Based on the questionnaire survey, this paper developed a theoretical model of the factors influencing consumers' purchase behavior for new energy hybrid vehicles using the theory of planned behavior and structural equation modeling techniques. It then used SPSS and AMOS to perform factor analysis, model fitness, and path analysis to reach the following conclusions: perceived behavioral control, behavioral attitude, and subjective norm have a significant positive influence on behavioral intention, and behavioral intention has a significant influence on actual behavior. However, there is no significant effect of perceived behavioral control on actual purchase behavior, but rather an indirect effect on actual behavior through the mediating variable of behavioral intention. The analysis of the multi-group model based on the individual characteristics of consumers showed that the coefficient of subjective norm on behavioral intention was higher for extroverted consumers than for introverted consumers; the influence of behavioral attitude on behavioral intention was significantly higher for introverted consumers than for subjective norm on behavioral intention. On the one hand, energy demand and consumption have increased, with China's reliance on foreign oil reaching 72% in 2021. Nonetheless, environmental pollution is a significant issue. 35.7% of China's prefecture-level cities have concerns with ambient air quality exceeding the limit in 2021. One of the main causes of energy consumption and environmental degradation is the sharp rise in car ownership. With an average annual growth rate of 29.38%, China's car population increased from 108 million in 2012 to 395 million in 2021, increasing fuel consumption and exhaust emissions significantly. The problem of air pollution brought by exhaust fumes from cars powered by internal combustion engines (ICEVs) gets worse as China's use of gasoline and diesel rises from 257 million tons in 2012 to 336 million tons in 2021. According to Givord2, diesel and gasoline levies lower the demand for conventional vehicles but have no effect on CO2 emission intensity. A crucial step in resolving the tension between fuel supply and demand, cutting pollutants, and improving the atmosphere is the development of electric vehicles. New energy cars have been acknowledged as a sustainable solution to minimize gasoline use and emissions in the transportation industry as conventional energy sources become more scarce globally3. From the standpoint of a sustainable economic development route and the preservation of the environment on which humanity depends, the development of new energy hybrid cars is of utmost strategic importance. Hybrid vehicles will continue to be the mainstay of energy-efficient vehicles in China for some time to come, despite the fact that new energy hybrid vehicles have many benefits and consumer acceptance of new energy vehicles is growing annually4. This is because new energy hybrid vehicles still lack key technologies, such as battery technology and charging infrastructure.China's rapid economic growth in recent years has been accompanied by declining air quality5, new energy vehicle policies have helped China's new energy industry flourish in part6. At this point, these laws are being updated and modified to match consumer demand for purchases7. In order to increase sales of new energy vehicles, study should be done on this market because the current market share of such vehicles in China is still quite low8. The poor figures on the adoption of hybrid vehicles globally may prompt a number of queries, such as: Are hybrid vehicles not appealing enough to customers to win their hearts and minds? When it comes to acquiring these automobiles, do car owners have any particular preferences? In this regard, Alberini et al.9 contended that consumer willingness to purchase hybrid vehicles may be triggered by a wide range of motivating factors, including economic considerations, while McLeay et al.10 suggested that studying the drivers affecting hybrid vehicle adoption could improve adoption rates.Although enthusiasm for private purchases is still low11. Now the question is: Why do people buy new energy hybrid cars? Also, what are the psychological underpinnings of consumer behavior and how do these psychological underpinnings influence behavior? How can efficient intervention policies be created to influence consumer purchasing decisions ? The theoretical community has not adequately addressed these issues. It takes a mix of various intervention methods to overcome the limits of a single strategic tool when developing appropriate promotion tactics since they must take into account both the internal psychology of customers and the influence of the external environment12. Based on the questionnaire survey, this paper developed a theoretical model of the factors influencing consumers' purchase behavior for new energy hybrid vehicles using the theory of planned behavior and structural equation modeling techniques, to clarify the psychological attributions and intervention pathways for the purchase behavior of new energy hybrid vehicles. The goal is to serve as a resource for various organizations to develop green and sustainable development strategies.The promotion of hybrid technology iterations and upgrades is very real and beneficial for reducing carbon emissions in the automotive industry, and it is also a crucial time to promote the use and development of hybrid technology. Hybrid vehicles are less noisy and vibration-free than conventional enginesA search of the literature reveals that current research by scholars can be broadly classified into three categories.14 took urban residents in Tianjin as an example to study the impact of environmental stimulus and psychological factors on the purchase behavior of new energy vehicles, and concluded that consumers care more about the comfort of the vehicle. Sun et al.15 conducted an empirical test on the role of government subsidies on the purchase intention of new energy vehicles using a hybrid logit model and found that price is an important factor in determining whether consumers choose new energy vehicles. Li and Guo16 used a binary logit model to study the purchase decision of new energy vehicles among Wuhan residents and found that consumers would focus on safety when purchasing new energy vehicles. Mi et al.17 used the exploratory research technique of rooting theory to analyze the factors influencing knowledge-based consumers' new energy vehicle purchase behavior, and found that knowledge-based consumers care more about the supporting service facilities of the vehicle. Huang and Ge18 constructed a model of the influence mechanism of electric vehicle purchase intention based on the theory of planned behavior, and concluded that monetary incentives have a significant positive effect on consumers' intention to purchase electric vehicles in Beijing. Hamamoto19 empirically investigated the factors influencing consumers' choice to purchase hybrid vehicles and showed that consumers who are more concerned about fuel economy may tend to choose hybrid vehicles.Li et al.20. Price sensitivity, according to Young et al.21, inversely attenuated the association between environmental responsibility and green purchasing. According to Young et al.21, price sensitivity adversely modifies the association between consumer willingness and environmental responsibility. According to Sheng et al.22, the price of green products is higher than the budget for purchasing, which is the main cause of the discrepancy between green consumption behavior and intention. According to Deng and Nam23, innovation behavior and consumers' perceptions of risk are positively correlated. Chan and Lau24 discovered a significant correlation between eco-emotion, eco-knowledge, and desire to make green purchases as well as actual purchasing behavior. Wang and Wang25 investigated the factors influencing Beijing residents' intention to buy new energy vehicles using the Theory of Planned Behavior. They came to the conclusion that purchase attitudes, subjective norms, and perceived behavioral control were the main influences on Beijing residents' intention to buy new energy vehicles.Many academics have investigated the psychological attribution of consumer buying behavior from various viewpoints in theoretical and empirical studies. According to empirical study of consumers' green consumption patterns from 2022, the new crown pneumonia pandemic increased consumers' desire to make green product purchases and had a favorable impact on consumer behavior26 studied the factors influencing residents' participation in commercial pension insurance based on the theory of planned behaviour, and the results showed that residents' participation in commercial pension insurance was significantly influenced by the traditional concept of "raising children for old age" and other personal will factors. Guo et al.27 constructed a model of driver training based on the TPB and used structural equation modelling (SEM) to capture the complex relationships between variables. Based on the TPB, Li et al.14 investigated the mechanism of conversion of virtual tourism experience to field tourism behaviour, and the results showed that virtual tourism experience, perceptual behavioral control significantly influenced virtual tourists' attitudes. Ma et al.28 studied the relationship between corporate innovation and founder management based on the extended TPB, and the findings showed that founders' male and highly educated, large firm size and other factors were effective in increasing firms' investment in innovation.The Theory of Reasoned Action (TRA) was developed by Icek Ajzen as a successor to the Theory of Reasoned Action (TRA) co-proposed by Ajzen and Fishbein. He expanded TRA to include a new concept of Perceived Behavior Control (PBC) of the self, which developed into a new model of behavioral research, the Theory of Planned Behavior (TPB). TPB is a new model