Background: The past decade has witnessed the establishment of flexible and integrative treatment (FIT) models in 55 German and Polish psychiatric catchment areas. FIT is based on a global treatment budget (GTB), which integrates funding of all acute psychiatric hospital services for a regional population. Prior research has identified 11 specific program components of FIT in Germany. In this paper we aim at assessing the applicability of these components to the Polish context and at comparatively analysing FIT implementation in Poland and Germany.Methods: Qualitative interviews about the applicability of the 11 FIT-specific components were conducted with the program managers of the Polish FIT models (n = 19). Semi-quantitative data on the FIT-specific components were then collected in 19 Polish and 10 German FIT models. We assessed the grading of each component, their overall degree of implementation and compared them between the two countries. In all study hospitals, structural and statistical parameters of service delivery were collected and compared.Results: The qualitative results showed that the German FIT-specific components are in principle applicable to the polish context. This allowed the comparative assessment of components grading and degree of implementation, which showed only subtle discrepancies between German and Polish FIT models. The little discrepancies point to specific aspects of care such as home treatment, peer support, and cooperation with non-clinical and social welfare institutions that should be further integrated in the components' definition.Conclusions: The specific program components of FIT as first defined from the German experience, serves as a powerful tool to measure, and evaluate implementation of integrated psychiatric care both within and between health systems. In recent decades, health service providers in several countries have made extensive efforts to establish community crisis alternatives to inpatient psychiatric admission. In Europe and the UK there is now a broad spectrum of team-based, outreach and integrative care models for assisting people with severe mental illness (SMI) –4. In adGermany and Poland are countries where acute psychiatric care is still predominantly provided in inpatient settings . There iIn Germany, integrated psychiatric care was first introduced with a legislative reform in 2000, allowing service providers—of both in- and outpatient sectors—to contract with selected statutory health insurance companies for a joint delivery of assertive outreach care . A GTB wThe development of FIT in Poland is based on a statutory health reform, namely the National Mental Health Program (NMHP), which was initiated in 2008. The key aim of the program was to reduce the need for inpatient wards by increasingly diverting to outpatient psychiatric care. This aim was pursued in two phases, namely first through the introduction of Community Mental Health Teams  and then of Mental Health Centres MHCs; 2017–2021) in 33 selected catchment areas –2021 in .The initial outcome evaluation studies of FIT (and of its precursor models) in Germany have shown a significant reduction of inpatient length of stay, as well as an increase of service users treated in the day-patient, outpatient and outreach settings –21. TheyThe aim of this exploratory study is to examine comparatively the structures and processes of FIT models in Germany and Poland, and to address the following research questions:What are the fundamental similarities and differences between service provision in the Polish and German models of integrated psychiatric care?To what extent can specific program components of the German FIT models be adapted for assessing implementation in the Polish context?This study was carried out between February 2020 and July 2021 under the auspices of the Polish-German Society for Mental Health (PGSMH). The aim of this psychiatric society is to strengthen exchange in research, practise, and thus cooperation between the two countries .As part of a previous process evaluation study , 11 empiWe selected a total of 30 model regions each in Germany and Poland on the basis of defined structural criteria, which included population density in the catchment area and duration of the model project. Thereby we aimed at representing the broadest possible spectrum of different FIT implementations. Of the 22 clinics that had adopted FIT in Germany as of August 2021, 10 clinics participated in the study. These are located in Heide, Itzehoe, Glauchau, Lüneburg, Riedstadt, Berlin (districts of Kreuzberg and Neukölln), Rüdersdorf, Bonn and Bochum. The data from the German clinics (except from Rüdersdorf) had been collected as part of a nationwide study to evaluate the effectiveness, costs and processes of FIT models  . Of the Specific FIT components see  enable uBefore being able to grade the FIT-specific components in the Polish MHCs, we had to validate and confirm the applicability of the components in the Polish model regions. For this purpose, we initially carried out qualitative expert interviews with managers and program developers from all Polish study centres . The intp < 0.05%) between the German and the Polish study centres. This question was addressed deductively, with testing of the null hypothesis “the same total score values in both countries” using the Mann-Whitney test. Due to the exploratory nature of this study, we made no alpha adjustment. The analyses were carried out with the SYSTAT software, version 13. Component one had to be excluded from the evaluation, as insufficient parameters were available for its quantification . Quantitative grading data were analysed in a series of steps: First, the components values and the total score were calculated for each centre and tabulated using descriptive statistics. The total score of overall FIT compliance was calculated as an equally weighted mean of each component value; in other words, all components were considered to be equally important dimensions of FIT implementation . We thention see . MissingTo be able to compare German and Polish study clinics and to contextualise FIT grading results, additional data were collected  from each study region. Performance data parameters were calculated based on routine data at each centre and then transmitted to the study team. All parameters collected were grouped for Germany and Poland and if possible, mean and standard deviation, weighted by the number of cases or patients, were calculated.Structural and statistical parameters of the Polish and German FIT models are summarised in In comparison to Germany, in Poland a relatively larger number of model regions has emerged in a much shorter period of time. In both countries, model clinics are mainly located in departments at publically owned general hospitals. The Polish centres have switched their entire care to model care, while the majority of German clinics provide model care only for patients covered by certain statutory health insurance companies. Polish models are mainly implemented in relatively less unpopulated catchment areas.In both countries, the majority of patients receive outpatient treatment, although this proportion is slightly higher in Poland. On the other hand, the day-clinic setting is increasingly used in Germany. The proportion of patients being treated in two to three different settings is slightly higher in the German model regions.n = 16) and program developers (n = 6) of the Polish models (n = 19) who participated in the survey rated all (sub-) components as generally suitable for the Polish context. However, some participants reported that certain FIT-specific components have a different relevance in Poland than in Germany and lack some aspects they deem crucial to the Polish FIT models. These differences are presented alongside the FIT-specific components as follows:In summary, managers .V. Therapeutic group sessions across all settings: In the Polish models, therapeutic groups are usually not offered across different settings. Survey participants attributed this to a differing underlying therapeutic concept, whereby group processes may be disrupted by the simultaneous presence of acute (= inpatient) and less acute  patients.VI. Outreach home care: This component is operationalized in the German FIT-components as acute treatment with a minimum treatment intensity of one home visit per week. In Poland, on the other hand, the intensity is controlled flexibly (sometimes <1 contact per week), since the treatment tended to be community-based and non-acute.VIII. Accessibility of services: The sub-component “waiting lists for patients with a request for admission” is mostly not implemented in the Polish FIT models, as the legal stipulation (NMHP) of Polish FIT explicitly calls for patients to receive care within 72 h after the first contact with mental health services.X. Cooperation across Sectors: The division of the sub-components on cooperation between actors in the social and health systems applies to both countries. Yet, the term “sector” [sektor] is used in Polish only to delimit these two areas of care, while it is used vaguely in German . Therefore, the Polish experts recommended using a more precise definition, such as “Cooperation across Institutions and Sectors.”XI. Expansion of professional expertise: The training and employment of peer-support workers is a high priority in the Polish models but is not included in the current version of the FIT-specific components.p = 0.02). The individual total score of each study centre can be found in the With a mean total score of 0.99, the German clinics were slightly higher in the overall degree of implementation than the Polish clinics with 0.75 see . AlthougThe mean ratings of the individual components in Germany and Poland are presented in The main result of the qualitative analysis is that the specific program components identified based on the German FIT models are generally suitable for describing the implementation of the newer Polish FIT models. We were able to operationalize and compare the characteristics of the FIT-specific program components in both countries, albeit with restrictions. Our comparison focuses on the differences between countries, and not between regions of a country.A central aspect in the qualitative findings concerned the operationalization of outreach home care (part of components III and VI): The Polish models operate according to the principles of CMHT, i.e., with independent outreach teams that carry out home visits as required, but with adaptation of the frequency and duration of contacts based on service users' needs . On the In the German operationalization of component XI  Peer Support Workers (PSW) are not included. In Poland, this professional group had existed at most of the sites since the advent of the FIT models . In the The overall degree of implementation proved to be significantly higher in the German than in the Polish regions, presumably in relation to the two-fold longer mean run-time of the FIT models in Germany. This is in line with previous evaluation results showing a growing degree of implementation over the duration of a FIT model project, or of a similar care and remuneration model , 39. NevGerman studies have indicated that clinics that have a FIT model contract with all health insurance companies implement the FIT components to a particularly high degree , 26, 39.From the perspective of health care systems, the present work reveals the advantages and disadvantages of a regulated market (RMS) vs. a national health system (NHS). Although by their formal typology, both countries qualify as RMS, the Polish NHF is more akin to an NHS. Since Poland has a single payer health service, it can presumably encourage reforms with greater effectiveness. In Germany, on the other hand, there is a patchwork of statutory health insurance companies. This makes it more difficult to implement system innovations—such as the FIT models—at the federal level, since all health insurance companies must first be convinced of its merits and have no obligation to enter such a contract. On the other hand, the possibility to conclude contracts with each single health insurance company—as it is in Germany—might enable a larger scope for small scale experimentation and for rapidly adopting new forms of care, since a decision need not occur at the federal level.This is the first comparative study assessing FIT in two different countries. As a first limitation of this study, we note that only 10 of 22 (45%) of model regions in Germany participated in the survey. Nevertheless, the sample can be regarded as representative, because the study centres were selected to reflect the broadest possible spectrum of the model clinics . For theThe FIT-specific components were developed in 2016 for German model regions, but proved robust for use in Poland, requiring only minor linguistic changes. However, the models in both countries have evolved, such that certain features are missing  or are not operationalized with sufficient precision . The qualitative survey made it possible to ensure that the existing components are generally suitable for use in the Polish model regions, with the acknowledgement of certain caveats.Ten German experts contributed to weighting of the specific components for the