To (1) evaluate the GoodOD guideline for ontology development by applying the OQuaRE evaluation method and metrics to the ontology artefacts that were produced by students in a randomized controlled trial, and (2) informally compare the OQuaRE evaluation method with gold standard and competency questions based evaluation methods, respectively.In the last decades many methods for ontology construction and ontology evaluation have been proposed. However, none of them has become a standard and there is no empirical evidence of comparative evaluation of such methods. This paper brings together GoodOD and OQuaRE. GoodOD is a guideline for developing robust ontologies. It was previously evaluated in a randomized controlled trial employing metrics based on gold standard ontologies and competency questions as outcome parameters. OQuaRE is a method for ontology quality evaluation which adapts the SQuaRE standard for software product quality to ontologies and has been successfully used for evaluating the quality of ontologies.In this paper, we evaluate the effect of training in ontology construction based on the GoodOD guideline within the OQuaRE quality evaluation framework and compare the results with those obtained for the previous studies based on the same data.Our results show a significant effect of the GoodOD training over developed ontologies by topics: (a) a highly significant effect was detected in three topics from the analysis of the ontologies of untrained and trained students; (b) both positive and negative training effects with respect to the gold standard were found for five topics.The GoodOD guideline had a significant effect over the quality of the ontologies developed. Our results show that GoodOD ontologies can be effectively evaluated using OQuaRE and that OQuaRE is able to provide additional useful information about the quality of the GoodOD ontologies. In recent years, ontologies have been successfully applied in different domains including e-commerce http://ontologydesignpatterns.org), principles like the OBO Principles (http://www.obofoundry.org/crit.shtml) or guidelines like GoodOD As engineering discipline, the ontology development requires the existence and application of methodologies and standards. In the last decades, different processes, strategies, and ontology development methods have been proposed. Among the methods proposed in the nineties we can highlight TOVE  Apart from the availability of development methodologies, measuring the quality of the resulting ontologies is necessary in order to monitor to which extent and how good methodologies, practices and guidelines are being applied. Consequently, methods for ontology evaluation have been developed by the ontology community, which can, roughly, be divided into three groups: ontology ranking Despite the differences between these groups, many of the approaches share some evaluation instruments like the use of quality models or metrics. Some methods use a gold standard to which the ontology is compared using ontology similarity metrics Another evaluation approach is the use of competency questions, which can be understood as the formulation of ontology requirements as questions, for which correct answers are created by domain experts. A good ontology has to provide the correct answers to these questions with the help of automated reasoning only little empirical evidence for the effectiveness of this approach. Besides, to our knowledge there are no empirical studies that compare different ontology evaluation methods. In this work we will try to make contributions to these areas by analyzing and comparing the results achieved with the GoodOD ontology construction approach Hence, it can be said that the alignment of ontology construction and evaluation methods is a current challenge that would be an important contribution to the progress in ontology engineering, although there is The ontology quality framework OQuaRE http://purl.org/goodod/guideline). The effectiveness of the guideline was evaluated in a randomized controlled trial.The GoodOD The objectives of this paper are (1) to employ the metrics of the OQuaRE framework as outcome parameter for the evaluation of the result ontologies derived from the GoodOD randomized controlled trial, and (2) to specify whether OQuaRE is able to provide additional useful information in addition to similarity and competency question based metrics.Ontology quality evaluation and Requirements (OQuaRE) is a framework for Ontology Quality Evaluation, based on the software product quality ISO 25000:2005 named as SQuaRE. The OQuaRE framework defines all the elements required for ontology evaluation: evaluation support, evaluation process and metrics. OQuaRE combines a quality model and quality metrics. It also addresses the traceability between ontology requirements and metrics.Currently, OQuaRE includes the quality model which defines a set of quality characteristics such as structural, reliability, operability, maintainability, compatibility, transferability and functional adequacy, for evaluating ontologies. Such characteristics have been adapted from SQuaRE to ontologies except for the structural one, which has been included due to its importance in measuring ontology quality, according to requirements, principles and characteristics of ontologies. Every quality characteristic has a set of quality subcharacteristics associated, which are measured by quality metrics.The ontology requirements as such are not defined in OQuaRE but they could be traced to the Quality Characteristics which are presented in terms of the capability of the ontology to fulfill some criteria. http://miuras.inf.um.es/oquarewiki. The most important characteristics for this study  and some of its subcharacteristics are described next:The complete description of the OQuaRE quality model is available at TRUCTURAL: Formal and semantic important ontological properties that are widely used in state of-the-art evaluation approaches. Some subcharacteristics are:S• Cohesion: The degree of relation between the classes. An ontology has a high cohesion if the classes are strongly related.• Redundancy: Capability of the ontology to be informative.• Formal relations support: Capability of the ontology to represent relations supported by formal theories different from the formal support for taxonomy.• Tangledness: This measures the distribution of multiple parent categories, so that it is related to the existence of multiple inheritance.UNCTIONAL ADEQUACY: The capability of the ontologies to be deployed fulfilling functional requirements. Some subcharacteristics are:F• Controlled vocabulary: Capability of the ontology to avoid heterogeneity of the terms.• Consistent search and query: The degree to which the formal model and structure of the ontology provides a semantic context to determine the result set wanted by the users, allowing better querying and method searching.• Knowledge acquisition and representation: Capability of the Ontology to represent the knowledge acquired .• Knowledge reuse: The degree to which the content of the ontology can be used to build other ontologies.OMPATIBILITY: The capability of two or more software components to exchange information and/or to perform their required functions while sharing the same hardware or software environment. Some subcharacteristics are:C• Replaceability: The degree to which the ontology can be used in place of another specified ontology for the same purpose in the same environment.• Adaptability: The degree to which the ontology can be adapted for different specified environments  without applying actions or means other than those provided for this purpose for the ontology considered.PERABILITY: Effort needed for the application. Individual assessment of such application by a stated or implied set of users. Some subcharacteristics are:O• Learnability: The degree to which the ontology enables users to learn its application.ELIABILITY: Capability of an ontology to maintain its level of performance under stated conditions for a given period of time.R• Availability: The degree to which an ontology, or part of it, is operational and available when required for use with different applications.• Recoverability: The degree to which the ontology can re-establish a specified level of performance and recover the data directly affected in the case of a failure.AINTAINABILITY: Capability of ontologies to be modified for changes in environments, in requirements or in functional specifications. Some subcharacteristics are:M• Modularity: The degree to which the ontology is composed of discrete components such that a change to one component has minimal impact on other components.• Reusability: The degree to which an asset (part of) the ontology can be used in more than one ontology, or in building other assets.• Analysability: The degree to which the ontology can be diagnosed for deficiencies or causes of failures (inconsistences), or for the parts to be modified to be identified.• Changeability: The degree to which the ontology enables a specified modification to be implemented. The ease with which an ontology can be modified.• Modification stability: The degree to which the ontology can avoid unexpected effects from modifications of the knowledge .• Testability: The degree to which the modified ontology can be validated.Quality metrics are composed of primitive and derived measurements. Primitive measurements correspond to metrics that can be measured directly on the ontology, such as number of classes, number of relations, etc, whereas derived ones combine some primitive measurements. A set of quality metrics has been reused and adapted from both ontology and software engineering communities. Some metrics adapted from software engineering are presented in The evaluation of an ontology in the OQuaRE framework comprises a score for each quality characteristic, which depends on the evaluation of the set of associated subcharacteristics. The evaluation of a particular subcharacteristic depends on its associated metrics.One metric can be associated with one or more subcharacteristics, and therefore may contribute to the score of more than one subcharacteristic. For instance, ANOnto “Annotation properties per class” contributes to knowledge reuse  and Redundancy , because annotation properties represent additional knowledge useful for reusing, so it is more informative and helps to be less redundant. Consequently, ANOnto contributes to Structural and Functional Adequacy characteristics.The metrics are presented in different scales. For instance, RFCOnto and ANOnto generate absolute values whereas CROnto and INROnto produce relative values. Hence, in order to measure a quality subcharacteristic, those values are mapped onto the range 1 to 5. This mapping is based on the SQUaRE scores of the quality characteristics and subcharacteristics where values are ranged between 1 and 5. A value of 1 means “not acceptable”, 3 is “minimally acceptable”, and 5 is “exceeds the requirements” It should be noted that high values in the metrics might not correspond to a high quality score. For this purpose we apply the recommendations