of behavioral research that considers attitudes, subjective norms and perceived behavioral control as the three main variables that determine behavioral intentions. The TPB has been widely used in academia to study a number of behavioral areas. For example, ZengIn summary, there is more research on the willingness to consume new energy-powered vehicles and less literature on the willingness to consume new energy-hybrid vehicles, which are clearly different. At the same time, most of the scholars' studies are based on the purchase intention of new energy hybrid vehicles in a particular city and use it to extrapolate the actual situation in China, which is not a representative enough sample. Therefore, this paper refers to scholars' research on the psychological attribution of purchase behaviour, uses the theory of planned behaviour and structural equations to clarify the psychological attribution of new energy hybrid vehicle purchase behaviour and intervention paths based on 358 questionnaires from 10 cities with different degrees of economic development, using the theory of planned behaviour and structural equations to enrich, to a certain extent, the theory of Theoretical research on consumer purchasing behaviour and its intervention strategies.TPB was developed by Icek Ajzen, according to this theory, behavioral attitude, subjective norm and perceived behavioral control are the three main variables that determine behavioral intention. Therefore, based on the TPB and structural equation model, this paper analyzes the psychological attribution and intervention strategy of new energy hybrid electric vehicle purchasing behavior.29. When considering hybrid car purchases, car users' preferences may determine their attitudes towards the purchase of a car30, and attitudes have a significant impact on the willingness to purchase environmentally friendly cars31. Regarding consumers' subjective norms and their behavioral intention to purchase new energy-powered vehicles, White and Sintov32 found that when people are aware that people in their social circle or around them are decarbonising the transport system by purchasing environmentally friendly vehicles, they tend to be encouraged to 'behave that way'. The higher the social pressure, the more likely people are to be influenced in their behaviour33. Based on the theory of planned behaviour and the theory of rational behaviour, Zhang34 explored the factors influencing consumers' green product consumption behaviour and showed that there is a mediating effect of perceived behavioral control between environmental concerns and consumer purchase behaviour. In addition, if certain features of the hybrid vehicle fall below their expectations or preferences, it may limit their interest in performing the intended purchase behavior31. Therefore, the effect of perceived behavioral control on behavioral intentions to purchase new energy powered vehicles will be further explored in this study.While decision making is considered to be the result of a number of complex factors, the TPB suggests that the most important factor influencing decision making is an individual's behavioral intention, with the separate variable of behavioral intention alone explaining an average of 22% of behavioral changeH1: There is a positive relationship between consumers' relevant behavioral attitude and their behavioral intention to purchase new energy-powered vehicles.H2: There is a positive relationship between consumers' relevant subjective norm and their behavioral intention to purchase new energy-powered vehicles.H3: There is a positive relationship between consumers' relevant perceived behavioral control and their behavioral intention to purchase new energy-powered vehicles.H4a: There is a positive correlation between consumers' relevant perceived behavioral control and actual purchase behavior.H4b: The relevant perceived control behavior of consumers can influence the actual purchase behavior through the mediating variable behavioral intention.H5: There is a positive correlation between consumers' relevant behavioral intention and their actual behavior of purchasing new energy-powered vehicles.Therefore, based on the theory of planned behaviour and the findings of the above scholars, this paper proposes the following hypothesis.The precise theoretical model of the scheme is depicted in Fig. Informed consent was obtained from all the subjects involved in the study.The five variables behavioral intention, behavioral attitude, subjective norm, perceived behavioral control, and actual behavior are all measured in this study using a survey questionnaire and a five-point Likert scale. The information in this research was gathered by postgraduate students traveling back to their hometowns on National Day in order to gather information because of the diversity of the sources used by university students and the practical necessity for a wide range of respondents in this study. The study is divided into sections according to the concentration of urban commercial resources, urban hubs, lifestyle diversity, and urban people's activity, and the surveyed cities cover Tier 1 to 5 cities, which are widely representative in terms of economic development and population distribution. This ensures that the sample is representative of the population as a whole. Table As can be seen from the data on the demographic variables in Table We confirmed that all methods were carried out in accordance with relevant guidelines and regulations, all experimental protocols were approved by the academic committee of Guangdong University of Foreign Studies, and consent was obtained from all subjects and/or their legal guardians.35 and uses AMOS software to conduct a validating factor analysis on 379 valid questionnaires. The results showed that the standardised estimates (Std-Estimate) of the potential variables corresponding to behavioral attitudes, subjective norms, perceptual behavioral control and behavioral intention respectively exceeded the benchmark value of 0.5, and most of the estimates were significant at the level of P < 0.01 (***). The validated factor analysis results showed that the proposed study variables had strong aggregate validity. Based on the results of the validation factor analysis, this paper further calculated AVE (average variance extracted) and CR (combined reliability) according to the formula, and the results are shown in Table 36. This indicates that the degree of extraction of the measures within the factors is good. Table In addition to the basic information of gender, age and income level, this questionnaire mainly asks consumers about their behavioral attitude, subjective norm, perceived behavioral control, behavioral intention and actual purchase behavior. Table Common method bias refers to artificial covariation between predictor and effector variables caused by the same data source or rater, the measurement environment, the item context and the characteristics of the item itself. There are two common tests for common method bias: (1) using validated factor analysis, all items analysed are placed in one analysis frame and if the model does not meet the fit indicators such as chi-squared freedom ratio, GFI, RMSEA, RMR, CFI, NFI, NNFI, etc., then the model is a poor fit, i.e. it means that all the measures should not belong to the same factor and therefore indicates that the data pass the common method deviation CMV test and that the data have no common method deviation issues. (2) Exploratory factor analysis EFA: factor analysis was conducted by placing all indicators under one factor, and if the variance explained by the factor was less than 40%, the study data were considered not to have serious common method bias, otherwise, common method bias was considered to exist.The results of the common method deviation test using method (1) in this study are shown in Table This paper uses structural equation model to test the research hypotheses. RMSEA is a more important indicator in the model fit evaluation system, as can be seen from Table The results of the tests of the model hypotheses are shown in Table 37 proposed that the conditions for testing the mediating effect are as followed: (1) regressing the independent variable on the dependent variable with a significant coefficient a, which is a prerequisite for the mediating effect; (2) regressing the independent variable on the mediating variable with a significant coefficient b, which means there is an effect of the independent variable on the mediating variable; (3) after controlling for the mediating variables and regressing the independent and mediating variables on the dependent variable simultaneously, the resulting regression coefficient c of the mediating variable on the dependent variable is significant, while the regression coefficient d of the independent variable on the dependent variable is insignificant, or the effect size is significantly reduced relative to c. The presence of mediating effect is determined when the above three conditions are met simultaneously. The coefficient d is used to determine whether the mediating effect is partially mediated (d is significant) or fully mediated (d is not significant). In this paper, all the observed variables involved in perceived behavioral control, behavioral intention, and actual behavior were averaged and centered, and then used SPSS 25.0 to analyze "dependent variable to independent variable", "mediator variable to independent variable", "dependent variable to independent variable and mediator variable". Finally, the existence and the type of mediating utility were judged based on the significance of the regression coefficients, and the results are shown in Table We further test hypothesis H4b by mediating effects: consumers' relevant perceived control behavior can influence actual purchase behavior through the mediating variable behavioral intention. Zhang et al.The results indicated that perceived behavioral control indirectly influences