original total scoring of the FIT model implementation . In the Due to the naturalistic study design with only limited numbers of FIT-adopting hospitals in both countries, we cannot exclude the possibility of ß-errors when comparing results between Germany and Poland. In view of the identified qualitative differences between individual FIT components in the two countries, the composite value  could only approximately serve as a standard for comparison.The FIT-specific components were originally identified in Germany in 2016 in order to evaluate the introduction of innovative, cross-setting and ward-replacing treatment models  and to promote quality assurance. A similar model of care has been piloted in Poland since 2018. With regard to the key research questions this study showed that 1. despite considerable health system differences between Germany and Poland, their psychiatric FIT models are very similar in terms of their core aspects of service provision; 2. the FIT-specific components are generally suitable for use in Poland, but they should be further supplemented and better specified to enable a more precise assessment of implementation differences between the two countries. In Poland and in Germany, decisions on the continuation or steadying of the FIT models in standard care will be pending in the next few years. Such decisions will require more scientific comparative knowledge about the evaluation and the implementation of FIT models also at the national level. The present findings constitute a first important step in this direction and point to the need for further research on integrative psychiatric care within the framework of Polish and German Mental Health Policy.julian.schwarz@mhb-fontane.de.The datasets presented in this article are not readily available because of the used data protection declaration and the nature of qualitative interviews where individual participants could be possibly identified. Parts of the dataset are available from the research group on reasonable request. Requests to access the datasets should be directed to Julian Schwarz, JS, MH, AC, and JT designed the study and applied for funding. JS, JG, and AC collected the qualitative and quantitative data and further structural and statistical data of service provision in the German and the Polish study regions. The qualitative analysis was conducted by JS. Statistical analyses were conducted by JT. JS drafted the first version of the manuscript, AC and MH supervised them. All authors are involved both in the preparation of the study and in its implementation, participated in the interpretation of the results, critically reviewed and commented on the manuscript, read and approved the final version of the manuscript.This work was funded by Brandenburg Medical School, Neuruppin, Germany.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 revealed that higher consumption of fruit yoghurt could be significant determinant of excess adiposity in Polish preschool children.Evidence suggests there has been a decrease in childhood dairy consumption. There is a need for further studies to evaluate the types of dairy products in relation to the risk of obesity in pediatric population. The aim of the study was to determine the associations between the frequency of consumption of different types of dairy products and body composition and excess adiposity in preschool children from Poland. A cross-sectional study of 1172 children aged 5–6 years was conducted using a bioelectrical impedance analysis for body composition estimation and a modified food frequency questionnaire (FFQ-6) to assess the habitual diets of the participants. Among the analyzed dairy products, milk was consumed most often, followed by fruit yoghurts, yellow cheese, and cottage cheese, and natural yoghurt was the least common. Participants that consumed fruit or natural yoghurt more frequently had higher adipose tissue content. The logistic regression analysis by the method of forward selection showed that more frequent consumption of fruit yoghurt significantly increased the risk of excess adiposity among the total sample (OR = 1.20,  Childhood obesity is major public health concern and may negatively affect the immediate health of the child. While the cause of excess weight is multifactorial, changes in diet and decreased level of physical activity have been proposed as contributing factors to the obesity epidemic . EvidencSpence et al. , in theiWritten informed consent was obtained from parents or legal guardians prior to participation in the study. The study was approved by the Bioethics Committee at the Medical Department of the University of Rzeszów, Poland, and it was conducted in accordance with ethical standards laid down in an appropriate version of the Declaration of Helsinki. The study was conducted from October to November in each year from 2018 to 2019. The details of the study design and a partial analysis have been reported elsewhere .Children’s body weight and height were measured, using standard protocol and equipment, which was calibrated before and during the period of data collection. A portable stadiometer  was used to assess body height. Body weight was measured with a body composition analyzer . Individual body mass index (BMI) was calculated as body mass (kg) divided by height (m) squared.The body composition was measured using a bioelectrical impedance analysis (BIA) method by body composition analyzer . The participants’ parents were instructed to ensure their child did not consume any meals or drinks for at least 8 h before the examination . For theTo assess the habitual diets of the participants, the modified food frequency questionnaire (FFQ-6) was used, which was self-reported by the parents/caregivers . Noor Hap < 0.05.Statistical analysis was performed using the SPSS 25 software . The normality of distribution of continuous variables was tested with a Shapiro–Wilk test. Continuous variables were presented as mean (±SD), and categorical data were presented as n (%). The Mann–Whitney test was used to present a statistically significant difference between boys and girls. The associations between the consumption of dairy products and body composition was determined using the Spearman’s rho correlation coefficient. Logistic regression analysis by the method of forward selection (likelihood ratios) was used to identify factors associated with an excess adiposity. The level of statistical significance was adopted at The study group consisted of 1172 children (48.8% girls). The general characteristics of the study population, according to sex, are shown in p < 0.05).In The associations between the frequency of dairy products consumption and the excess BFP prevalence are presented in p < 0.001). Among girls, excess BPF was associated with more frequent consumption of milk and fruit yoghurt . Among boys, excess BPF was also associated with more frequent consumption of fruit yoghurt  and natural yoghurt .To the best of our knowledge, this is the first study to evaluate the associations between frequency of dairy products consumption and body composition and excess adiposity in preschool children from Poland. Overall, our findings suggest that among the analyzed dairy products, milk and fruit yoghurt were consumed most often, both in girls and in boys. Yellow cheese and cottage cheese were eaten less frequently, and natural yoghurt was the least frequently consumed. No difference in frequency of consumption of dairy products among girls and boys was found. Slightly different results are provided in the study of Abreu et al. , who aimOur results showed a positive association between the frequency of fruit yoghurt consumption and BFP in total sample and girls; however, these associations were weak  . MoreoveControlled intervention studies have also examined the associations between dairy and/or milk consumption and BPF or body weight. Calleja et al. , in a raOur results showed that more frequent consumption of milk, fruit yoghurt, natural yoghurt, and yellow cheese was significantly associated with excess BFP in total sample of preschool children. However, logistic regression analysis showed that the strongest predictor of excess adiposity in boys and girls was higher consumption of fruit yoghurt. This relationship may be explained by the fact that fruit yoghurts contain high amounts of carbohydrates , which promote the development of obesity . In the To comprehensively interpret the results, the particular age of the subjects should also be considered. The present study was conducted in kindergartens; therefore, during weekdays it could be assumed that half to two-thirds of daily nutrient needs were provided by the kindergarten staff, leaving one-third to one-half of daily intake to be chosen by parents. The same could be applied to meal times. Since the kindergarten menu in most cases is prepared under the supervision and guidance of dietitians, it seems to be particularly important to ensure an adequate level of nutritional education for parents. In order to prevent overweight and obesity at a later age, in addition to teaching preschool children to make appropriate nutrition choices, children should also be encouraged to maintain a high level of physical activity and minimize sedentary behaviors. This becomes especially important in the later years, when children start attending school and decide more about their own nutrition. As the child grows older, external factors such as the environment of peers, media coverage, stressful situations related to school and family environment, and eating habits in the family will have an increasing influence on the child’s nutritional decisions.The potential mechanism underlying any relationship between dairy products consumption and adiposity remains unclear. Several mechanisms were proposed to explain how dairy might affect energy balance and body composition. Dairy products are a significant source of calcium, vitamin D, and protein that may promote lower adiposity ,24. It hDue to the cross-sectional nature of the study and limited data, it is difficult to unambiguously explain the potential mechanism that could affect the relationships between the consumption of dairy products and body fat in the studied group. The observed differences in significant correlations between the frequency of fruit yoghurt consumption and BFP according to sex could be the effect of several additional factors that were not assessed in the present study, such as differences in energy expenditure , lifestyle factors, individual metabolism and other predispositions to obesity, as well as caloric intake from non-dairy products or the combination of certain products in the diet. The lack of these data should be considered an important limitation of the present study, as all of these factors could potentially affect the results.Our study has several strengths and limitations. A limitation of this study is the cross-sectional design, meaning the causal pathways underlying the observed associations could not be examined. Moreover, we cannot be certain that confounding factors, such as intake of other food products, level of physical activity, or genetic factors, have not influenced our results. There were insufficient data to calculate total daily energy, which would have improved our understanding of the mechanism underlying the observed relationship. Data collection was carried out in the fall; therefore, environmental factors could also potentially affect the physical activity patterns of children, which may influence body composition in addition to dairy intake. Although measures of both caloric intake in the diet  and energy expenditure  would have enriched our ability to draw conclusions from the results, the lack of those measures does not negate the relevance of this study to public health.The study, however, benefits from a number of strengths, including a relatively large sample size and a focus on early childhood. That is an important time frame that should be targeted by preventive strategies intended to reduce body fat and consequently, decrease the risk of noncommunicable diseases. Moreover, body composition was measured by using the BIA method that has demonstrated excellent test–retest reliability, moderately strong absolute agreement with DEXA, and high specificity for overfat and obese classification .Future research should include a greater emphasis on longitudinal studies to determine the long-term impact on weight and adiposity of inclusion of dairy products in children and adolescent. It is also important to examine the mechanisms by which dairy impacts weight and adiposity in order to provide a physiological understanding.Dairy products are usually the core of a balanced diet for children at an early age. Evidence-based and thoughtful directions for caregivers regarding dairy products intake could reinforce a harmonious and healthy development of adolescents. The results of the present study suggest that higher consumption of fruit yoghurt in Polish preschool children could be a factor that contributes to excess adiposity in this population. However, when interpreting these results, it should be taken into account that the potential mechanism by which the consumption of dairy products affects body fat is very complex and depends on many other factors.