and best practices of the Software Engineering community for software metrics and ontology evaluation metrics.Finally, the score of each subcharacteristic is calculated by the weighted average of the scores for its metrics. Likewise, the score of each characteristic is calculated by the weighted average of the scores of its subcharacteristics. The scoring mechanism based on weights provides a flexibility which permits to adapt the method to the need of a particular community.http://purl.org/goodod/guideline). The main objective of this guideline is to help domain experts to develop good ontologies focusing on good practices. The GoodOD guideline brings together good practice rules, ontology design patterns and top-level categories, in order to provide ontology developers with standard solutions to recurrent modelling tasks.In the Good Ontology Design (GoodOD) project a guideline was formulated describing principles of good ontology design . The most important classes and relations from the upper domain ontology BioTop The effectiveness of the GoodOD guideline was evaluated in a randomized controlled trial in which the performance of ontology developers was compared after specific and unspecific training. As outcome parameters gold-standard based similarity measures Main results and conclusions from the study were that in the gold-standard based evaluation approach no significant effect of the specific training on the quality of ontologies could be detected. However, these results are not sufficient to conclude that there are generally no effects of the GoodOD principles. With the competency-question based approach a small but significant effect of the guideline-based training over the unspecific training could be shown (about 10% better). However, when analyzed on the level of single topics, a significant effect was measureable only for one topic.Due to the high complexity and the educational nature of the study, the results should be carefully interpreted. The small effects of this study do not mean that construction principles should be abolished. They indicate that better evaluation methods must be developed. It is also optimistic to expect that significant training effects can be measured already after a one-week training phase. To our knowledge, the GoodOD study is the only empirical study investigating the effects of construction principles and ontology development guidelines on the quality of resulting ontologies so far.In this study the results of a randomized controlled trial are re-assessed by a complementary ontology evaluation framework (OQuaRE) and compared with prior results.The objective of this trial was to investigate whether guideline-based ontology training has an effect on the performance of ontology developers. The intervention of this trial was a curriculum implementing the principles of the GoodOD-guideline.ESIGN: The study was conducted as a randomized controlled trial with a crossed intervention in a post-test only design.DOPULATION AND SAMPLE: The target population of the study were students with a combination of subjects from the Life Sciences and Computer Sciences. 24 students with a proven combination of the subjects in Biology or the Life Sciences and Computer Science from Austria, Germany, Slovenia and Switzerland were recruited. The study was conducted in summer 2011 at the Department of Medical Biometry and Medical Informatics of the University of Freiburg, Germany.PLLOCATION: The students were randomized and allocated to one of two intervention groups.ANTERVENTION: A curriculum implementing the GoodOD-guideline (see above) in 16 modules was used as intervention. After a 2.5 days training in which both groups received the same training, the groups were randomized and received differential training for 1.5 days.IProcess and Participation (PRO), Immaterial object (IMM) and the Closure ODP (CLO), whereas group B was trained on Collective material entity (CME), Information object (INF) and the Spatial disjointness ODP (SPA).In the differential training phase, modules with different content but balanced in difficulty and duration were taught to each group see . Group AUTCOME PARAMETERS AND DATA COLLECTION: After the training phase, the students were asked to fulfill 12 modeling tasks with different content. Each student developed 12 test ontologies, six ontologies for the three topics in which they had received specific guideline based training and six ontologies for the three topics in which they only received unspecific training. It should be noted that the assessment of each topic included two different ontology development tasks. The students developed the test ontologies with the Protégé ontology editor, so that 12 OWL ontologies were collected from each student in 12 individual OWL files resulting in a total of 288 files.OThe outcome parameter of the study was the quality of the resulting ontologies. The main outcome parameter was the quality of the ontologies measured as the similarity with gold standard ontologies and the secondary outcome parameter was the quality of the ontologies measured with a competency-question based approach.In this work, OQuaRE is introduced as a new set of secondary outcome parameters. The authors of the GoodOD study see this extension of outcome parameters, although not declared in the original study protocol, as a legitimate and valuable application of further quality measures on the original research question of the study. For the detailed application of OQuaRE see the next section.NALYSIS AND REPORTING: For the calculation of similarity between students' ontologies and gold standard ontologies, a set of gold standard ontologies was developed by the authors of the GoodOD study. A software, the Good Similarity Evaluator AFor the competency-question based measurement a set of questions and their allowed answers were designed by the experts. They were expressed in Manchester OWL 2 Syntax as DL axioms. The competency questions were used to check different aspects of the ontologies, such as the correctness of the asserted hierarchy, the correct and exhaustive introduction of disjointness axioms, the correct usage of classes and relations of top-level ontologies and the correct usage of ODPs.The reporting of the study follows the CONSORT statement for the reporting of randomized controlled trials THICALAPPROVAL: Ethical approval was requested from the ethical authority of the University of Freiburg, Freiburg, Germany. The chair of the University of Freiburg ethics committee reviewed the project and concluded that a full formal ethics committee statement was not required due to the educational nature of the study. It was designed according to the general requirements for educational studies at the University Medical Center Freiburg, Freiburg, Germany, and was performed with written informed consent of the participants.EIn this experiment, 288 OWL files corresponding to 12 ontologies developed by 24 students were reused. Each ontology was evaluated using a predetermined OQuaRE configuration that will make use of 29 OQuaRE subcharacteristics. The application of OQuaRE was done using a home-made Java tool, which calculates the corresponding scores and returns a score in the range 1 to 5 for each characteristic, subcharacteristic and metric.A random selection of ontologies was performed to obtain independent ontology samples with equal sample sizes in each of the 12 combinations of untrained and trained students by topic, balancing the inability of the tool to process all of the 288 OWL files; 6 randomly selected OWL files per ontology from different students were discarded from the study. The process assured that the data contained ontologies from all of the 24 students. Consequently, the final set of data consisted of 216 OWL files corresponding to 12 ontology construction tasks, each one tackled by 18 different students  randomly selected from a set of 24 students, and supplemented by two gold standard ontologies.Next, we describe the methodological approach followed to perform the statistical analysis of the data which was done using R packages. Firstly, using data from the evaluation of students' ontologies, a two-way ANOVA model Secondly, to compare the gold standard against the students, the mean distances from both untrained and trained students to the gold standard were used. This distance was computed by means of the difference in absolute value of the gold standard measure minus the untrained and trained students observed scores, respectively.Additionally, descriptive multivariate analysis was used to analyse the 29 OQuaRE subcharacteristics together. Clustering methods were applied to describe, through internally homogeneous groups of subcharacteristics, the change of those groups from untrained to trained case. Principal Component Analysis was applied to quantify and describe in detail this change.http://miuras.inf.um.es/oquarewiki.In this section we present the main results of our data analysis. For the sake of simplicity, we do not show the OQuaRE scores for all of the ontologies, which can be accessed at p–value<0.03)  were reused. This analysis showed that there is a significant effect of the interaction training by topic for 22 OQuaRE subcharacteristics (.000<ue<0.03) . This meue<0.03) .p–value<0.03) were found for topics CME, IMM, CLO, INF and PRO. Concretely, IMM and CLO presented significant effect of training for one and two subcharacteristics respectively. INF presented significant effect of training for six subcharacteristics and CME presented significant effect of training for eleven subcharacteristics with significance levels less than 0.05 . Finally, in PRO, 17 subcharacteristics presented significant effect of training and 12 of them with a high significance level less than 0.000 .For the 22 subcharacteristics with significant interaction effect see , new anaThe left side of In summary, twelve subcharacteristics did not reveal any training effect in any of the topics see . HoweverThe mean distances from both, untrained and trained students to the gold standard were obtained and the difference analyzed for every topic . In each case, the distance was computed by means of the difference in absolute value of the gold standard measure minus the observed score from students.As previously mentioned, The effect of the training is summarized in In conclusion, the effect of the training was significant in 17 subcharacteristics, either due to differences between untrained and trained means, or between untrained and trained mean distances to the gold standard. We consider that this effect is high for PRO, intermediate for CME and INF, and small for CLO, IMM, and no effect was found for SPA.x1, x2 and G represent the mean values of the ontologies from untrained students, trained students and the gold standard ontologies respectively.We have performed a multivariate analysis of the means distances from untrained and trained students to the gold standard in the set of the six topics , to describe the 29 OQuaRE subcharacteristics together. First, the original data were transformed by x6 data matrices, namely, D1 and D2. These matrices correspond