actual behavior through the mediating variable of behavioral intention. The calculated contribution of the mediating effect to the total effect was 49.12%, and the mediating effect explained 24.4% of the variance variance of the dependent variable.38 concluded that individual characteristics such as gender and age have significant effects on green consumption behavior. Due to this, this paper constructed a multicluster model based on gender, age, income, and education to analyze the psychology attributions of different types of consumers' new energy hybrid vehicle purchase behavior. We hope the results will suggest corresponding policy insights for the effective promotion of new energy vehicles.Xian et al.As can be seen from Table 39 discovered that low-income groups were more receptive to and interested in incentives than other groups, and that persons with higher education levels tended to advocate the purchase of hybrid automobiles40. Also, men are more logical than women, who are more likely to be driven to buy eco-friendly products41. Female consumers, on the other hand, are more interested in premium or recently introduced products and are more fashion aware. In comparison to conventional vehicles, modern energy hybrid vehicles are newer in terms of configuration and performance. Customers will be more likely to select to buy new energy hybrid cars, indicating a stronger desire to buy, if doing so will increase their sense of superiority over other community members and make them feel better about themselves. For extroverted buyers, a sense of social acceptance or moral superiority dominates their impression of the value of a new energy hybrid vehicle.In terms of significance level, the model tests for consumers with different individual characteristics satisfy hypotheses H1, H2, H3, and H5. The magnitude of the effect coefficients shows that compared to male, low-educated, low-income, low-transportation-consuming, and youth consumers , females, highly educated, high transport consumption, high income, middle-aged consumers  had a greater degree of influence of subjective norms on behavioral intentions. This may be because, when buying a new energy hybrid vehicle, these consumer groups are extremely externally focused and are more impacted by social groups than by elements like consumer behavioral control and vehicle perception. For instance, middle-aged, high-consumption consumers frequently must choose their own consumption habits based on the same circle of groups as their own due to their position or employment requirements. He et al.The influence of behavioral attitudes  on behavioral intentions was significantly higher for male, low education, low transportation consumption, low income, and youth consumers than the influence of subjective norms  on behavioral intentions. It's possible that buying a new energy hybrid car is an expensive proposition for young consumers, the majority of whom are still in school. As a result, they will be more focused on the cost effectiveness of the vehicle when considering making the purchase. Consumers with low income, low education levels, and low levels of transportation spending will prioritize determining if the advantages of purchasing a new energy hybrid automobile outweigh those of using public transit. Men are more logical while shopping, thus they will consider the cost-effectiveness of significant outlays on cars. As a result, these buyers are incredibly introspective and have a tendency to follow their hearts while looking for a hybrid car. As opposed to outside expectations or interference, they prefer to follow their hearts and concentrate on whether a product's performance is consistent with their own. For instance, this consumer segment is concerned with the product's pricing. Consumers who are more reserved tend to value new energy hybrid vehicles more due to economic considerations.42. In addition, none of the perceived behavioral controls for different individual characteristics had a significant effect on actual behavior, but behavioral intention still had a significant positive effect on actual behavior.Although the effects of perceived behavioral control on behavioral intention were all significant, its coefficient of influence on behavioral intention was lower than that of behavioral attitude and subjective norm. This may be due to the high recognition of new energy hybrid cars in life. On April 18, 2016, in order to better distinguish and identify new energy hybrid cars and implement differentiated traffic management, China launched a special number plate for new energy hybrid cars. New energy license plate in the color of green as the main color, reflecting the "green environmental protection" implication. And new energy hybrid car number plate to increase the special logo, the logo as a whole to green as the background color, meaning electric, new energy, green circle in the right side of the electric plug pattern, the left side of the colorful part and the English letter "E" (Electricity) similar. Therefore, most of the people can quickly identify the new energy hybrid cars. Consumers' perception of the role of new energy vehicles in environmental management is biasedFirstly, based on the theory of planned behavior and the mediating effect, we studied the psychological attribution of consumers' new energy hybrid electric vehicle purchase behavior, we drawed the following conclusions: there are significant positive effects of perceived behavioral control, behavioral attitude, and subjective norm on behavioral intention, and behavioral intention also has significant effects on actual behavior. But there is no significant effect of consumers' perceived behavioral control on actual purchase behavior, it indirectly influences actual behavior through the mediating variable of behavioral intention.In order to understand the psychological attributions of different types of consumers when purchasing new energy hybrid vehicles, this paper further constructed a multi-cluster model to analyze the findings of different individual characteristics of consumers. The findings are as follows: for extroverted consumers , they are more likely to be influenced by other members of the society around them when deciding to purchase a new energy hybrid vehicle, and they are more concerned with the feeling of superiority or status enhancement brought by the purchase than the consumers' own need or knowledge of the product. For introverted consumers , they care more about the cost effectiveness of the car when shopping, and the influence of behavioral attitude on behavioral intentions is significantly higher than the influence of subjective norm on behavioral intentions. However, for both introverted and extroverted consumers, the coefficients of perceived behavioral control on behavioral intention were slightly lower than those of behavioral attitude as well as subjective norm, while behavioral intention still had a significant positive effect on actual behavior.Develop differentiated communication programs43. The timing of new energy vehicle purchases by consumers is influenced by a number of variables, including education, annual income, government legislation, and peer judgments44. Hence, targeted marketing initiatives for customers with various traits might encourage customer buy behavior. This study classified female, high education, high transportation consumption, high income, and middle-aged customers as extroverted consumers, and these consumer groups had a strong outward orientation in their spending patterns, according to the findings of the cohort structure model analysis. Men, people with low levels of education, poor transportation, people with little money, and those in their twenties are categorized as having an inward-looking consumer behavior. It is evident from the preceding analysis that there are differences between the characteristics that influence introverted and extroverted consumers' propensity to buy new energy hybrid automobiles. Being environmentally conscious will increase a person's likelihood of buying a hybrid vehicle because previous government publicity on hybrid vehicles has centered on their environmental friendliness and extroverted consumers are more interested in the sense of superiority that a hybrid vehicle can bring. It's vital to remember that introverted consumers are currently more interested in the advantages of the new hybrid vehicle itself than they are in the environmental benefits of green products. More can be done to highlight the advantages of acquiring new energy hybrids, such as purchase incentives, extended warranties, etc., when promoting these vehicles. Tax credits for new-energy vehicles can lower consumers' tax rates on vehicle purchases45. In parallel, specific industry norms are being established to further safeguard consumers' rights and interests and allay their concerns around the purchase of new energy hybrid vehicles.The variables determining how consumers of different genders, ages, educational levels, and income levels use green products varyImproving the performance of new energy hybrid vehiclesSubjective norm have a significant positive effect on behavioral intentions. New energy hybrid vehicles as a new industry, many consumers may not know much about new energy hybrid vehicles, and extroverted consumers are more inclined to the opinions and views of people around them. Therefore, in addition to increasing the publicity and promotion of new energy hybrid vehicles, it is more important to improve the quality of new energy hybrid vehicles, optimize performance, and establish a good reputation among consumers who have already purchased new energy hybrid vehicles in order to win more consumer recognition.Reduce the development cost of new energy hybrid vehicles46. At present, many consumers are reluctant to purchase new energy hybrid vehicles because of the high price and the subsequent maintenance costs are unaffordable. For example, the previously mentioned