Crowdsourced online genealogies have an unprecedented potential to shed light on long-run population dynamics, if analyzed properly. We investigate whether the historical mortality dynamics of males in familinx, a popular genealogical dataset, are representative of the general population, or whether they are closer to those of an elite subpopulation in two territories. The first territory is the German Empire, with a low level of genealogical coverage relative to the total population size, while the second territory is The Netherlands, with a higher level of genealogical coverage relative to the population. We find that, for the period around the turn of the 20th century , mortality is consistently lower and more homogeneous in familinx than in the general population. For that time period, the mortality levels in familinx resemble those of elites in the German Empire, while they are closer to those in national life tables in The Netherlands. For the period before the 19th century, the mortality levels in familinx mirror those of the elites in both territories. We identify the low coverage of the total population and the oversampling of elites in online genealogies as potential explanations for these findings. Emerging digital data may revolutionize our knowledge of historical demographic dynamics, but only if we understand their potential uses and limitations. The investigation of long-run population development is often limited by the availability of data. Recently, the digital revolution has produced an unprecedented amount of information that researchers can draw upon to study the historical development of human populations . For exa2This paper calls for a more cautious analytical treatment of online genealogies. Specifically, we evaluate the representativeness of two genealogy-derived lifespan measures: 1) remaining life expectancy at age 30 y and 2) lifespan variation measured by the Gini coefficient of the remaining life expectancy. To do so, we estimate male life tables from familinx, and compare them to two sets of “benchmark” life tables. The first set is national life tables that represent the general population. The second set is made up of life tables of scholars, a (knowledge) elite with higher social status and a mortality advantage .We find that lifespan estimated from online genealogies is biased toward the lifespan dynamics of elite populations . We explore two dimensions of the sample characteristics of familinx that drive this tendency: 1) The coverage of the total population in the genealogies is poor, and 2) elites (proxied by scholars) are overrepresented in the genealogies. We investigate these dimensions by studying two cases: the German Empire, for which the coverage of the total population in familinx is relatively low, and The Netherlands, for which the coverage of the total population in familinx is relatively high.We first compare male remaining life expectancy at age 30 y drawn from familinx, In both territories, herlands A and B. Reliable life tables for the two territories do not exist for the period before 1850. However, We now explore whether the coverage and oversampling of scholars in familinx help to explain the observed differences. We define coverage as the share of the real-world population  recorded in familinx in any given year A. The coSecond, we compute a factor of scholarly oversampling, that is, the ratio of the share of scholars in familinx (identified using pattern matching techniques) to the share of scholars in the total population B. We finWe showed that the historical lifespan duration and inequality in familinx, a popular dataset of crowd-sourced genealogies, do not resemble those of the general populations in two European territories. Indeed, we found that the lifespan measures in familinx are biased in the direction of the lifespan measures of scholars, a particular elite group for whom quality historical data are available. Familinx’ and scholars’ lifespan measures overlapped over the entire observation window in the German Empire, while, in The Netherlands, they did so up until the early 19th century. These findings are robust to a number of alternative specifications.The bias is more pronounced if the genealogies have poor coverage and representativeness. Elites are likely to be oversampled because they are more visible in the historical records than “ordinary” individuals, especially for more-remote historical periods. The development of vital registration systems accelerated the inclusion of nonelites in the historical record. This, in turn, improved both representativeness and coverage.The genealogists themselves may introduce social biases derived from their own sociodemographic profiles or if they are selective in their reconstruction of family trees. This problem may be compounded by biases affecting ascendant genealogies in general, such as survivor bias, lineage extinction, and data missing not at random . These pOnline genealogies offer an unprecedented wealth of historical information about human societies. In particular, the transnational network structure of the data promises to revolutionize our understanding of historical population dynamics, especially when combined with other data sources . Our stuSI Appendix). The remaining samples include 137,047 male deaths in 1500–1910 in the German Empire and 69,085 male deaths in 1600–1910 in The Netherlands. We exclude observations after 1910 given the known data quality issues in familinx for the 20th century derived from measures taken by ref. We use online genealogical data from familinx , keepingNational life tables constitute the benchmark for the general male population. For The Netherlands, we use life tables with 10-y time intervals and 5-y age groups drawn from the Human Mortality Database (HMD) for the period since 1850–1859. For the German Empire, we use life tables drawn from the Human Life Table Database for males in 5-y age groups in 1871–1881, 1881–1890, 1891–1900, and 1901–1910.We use life tables for scholars—that is, individuals who were active in universities and academies of sciences in the territories of interest—as a proxy for an elite population . Our samSI Appendix. Briefly, life tables estimated from the familinx data and the scholars’ data use two-dimensional smoothing with P splines (Life expectancies at age 30 y in  splines . We calc splines . Our fin splines , and theSupplementary File


Aerobics is the fusion of gymnastics, dance, and music; it is a body of a sports project, along with the development of the society. The growing demand for aerobics inevitably increases the demand for aerobics coach and teacher and has opened elective aerobics class which is an effective way of cultivating professional talents relevant to aerobics. Aerobics has extended fixed teaching mode and cannot conform to the development of the times. The motion prediction of aerobics athletes is a new set of teaching aid. In this paper, a motion prediction model of aerobics athletes is built based on the wearable inertial sensor of the Internet of Things and the bidirectional long short term memory (BiLSTM) network. Firstly, a wireless sensor network based on ZigBee was designed and implemented to collect the posture data of aerobics athletes. The inertial sensors were used for data collection and transmission of the data to the cloud platform through Ethernet. Then, the movement of aerobics athletes is recognized and predicted by the BiLSTM network. Based on the BiLSTM network and the attention mechanism, this paper proposes to solve the problem of low classification accuracy caused by the traditional method of directly summing and averaging the updated output vectors corresponding to each moment of the BiLSTM layer. The simulation experiment is also carried out in this paper. The experimental results show that the proposed model can recognize aerobics effectively. In the current era, aerobics , 2 is a The main training objectives are to develop physical fitness and cultivate interest. The required course of aerobics is aimed at the students majoring in physical education. Its training goal is to train students to have specific aerobics skills. The students of the aerobics class aim to train the aerobics professional and technical talents. With the development of society and the increasingly fierce social competition, the cultivation of students needs to conform to the changes of the current times and keep pace with the times. Students are required to learn basic calisthenics skills and consider the needs of students' future careers. The current aerobics special courses mostly use the traditional teaching model. With the development of time, students will feel that learning is boring, learning enthusiasm is not high, and the learning efficiency of technical movements is low. With the development of society and new curriculum reform requirements, aerobics' teaching materials and teaching have higher requirements. The teaching content needs to be gradually enriched, and the teaching methods need to keep pace with the times. The current trend of aerobics project development is to absorb excellent teaching methods or apply advanced teaching tools to traditional aerobics professional courses and promote teaching effectiveness.As a set of new teaching aids, the IoT-enabled wearable inertial sensor –15 and tThe IoT-based wearable inertial sensor and BiLSTM network aerobics action recognition