to the mean distances from untrained and trained students to the gold standard respectively. Classification and sort methods were applied to the matrices to identify similar behaviours between subcharacteristics for both untrained and trained cases with respect to their distance to the gold standard.This transformation was applied to all of the subcharacteristics for the six topics, obtaining two 29LASSIFYINGSUBCHARACTERISTICS. Based on the Euclidean distance between subcharacteristics and Ward's minimum variance method of linkage criteria, hierarchical clustering was applied for both cases. The hierarchical cluster allowed to classify the subcharacteristics in four homogeneous groups for untrained and trained cases  which was 93% for untrained students and 87% for trained ones. The unexplained variance (within groups) was 4.9%, 0.0%, 1.9% and 0.6% for untrained students and 5.6%, 0.0%, 3.5% and 3.4% for trained ones, respectively in each group.Additionally, a K-means classification with four groups obtained the same distribution of subcharacteristics as hierarchical cluster except for ORTINGSUBCHARACTERISTICS. Principal Component Analysis (PCA) was applied to order the subcharacteristics by distance between untrained or trained groups to the gold standard for every topic. PCA was applied to the D1 and D2 matrices to represent the subcharacteristics in two dimensions. The representations obtained were of high quality: more than 98% of total variance was explained for untrained students, and more than 92% of total variance for trained ones, as is shown in SThe first component was highly correlated with CLO, CME, IMM, INF and PRO for both untrained and trained students. Therefore, subcharacteristics with highest positive values in this component presented the highest mean distances to the gold standard for those topics.The second component was highly and positively correlated with SPA for both untrained and trained cases and highly negatively correlated with PRO for untrained case. Consequently, subcharacteristics with high positive values in this component presented the largest differences in distance to the gold standard, for both untrained and trained cases for SPA. Additionally, for the untrained case, subcharacteristics with high negative values in this second component presented the largest distances to the gold standard for PRO.Values for first and second principal components and membership clusters are displayed in The first component of the untrained case is significantly correlated with the first one of the trained case, consequently, a relation between behaviours for both cases was observed for CLO, CME, IMM, INF and PRO:• Redundancy and Controlled Vocabulary obtained positive and atypical values in the first component, which means that distances to the gold standard were high in both cases.• Tangledness and Modification stability presented the largest decrease of mean distances to the gold standard from untrained to trained cases. Conversely, Recoverability, Cohesion, Availability and Replaceability presented the highest increase in distance to the gold standard from untrained to trained case.The second component showed that:• Result Representation obtained highest and atypical values in both untrained and trained cases, and the distances to the gold standard were high for SPA.• Tangledness, Modification Stability, Result Representation, Modularity, Clustering and Similarity, Guidance and Decision Trees had the highest increase of the mean distances to the gold standard from untrained to trained cases. Conversely, Knowledge Acquisition, Availability, Cohesion, Replaceability and Recoverability presented the highest decrease from untrained to trained case.In conclusion, the first principal component sorting showed that PRO, IMM, CLO, CME, and INF are highly correlated. The mean distance for these topics decreased from the untrained cases to the trained cases for 19 subcharacteristics, most of them with negative values in both cases . In contrast, this mean distance increased from untrained to trained for the other 10 subcharacteristics, and most of them presented positive larger distance to the gold standard , except for Result Representation, for which distances were negative.The second component presented a high correlation with SPA for both untrained and trained cases, and with PRO for the untrained ones. The first and second components are uncorrelated, therefore, the behaviour of SPA is independent of the behaviour of the rest of topics in both untrained and trained cases.In this study, OQuaRE was used to evaluate a set of biomedical ontologies developed by 24 students after guideline-based training. To measure the effect of the training over the properties of the ontologies, two different studies were carried out: (1) comparative analysis of the properties of the ontologies developed by untrained and trained students; (2) analysis of the distances of both sets of ontologies with respect to a set of gold standard ontologies. Additionally, the subcharacteristics have been ordered and classified according to the respective distances to the gold standard solutions.Our research objectives were inspired by the work presented in Second, we have tested whether the ontologies developed by trained students were closer to the gold standard than those developed by the untrained ones were. In Consequently, we believe that these results permit to say that OQuaRE is able to capture the findings of the previous GoodOD evaluations, which was one major objective of this work.A second objective was to study what additional information OQuaRE could provide about the quality of the ontologies developed and the effectiveness of GoodOD. According to our results, the GoodOD training had a significant effect on 59% of OQuaRE subcharacteristics and therefore on the quality of the ontologies developed by the students, and these differences were identified between ontologies developed by specific training and those without it.Mean values for ontologies developed by untrained students and trained students, and for the gold standard ontologies were similar and high for seven subcharacteristics see . The higIn general terms, Tangledness and Modification Stability obtained the highest positive effects of the training. The ontologies developed after the training presented less multiple inheritance and were more stable for changes in their classes, properties and terms. This effect might be due to the training of the GoodOD guideline, where a quality criterion is to construct ontologies in a way that multiple parenthood is inferred and not asserted.Additionally, Recoverability, Cohesion, Availability and Replaceability obtained the most negative effects of the training. Such subcharacteristics are associated with the dependence between ontology classes.More findings can be described when focusing on specific topics. Comparing the data for PRO in For CME, Redundancy, which is the capability of the ontology to be informative; and (2) Controlled vocabulary, defined as the capability of the ontology to avoid heterogeneity of the terms. Both subcharacteristics are related to the number of annotations per class. We have found that ontologies of trained students included annotations for less than 10% of the classes, whereas the gold standard included them for almost 100%. For topics SPA, INF and CME, untrained students presented lower values than trained ones for those subcharacteristics. This means that training had a positive effect with respect to those specific subcharacteristics. For topics PRO, IMM and CLO, the training effect was negative. This might be due to the annotations created by the students before and after the training. Although finding an explanation for such behaviour is out of the scope of this work, we believe that such information would provide an interesting feedback for further developments and applications of the GoodOD guideline.In These findings lead to the conclusion that OQuaRE is able to provide fine-grained information about the quality of the ontologies because of its organization in quality characteristics and subcharacteristics.As it has been aforementioned, due to technical limitations, we have not been able to work with the complete original dataset. Consequently, the study was designed to reduce potential biases. Our design was based on independent samples with equal sample sizes to use an F statistic in the ANOVA analysis less sensitive to the eventual non-compliance of the normality and homocedasticity hypotheses of the sample. In a different situation, we would have needed to test the hypotheses the ANOVA model is based on and to deal with the non-uniqueness of the solution.The current version of OQuaRE lacks a module for the definition of a set of Ontology Quality requirements which would permit a more direct traceability between competency questions and quality metrics, allowing the measurement of the ontologies from the development phase. Additionally, we are working on including new axiom-based metrics in the framework. Besides, new experiments involving both OQuaRE and GoodOD would permit a coordinated evolution of approaches for guiding the construction of the ontologies and to evaluating those ontologies.It should be noted that neither the OQuaRE metrics nor the GoodOD methods are meant to be sufficient for a full picture of the quality of an ontology, even when combined. Nevertheless, the work that we present in this paper is one of the very first efforts to combine different methods and our results suggest that it is a promising way to proceed. We aim at extending our approach with new metrics and combining our results with other ontology quality approaches; a possible candidate for such an extension could be the measurement of the cognitive quality of ontologies In this work, OQuaRE was used to evaluate the quality of a set of ontologies developed using the GoodOD guideline for good ontology design. The quality of the ontologies was previously measured a competency-question based approach and the measurement of the similarity to gold-standard ontologies. A comparison of OQuaRE with the two previous evaluations was done.OQuaRE results showed a significant difference in terms of quality between untrained and trained students for three topics. Additionally, compared to the gold standard, training resulted in both positive and negative effects on five topics. OQuaRE was able to draw similar conclusions as the original GoodOD evaluations, and to provide specific results such as correlations between different topics, the set of subcharacteristics affected by training, and the differences, by subcharacteristics, among ontologies developed by untrained and trained students and gold-standard ontologies.Summarized, GoodOD and OQuaRE can be used together to take advantage of their respective strengths to develop and evaluate ontologies. To the best of our knowledge, this is one of the very first studies that attempts to compare and combine independent ontology development and evaluation methods. We believe this to be an important contribution to the progress of the ontology engineering community.