introverted consumers, who buy new energy hybrid vehicles, care more about the performance of the product and whether the price/performance ratio meets their expectations, and the pricing factors that are classified as expensive hybrid vehicles can lead to the fading of positive attitudes toward the purchase of the vehicle47. If the price of hybrid vehicles can be reduced to an affordable price, it may attract the interest of people with positive attitude towards hybrid vehicles. Therefore, this paper suggests that companies should actively develop new technologies to reduce production costs, so that the price of new energy hybrid cars down; establish an industry standard related to the development of plug-in hybrid electric vehicles, so that their related components are common and accessories form a large-scale production, thereby reducing vehicle prices; at the same time, the government should also increase subsidies to further reduce the cost of new energy hybrid vehicles purchased by consumers.Although new energy hybrid vehicles have the advantage of energy saving and environmental protection, their high annual maintenance cost becomes an important factor that hinders the market sales volumeBased on the above findings, this paper offers the following policy insights.This study uses a classic theory from social psychology to analyse psychological attributions and intervention strategies for new energy hybrid vehicle purchase behaviour through questionnaire and software analysis. However, this paper is a cross-sectional related study, which is a key limitation of this paper. Cross-sectional studies, also known as cross-sectional surveys, because the descriptive information obtained is collected at a point in time or over a short time interval, it objectively reflects the relationship between variables at this point in time and cannot be used to analyze behavior over time or to establish long-term trends. Therefore, the findings of this study can only be used as exploratory findings, which are only applicable to describe and explore the relationship between variables of the survey respondents during the survey period, and cannot be used to prove causality. The policy recommendations presented in this paper can only be used as a reference for policy-making authorities in the surveyed areas. Specifically, actual purchase behaviour may in turn reinforce consumers' willingness to engage in such behaviour again in the future, while behavioural intentions may provide motivation for actual purchase behaviour in the form of favourable behavioural attitudes, subjective norms and perceived behavioural control. For this reason, in future research, more attention should be paid to the need for data collection to be conducted earlier, to lengthen the data collection period and to obtain data from different time periods to ensure that the data are suitably unbiased.


Users face significant challenges in reusing neuroimaging data due to the lack of provenance metadata, such as experimental protocols, study instruments, and details about the study participants, which is also required for interoperability. To implement the FAIR guidelines for neuroimaging data, we have developed an iterative ontology engineering process and used it to create the NeuroBridge ontology. The NeuroBridge ontology is a computable model of provenance terms to implement FAIR principles and together with an international effort to annotate full text articles with ontology terms, the ontology enables users to locate relevant neuroimaging datasets.Despite the efforts of the neuroscience community, there are many published neuroimaging studies with data that are still not Building on our previous work in metadata modeling, and in concert with an initial annotation of a representative corpus, we modeled diagnosis terms , magnetic resonance imaging (MRI) scan types , clinical symptom assessments , and a variety of other assessments. We used the feedback of the annotation team to identify missing metadata terms, which were added to the NeuroBridge ontology, and we restructured the ontology to support both the final annotation of the corpus of neuroimaging articles by a second, independent set of annotators, as well as the functionalities of the NeuroBridge search portal for neuroimaging datasets.The NeuroBridge ontology consists of 660 classes with 49 properties with 3,200 axioms. The ontology includes mappings to existing ontologies, enabling the NeuroBridge ontology to be interoperable with other domain specific terminological systems. Using the ontology, we annotated 186 neuroimaging full-text articles describing the participant types, scanning, clinical and cognitive assessments.The NeuroBridge ontology is the first computable metadata model that represents the types of data available in recent neuroimaging studies in schizophrenia and substance use disorders research; it can be extended to include more granular terms as needed. This metadata ontology is expected to form the computational foundation to help both investigators to make their data FAIR compliant and support users to conduct reproducible neuroimaging research. Reproducible science involving replication and reproducibility using meta-analysis as well as mega-analyses are critical to the advancement of neuroimaging research . ReanalyFor example, the neuroimaging data repositories supported by different divisions within the US National Institutes of Health (NIH) lack common terminology and representation format for metadata information describing the datasets . SimilarPubMed and Google Scholar search features allow users to find papers related to a neuroimaging question of interest; however, the results do not analyze the study metadata such as the experimental design, the modality of data collected, and the status of data sharing. These existing search engines are powerful tools for exhaustive search using sophisticated artificial intelligence methods to find relevant results; however, the lack of support for FAIR principles makes it difficult for users to find relevant papers with accessible study data. To address this limitation, we are developing the NeuroBridge data discovery platform as part of the NIH-funded Collaborative Research in Computational Neuroscience (CRCNS) program to be a bridge between neuroimaging researchers and the relevant data published in literature. The NeuroBridge platform aims to identify, index, and analyze provenance metadata information from neuroimaging articles available in the PubMed Central repository and map specific studies to user queries related to research hypotheses. The NeuroBridge platform with its multiple components and sources is described in more detail in a companion paper in this Research Topic . To enabstudy instrument, study data, and study method  as part of the Provenance for Clinical and Health Research (ProvCaRe) project (In Vivo Experiments (ARRIVE) guidelines  PROV specification to represent provenance metadata for biomedical domain. The PROV specification was developed as a standard provenance model for cross-domain interoperability and has been widely used to support FAIR guidelines in a variety of applications . The PROThere has long been a recognition of the importance of data sharing in neuroimaging studies and there has been multiple efforts to standardize terminologies describing neuroimagin datasets . We haveThe NeuroBridge platform overall builds closely on our work done in the SchizConnect project, which was developed to access multiple institutional neuroimaging databases . The SchThe NeuroBridge project aims to generalize and expand the SchizConnect platform to develop a data discovery system that can be a bridge between the needs of neuroimaging researchers and the relevant data from scientific literature. Published articles describing neuroimaging studies and datasets generated in these studies are an important resource for investigators. The NeuroBridge platform aims to automatically extract provenance metadata terms from these articles and use the terms to identify datasets that are highly relevant to a user’s research question. In this paper, we describe a novel iterative ontology engineering process that was developed and implemented to create the NeuroBridge ontology that supports: (1) Fine granularity annotation of full text articles describing neuroimaging studies; (2) Automated parsing and indexing of terms describing experimental design details of neuroimaging studies; and (3) Interactive user queries to locate experimental studies that match research terms . The autThe first phase of the ontology engineering process involved defining the scope of the ontology to support FAIR guidelines in the neuroimaging domain. Given the lack of existing community standards for modeling neuroimaging metadata, we built on our experience in dataset sharing efforts in the SchizConnect project , and extended them to current literature describing substance abuse disorders studies using neuroimaging studies.In the second phase, the metadata terms were classified into the three ProvCaRe S3 model categories of study data, instruments, and method. These metadata terms were collaboratively modeled in the NeuroBridge ontology and subsequently used to annotate full text articles describing neuroimaging experiments as part of the third phase of the ontology engineering process. In the final phase, the feedback from the metadata annotation phase was used to evaluate the NeuroBridge ontology followed by extensive restructuring and expansion to meet FAIR guidelines for neuroimaging datasets. We created a document corpus consisting of articles describing potential fMRI datasets generated from schizophrenia related studies by querying the PubMed Central repository for papers published between 2017 and 2020 using the following phrases:Query 1:  (”schizophrenia”[mh]) NOT  NOT Similarly, the following query expanded on the above query with a focus on substance abuse aspect:Query 2:  (”substance-related