model enrich the conventional aerobics teaching methods. It makes up for the deficiency of conventional teaching, provides a theoretical basis for the development of innovative aerobics teaching methods, and provides a theoretical basis for optimizing professional aerobics courses.By combining the attention mechanism on the BiLSTM network, we solve the problem that the traditional method directly sums up the updated output vectors corresponding to each moment in the BiLSTM layer. It takes the average value, which leads to low classification accuracy, to improve the robustness of the aerobics action recognition model.The main contributions of this paper are as follows:The rest of the paper is organized according to the following pattern. In Aerobics originated in 1968 from the space agency. In 1969, Jackie Solon defined aerobics as a combination of gymnastics and modern dance. The famous Swedish modern gymnast Meekman defined aerobics as “the rhythmic body movement into the gymnastic movements, which can not only reflect the creativity of movements but also conform to the progress of the times as a new form of gymnastics.” Masako Sato wrote “self-taught calisthenics” and opened the first calisthenics school in Japan in 1980, defining calisthenics as “the application of effective movements from jazz techniques to body movements, using the principles of gymnastics as part of gymnastics.”The popularization of aerobics teaching in various colleges and universities makes more students understand and love the aerobics movement. However, with the progress of the times, there are many problems in aerobics teaching, so each scholar has analyzed the aerobics teaching differently. Fan Yang, a scholar, thoroughly analyzed aerobics' teaching situation in colleges and universities in Beijing from teaching content and teaching methods. The primary deficiencies in aerobics teaching are analyzed: the students' lack of understanding and understanding of aerobics class causes the students to be not optimistic about aerobics learning and makes the teaching quality and efficiency of aerobics' more efficient courses are not high. The calisthenics teaching materials are old and mostly self-compiled. There is no scientific and complete teaching system, making it a stumbling block to the development of calisthenics. Only the reform can comply with the development needs of calisthenics. The teaching content is single and lacks innovation. There is no precise stage, and the teaching knowledge is simple, which cannot meet the current teaching show. At present, many colleges and universities use multimedia equipment or new forms in calisthenics teaching, but they generally use conventional calisthenics teaching.At present, many scholars have carried out much research on the teaching mode of aerobics, aiming to make up for the shortcomings of the traditional teaching mode . Among tThe ZigBee wireless sensor network is responsible for collecting the data of the inertial sensors and transmitting it to the cloud platform via Ethernet. The cloud analyzes the data and inputs it to the BiLSTM network  for aerox in the limb coordinate system to the reference coordinate system. The following equation can express this rotation relationship:BRq)−1 is the inverse of the quaternion (BRq). In addition, in the field of attitude estimation, a typical somatosensory network needs to process data from multiple magnetic-inertial sensors at the same time.Although Euler angles can more intuitively describe the posture of aerobics, there is a problem with gimbal locks. In addition, the quaternion method is more efficient to calculate, so this article uses rotating quaternion to describe any human body motion posture. Human pose estimation aims to find a rotating quaternion that can rotate any vector g is the gravitational acceleration, m is the strength of the Earth's magnetic field, bA is the linear acceleration interference introduced due to human movement, bM is the magnetic field interference generated by the ferromagnetic material in the environment, nA and nM are the sensors generated by the sensor measurement, respectively, noise can be simply assumed to be Gaussian white noise with zero mean.The measurement signals of accelerometers and magnetometers can be divided into the following parts:ω is the angular velocity and nG is the measured noise, which is considered to be Gaussian white noise with a mean value of zero.The measurement equation of the gyroscope is as follows:In this paper, a new neural network model –27 is cot of the BiLSTM layer is updated as follows:ht is composed of forward ht and backward ht states and Wf, Wi, Wo, and Wc are the forget gate, input gate, output gate, and updated weight, respectively.Each sequence of BiLSTM has two LSTM layers: forward and backward, respectively, which makes up for the lack of contextual semantic information of LSTM. Each LSTM layer corresponds to an output layer. The bidirectional structure provides complete past and future context information at each moment in the input sequence of the output layer. The gate mechanism determines the transmission of information and can learn information that is important to current information. The forget gate determines which information is not important for classification. The input gate determines which information needs to be updated. The output gate determines which information to output; the state information of the hidden layer at a time The two functions of the attention mechanism are as follows: selecting the important information within the visual scope and reasonably arranging focusing visual resources to present the important information. Neural network attention mechanism can make the network model focus on the information input and then select the essential characteristics of the attention mechanism to accept any input. Regardless of its structure, under the condition of limited computing power, attention mechanism is the main method to solve information overload and a kind of effective resource allocation scheme; computing resources can be allocated to more important task information.In the process of aerobics movement recognition, the traditional method directly sums up the updated output vector corresponding to each moment of the BiLSTM layer. It takes the average value so that it is assumed that each feature has the same contribution degree. However, feature vectors represent high-dimensional sparse features with a large number of noise and redundant features. Direct summing and averaging will easily lead to low classification accuracy. Therefore, we expect redundant or unimportant features to take a smaller proportion of weight. In comparison, features with a strong ability to distinguish categories will take a more significant proportion of weight.In recent years, the attention mechanism has been applied to various recognition tasks , 31. It Feed the two parts of the input layer to the model for training. After passing the BiLSTM layer and the attention mechanism layer, the cross-entropy loss function of the model is calculated through the softmax layer as shown in the following equations:This study selects 800 college students from a certain city as the research objects. According to their gender and aerobics level, they are divided into male, first-grade aerobics, male second-grade aerobics, male general, and female athletes. There was no statistical difference in basic information such as height, weight, and BMI for 10 people in each group, including the first-level female aerobics group, the second-level female aerobics group, and the female general student group.The experimental environment configuration is Intel i5-3337U 1.8 GHz, 4G memory, Windows7 64-bit system. The experimental simulation uses a framework based on TensorFlow 1.9.0, and the programming language is implemented using Python 3.5 and MATLAB R2017b.∗ is the action category recognized by the model.Figures 4It can be seen from the above results that when performing action recognition on aerobics, recognition rates of 84.59%, 81.74%, 88.70%, and 85.22% were obtained, respectively, which proves the effectiveness of the model in this paper.In this paper, a motion prediction model of aerobics athletes is built based on the wearable inertial sensor of the Internet of Things and the bidirectional long short term memory network. Firstly, a wireless sensor network based on ZigBee was designed and implemented to collect the posture data of aerobics athletes through inertial sensors. It transmits the data to the cloud platform through Ethernet. Then, the movement of aerobics athletes is recognized and predicted by the BiLSTM network. Based on the BISTM network and the attention mechanism, this paper proposes to solve the problem of low classification accuracy caused by the traditional method of directly summing and averaging the updated output vectors corresponding to each moment of the BiLSTM layer. The simulation experiment is also carried out in this paper. The experimental results show that the proposed model can recognize aerobics effectively. It enables students not only to learn the movement routines but also essential in learning the arrangement methods and leading exercises of high-quality courses. It constantly imitates and learns, finds the way and style suitable for their own, stimulates students' innovation ability, and promotes improved aerobics courses' quality.