The Trivers-Willard hypothesis predicts that high-status parents will bias their investment to sons, whereas low-status parents will bias their investment to daughters. Among humans, tests of this hypothesis have yielded mixed results. This study tests the hypothesis using data collected among contemporary peasants in Central South China. We use current family status (rated by our informants) and father's former class identity (assigned by the Chinese Communist Party in the early 1950s) as measures of parental status, and proportion of sons in offspring and offspring's years of education as measures of parental investment. Results show that (i) those families with a higher former class identity such as landlord and rich peasant tend to have a higher socioeconomic status currently, (ii) high-status parents are more likely to have sons than daughters among their biological offspring, and (iii) in higher-status families, the years of education obtained by sons exceed that obtained by daughters to a larger extent than in lower-status families. Thus, the first assumption and the two predictions of the hypothesis are supported by this study. This article contributes a contemporary Chinese case to the testing of the Trivers-Willard hypothesis. According to the Trivers-Willard hypothesis (TWH), natural selection has shaped the way that parents differentially allocate resources, such as time and energy, to their offspring by sex: parents in good condition during the period of parental investment will invest more in sons, while parents in poor condition during parental investment will invest more in daughters  there is a positive correlation between the condition of parents during parental investment and the condition of offspring at adulthood, and (ii) advantages in condition have greater effects on adult male reproductive success compared to the effects on adult female reproductive success. Thus, following the logic of natural selection, it is not difficult to arrive at two specific predictions of the TWH: as parental condition declines, parents tend to (i) produce a lower sex ratio of males to females at birth, and (ii) allocate relatively more resources to daughters postnatally.There is widespread evidence that the two assumptions of the TWH conform to the reality of human societies. For human societies, the first assumption holds that there is relatively stable intergenerational transfers of socioeconomic status. Probably this was most evident in agricultural societies, in which most people's class position was largely determined by family origin and typically remained unchanged for life  in the late 1940s and early 1950s, each peasant family was assigned one of seven class identities on the basis of family economic status: landlord, rich peasant, upper middle peasant, middle middle peasant, lower middle peasant, poor peasant, and landless laborer. We did field work in the Hunan Province. The Province was taken over by the CCP in 1950 and the land reform there should be conducted in the early 1950s. At that time, some land and other property of landlords and rich peasants were forfeited and redistributed to landless laborers, poor peasants, and lower middle peasants, to effect a more equitable distribution of wealth. Before the Land Reform, landlords and rich peasants were at the top level of the sociopolitical and economic hierarchies in rural China, middle peasants middle, and poor and landless laborers bottom. After the Reform, previous poor and lower-middle peasant families were privileged in many aspects including education and employment, while previous rich and middle class families, especially landlord and rich-peasant families, were disadvantagedly discriminated, until class identities were officially abolished in 1979 Unger, . From thThe first goal of this study is to test the first assumption of the TWH, relatively stable intergenerational transmission of socioeconomic status, with data about contemporary Chinese peasants. We expect to find that the higher the family status in the past generations which can be measured by former family class identity, the higher the current family status. In addition, parental age, education, and number of offspring affect current family status. Since the 1980s, China has been experiencing a rapid process of urbanization, during which rural-urban migration is the main source of urban population growth  per capita in Shaodong in 2014 was around 4800 US dollars, while the figure for China as a whole was around 7300 US dollars in the same year, in terms of the present USD to RMB exchange rate.Data were collected in July and August 2015 in five adjacent To collect the data, we first copied the pages of household registers about family heads from the police department. Under China's household registration system, usually every family register in a local police department the basic information about each family member' sex, birth date, ethnicity, etc. But the registers do not necessarily perfectly reflect the birth, death, and migration of a local population. For example, those children who were born with no official approval and whose parents were unable to pay the fines levied by the government usually are excluded from the registration system. The registers also do not cover the information about family members' current socioeconomic status and previous family class identity, which is crucial for this study.As the registers provided the information about each famiy head's sex and age, then we tried to find two informants in each village to obtain other relevant information about each family. One informant was a retired older-than-60 village head, Chinese Communist Party (CCP) branch secretary in the village, or village accountant. The other was the current village head, CCP branch secretary in the village, village accountant, or a teacher of the local primary school, with a middle age. We paid each of them about 32 US dollars as reward in advance. They informed us of each family head's education level, current family socioeconomic status in the local community, fathers' previous class identity, and each biological son's and daughter's birth year and education level. All the informants kept living in the investigated area for decades. In every village, usually both informants easily concurred on the above information.The reason that we did not directly interview the family heads for primary data was that many peasants were oversensitive to questions about offspring, current family status, and father's former class identity. In our preliminary fieldwork conducted in June 2015, an interviewed peasant with a landlord family origin told us that his family origin was poor peasant, presumably because his father was persecuted to death during Chairman Mao's era only for being a previous landlord and this event connected to class identity was a trauma for him. Like many Western people, some Chinese peasants regard personal or familial socioeconomic status as privacy. Moreover, many peasant parents have one or more unauthorized births. They would not like strangers to know this, lest this would be reported to the local government.We finally obtained intact information about 1418 family heads . See Table current family socioeconomic status as the outcome variable. A score of 1 means bad family socioeconomic status in the local community, a score of 2 means average status, and 3 means good status.Testing the first assumption of the TWH, we used In our pilot fieldwork in January 2015, we discovered that Chinese peasants usually classified their general family socioeconomic status into three categories of “bad,” “average,” and “good.” More specific classifications seemed to confound them sometimes. It is this trichotomy that we finally used to collect the data presented here.proportion of sons in offspring as the outcome variable. We divided the number of sons of each family head by the total number of his/her offspring to obtain this variable, for all those with at least a child. For example, if a family head has a son and a daughter, he or she will obtain a score of 0.5 on the variable. The greater the value, the relatively more prenatal investment in sons.In testing the first prediction of the TWH, we used offspring's years of education as an outcome variable, for all the 2818 offspring (in the 1230 families) who were at least 18 years of age. Also, for the 674 family heads who had at least a son and a daughter and all of whose offspring were at least 18 years old, we divided the average years of education of sons by the average years of education of daughters to obtain a new variable, ratio of sons' average education to daughters', for gauging sex-biased postnatal parental investment. For example, for a family head, if two sons' years of education are 6 and 9 years, and two daughters' years of education are 6 and 16, then the average years of education for sons and for daughters will be 7.5 and 11, and the variable ratio of sons' average education to daughters' will have a score of 7.5/11=0.68. The greater the value, the relatively more postnatal parental investment in sons.As for testing of the second prediction of the TWH, we used age, years of education, number of offspring, and father's former class identity as independent variables. As current family socioeconomic status is an ordinal variable and the test of parallel lines showed that the data did not meet the proportional odds assumption for performing an ordinal logit regression analysis  between former class identity and current family socioeconomic status is 0.079 .As expected, all the four independent variables are significant predictors of the dependent variable current family socioeconomic status Table . The valAnother interesting finding is concerned with the relationship between number of offspring and family status. The Chinese government has been propagandizing for decades “the more children, the poorer,” to urge