disorders”[mh]) NOT  NOT The first query expression generated a corpus consisting of 255 articles, while the second query expression generated 200 articles. We selected 100 articles from each query result to manually process and annotate them using provenance metadata terms. During the annotation phase, we removed articles that were reviews, or meta-analyses, or position papers related to the neuroimaging domain, which resulted in a final count of 186 articles in the document corpus. This corpus included a few papers published on the psychosis datasets available through SchizConnect, but the entirety of the substance abuse papers, and majority of the schizophrenia papers were not part of the SchizConnect project.prov:Entity, which may be physical or digital , prov:Activity to model the process of creation or modification of entities , and prov:Agent, which takes responsibility for an activity . In addition to these terms, the PROV specifications also includes relationships that can be used to represent detailed provenance metadata, for example an experimental study prov:used a neurocognitive test of language function . The PR details .Although the ProvCaRe ontology models the core provenance metadata terms associated with biomedical health domain, the ontology does not model terms at the required level of granularity for neuroimaging experiments. Therefore, the NeuroBridge ontology restructured and expanded the ProvCaRe ontology with a focus on neuroimaging experiments and broadly neuroscience research studies. Our approach is based on ontology engineering best practices to re-use and expand existing ontologies for specific domain applications . In the In the next step, we reviewed the Neuroimaging Data Model-Experiment (NIDM-E) ontology that was designed to describe different modalities of neuroscience datasets, including terms from the Digital Imaging and Communications in Medicine (DICOM) and Brain Imaging Data Structure (BIDS) specifications . We focuAt the end of this first phase of the ontology engineering process, the NeuroBridge ontology had a broad representation of provenance metadata terms describing neuroimaging studies. To evaluate the coverage of the NeuroBridge ontology, we used it for manual annotation of full text articles in our document corpus.repeatable, which could be used to annotate new metadata features in papers as they are identified, and extensible, which could be customized for annotation of experimental studies described in broader neuroscience articles. The first “draft expansion” pass was marked by extensive collaboration between the members of the text annotation and the ontology engineering team. The goal of this pass was to identify metadata terms that were needed for annotation of the papers, but they were missing in the first version of the ontology.In the next phase, we implemented a two-pass text annotation process that was designed to be This phase was implemented using a variety of online tools, including spreadsheets and shared copies of published articles from the document corpus that were distributed using Google Drive. There were two main workspaces: the first workspace, implemented as a spreadsheet, listed the assignment of annotation team members to specific documents (two annotators per document), which recorded the citation, links to the documents, basic bibliographic data, and notations related to the annotation process, such as the agreement between annotators regarding the metadata annotations. The annotation team members were trained remotely via teleconference due to the coronavirus pandemic. The original team of annotators were trained by co-author JAT to find the relevant parts of papers for annotation.After this training phase was completed, the annotation teams (with at least two members) were assigned the articles for annotation. A second workspace contained the annotations made by the annotation team members, with each row of this spreadsheet corresponding to a reviewed article and the metadata annotations listed in the columns. Both the workspaces were live documents that were modified by all the members of the annotation team.The annotation team members focused on the title, abstract, and methods sections of the papers. Their goal was to identify the available or needed labels for each article with four categories of provenance metadata:1.Subject groups: This included disorder types  as well as control groups (identified as “no known disorder”) if present in the article.2.Imaging methods used in the study: For example, resting state or task-based functional imaging, and T1 weighted imaging.3.Behavioral data collected in the study. For example, standardized scales for symptom severity, cognitive batteries, personality assessments. In addition, unique non-standardized scales, and measures such as medication status or specific cognitive experiment data were also identified and annotated.4.Data and resource sharing. Mark the presence or absence of a formal data sharing statement for the project.The second workspace was used to record the above four categories of provenance metadata annotations associated with specific sections of text in the article. Additional columns in this workspace were used to record the agreement between members of the annotation team regarding the category of metadata terms. The annotators also used this workspace to record metadata terms that could not be mapped to an appropriate ontology term. These missing terms in the ontology together with feedback related to class structure of the ontology were used as feedback by the ontology engineering team to revise the NeuroBridge ontology.subject groups, imaging methods, behavioral assessments, and data sharing policy description.As part of the tightly coupled cycle of ontology engineering and text annotation, the ontology engineering team agreed that no existing ontology terms were to be removed to preserve backward compatibility with metadata terms already used to annotate the articles. However, the annotations could be modified after the expanded version of the ontology was finalized. The feedback from the annotation phase identified missing terms across all the four categories of provenance metadata, that is, NeuroBridge:NoKnownDisorder was modeled as subclass of NeuroBridge:ClinicalFinding). This modeling approach allowed us to represent the information that these participants did not have the given disorder that characterized the other samples in the same study, but there was no guarantee they did not have some other disorder. It is important to note that in disorders with genetic risk, the relatives of affected individuals are of special interest. However, we deferred modeling this provenance information to the next version of the ontology as it required the annotation of a new set of articles describing whether family members of subjects are included in the “no known disorder” group, and the complexity of a family tree . If the family members were not reported to have been diagnosed with any disorders, the annotation noted that the study collected the “no known disorder” subject group.Within the subject groups category, the ontology engineering team , reviewed the modeling approach for representing the distinction between samples of unaffected family members of a study subject with a particular disorder, and “healthy controls.” We had already identified that “healthy controls” in any given study may or may not be defined in a consistent manner across studies; therefore, these terms were annotated as a group with “no known disorder”  generating high quality, manually annotated text describing neuroimaging experiments, which were subsequently used to train a Bidirectional Encoder Representations from Transformers (BERT) deep learning model ; and (b)Inception text annotation tool to confirm that the annotations originally marked in the spreadsheets could be used in annotating the text .The inter-annotator agreement was computed for the annotations done in Inception; the initial work that used online spreadsheets required the annotators to work in pairs to identify the terms needed for the ontology expansion, so agreement would not be meaningful. Inception calculated Cohen’s kappa as measures of pair-wise agreement between annotators, which ranged from 0.75 to 1.0 (mean 0.92). We exported the annotated text corpus from the Inception tool as https://bioportal.bioontology.org/ontologies/NEUROBRG.The new iterative ontology engineering process implemented in this paper resulted in the first release version of the NeuroBridge ontology, consisting of more than 660 classes and 3,200 axioms representing a variety of neuroimaging experiment related provenance metadata. The ontology class expressions leverage more than 40 OWL object properties together with class level restrictions to represent the four categories of metadata information used during the annotation phase of this study. The ontology was evaluated using the Protégé built-in FaCT++ reasoner, which performed classification of concepts using subsumption reasoning followed by satisfiability to identify incorrect subsumptions . The staThe 186 articles in the document corpus included annotations with 153 unique metadata terms. The annotation team used the metadata terms to label the study method text, the subject groups, the imaging techniques, and additional data. The annotation process ensured that there would be a minimum of one provenance metadata term for each of the first three of those categories, which resulted in a minimum number of concepts per article to be three, with the assumption that there was no other cognitive or behavioral data or information about the recruitment, which may occur with the use of legacy data. papers per concept were 3 and 12.54, respectively, representing a skewed distribution of papers referring to concepts. The most common concepts in this corpus are shown in NeuroBridge:NoKnownDisorder), and the most common imaging techniques . Disorders represented in these