Healthcare organisations face major challenges to keep healthcare accessible and affordable. This requires them to transform and improve their performance. To do so, organisations must influence employee job performance. Therefore, it is necessary to know what the key dimensions of job performance in healthcare are and how these dimensions can be improved. This study has three aims. The first aim is to determine what key dimensions of job performance are discussed in the healthcare literature. The second aim is to determine to which professionals and healthcare organisations these dimensions of job performance pertain. The third aim is to identify factors that organisations can use to affect the dimensions of job performance in healthcare.A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The authors searched Scopus, Web of Science, PubMed, and Google Books, which resulted in the identification of 763 records. After screening 92 articles were included.The dimensions – task, contextual, and adaptative performance and counterproductive work behaviour – are reflected in the literature on job performance in healthcare. Adaptive performance and counterproductive work behaviour appear to be under-researched. The studies were conducted in different healthcare organisations and pertain to a variety of healthcare professionals. Organisations can affect job performance on the macro-, meso-, and micro-level to achieve transformation and improvement.Based on more than 90 studies published in over 70 journals, the authors conclude that job performance in healthcare can be conceptualised into four dimensions: task, contextual and adaptive performance, and counterproductive work behaviour. Generally, these dimensions correspond with the dimensions discussed in the job performance literature. This implies that these dimensions can be used for further research into job performance in healthcare. Many healthcare studies on job performance focus on two dimensions: task and contextual performance. However, adaptive performance, which is of great importance in constantly changing environments, is under-researched and should be examined further in future research. This also applies to counterproductive work behaviour. To improve job performance, interventions are required on the macro-, meso-, and micro-levels, which relate to governance, leadership, and individual skills and characteristics. Together with governments and policymakers, healthcare organisations face major challenges to ensure healthcare remains accessible and affordable. This requires healthcare organisations to transform and improve their performance. These challenges cannot be met without the involvement and excellent performance of healthcare employees.The Organisation for Economic Cooperation and Development (OECD) expects that in 2050, almost 27% of the population will be over 65 years old and more than 10% will be over 80 . AccessiJob performance has been widely discussed and conceptualised in various ways . This isTask performance has a direct relationship with the organisational technical core –14. The Which of the four job performance dimensions are described in studies focusing on job performance in healthcare?To which professionals and health organisations do the dimensions of job performance discussed in the studies pertain?How and on which level can organisations affect the job performance of healthcare professionals?To change and improve the performance of healthcare professionals, and thus the performance of healthcare organisations, it is important to determine whether the four dimensions can be used as a reference for job performance research in healthcare. Although Greenslade and Jimmieson (2007) propose a framework, it focuses specifically on nurses and only includes the task and contextual performance dimensions, thus having little applicability in healthcare research in general. Therefore, it is important to determine how job performance in healthcare is treated in the research literature and whether it relates to the dimensions of task, contextual, and adaptive performance and counterproductive work behaviour. To arrive at findings about whether the four dimensions can be applied to the broad field of healthcare, it is important to investigate in which sectors of healthcare and in relation to which professionals the dimensions have been used in research. Finally, to change and improve the performance of the healthcare professional, it is relevant to determine how and at which level organisations can implement changes to affect job performance. In summary, the purpose of this review is to answer the following questions:This research was accomplished by conducting a systematic literature review. The method section describes the process of identification, screening, and assessing the eligibility of studies. The results section begins with an overview that sets out the distribution of the studies. The overview reveals in which year, and in which journal the articles were published. It also details whether studies were carried out in developed or developing countries. Further, this paper explains how it assesses the methodological quality of the studies. Following this overview, this paper presents the answers to the research questions, beginning first with the job dimensions identified in the selected studies, and then proceeding to an analysis of the type of organisations the studies examined and the healthcare professionals to which the studies pertain. Finally, the results section describes the factors that can affect job performance at different organisational levels. The discussion section discusses the results and reflects on a few of this paper’s limitations. The conclusion section provides suggestions that can be used for future research on job performance in healthcare based on this study’s findings.The literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement . To findStudies included in the review must meet the following criteria. They must relate to job performance in the field of healthcare. Job performance or comparable terms, such as work performance or work behaviour, must appear in the title or abstract. Studies that examine at least one of the four dimensions or related terms are also eligible. Studies published between 1996 and December 2019 were selected. As part of the pragmatic approach to gathering literature, only studies written in English were considered. All articles published in international journals that were selected for this study must have been peer-reviewed.Through the search strategy, 763 records were identified, including four books. After 17 duplicates were removed, the titles and abstracts of the remaining 747 records were screened. This resulted in the exclusion of 497 records (including three books). Although the studies are related to healthcare, job performance was not the main objective of these studies. For example, a few studies examine musculoskeletal disorders and their impact on nursing tasks , 17. OthFull-text articles were not available for two studies. After completing the process of screening and analysing the articles, a total of 92 articles, including one book chapter, met the eligibility criteria. The study selection process is depicted schematically in Fig. After categorising the articles by year of publication and the journals and countries in which they were published, the methodological quality of the studies was assessed using the integrated quality criteria for the review of multiple study designs . StudiesBefore answering the research questions, this paper provides an overview that sets out the distribution of the studies. The overview reveals in which year and in which journal the articles were published. It also shows whether the studies were carried out in developed or developing countries. Results of the assessment of the methodological quality of the studies are provided below.Table , ergonomics [BMC Health Services Research, the Journal of Advanced Nursing, the International Journal of Medical Informatics, and the Journal of Managerial Psychology. Most of the studies were conducted in a single country, which raises questions about their external validity.The articles included in this review were published in 76 different journals . The jougonomics , and crigonomics . Almost Figure To assess the methodological quality of the studies, the ICROMS quality assessment tool was used . The tooThe ICROMS tool has a scope for further development of quality criteria applicable to additional study designs, such as surveys and cross-sectional studies . TherefoThe first research question examines which of the four dimensions of work performance  are described in studies of work performance in healthcare. The results show that these dimensions are applicable to work performance in healthcare.The review of the literature revealed studies that directly refer to Motowidlo et al. , who claPatient feeding , direct The results reveal that over 47% of the studies focus on task performance, such as primary care tasks , supportThe second research question concerns the type of healthcare organisations in which the studies investigate job performance and the type of healthcare professionals to which the studies pertain. The studies examine job performance in several healthcare fields and with respect to various types of healthcare professionals. Table About 52% of studies in the sample concern the job performance of nurses , meso-level (management/team), and micro-level . This distinction reveals that the job performance of healthcare professionals can be affected on all three levels.On the macro-level, job performance can be affected by how an organisation is structured , the extAt the meso-level, managerial support and supervision and training programmes contribute to job performance levels , 76, 91.On the micro-level, the extent of work engagement, role clarity, and autonomy , 96, as opposed to person oriented – affect job performance in a negative manner . In summfirst systematic review of the dimensions of job performance in healthcare, given that the study selection research process only produced one study that examine frameworks on job performance in healthcare. This one exception concerns Greenslade and Jimmieson’s framework; however, their study focuses specifically on nurses and thus is not broadly applicable to the field of healthcare [To the best of the authors’ knowledge, this paper appears to be the althcare . The revStudies concerning job performance in healthcare tend to apply at least one of the four dimensions of job performance. Studies without a direct reference to the task, contextual, or adaptive performance or counterproductive work behaviour dimensions offer descriptions of the activities, skills, and behaviours of healthcare employees. Based on the definitions of the dimensions, these activities, skills, and behaviours are attributable to at least one of the dimensions of job performance. Therefore, future studies about job performance in healthcare could be built on these dimensions.Although the four dimensions do appear in healthcare literature concerning job performance, there is a discrepancy in the extent to which the dimensions have been studied. Task performance (49%) and contextual performance (39%) have been exhaustively investigated, whereas adaptive performance (8%) – which is also of great importance in constantly changing environments such as healthcare – appears to be under-researched. The same is true of the counterproductive work behaviour dimension, which can have a substantial and negative effect on job performance. Authors should consider this gap in job performance research in future research endeavours.This review shows that scholars have studied the dimensions in different types of healthcare organisations and with reference to a variety of healthcare professionals. The main type of healthcare organisation the studies examine is hospitals and the departments and wards within them. About 22% of the studies were conducted in nursing homes, community centres, and home care organisations (among other organisations). Because most studies were conducted in hospitals, it was expected that most of the surveyed professionals would be physicians (26%) and nurses (52%). Other professionals the studies examine include mental healthcare professionals, psychologists, pharmacists, lab technicians, and supervisors. Consequently, the results show that the task, contextual, and adaptive performance and counterproductive work behaviour dimensions all apply to the broad field of healthcare and pertain to professions that exist within the healthcare sector. As such, these dimensions are useful for examining job performance in the broad context of healthcare and healthcare professionals.This research not only investigated which dimensions of job performance can be used in the context of healthcare but also how and at what level these dimensions could be affected. The results show that the job performance of healthcare professionals can be affected on three levels. On the macro-level, the structure of an organisation, support for the board among an organisation’s employees, and organisational culture are examples of factors that affect job performance. At the meso-level, job performance can be affected to how management acts, how work is organised, and how teams function. On the micro-level, job performance is affected by employee motivation, the educational levels of the professionals in question, and employees’ personal characteristics. These levels are interdependent. Thus, organisations cannot simply improve the job performance of healthcare professionals in isolation from other efforts, and research aimed at improving job performance must be conducted with reference to these three levels. Given the apparently limited research regarding the adaptive performance and counterproductive work behaviour dimensions in healthcare, this paper suggests researchers investigate these dimensions with reference to the factors at the aforementioned levels to influence these dimensions.The review set out in this paper has a few limitations. First, it is not certain that the review identified and covered all studies concerning job performance in healthcare. One reason for this is the fact that only English articles were eligible for inclusion based on the eligibility criteria. By including studies that were conducted in non-English speaking regions and in both developed and developing countries, this paper tries to reduce the impact of this potential limitation. Second, since the search criteria focused on at least one of the four dimensions, there is a possibility that other potential dimensions may not have emerged from the results. A possible third limitation is based on the fact that job performance is described in many ways, and there are many different terms that could be related to dimensions of job performance. Finally, the ratio between studies that were conducted in developed and developing countries within the sample implies a validation risk. However, studies that were conducted in either developed or developing countries are referred to in Greenslade and Jimmieson’s  and MotoThis research aimed to provide a concept that can be used for research on job performance in healthcare. Based on an examination of more than 90 studies published in over 70 journals, this research shows that job performance in healthcare can be conceptualised into four dimensions: task, contextual, and adaptive performance, and counterproductive work behaviour. While some of the studies directly refer to these dimensions, other studies describe tasks, skills, and behaviours without making direct reference to the four dimensions. However, these tasks, skills, and behaviours were assigned to one of the dimensions of job performance if they were in alignment with their definitions. In healthcare studies on job performance, the focus is on task and contextual performance. However, adaptive performance, which is of great importance in a constantly changing environment, is under-researched and should be considered a topic for future research. This is also suggested for the counterproductive work behaviour dimension. To improve job performance, interventions – in conjunction with one another – are required on the macro-, meso-, and micro-levels, which concern governance, leadership, and individual skills and characteristics.