people to control birth. Ironically, when number of offspring was assumed to really influence subsequent socioeconomic status and was entered into the above regression, we found that it could enhance, rather than weaken family status.Results of the test of prenatal investment in offspring Table  show thaTable 5). The effect sizes (Spearman rs) for current family socioeconomic status and former class identity in predicting proportion of sons in offspring are 0.052  and 0.042 , respectively. To sum up, the first prediction of the TWH is confirmed.As the value of current family socioeconomic status and former class identity rises, the mean value of proportion of sons in offspring keeps rising  for current family socioeconomic status and former class identity in predicting ratio of sons' average education to daughters' are 0.077  and 0.081 , respectively. To conclude, the second prediction of the TWH is supported.The mean value of ratio of sons' average education to daughters' in each family goes up hand in hand with current family socioeconomic status and former class identity Table . The treTaken together, the data from this study support the validity of the first assumption and the two predictions of the TWH among contemporary Chinese peasants. First, we found that those family heads whose father had a higher class identity assigned by the CCP in the early 1950s tended to have a family with a higher socioeconomic status currently. This means that there were transfers of socioeconomic status across generations to some extent in the previous decades. Thus the first assumption of the TWH is supported. Probably this is the first time for testing that assumption in a population studied. Second, when parental socioeconomic status during parental investment was measured by both current status and former class identity, we found that high-status parents were more likely to have sons than daughters among their biological offspring. Finally, the data show that as family heads' current family status or former class identity increases, the education of sons increases to a larger extent than that of daughters. This means that high-status parents invest relatively more in the education of sons compared to low-status parents.In humans, the TWH is essentially involved with the relationships between parental socioeconomic status and sex-biased parental investment in children. Similar to several earlier studies (e.g., Bereczkei and Dunbar, ratio of sons' average education to daughters to examine sex difference in educational investment in offspring within each family. In fact, we found that the mean value of this variable kept rising as family status increased.Along with previous studies (Bereczkei and Dunbar, Also, similar to such studies supporting the TWH as Voland et al.  and CronBut some people may complain that cultural factors are ignored in the testing of the TWH. In fact, many studies (e.g., Li and Cooney, The TWH provides an evolutionary or ultimate explanation for sex-biased parental investment, concerned with the fitness consequences of parental behaviors. The present study discovers what the TWH predicts in contemporary Chinese peasants. However, the specific mechanisms by which the results come about are unclear. For example, peasants' choice of educational investment in offspring may be directly influenced by schooling costs or manual labor needs. As ultimate and mechanistic or proximate explanations are complementary, future studies that clarify the mechanisms will help us achieve a fuller understanding of the Trivers-Willard effect.LL designed the study. WZ and TW collected the data. All of the authors discussed the data and wrote the paper.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.


HIV/AIDS remain a major public health concern in Nigeria. People living with HIV/AIDS (PLWHA) face not only personal medical problems but also social problems associated with the disease such as stigma and discriminatory attitudes. This study provides an insight into HIV/AIDS related stigma and discrimination against PLWHA in Nigeria.The data for this study was extracted from the 2013 Nigeria Demographic and Health Survey conducted by the National Population Commission. All men and women aged 15–49 years, permanent residents and visitors of the households were eligible for the interview. Several questionnaires were used in the survey, some covering questions on HIV/AIDS.A total of 56 307 men and women aged 15–49 years participated in this national survey. About half of the population in Nigeria have HIV stigma. Younger persons, men, those without formal education and those within poor wealth index are more likely to have stigma towards PLWHA. In addition, married people are more likely to have stigma on PLWHA and are more likely to blame PLWHA for bringing the disease to the community. Also about half of the population discriminates against PLWHA. However, those with higher levels of education and those from higher wealth index seem to be more compassionate towards PLWHA. About 70% in the population are willing to care for relative with AIDS, even more so among those with higher level of education.There is a high level of HIV stigma and discrimination against PLWHA in the Nigerian population. Education seems to play a major role in the society with respect to HIV stigma and discrimination against PLWHA. Educating the population with factual information on HIV/AIDS is needed to reduce stigma and discrimination towards PLWHA in the community. Human Immunodeficiency Virus (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS) remain a major public health problem in Nigeria which is only second behind South Africa in terms of the number of people with HIV/AIDS . DespiteStigmatization can lead to prejudicial actions and thoughts among governments, communities, health care providers, employers, family members and colleagues . There cHIV infected patients might also experience a number of undesirable conditions in their life such as: hostility, denial of gainful employment , forced Issues pertaining to availability, affordability and accessibility of treatment and care of PLWHA have been cited for the poor control of HIV infection. However, how HIV stigma affects PLWHA are not well understood. Previous studies have revealed that eliminating stigma in the population will increase the acceptance of an individual as well as community towards PLWHA . UnderstThe data for this study were taken from the 2013 Nigeria Demographic and Health Survey (2013 NDHS), conducted by the National Population Commission. In this survey, women and men aged 15–49 years of age, permanent residents or visitors of the households were included. A stratified three-stage cluster design was used in this study. Prior to the commencement of the study, a complete listing of the household was obtained. Training on how to use the Global Positioning System (GPS) receiver was delivered to the enumerators .In the survey, besides others, there were questionnaires on HIV/AIDS, one to be answered by the men and the other to be answered by the women. The questionnaires were administered in different languages namely Igbo, Yoruba and Hausa in order to overcome language barriers that may confound the results. In the questionnaire there were sections on stigma and discrimination towards PLWHA, acceptance on various issues pertaining to stigma and discrimination such as willingness to take care of their infected family members, preference to buy vegetables from HIV-infected vendor, discrimination towards female infected teacher, perception on whether HIV positive people should be ashamed of themselves and perception on whether HIV infected people should be blamed for bringing the disease to the community. Socio-demographic information such as age, highest educational attainment, marital status and household monthly income was also gathered.Inclusion criteria for this study were women and men aged 15–49 years of age in the household and those who gave consent to participate in the study. Participation was solely voluntary, since the information gathered were concerning personal and sensitive issues such as their sexual relationship, stigma and attitudes of discrimination towards PLWHA. The interviewers ensured that participants had been informed about the study protocol, upon which a written informed consent was obtained. Ethical clearance to conduct NDHS was obtained from the National Health Research Ethics Committee of Nigeria, Federal Ministry of Health, Abuja, Nigeria. NDHS data are public access data and were made available to us upon request by Measure DHS.Statistical Package for the Social Sciences (SPSS) version 20 with complex samples procedure was used for the analysis. Frequency and percentages were used to describe the demographic characteristics of the respondents. The univariate logistic regression analysis procedure in the complex samples add-on module in SPSS was used to test the differences between the male and female subjects on HIV stigma discrimination against PLWHA. The multivariate logistic regression procedure was used to test for factors associated with HIV stigma and discrimination against PLWHA.A total of 56 307 men and women aged 15–49 years had participated in the study. Majority of the participants were aged 21–30 years (34.6%), had secondary education (40.5%), were able to read (62.1%), in the richer wealth index (22.2%), resided in rural areas (59.7%), resided in North West region (24.5%), Christians (51.4%) and were married (61.6%). The socio-demographic characteristics by gender are shown in Results for HIV/AIDS related knowledge and behavior, overall and by gender, are presented in Results from analyses on stigma and discrimination against PLWHA, overall and by gender, are presented in Results from multivariate analysis on factors associated with HIV discrimination are presented in Negative perceptions towards PLWHA are some of the common