papers were chosen to include NeuroBridge:schizophrenia, which account for its common use; but substance use disorder was more diverse, with NeuroBridge:AlcoholAbuse and NeuroBridge:CocaineAbuse being the most common metadata terms.Conversely, the number of papers referencing each concept ranged between 1 and the entire corpus; the median and average number of Surprisingly, only 22% of the articles in our corpus of 186 recently published papers had an explicit data sharing and access statement, despite the increasing focus on data sharing within different domains of biomedical research. This statistic clearly highlights the challenges in making neuroimaging data findable and accessible.In addition to its use in annotation of full-text articles, the NeuroBridge ontology also is incorporated into the NeuroBridge platform for use. The NeuroBridge platform allows users to compose a search query using ontology terms together with logical connectives such as AND, OR. The query expression is automatically expanded using OWL reasoning to include relevant subclasses of a selected ontology term, and this expanded query expression is used to search for neuroimaging experimental studies that match the query constraints . Please The NeuroBridge ontology combines the experience gained from neuroimaging data sharing projects, such as SchizConnect, NI-DM, CogPO and CogAtlas, with the S3 framework of the ProvCaRe project. This combination expands both ProvCaRe and the previous terminologies to capture important features of multiple domains of biomedical research. This positions NeuroBridge as a backbone for interoperability in annotating the neuroimaging literature. By incorporating substance use disorder papers in the corpus of this study, we confirmed that the S3 framework and the basic SchizConnect terminologies were sufficient to capture metadata information about neuroimaging studies in a different subfield of mental health. However, each of the different categories of metadata terms modeled in the ontology can be further extended to model additional study metadata describing its subject recruitment and data collection methods.The metadata terms describing MRI techniques are similar across mental health studies and within our 186 functional imaging papers, 84 used task-based imaging, and the remaining 102 (55%) used resting state approaches. Within the task-based neuroimaging, there were a surprisingly limited number of tasks in these papers. The task name was not always specified in the text: For example, the Balloon Analogue Risk Task (BART) or the Monetary Incentive Delay Task were used in 15 of the papers, variations on a cue-reactivity paradigm were used in another nine papers, and the Stop Signal task in another seven papers for example. Naturalistic viewing was used in two papers, and another two dozen tasks such as reality monitoring, paced serial addition, or visual perspective taking were used once each in the corpus. A dozen papers did not include an explicitly named or recognizable imaging paradigm in the text. Future extensions of this corpus are planned to extend the representation of the task paradigms, and to annotate the descriptions of the task in the text. This would allow automated methods for text mining to group papers based on similar task descriptions, and to identify potential task labels that will be added to the ontology.The rating scales and questionnaires used in the studies in this corpus cover a wide range of topics. We did not create labels for every scale identified in the annotation process. In the ontology, we classified the scales based on higher-level use, such as symptom severity ratings, personality scales, social function scales, and craving scales among others. This is not a challenging issue unique to neuroimaging study metadata, as every domain has its own clinical and cognitive tools, and new assessments and scales are developed continually. The NIH CDEs represent an effort to make data more interoperable, by representing common variables with standard terms. The NIMH National Data Archive (NDA) contains data from highly varied NIMH-funded studies across multiple experimental study designs and subject groups, all tagged with CDE terms. We explored using the NDA’s CDEs and matching those against the terms identified in the papers and incorporating them into the ontology, as the data archive is representative of recent research techniques. But there are several notable challenges to that approach, for example the CDEs do not have standardized structure which can be modeled as computable metadata terms. The CDE terms describe specific questions based on the studies that submit them. This can lead to idiosyncratic effects, for example, the term for the Scale for the Assessment of Positive Symptoms (SAPS) is defined as only the formal thought disorder symptom severity part of the SAPS, linked to psychiatric outcomes in Parkinson’s Disease, rather than being defined as the Scale itself. These limitations in terms of standardization and lack of structure excluded the NIH CDE for these scales from being modeled in the ontology.We note that this study successfully demonstrated the implementation of an internationally coordinated metadata annotation process, and online annotation efforts of neuroimaging papers across multiple naive teams. Teams were recruited from several undergraduate programs in the US and in India, and students worked for research credit or in some cases for a summer stipend. The use of current distributed-access tools allowed interactions across teams, levels of expertise, and time zones.Searching for relevant information over a large corpus is challenging and this task is more difficult if the objective is to query information described in the article’s text. In this scenario, exact matches between query term and terms in text are difficult; therefore, deeper domain knowledge in the form of an ontology has been acknowledged to be an effective approach for processing unstructured text in the knowledge representation and Semantic Web communities. The main contribution in our approach is the use of the NeuroBridge ontology in the NeuroBridge search over published articles. The NeuroBridge search feature is designed to use machine learning techniques together with ontologies to support queries beyond simple syntactic and grammar-based term matching; it is designed to use multi-faceted ontology structure to perform domain-specific search. This captures the nuances of data references without being tied down to any specific syntactic structure.The NeuroBridge ontology and the NeuroBridge platform are distinct from traditional systems such as the Ontology Based Data Access (OBDA)  (OMQA/OBQA) , which aA key limitation of this study is the use of a time-intensive ontology engineering process, which makes it challenging to scale the NeuroBridge ontology to include other domains such as cardiac or spinal imaging studies, or even brain tumor scanning. This would require novel expansion methods to be implemented to add new terms in the ontology. As noted above, we do not explicitly model all published assessments, and the model of subject groups, as currently implemented, does not capture all possibilities. We also have not modeled all the possible details of a neuroimaging study, for example, imaging protocol parameters, quality assurance steps, data processing and analysis phases together with their many parameters, and the statistical results or their interpretation. This version of the ontology would not support, for example, searching for datasets of a certain sample size, which used a particular MRI platform machine, or user queries based on their conclusions .The representation of neuroimaging behavioral tasks in the ontology does not include the Cognitive Paradigm Ontology (CogPO) approach, which focused on describing the choice of stimuli, the instructions given to the subject, and the responses that the subjects were expected to make till now . The Coghttps://neurobridges.org/, and in BioPortal (rrids.org for consideration for a research resource identifier.The goal of this project is to apply metadata annotations which address FAIR guidelines to the literature of published human neuroimaging studies, even though the studies themselves may not be sharing their datasets through FAIR-compliant methods. The objective of the study is to meet an important requirement of making neuroimaging metadata computable through the NeuroBridge ontology, which will enable neuroimaging data to be compliant with the FAIR guidelines. The use of the ontology for text annotation and supporting user queries in the NeuroBridge portal will allow us to identify and present the relevant neuroimaging papers to the user and to request access from the study authors as necessary for re-use of experimental data. For the purposes of finding neuroimaging datasets that use similar methods and that could be aggregated for a novel analysis, the NeuroBridge ontology is addressing what current ontologies in the fields today are lacking, i.e., describing the methods that neuroimaging studies employed to collect the data. The NeuroBridge ontology is available at ioPortal . The corhttps://bioportal.bioontology.org/ontologies/NEUROBRG and the annotated text will be available through https://github.com/NeuroBridge/Annotation-Project/releases.The original contributions presented in this study are publicly available. The NeuroBridge ontology data is available through the NCBO Bioportal as SS, LW, MT, and JT conceptualized and designed the study. JT, MT, AA, and YW developed the annotation process involving the identification of metadata terms and their use in annotation of neuroimaging articles, with input from HL. SS, LW, and JT revised and developed the ontology with input from JA, AA, HL, AR, MT, and YW. JT, MT, and SS co-wrote the first draft of the manuscript. All authors contributed to the manuscript revision and read and approved the submitted version of the manuscript.