Since 2000, there has been qualitative growth in the field of scientometrics. Innovations such as the DOI and the ORCID have irrevocably changed the scientific landscape. They have enabled analyses previously unheard of, in the decades preceding the new millennium. This paper proposes open science indicators  as article-specific metadata fields. The authors reference the history of funding information, from bare acknowledgements to metadata field. The authors describe the mission of the Center for Open Science, and its TOP Factor database, as well as the performance of open science badges. Possibilities for a pilot study are explored, with an acknowledgement of the complexity of this undertaking. Since the electronic indexing of scientific publications, there has been qualitative growth in the scientometrics field. Innovations such as the DOI (2000) and the ORCID (2012) have transformed the landscape of our science. They have enabled bibliometric analyses that would have been unheard of years before. New bibliographic data sources such as Crossref (2000), Dimensions (2018), and Microsoft Academic (2016) are now challenging Web of Science and Scopus for their turf. The scientometric landscape is unfolding over time, driven by multiple stakeholders , from heterogeneous fields. This paper sets forth the possibility of open science indicators as metadata fields, functioning on an article-specific level.Psychological Science; Journal of Personal and Social Psychology; Journal of Experimental Psychology: Learning, Memory and Cognition). Surprisingly, the authors found that while 97% of the original set of studies showed statistically significant effect sizes, this was only reproduced in 36% of the replicated studies. This disclosure rocked the foundations of the scientific community, as it questioned the viability of a large percentage of its published findings. In response, the Open Science (OS) movement was born. The movement drew upon assumptions from the five OS schools of thought  and Scopus are considered the most comprehensive and most trusted data sources. These “titans of bibliographic information” are regularly used for journal selection, research evaluation, and bibliometric analyses , p. 1. IAn illustration of this reshaping can be seen in funding acknowledgements (FA), which are now accessible in WoS and Scopus metadata. These statements are typically one sentence in length, and provide acknowledgement of the research-funding source. In the 1990s, Another aspect of reshaping has been through public access mandates. These mandates were in response to the 2013 memorandum titled “Increasing Access to the Results of Federally Funded Scientific Research” . Further iterations could store repository information for open data, open material, and preregistration. For this task, the organization Crossref might be consulted. Crossref is a collective of academic publishers that is developing shared infrastructure to support more effective scholarly communications . What is needed at this point is a core group of scholars, committed to the vision of legitimizing OS indicators as metadata fields.We are aware of the challenges we face, in bringing this idea to fruition. We are aware of the time it took for FA information to be legitimized in bibliographic metadata—but in this digital age, we are hoping things run faster. We console ourselves that patience is required and that change does not happen overnight. Through this journey, our spirits are intact; we continue to follow our ideal. For a more transparent research culture, OS standards must move forward; OS indicators must move into the mainstream. They must be article-specific; they must be readily accessible; they must have metadata fields of their own.


The comments written by R. Otter et al., a consortium of toxicologists employed by the chemical industry, are essentially oriented towards three main themes to which we propose to provide some answers:The medical procedures used in the NICU of Clermont-Ferrand and Lille are those usually applied in neonatal intensive care units. The medical devices (MDs) used include respiratory assistance MDs , infusion and parenteral nutrition MDs , enteral nutrition  and transfusion. Many of these MDs are made of plasticized PVC. The use of these MDs and the rhythm of their replacement varies depending on a patient’s condition. In the context of our article, we wanted to carry out an overall assessment of patient exposure, without focusing on individual situations or kinetic monitoring. We therefore presented the exposure results by plasticizer and by type of treatment. For this purpose, we calculated an exposure dose based on various elements such as the plasticizer composition of each MD, its dimensions (contact surface with the fluid conveyed), the duration of the exposure, etc. The precise listing of all these factors does not seem essential to a good understanding of the study, does not bring any added value and would considerably burden down the manuscript.R. Otter et al. believes that our model is unreliable, and they provide references related to other diffusion models. The proposed references are related to gas-phase diffusion models studied the migration of DINP and DINCH. However, these plasticizers are not those contained in our respiratory assistance MDs, which are plasticized with DEHP. There are several publications presenting the diffusion of DEHP from PVC to gases ,3,4,5,6.We will let industrial toxicologists take responsibility for what they say about the toxicity of plasticizers, especially DEHP, and the potential risk to children they could cause. We simply wish to insist on the value of biomonitoring studies for estimating the exposure risk of individuals in real situations. We nevertheless take note of the arguments of R. Otter et al. to put the plasticizers’ toxicity into perspective. From our point of view as clinicians, only through the multiplication of biomonitoring studies is possible to judge the consistency of results. However, it is an indisputable fact that the first 1000 days of life represent a critical period during which neonates and children are particularly vulnerable to exposure to low doses of endocrine-disrupting substances, and the consequences can be serious ,9,10,11.® study are essential to enrich knowledge on the subject and provide all the elements aimed at securing the therapeutic care of patients. We believe that progress is still to be made to improve the quality of medical devices and to eliminate the presence of any compound that may present the slightest risk of being an endocrine disruptor.Field studies such as the Armed


Textile metal threads were used to decorate historical Croatian textiles. There are three basic types of metal threads usually used on historical textiles in Croatia. These are narrow stripes, wires, and combined metal textile yarn called “srma”, made of metal thread spirally wrapped around the nonmetal textile yarn. Textile yarns were made of silk, linen, wool, or cotton. Metal threads were primarily made of gold, silver, and copper, and different alloys of these metals or threads are layered in the structure. Analysis of metal threads with three different methods was made and the most adequate method for the analysis of metal threads from historical textiles was established. Metal thread analysis was performed with scanning electron microscopy with an energy-dispersive X-ray detector (SEM-EDX), which was determined to be the most suitable for the analysis of historical textiles if cross-section analysis of metal threads is also performed. Textile threads from combined metal textile threads were analysed with a light microscope. This information of the metal threads’ content and structure as well as the composition of textile thread can lead to an understanding of the technology of production threads and also temporal and spatial dating of textile objects which is helpful to conservators and restorers of valuable historical textiles. Precious metals have been used to decorate textiles since ancient times to create luxury items for the secular and religious elite. The topic of this paper is the analysis of metal threads and textile yarns wrapped with metal threads from Croatian historical textiles. The term historical textiles includes clothing of the peasant, civil, and aristocratic classes, and liturgical textiles from the period from the 17th to the first half of the 20th century . The conIn Croatia, garments have been decorated with metal threads since the Middle Ages (the period of the Old Croatian state) as evidenced by the findings of reticulated