manifestations of AIDS stigma which leads to discrimination and prejudice attitudes. Consistent with previous studies ,17,25,28In our study, among the factors tested, age, gender, education and wealth index were significantly associated with HIV stigma. Younger persons, males, those with lesser education and those in the lower wealth index tend to agree more that people with HIV should be ashamed of themselves and that people with HIV should be blamed for bringing the disease into the community. These findings are similar to that of several other studies. It is interesting to note that those with higher levels of education and in the higher wealth index are more sympathetic towards PLWHA. This could be due to higher awareness among the educated and wealthy ones on the prognosis of PLWHA and the availability of anti-retroviral treatments.The HIV status of a person puts forward negative impact on their access to health and education services as well as discrimination in their working life. Based on this study, nearly half (40%) of people in the population do not agree that female teachers infected with HIV should be allowed to continue teaching, even when they are not sick. In developing countries teachers are highly respected and looked upon in the communities as role models and they are seen as those responsible in teaching moral values among the children. When infected with HIV, these teachers, especially the females, seem to lose the respect in the community. However, women, with higher level of education and those in the middle and rich wealth index category are more tolerant in this regard. Our finding corroborates with Oyediran et al. (2005)  who founThere is increasing concern about family caregivers’ reluctance to care for and treat family members with HIV/AIDS. As a result of this, most PLWHA would not disclose their HIV status even to their family members to avoid distancing reactions and discriminatory practices towards them. Studies have found that family caregivers also possess stigma and prejudice attitudes towards their own family members who have HIV/AIDS . Based oIn this survey, question on willingness to buy vegetables from HIV-infected vendor was used to assess how people associate themselves with PLWHA outside their domains. Our results showed that only half of the population indicated willingness to buy vegetables from HIV-infected vendor, though men, those with higher level of education, those who are able to read, those in the rich wealth index category and those staying in urban locations tend to be more tolerant in this aspect. This is a very serious level of discrimination towards PLWHA. In order to have normal lives within the community, PLWHA may adopt certain coping mechanisms like concealing their HIV status since people refuse to trade with them .The findings from this study call for the need to promote positive and acceptable attitudes towards PLWHA in the Nigerian population. Programs should be put in place to increase the awareness on HIV/AIDS in the population, promote compassion towards PLWHA and emphasize on respect for the rights of PLWHA. A study conducted in South Africa, identified four areas that need to be addressed to combat HIV stigma; fostering awareness and knowledge among the public, educating PLWHA, advocating for the rights of infected persons and providing emotional as well as physical support . There iOur study had determined the magnitude of HIV stigma and discrimination against PLWHA in Nigeria. More epidemiological studies need to be conducted to understand the impact of stigma and discrimination on prevention of HIV/AIDS. Future studies should also focus more on the HIV/AIDS-education or intervention programs that aim to increase the knowledge and awareness of population in the communities, especially among the rural communities. By increasing the populations’ knowledge on HIV/AIDS, stigma and discrimination towards PLWHA could be reduced.This study observed high discriminatory attitudes and practices towards PLWHA; however about 70% of the population are willing to care for relatives with HIV/AIDS. In order to combat HIV/AIDS epidemic in Nigeria, issues pertaining to stigma and discrimination need to be addressed. Health promotion campaigns should incorporate a shift from fear to care for PLWHA as this is important for effective preventive measures. As stigma and discrimination continues to be a hidden factor that acts as impediment for the effective prevention program, policy makers need to strengthen the HIV/AIDS intervention and health education program in local communities in Nigeria. Educating the population with respect to improve their understanding on HIV/AIDS transmission and control are crucial to reduce this menace in Nigeria. Education and knowledge are believed to be the vanguard for the disease prevention. Behavioral change strategies should be delivered among the population in order to impede the spread of the disease.


With many developed countries experiencing the aging of the population, older people play a large role in contributing to environmental problems but also to environmental solutions. The purpose of this research is to understand the awareness and behavior of current older people living in retirement villages towards sustainability development. To achieve this, a sustainability literacy survey was conducted with 65 older residents of a private retirement village located 10 Km outside the Brisbane, Australia's central business district (CBD). Most of residents recognized the importance of environment protection and would like to lead a more environmentally friendly lifestyle. In addition, the majority were willing to pay higher prices for a living environment with sustainable features. The importance of positive social communications was emphasized with most residents having established good relationships with others in the village. The findings provide an important insight into consumer perspectives regarding the sustainable features that should and can be incorporated into the village planning and development. Sustainable development, defined as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs” , has gaiWith the increasing proportion of aging population around the world, the actions of older people are likely to have a corresponding increasingly important role in the sustainable development of the community. Older people are expected to consume more energy due to both their increased numbers and their lifestyles, such as spending more time at home (requiring more electricity and water) and using their cars frequently , 5.However, older people can also make major contributions to solving environmental problems , 7. OldeDue to the increasingly significant potential impact of older people on both environmental problems and solutions, it is important to understand their current attitudes and behaviors concerning sustainable development, considered as one of the highest priority topics for research on aging and environmental sustainability . Older pHowever, few studies have documented older people's attitudes and knowledge relating to sustainable development. Understanding and knowledge of sustainability issues have been termed sustainability literacy, which is “… the understanding, skills, attitudes, and attributes to take informed action for the benefit of oneself and others, now and into a long term future” . Older pRetirement villages are becoming accepted as a viable accommodation option and house over five percent of Australians aged 65 years and over. A survey of 76 older people living in not-for-profit retirement villages in South Australia found that they are both very conscious of resource consumption and concerned about energy costs . To dateThis research explores the perceptions of older people, living in a comparatively large and luxurious Queensland for-profit retirement village, regarding sustainable issues relating to environmental, economic, and social aspects of sustainability. This paper focuses on resident's sustainability concerns, impacts on activities of daily life, and sustainability literacy.The study sought to investigate the sustainability literacy of residents living in a Queensland for-profit retirement village. Data were collected from October to December 2012. Ethical approval was granted by the Queensland University of Technology Human Research Ethics Committee. Approval from the target regiment village was also obtained to provide necessary assistance for data collection.The survey was conducted in a private retirement village in a suburb of Brisbane, Queensland, Australia, located approximately 10 kilometers northwest of the Brisbane central business district (CBD) close to amenities such as transport, health services, stores, and libraries. The retirement village developer aspires to be a leader in sustainable property and infrastructure, focusing on transitioning to a low-carbon, energy-efficient, and resource-conservation model that reflects and advances social and environmental best practice. The village contains 254 one-, two-, or three-bedroom homes.Based on sustainability literacy surveys for university students, a survey was developed focusing on attitudes and behaviors concerning sustainable development. The questionnaire included questions on environmental, economic, and social issues and comprised two main parts see . The firSurvey forms were placed in the village's community center's reception room from October 26, 2012, until December 4, 2012, with a covering letter explaining the purpose of the research.Sixty-five residents returned the completed questionnaire, providing an overall response rate of approximately 25%.The frequencies of degree of agreement of the importance of sustainability activities as well as the median score and interquartile ranges (IQR) are shown in Based on survey results, the relationship between sustainable awareness of respondents and their daily