Air pollution, including particulate matter, causes health problems for residents of major cities around the world, including New Delhi, India. Public participation is important in framing policies related to such public health issues.To study how the public’s comments on air pollution, which had been collected on the orders of the Indian Supreme Court, influenced air pollution policy in New Delhi.We filed a Right to Information Act, 2005 application with the Commission for Air Quality Management (CAQM) to obtain a copy of the comments. These were compiled and compared with key major areas identified in the policy released by the regulatory authority.There were a wide range of comments from experts, residents and resident associations. In total, 115 comments were compiled and studied, and several recurring themes were found to have been incorporated into the policy. This included the need to switch to green public transport and cycling, the use of alternative fuels and reduced agricultural crop residue burning.Our study revealed that the public and experts have indeed influenced the CAQM air pollution policy. This is important, as it highlights a democratic, inclusive and stakeholder-based approach. Nonetheless, a future concern lies in how this policy is translated into actionable regulations with effective implementation in the field. Like many other cities in the world, New Delhi, India, has an air quality crisis and related public health issues due to the presence of high concentrations of particulate matter with a diameter of 2.5 µm (PM 2.5).19The aim of this paper was to examine the comments from stakeholders, as requested by the Indian Supreme Court’s directive on air pollution in Delhi. This has enabled us to gain a better understanding of how stakeholder views have influenced air pollution policy.To obtain the public and expert stakeholder responses to the pollution control measures, we filed a Right to Information Act, 2005 application before the Commission for Air Quality Management (CAQM) for the National Capital Region and Adjoining Areas created under the Air Quality Management in National Capital Region and Adjoining Areas Act, 2021.There were some important initial observations. Of the 115 individual responses, 25 were from identifiable experts in the field based on their designation . Furthermore, three responses were from either a resident welfare association representative or part of a campaign group representing people directly affected by air pollution in New Delhi, or a group affected by government action in curbing pollution . The number of recurring responses is shown in After analysing and consolidating the stakeholder approach results, the CAQM formulated a policy known as the ‘Policy to Curb Air Pollution in the National Capital Region.’23The process of formulating an air pollution policy shares similarities with initiatives in other regions, such as Bradford, UK, where stakeholder input and public focus groups, along with document analysis,Some countries have notified or released  environmental standards under national laws or legislation, making them enforceable.We discuss here the policy-related outcomes that have been developed by the CAQM under two scenarios: 1) before the occurrence of high pollution exposure levels; and 2) once the pollutant exposure levels have exceeded the standards, and there is an immediate need to reduce pollution levels.1.This is the policy created by the CAQM for the period before pollution occurs.Firstly, clean air for all, good health, well-being and increased productivity. Secondly, action for clean air requires speed, scale and urgency. Thirdly, equitous, inclusive, affordable, innovative approaches. Fourthly, scientific, technical and behavioural solutions. Fifthly, protect the vulnerable from the pollution risk. Sixthly, multi-sector policy response and a systems-based approach and finally, air pollution management needs an air shed and a regional approach.The sector-wise heads for the abatement of air pollution are listed in It is important to note that the above policy remains to be implemented and made enforceable. The CAQM has powers provided by the Indian Parliament to create rules and has created some with respect to crop residue burning. For example, a grievance mechanism has been created under Section 14 of the CAQM Act 2021.2.Another part of policy developed by CAQM is the need for redress after exposure levels have exceeded standards, called the Graded Response Action Plan (GRAP).31This study set out to study the comments from members of the public and domain experts collected through open public invitation. These were categorised into recurring themes, with a primary focus on green transportation, transitioning to public transit, and cycling, closely followed by the related aspect of adopting green or alternative fuels. Crop residue burning ranked as the third most important concern. This led to the creation of the policy by the CAQM. The inclusion of stakeholder suggestions as per the suggestion of the Indian Supreme Court sets a precedent for other countries with problems that are similar to India: it is a democratic decision-making process for something that effects all our lives. The next challenge lies with the executive wing of the government and the CAQM to implement the policy effectively. Future research in this area should monitor implementation of the policy and its effects in reducing air pollution in New Delhi and the adjoining areas.


Death care work consists of dealing with traumatic events frequently, if not daily. This type of exposure is considered characteristic of the profession and can lead to significant negative consequences such as secondary traumatic stress. However, sometimes positive changes can occur as a result of experiencing trauma, which is referred to as vicarious posttraumatic growth. The aim of the present study is to investigate the role of vicarious posttraumatic growth (VPTG) in the relationship between secondary traumatic stress (STS) and work ability (WA) in a sample of 231 death care workers in northern Italy. Regression analysis with interaction was performed using PROCESS. The results showed a negative association between STS and WA and a positive association between VPTG and WA. The interaction between STS and VPTG was also statistically significant. The moderating role of VPTG was partially confirmed by the analysis: at low and moderate VPTG levels, the conditional effect was negative and statistically significant, while at high VPTG, STS exposure had no significant and negative effect on WA, as if VPTG had some kind of protective role against STS. These results provide new insights into the role of VPTG in work environments with daily trauma exposure, such as death care. Death is a fundamental and inevitable aspect of life, yet dealing with it is a difficult task for many. Dealing with death means confronting our finitude as human beings, the uncertainty of how much time we have left, and the awareness of what will happen to the body we have inhabited when we have left it. Professionals in the field of death care are those who, despite the difficulty of the task, take charge of the entire process of caring for the body–from the moment of death to burial/ash scattering–and relieve the bereaved of some of the burden of loss; in this sense, they could be placed under the category of the helping professions.Death care encompasses several services, including cremation services, funeral services , mortuary services (and forensic work) and cemetery services. Workers in all these areas are constantly exposed to the sight of coffins and/or corpses (in various states of decomposition) and the suffering of the bereaved due to the specific nature of their work –7. OvereThe aim of this study is to examine the relationship between occupational trauma exposure, the capacity of death care workers to overcome traumatic events, and their perceptions of work ability in a currently under-researched work context, such as death care. The theoretical framework used is based on the Job Demands-Resources Theory, JD-R  and the The literature on trauma and its effects–both short- and long-term–is extensive, but indirect exposure to trauma has only recently been studied. The term secondary traumatic stress (STS) was introduced to describe the negative effects experienced by those in close contact with trauma victims . This caIt should be noted that the term secondary traumatic stress is used interchangeably with the term of vicarious traumatization . AlthougSeveral studies have shown that STS is related to negative psychophysical outcomes , such asIn one of the few studies of death care work STS scores were found to be higher in workers who had less frequent exposure to corpses ; STS scoThe interest in work ability (WA) stems from occupational health research to “predict” work capacity in the aging population. One of the most commonly used definitions of the construct is that of Tuomi and colleagues, namely “How good is the worker at present, in the near future, and how able is he or she to do his or her work with respect to work demands, health, and mental resources?” , p.67). 