creations in graves. These remains speak of the early use as well as of the trade of the Kingdom of Croatia within the wider Mediterranean area . TextileAnalyses of metal threads in Croatia are determined in certain historical textiles mostly by thin-layer chromatography, inductively coupled plasma-optical emission spectrometry (ICP-OES) and using atomic absorption spectrometry (AAS). These methods are destructive and require the dissolution of samples prior to analysis. These destructive methods require special and long-term sample preparation. The results give a precise chemical composition, but do not provide an overview of the sample’s structure ,11. The Therefore, the SEM-EDX method was selected as most acceptable and suitable for the analysis of metal threads from historical textiles but it had to be used both in surface and cross-section analysis. This method is fast and simple and with minimal sample preparation, it reveals the morphology of the sample by SEM analysis, while the results of the EDX spectrum detect the chemical composition, but also the type and range of corrosion products found on the metal surface ,25,26.Samples of metal threads were collected with the permission and supervision of conservators and restorers so that only hanging threads were taken for analysis. All regions of Croatia are included: Osijek east, Varaždin north, Zagreb, Prilišće in central Croatia, Novigrad near Zadar, Split, and Dubrovnik in southern Croatia. Two groups of samples from metal thread stand out and these are from liturgical vestments and threads from folk costumes. Folk costumes unlike liturgical vestments often have some local characteristics related to the customs of that area and have special features. Liturgical vestments samples are from the Treasury of the Zagreb Cathedral, Varaždin City Museum, Prilišće Museum, Novigrad Museum, and Slavonia Museum in Osijek. Folk costumes samples are from Ethnographic Museum Zagreb, Museum in Sinj, Ethnographic Museum Split, Ethnographic Museum Dubrovnik, and Slavonia Museum in Osijek. a) metal narrow stripes or lamellas; (b) metal wires, and (c) combined metal textile threads called “srma”.Threads that are found on these historical items can be classified into three groups : (a) metMetal threads can be woven into textiles, part of a fringe hanging from textiles, but also it can be in the decorative ribbons stitched on textiles. There are 156 samples of metal threads, 73 are from liturgical vestments  and 83 fAnalysis of surface and cross-section of 156 samples was performed with SEM-EDX. Characteristics of used SEM-EDX device ; device type: MIRA FE-SEM, electron gun: Schottky emitter, operating voltage: 20 kV, electron flux current: 2 pA to 100 nA, working distance: 25 mm, detector: Bruker AXS, Quantax EDX detector type SDD (Silicon Drift Detector). Textile yarns from combined metal textile threads were analysed with a light microscope. The Olympus cx22 microscope with a total magnification of 100× was used for analysis.During the analysis, it was found that the cross-section of metal threads can be obtained easily by bending the thread at an angle of 90°. The metal thread was cut to a suitable length for measurement. It is placed at a right angle so that the cut tip (part) remains open towards the direction from which the electron beam is coming. In this way, the cross-section is visible as the surface that the SEM device scans. Due to the stiffness of the metal thread, it remains in a bent position, so there is no need to fix the thread with resin, no coatings on the samples were done. SEM-EDX can determine the metal composition inside the thread in a bent position . A greenSEM-EDX pictures  and analThe main difference between the chemical composition of metal threads from folk costumes and those from liturgical vestments is that in some threads from folk costumes nickel appears, and in some threads from liturgical vestments aluminium appears . HoweverThe main difference in comparing textile yarns from combined metal textile threads from liturgical vestments and those from folk costumes is that flax is present in some threads from liturgical vestments . TextileSilk is more represented in textile yarns from liturgical vestments than in textile yarns from folk costumes and only one in metal threads from the Treasury of the Zagreb Cathedral. Metal threads with silk core are of better quality and more valuable. Most textile threads from folk costumes are made of cotton which are lower quality threads .The textile part of combined metal textile threads is matched with the metal part in quality and colour. In samples with metal threads of gilded silver or pure silver, there is a silk textile core. Cotton and linen are textile parts of samples that have copper or copper alloys for the metal component. The gold metal threads contain yellow textile cores, while the silver ones contain a white textile core. All this indicates the dedication and attention to detail in the production of the metal threads used to decorate historical textiles.The liturgical vestment metal threads from the Treasury of the Zagreb Cathedral stand out in particular: they are the oldest from the 17th and 18th centuries and most valuable specimens of gilded silver and pure silver. The only textile yarn in combined metal textile threads is silk. These are items decorated by embroiderer Stoll, metal threads that he procured himself, and items donated by the empress Maria Theresa. Only the best materials, including metal threads, were preserved in the treasury . So the From folk costumes samples, the samples from Sinj stand out. They are the most valuable because silver dominates at about 60%, there is gold only on the surface of about 8%, and there is also copper in 30–40%. In the combined textile metal thread samples from Sinj, silk dominates as a non-metallic core, only two samples are made of cotton that have copper metal threads. There is no documentation of age for these samples but it is assumed that they are older ones.Liturgical and folk metal threads from Osijek are mostly made of pure copper and some of copper–zinc and also silver-plated copper and are from the 19th and 20th centuries. Gold is present only on the surface on two samples, averaging 3.8% in folk costume metal threads and three samples average 11% in liturgical vestment threads. It is observed that older metal threads from the 17th and 18th centuries are better quality with more gold and silver than those of the 19th and 20th centuries as stated in the paper by Karatzani .It is observed that there is more gold and silver on the threads of the liturgical vestment on the surface and in the cross-section, Metal threads were used as an ornament on festive folk costumes that were worn only on special occasions in women’s as well as men’s clothing . ExceptiDecoration of historic textiles with metal threads is very important in the cultural and religious life of Croatia and it reaches far into the past. In order to preserve this valuable historical textile from deterioration, its restoration and conservation are needed. Prior to each restoration procedure, a quick and easy detection of the used metal thread type is required. In this paper, the SEM-EDX method is presented as the most suitable for fast, simple, but also thorough analysis for this type of sample if a cross-section analysis is also performed. A simplified cross-sectional analysis of a metal thread is also presented in which, due to the stiffness of the metal, it is not necessary to place samples in the resin but only to bend the thread. By analysing the cross-section as well as the cross-sectional image with SEM-EDX, it is possible to determine whether samples are homogeneous or gilded and silver-plated.Knowing the type and structure of the metal thread, the approximate origin of the metal threads for unknown samples can be determined. The analysis confirmed that older threads are more valuable because they have more gold and silver than newer ones.Copper is the main element in metal threads from folk costumes but silver and copper are in metal threads from liturgical vestments. There is no copper on metal threads from Zagreb Cathedral liturgical vestments, only silver and gold. More gold and silver is found on metal threads from liturgical vestments than from folk costumes. The textile part of combined metal textile threads is matched with the metal part, so more silk is found on samples from liturgical vestments. Metal threads from liturgical vestments are more valuable than those from folk costumes because they are older, especially those from the Treasury of the Zagreb Cathedral.