activities is drawn see . In geneGiven their increasing number in our society, older people play an important role in fulfilling the sustainability agenda. It is predicted that a growing proportion of older people will live in retirement villages in the next 10 years. Understanding the attitude and behavior of retirement village residents is of great importance for the delivery of sustainable retirement villages in the future. The results of the questionnaire survey reveal that the majority of respondents have a sound understanding on the holistic aspects of sustainability, which requires the reconciliation of environmental and economic demands and the need for social equity. In other words, there was sufficient sustainable literacy within the senior citizen community living in the studied retirement village. In particular, the most important sustainability issue perceived by respondents was “reporting housing issues to the facility manager for repair.” This clearly indicated that respondents are fully aware of the effectiveness of resolving housing issues by having facility management professionals engaged. Similarly, respondents perceived the interaction with other village residents to be very important. This showed older people's attention to social sustainability-related issues. Environmental sustainability issues, such as energy, resource, and water efficiency, were also assigned high priority by respondents for achieving sustainability.This sustainability literacy of retirement village residents is correlated with their behavior in terms of daily activities. A sustainable development not only protects the natural environment  and increases economic growth  but also promotes social progress that takes into account the needs of everyone . For environmental sustainability, most respondents agree on the importance of energy and water saving, recycling, and using fewer products that are harmful to the environment. Furthermore, most respondents manage to save energy in their daily activities. For example, more than 90% of respondents use as little water as necessary and turn off lights and electrical devices when not in use. This confirms previous findings that older people in retirement villages are concerned about environmental issues and welcome more energy saving in their living environment , 15.For economical sustainability, it is interesting to find that most respondents agreed with paying a higher price for homes with environmental friendly features. This is different from previous findings that although nearly all the residents in retirement villages would like to have their facilities more environmentally friendly, most are concerned about the costs involved and are reluctant to pay a higher price for an environmentally friendly home , 15. TheFor social sustainability, it is within expectations that most of the respondents agree with the importance of attending social group activities and having sufficient engagement with other village residents. In fact, almost all the residents have very good relationships with their neighbors and village managers and attend social group activities quite often . As confirmed by the findings of previous research, social activities, friendships, and social networks are important for the residents' quality of life , 16–18. As shown in The study described in the paper conducted a sustainability literacy survey of residents of a private retirement village in Queensland in order to explore their attitudes and activities relating to sustainability issues. The survey results show that most residents have sufficient literacy as they recognize the importance of environment protection and would like to lead a more environmentally friendly lifestyle. In addition, the majority of respondents are willing to pay a higher price for a living environment with sustainable features. Furthermore, almost all the respondents agree with the importance of social communications and good relationships with other residents in the village. Results also showed a close connection between village residents' sustainability literacy and their behavior in terms of daily activities.These findings provide useful inputs into the type of sustainable features to incorporate into retirement villages. As residents are very aware of energy and water saving, energy-efficient designs  and materials  and water saving fixtures  can be adopted. In addition, given that retirement village residents regularly attend social group activities and recognize the importance of social sustainability in their quality of life, developers are recommended to incorporate socially friendly facilities into their villages, for example, by providing as a community center, game room and community garden, to facilitate social engagement and create a living environment that creates opportunities for residents to develop friendship networks and participate in a range of activities in the village and the wider community. Finally, considering that the majority of residents rarely exercise because of their physical limitations or lack of sustainability literacy, the incorporation of sustainable features in retirement villages should take into consideration their physical conditions and unique requirements. For example, a village bus (within and outside the village) would provide a welcome service. Furthermore, due to the changing demographic conditions of potential residents especially with impending retirement of the “baby boomer” generation, future retirement village planning should take full consideration of their unique requirements as they are likely to be wealthier, healthier, and more socially active than previous generations.There are more than 1800 retirement villages in Australia and residents in villages of different types (not-for-profit or for-profit), different locations (urban or remote suburb) and different sizes, and so forth may have different perceptions and behaviors relating to sustainable development. For example, as this study has shown, issues concerning affordability can be quite different in different circumstances. Future research opportunities therefore exist to conduct a larger scale survey at national level in order to provide a full profile of the sustainable literacy of the residents of retirement villages.


Cardiovascular diseases are the deadliest diseases worldwide, with 17.3 million deaths in 2008 alone. Among them, heart-related deaths are of the utmost relevance; a fact easily proven by the 7.25 million deaths caused by ischemic heart disease alone in that year. The latest advances in smartphones and mHealth have been used in the creation of thousands of medical apps related to cardiology, which can help to reduce these mortality rates.The aim of this paper is to study the literature on mobile systems and applications currently available, as well as the existing apps related to cardiology from the leading app stores and to then classify the results to see what is available and what is missing, focusing particularly on commercial apps.Two reviews have been developed. One is a literature review of mobile systems and applications, retrieved from several databases and systems such as Scopus, PubMed, IEEE Xplore, and Web of Knowledge. The other is a review of mobile apps in the leading app stores, Google play for Android and Apple’s App Store for iOS.Search queries up to May 2013 located 406 papers and 710 apps related to cardiology and heart disease. The most researched section in the literature associated with cardiology is related to mobile heart  monitoring systems and the methods involved in the classification of heart signs in order to detect abnormal functions. Other systems with a significant number of papers are mobile cardiac rehabilitation systems, blood pressure measurement, and systems for the detection of heart failure. The majority of apps for cardiology are heart monitors and medical calculators. Other categories with a high number of apps are those for ECG education and interpretation, cardiology news and journals, blood pressure tracking, heart rate monitoring using an external device, and CPR instruction. There are very few guides on cardiac rehabilitation and apps for the management of the cardiac condition, and there were no apps that assist people who have undergone a heart transplant.The distribution of work in the field of cardiology apps is considerably disproportionate. Whereas some systems have significant research and apps are available, other important systems lack such research and lack apps, even though the contribution they could provide is significant. According to reports from the World Health Organization, an estimated 51 million people died in 2008 from any type of disease, communicable and noncommunicable, with the latter causing the most deaths. Among them, the worldwide leaders in mortality are cardiovascular diseases (CVDs), with 17.3 million deaths in 2008 alone, representing 30% of all deaths globally. Moreover, these deaths occur in a disproportionate way, with more than 80% occurring in low- and middle-income countries. Regrettably, no better outlook is expected, since it is estimated that more than 23 million people will die annually from CVDs by 2030 [Ischemic heart disease (or coronary heart disease) is especially fatal among CVDs, responsible for 7.25 million deaths in 2008. Further, there are more heart-related diseases with a significant fraction of deaths, such as hypertensive heart disease and inflammatory heart disease. In fact, more people die of heart malfunction than of AIDS and all cancers combined. The contribution of these diseases to disabilities is notable—62,587 million Disability-Adjusted Life Years (DALYs) are due to coronary heart disease. These data mean massive costs to the economy of all countries, being estimated at US$448.5 billion in the United States alone in 2008 [In light of such statistics, it is imperative that we reduce these