing procedures for in vitro assessment of sperm focus on human, laboratory animal or livestock species with important economic weight. However, the description of semen quality parameters in other wild or less studied, but no less important, species  is vital for animal biodiversity conservation programs.Despite improvements in recent years, the predictive ability of the in vitro analysis of semen continues to be limited. Optimization and standardization of procedures for sperm quality parameter evaluation is essential in order to obtain reliable data. Among sperm parameters, total or progressive motility and kinetics are some of the most frequently utilized and those with a closer correlation with fertility. Other important parameters include sperm viability, morphology, DNA fragmentation, and acrosome integrity. In this context, the use of automated technologies is advisable as they are more objective and are capable for analysing a huge number of cells per sample in a short time. Examples are computer-assisted sperm analysis (CASA) systems for motility, morphometry and flow cytometry for other sperm parameters using several fluorescent probes. However, applied procedures are not completely optimized or standardized. In addition, in vitro methodologies to assess the in vitro quality of sperm which have been optimized for one animal species can require adaptation or modification to other species due to differing sperm morphologies and physiology between species.Biology entitled “Factors Affecting in Vitro Assessment of Sperm Quality” focuses on the most frequently used and advanced procedures for in vitro sperm evaluation, mainly sperm motility, and their application in studies on the conservation of semen doses. The Special Issue contains six papers, including one review paper. There are two papers for each of the three main topics.This Special Issue of Topic 1: optimization of sperm motility evaluation with a new Open CASA system and the statistical analysis of CASA technology parameters.CASA technology comprises both commercial and open systems. Commercial systems started to appear about 40 years ago and several brands can guarantee the quality of their results; subsequently, they are used in many laboratories around the world. More recently, Open CASA software has increased the accessibility of the technology, allowing scientists to improve the analysis capabilities of the software. In fact, similar to other open software, Open CASA is easier to improve through the collaboration of different scientific groups. In this Special Issue, three new modules for the analysis of chemotactic sperm accumulation, sperm functionality (based on fluorescent stained cells), and sperm concentration are presented. In particular, the study of chemotaxis provides a very useful tool for the research into how sperm reacts to a variety of substances, making such knowledge available for future applications in the field of fertility. Of similar importance is a novel module that can automatically measure one technique for the evaluation of different sperm functional parameters. As a result of the introduction of these three new modules, Open CASA (hosted at Github) is now the most powerful CASA system .Independent of the CASA technology used, the data obtained  has for a long time been evaluated with classical statistics simply using the comparison of results following ANOVA  to differentiate among species, brands, or treatments. This approach continues to be used by some laboratories, but it may be considered much too limited. During the last 20 years, a new approach has been introduced with the analysis of sperm subpopulations (SPs). It has been shown that the former model, that considered the ejaculate as one population of spermatozoa competing in some way to arrive at the oocyte, is not satisfactory. Rather than considering the population as a whole, sperm cells in each ejaculate have been shown to have clearly defined differences. However, the mathematical calculation of sperm SPs is not enough to indicate their biological significance. New approaches such as Bayesian statistics can help to determine how SPs influence the fertility of samples [Topic 2: importance of in vitro sperm parameters to assess the effects of semen conservation.In the first work relating to this second topic, Peris-Frau et al.  analysedIn the second work, Sadeghi et al.  examinedTopic 3: advances in the characterization and quality analysis of sperm in aquatic and aerial species: from dolphins to bees.Tursiops truncatus) and the influence of blood testosterone and refrigeration on the sperm morphometry. Two different sperm subpopulations, which differed between males, were described. The levels of blood testosterone and the storage period in refrigeration had a substantial impact on some sperm morphometric traits , while they were barely affected by the refrigeration temperature.In the first work under this heading, Fuentes-Albero et al.  present Apis mellifera) drones. The main seminal parameters, such as sperm concentration, motility, viability and mitochondrial membrane potential are reviewed. This review highlights the importance of improving current sperm quality in vitro analysis and proposes future research lines. Given the particular morphology and physiology of honey bee sperm, there is a need for the development of technologies specifically adapted to bees. Despite advances in recent years, the development of more sophisticated and objective methods to evaluate sperm quality still remain to be developed, mainly in the case of the honey bee.In the second work, Yániz et al.  provide Finally, we would like to acknowledge all the authors who have participated in this Special Issue by contributing their works, and we would also like to thank the anonymous reviewers.