The objective of this meta-analysis was to evaluate the factors associated with the mortality of elderly Italians diagnosed with coronavirus who resided in institutions or who were hospitalized because of the disease. Methods: A systematic review following the recommendations of The Joanna Briggs Institute (JBI) was carried out, utilizing the PEO strategy, i.e., Population, Exposure and Outcome. In this case, the population was the elderly aged over 65 years old, the exposure referred to the SARS-CoV-2 pandemic and the outcome was mortality. The National Center for Biotechnology Information (NCBI/PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used until 31 July 2020. Results: Five Italian studies were included in this meta-analysis, with the number of elderly people included varying between 18 and 1591 patients. The main morbidities presented by the elderly in the studies were dementia, diabetes, chronic kidney disease and hypertension. Conclusions: The factors associated with the mortality of elderly Italian people diagnosed with SARS-CoV-2 who lived in institutions or who were hospitalized because of the disease were evaluated. It was found that dementia, diabetes, chronic kidney disease and hypertension were the main diagnosed diseases for mortality in elderly people with COVID-19. One of the greatest achievements of humanity has been longevity, which—although there are still differences between countries influenced by the socioeconomic context of each—in general, is led by progress in the population’s health markers. Achieving old age, which was once the privilege of a few, has now become one of the world’s main goals and challenges .In this way, aging has become a global phenomenon and a success story for public health policies and socioeconomic development. However, there are new challenges for society that this presents. Our society needs to adapt to this new scenario, to maximize the functional capacity and health of the elderly and to promote their social inclusion and safe participation . In viewThe COVID-19 pandemic (SARS-CoV-2) has caused considerable mortality in populations considered at risk, such as the elderly population, especially those who are institutionalized, a scenario in which social isolation is difficult in a situation such as a pandemic. The vulnerability of this population is linked with the physiological aspects of aging, which impact the effectiveness of the immune system, triggering morbidity and mortality from infectious diseases .Thus, it is necessary to investigate the main factors that make institutionalized elderly people more vulnerable to death. Fragility is a condition that worsens with advancing age and with COVID-19 infection, especially for the hospitalized elderly, who tend to develop a more accentuated presentation of the classic symptoms of the disease .Since the onset of the COVID-19 pandemic, several studies have begun to be carried out in different contexts, generating scientific evidence and statistical data that point in certain directions. It has become a challenge for all related researchers to contribute to the advancement of knowledge regarding the reach of COVID-19 and the factors associated with mortality. In this specific case, it was proposed that we carry out a systematic review of studies published in Italy between March and July 2020 to identify such factors. The decision to select texts that were published from Italian research was made as local transmission first took place in Italy before the spread of COVID-19 went on to impact other European regions .In Italy, the contagion’s outbreak started on 20 February 2020, with the number of confirmed cases increasing by 428% in the following 30 days. Residential facilities for the elderly were the hardest hit, according to data released by the Istituto Superiore di Sanità (ISS) . The eldThe objective of this study was to synthesize the factors associated with the mortality of elderly Italian people diagnosed with coronavirus who lived in institutions or who were hospitalized because of the disease.The systematic review format was chosen based on the recommendations of The Joanna Briggs Institute (JBI), following the nine steps for its development: (1) construction of the preliminary research protocol; (2) formulation of the review question; (3) definition of inclusion and exclusion criteria; (4) search strategy; (5) selection of studies for inclusion; (6) data extraction; (7) synthesis of the data; (8) narrative summary; 9) references [ referencThis study used public, free-to-access articles located in databases of scientific literature. Primary studies on the mortality of elderly Italians with a diagnosis of coronavirus were selected, with publications in the English, Italian and Spanish languages included, which carried out quantitative and qualitative analyses. To formulate the research question, the PEO strategy was used, i.e., Population, Exposure and Outcome . It was Primary studies on the mortality of elderly people diagnosed with coronavirus;Studies in English, Spanish or Italian.The inclusion criteria for the selection of articles were:Studies that were not of Italian elderly people;Studies on the elderly who were not institutionalized or hospitalized;Studies that did not answer the guiding question of the systematic review.Once the inclusion criteria were established, these were set as the exclusion criteria:The search for publications was carried out in July 2020 in the following databases: The National Center for Biotechnology Information (NCBI/PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search strategy combined controlled and uncontrolled descriptors, according to the indication offered in each database. To search for articles on PubMed, controlled descriptors from Medical Subject Headings (MeSH) were used; Heading-MH was consulted for the CINHAL database; Embase subject headings (EMTREE) were used to search EMBASE; Health Sciences Descriptors (DeCS) was used to search LILACS. For these searches, “aged”, “coronavirus infections” and “mortality” were used. The Boolean operator “AND” was used in all combinations as follows: “aged AND mortality AND coronavirus infections”. There was no time limit for publication. For the selection of articles, the Rayyan application, developed by the QCRI (Qatar Computing Research Institute), was used, which helps in systematic reviews by facilitating the selection process for reading articles. That process took place in three stages: in the first stage, the databases were searched; secondly, the title and abstract were read: two researchers performed a bibliographic search and independently extracted data from the included studies, where disagreements were resolved by a third investigator or by consensus, with the aim being to identify studies for the third stage; thirdly, the articles were read in full, with the aim of selecting those that were in agreement with the inclusion criteria .While developing the search and selection of articles, from searching the databases to selecting studies by reading titles and abstracts or the full text, the PRISMA protocol was used  Figure  to guaraFrom the findings, the results were organized by performing a descriptive synthesis of the data, as shown in 2) statistic [The meta-analysis was conducted using Stata software, version 16.0. Initially, the mortality rate was estimated using the number of deaths as the numerator and the total number of analyzed samples as the denominator, multiplied by the constant 100%. A grouped meta-analysis of the mortality rate was performed using random effects models . The hettatistic .Next, the factors associated with mortality were analyzed, with the outcome being death. Thus, two groups were compared (non-survivors versus survivors). The following quantitative variables were considered as predictors: age and the Charlson Index. For studies that presented data such as the median and interquartile range (IIQ) , these w2) statistic [p-value < 0.05 were considered statistically significant.The effect size was reported as the standardized mean difference (SDM) for quantitative variables or the relative risk (RR) for qualitative variables. All of these measures were followed up with a 95% confidence interval . The hettatistic . Fixed oThe protocol for this article was published in the International Prospective Register of Systematic Reviews, PROSPERO, in August 2020, under the register: CRD42020201790.The number of elderly people included in each study varied between 18  patientsThe main morbidities presented by the elderly in the studies were: dementia , diabete2, 97.71%; p < 0.001).The meta-analysis was conducted for each predictor variable, stratified into quantitative and qualitative variables.The Analysis of quantitative variables showed that mortality increased with increasing age  and Charlson Index scores  .The analysis of quantitative variables showed that the risk of mortality was higher in individuals with diabetes , COPD , chronic kidney disease , hypertension , FH  or dementia  .This study aimed to synthesize the factors associated with the mortality of elderly Italians diagnosed with coronavirus who were institutionalized or hospitalized. The data show that diabetes, chronic obstructive pulmonary disease, hypertension and dementia were morbidities that considerably increased the risk of death in the elderly. This association is presumed to be related to the high prevalence of these diseases in the elderly population .The Instituto Nazionale di Statistica (ISTAT) of Italy, in its 4 May 2020 report, states that the impact of COVID-19 is greater in people with extremely compromised health conditions, causing the mortality of these people to occur in a shorter time. The document also reports that, in some cases, COVID-19 may not be the leading cause of death, but a contributing factor to overall mortality . There aItaly has the lowest prevalence rate, by age, for chronic obstructive pulmonary disease and cardiovascular diseases . This maOn the other hand, the country has the highest prevalence rate, by age, for dementia. As aging progresses, the risk of this diagnosis increases. It is a progressive neurodegenerative syndrome characterized by a cognitive decline that limits social functions and activities of daily living . In addiWe conclude with the belief that the objective proposed for this study had been achieved, i.e., to synthesize the factors associated with the mortality of elderly Italians diagnosed with coronavirus who lived in institutions or were hospitalized because of the disease. Looking ahead, it is expected that public policies will be developed for the new reality of humanity profoundly marked by the pandemic.NCCDs, when associated with SARS-CoV-2, are factors in the deaths of the elderly. Data relating to NCCDs are, therefore, fundamental for the elaboration of public policies and health promotion practices and the prevention of chronic diseases throughout aging. In addition, prevention strategies against coronavirus for the elderly population with NCCDs, such as chronic obstructive pulmonary disease or dementia, must be planned with a clear and precise target to prevent so many deaths from occurring among the elderly.Certainly, we should not create more institutions that house elderly people without taking into account the greater risks that life in a large community has for the coexistence with and contagion of these diseases. It will be necessary to think creatively about new living spaces and new ways of handling work as health professionals and operators in these establishments.The vaccination priorities for the institutionalized elderly, as established by all governments, were touched by the social movement that reverberated around the world when several army trucks transported burial coffins in the Italian city of Bergamo in March 2020. The mortality of the elderly who lived in socio-sanitary care institutions or who were taken into hospitals showed the true danger of NCCDs meeting SARS-CoV-2.With vaccination slowly arriving in each country, as the pharmaceutical industry works to deliver enough doses and countries strive to implement efficient logistics for the distribution and application of the drug, it is hoped that all of this will pass, and that this time of great pain and suffering for many families will facilitate our learning and the growth of authorities and new public policies aimed at protecting the elderly.The most important limitation of this research is the small number of articles found in Italy, which prevented further analysis. In future studies, factors related to chronic diseases should be considered since these aspects impact the mortality of elderly people with COVID-19.