numbers, not only in health care environments such as hospitals or primary health care facilities, but also in patients’ homes and workplaces. To meet this objective, mHealth, defined as “the use of mobile computing and communication technologies in health care and public health” , is of uTo aid in this initiative, it is important to acknowledge the use of smartphones and tablets as devices that have become essential to users in recent years. In numbers, there were more than 6 billion mobile subscriptions and more than 1.7 billion mobile phones sold in 2012 alone, of which 712.6 million were smartphones -21. The The aim of this paper is to conclude research on mobile applications for the most important diseases and health conditions, which we began previously with a study about mobile applications for the most prevalent health conditions . This tiTwo reviews were developed and took place up to May 2013. The first was a review of existing mobile systems and applications in the field of cardiology found in the literature, and the second, a study of commercial apps related to cardiology found in the leading app stores.To perform the literature review, the following systems and databases were used: Scopus, IEEE Xplore, Web of Knowledge, and PubMed. The methodology followed is presented in The results were limited to the last 10 years, from 2003 to the present day, and the eligibility requisites used were the following: only papers published originally in English were studied. Publications about mobile systems or applications not focused on cardiology or designed for more than 3 different fields were dismissed, but if the application was intended for 3 disciplines or fewer with being cardiology one of them, then it was included in the review. Similarly, papers regarding systems for many diseases (not only cardiac diseases) were rejected. Articles with algorithms for classification, detection, compression, encryption, or authentication of ECG data (or other types of heart signs) were studied, but publications about the possible influence of the electromagnetic fields irradiated by mobile phones in the heart rate or in implanted cardiac devices were dismissed.When the selection of papers was finished, the authors convened in order to classify the articles in different categories by reading their abstracts as well as the whole article when required. Once this process was completed, a revision was done and similar categories were merged to obtain a more condensed classification.The second review was a search of apps related to cardiology in the two leading commercial stores for smartphones ,24: the The methodology used in this review is the same used in the previous one, shown in In the App Store, since the apps are separated for iPod and iPhone and for iPad, only the first ones were searched, although in many cases they were also available for iPad. During the search on Google play, some problems arose. When searching by “cardiology” or “heart”, the store indicated that there were at least 1000 results, although it showed only 480. Google was asked about this discrepancy and the issue is still under investigation; hence, it was decided to use other search words in order to obtain the highest number of apps related to cardiology in this store. These words were infarction, heart attack, heart failure, heart disease, fibrillation, coronary heart, angina, and arrhythmia. Additionally, in some of these new searches on Google play, it was indicated that a certain number of results has been found but, when exploring the pages of the results found, the last pages  were blank. This issue did not affect the review since the apps studied are the ones shown, although it is not known if there were more apps that were not visible due to this error.Once the selection of cardiology-related apps was complete, the authors convened again to sort the apps by their purpose in different types, by reading the summary and explanation given by the stores and downloading them when the explanation specified was not clear enough. In these cases, the smartphones used were an iPhone 4 if the app was designed for iOS and a Samsung Galaxy S SCL GT-I9003 in the case of an app for Android. Finally, revisions were done in order to shorten the classification, similar to the process followed in the literature review.A total of 406 relevant papers were found in all the databases and systems used. The classification of the papers by their content is shown in In A total of 710 relevant apps were found in the App Store and Google play, although we note that some apps are available in both stores. In this study, these apps are counted separately. Hence, 439 apps are available for iOS and 271 for Android. The majority of the apps for iOS are found in the categories of Medicine (303) and Health & Fitness (111), whereas the remaining are included in Utilities (8), Education (7), Entertaining (3), Lifestyle (2), Sports (2), Books (1), Reference (1) and Social network (1). The apps for Android are found in the categories of Medical apps (188), Health & Fitness (65), Education (8), Lifestyle (7), and Books & Reference (3). The classification of these apps sorted by their functions and in decreasing order are shown in If the classification was performed taking into account the target public to whom the app is destined, another sort was conducted. To understand Finally, statistical values on the prices of the apps separated by commercial store are summarized in In light of the results presented in the previous section, several interesting findings can be extracted. Focusing on the literature review, the majority of the 406 articles found are about systems that normally use a mobile phone or smartphone and only a small percentage concerns mobile apps exclusively. In addition, as An example of a heart monitoring system is the one proposed by Yap et al (2012), which uses a chest-belt wireless ECG measurement system in combination with an Android app for monitoring ECG in real time . In thisOther systems with a number of papers are the following: cardiac rehabilitation mobile systems ,36, extrExamining the dates of publication of these papers, shown in In the review of cardiology-related apps, many outcomes were observed. The first notable conclusion from classification  is the dDespite the fact that the classification shown in There are other categories with very few apps (or even no apps), which could provide significant assistance and help. Examples are guides for cardiac rehabilitation and apps for the management of a cardiac condition, with only one app of each type.Since a rehabilitation program for people who have suffered or suffer heart problems (or have had a heart surgery) is vital ,38 in orComparing the results for each store, several conclusions can be made. First, there are more apps related to cardiology in the App Store, despite the fact that Android is more prevalent than iOS ,24. FiguThere are various lines of investigation for further research. New applications are needed for the management and monitoring of specific cardiac conditions, designed for the patients affected by them, since there are few currently available. The development of applications with this aim could be rather valuable. Another potential field of research could be the creation of an app with guidelines and information for people who have undergone a heart transplant. Such an app could assist them in their new condition and facilitate their new state. Another field to supply is related to resuscitation guides and instructions. Although there are several useful apps with such functions, the creation of an app with different functionalities parallel to the existing ones could be another beneficial field of research, perhaps developing the idea of the location of cardiac emergencies for people trained in resuscitation skills.


Abdominal pain is a common symptom in the ER, covering 10% of the assists. The delay in diagnosis and treatment adversely affects the patient's prognosis.Transabdominal ultrasonography is most commonly used to obtain images of hepatobiliary, urogenital, and pelvic structures. However, improvements in ultrasound technology and increasing familiarity with ultrasonographic findings in a variety of gastrointestinal disorders, as Crohn's disease (CD), are broadening its applications, and it is an aspect to be considered by EP in patients with recurrent abdominal painwe present a case of CD, diagnosed at ER, through the use of US scanning used by EPa patient with abdominal pain, with a final diagnosis of an CD36 year old male, was admitted to the ER for the third time by abdominal pain. Emergency analytical were unremarkable, as in the preceding cases. Because of the pain the emergency physician underwent an ultrasound scan observing area terminal ileum same transmural thickening with luminal narrowing and decreased peristalsis, involvement of the mesenteric lymph nodes and multiple underlying fat, suspecting CD. We entered the patient performing CT abdomen and ileo-colonoscopy confirmed the diagnosis.Bedside ultrasound of the patient by the EP could be an useful tool in cases with abdominial pain whose clinical data and laboratory are unclear. Suspicion of CD, the sensitivity of ultrasound is nearly 90%, especially if ileal location, as in the case presented; being the specific data and the transmural segment thickening, and the presence of fistulae or abscesses. Stenosis exists ultrasound specificity is greater than 95%. Due to its great advantages such as low cost, accessibility, not irradiated and non-invasive ultrasound should be considered in the diagnosis and monitoring of all CD, therefore EP must be trained to diagnose sonographically acute complications of this disease.The study was conducted in accordance with the ethical standards dictated by applicable law. Informed consent was obtained from each owner to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.