7. 6] invlived as traumatic [life-altering event” for a particular person ([The term “posttraumatic growth” (PTG) appeared for the first time in the mid-1990s in two works by Tedeschi and Calhoun ,48. Postraumatic ,50. The raumatic –53), tha person : Secondary traumatic stress (STS) is negatively associated with work ability (WA).Hypothesis 2 (H2): Vicarious posttraumatic growth (VPTG) has a moderating role in the relationship between secondary traumatic stress (STS) and work ability (WA).The present study was conducted in accordance with the guidelines of the Declaration of Helsinki (and subsequent revisions) and the ethical requirements of Italian legislation and approved by the Bioethics Committee of the University of Turin (protocol code no. 0598340).The professional reference sector is complex in terms of organization and accessibility compared to other sectors, therefore a convenience sampling method was chosen and the sample size was not estimated in advance. The funeral agencies of the provincial capital and some neighboring municipalities, the mortuaries of the main provincial hospitals and the municipal mortuary, the provincial offices of the cemeteries and the provincial crematoria were contacted.An ad hoc questionnaire was prepared and distributed in hard copy to participants at times and dates agreed with employers/managers who agreed to participate in the study. The questionnaire was accompanied by a sheet explaining the aims of the study and how the data would be processed (in accordance with EU Regulation 2016/679). To participate in the study, workers had to read and sign the consent form. The researcher attended the meetings and presented the research project and the objectives of the survey to clarify any doubts the participants might have. The response rate was 90% of the distributed questionnaires. The questionnaire did not provide for the collection of personal data and participants did not receive any compensation; in addition, the consent form signed by the participants was collected separately from the questionnaire so that it was not possible to trace it back to the individual participant.A total of 259 participants completed the questionnaire. Five participants were excluded because they had not completed at least one of the scales under study. Eighteen participants were excluded because they could not answer the items on secondary traumatic stress because they did not interact with other people during their work. A multivariate test for outliers using the Mahalanobis distance also revealed five participants as outliers, who were then excluded from the analyses.The final sample to test our hypotheses included 231 participants  aged 20 to 74 years . The socio-demographic characteristics of the respondents are shown in The measurement scales used in the study are all validated instruments with good consistency and reliability in the literature. The STS and WA have been used in previous research on death care ,6,23. ThSecondary traumatic stress was measured with the 17 items of the Secondary Traumatic Stress Scale (STSS) developed by Bride and colleagues [lleagues . The inslleagues . In the Work ability was measured using the Work Ability Index-2 (WAI2) [2 (WAI2) , a 2-iteVicarious posttraumatic growth was measured with the 10 items of the Posttraumatic Growth Inventory-Short Form [ort Form ,75 on a ort Form . When usStatistical analyses were performed using Statistical Package for the Social Sciences (SPSS 28.0), and a regression model with moderation was tested using Hayes PROCESS . In a preliminary phase, multiple imputation (MI) was performed after we determined that the data were not missing completely at random. The percentage of missing values for each scale studied ranged from 0.4% to 0.8%. To test our hypotheses, secondary traumatic stress (STS) was the independent variable, vicarious posttraumatic growth (VPTG) was the moderating variable and work ability (WA) was the dependent variable. Having children or not, job tenure, and exposure to bereaved clients  were used as control variables in the model, as they had been identified in previous studies ,77 as po2 deviation from zero. As recommended, a power of at least 0.80 is acceptable for social science [To assess power for moderation analysis with a sample size of 231 and an alpha of 0.05, a post-hoc power analysis was performed using Gpower 3 software , with li science .Frequencies, means, and standard deviations were calculated to summarize the variables included in this study. Pearson correlation (r) was used to test the relationship between variables and results were interpreted according to Cohen’s conventions . StandarThe Johnson-Neyman technique was used to test for statistically significant interactions in the relationship between secondary traumatic stress and work ability. This technique was used to identify areas of significance in the moderator variable (vicarious posttraumatic growth).Before testing the hypotheses under investigation, some preliminary analyses were performed. The normality assumptions of the regression model were tested. A graphical inspection of the residuals using the Q-Q plot and a scatterplot of the residuals to test homoscedasticity showed no relevant violations of the assumptions. In addition, the Durbin-Watson score (2.09) confirmed the independence of the residuals of the multiple regression models. A test for multicollinearity was performed and the VIF values were all below the cut-off of 5. To test for common method bias, Harman’s single factor test method was used in an exploratory factor analysis. One factor, which included all variables examined, confirmed that the first factor extracted  explained 25.3% of the total variance, less than 40%, which could indicate method bias .The bivariate correlation and descriptive statistics are shown in STS was not correlated with VPTG, while a negative correlation was found between STS and WA, VPTG was positively correlated with WA. Among the control variables, a significant negative correlation was found only between VPTG and exposure to bereaved clients (0 = exposure).Regarding the results of the moderation model see , the hypThe direct association between STS and WA was negative and statistically significant , p < .001), confirming H1. The association between VPTG and WA was positive and statistically significant , p <. 01). The interaction between STS and VPTG was positive and statistically significant , p < .01). Together, the variables accounted for approximately 20% of the variance, R2 = .20, F  = 9.3, p < .001. A non-significant association emerged between the control variables and WA.Regarding the conditional effect of the interaction term, the Johnson-Neyman see , the tecThe aim of the present study was to better understand the role of vicarious posttraumatic growth in workers who are continuously exposed to trauma at work. Given the lack of studies in the literature, the results obtained are particularly interesting and contribute to new knowledge about this occupational field.The first hypothesis of the study (H1) states a negative relationship between secondary traumatic stress and work ability. As we have seen, secondary traumatic stress corresponds to the symptomatological framework of PTSD and is experienced by people who live traumatic situations indirectly, for example through their work. Higher levels of activation, intrusive thoughts of traumatic memories and avoidance behaviours towards emotions or stimuli that remind people of traumatic events are symptoms that can make workers more vulnerable and affect their ability to work in the long term. This hypothesis was confirmed by the analyses, and although the association between STS and WA has not been examined in previous studies in the field of death care work, this finding is consistent with other studies in other professions that deal with trauma. For example, in the study by Bock and colleagues ,82, nursliving through the traumatic experience: it is not possible to avoid it. With this in mind, it was necessary to consider symptoms related to working with trauma in the model. The results of the analysis partially confirmed the second hypothesis (H2). VPTG indeed seems to have a significant moderator role in the relationship between STS and WA when VPTG scores are low or moderate; its role as a moderator loses statistical significance when VPTG scores are higher. This result is interesting because it suggests the protective role of VPTG against STS. It underscores that stress related to traumatic experience loses significance when individuals have experienced growth. This finding is consistent with previous research on workplace trauma, which found that VPTG moderated the effects of STS in therapists who worked with trauma survivors [Regarding the second hypothesis (H2), we have argued that vicarious posttraumatic growth plays a moderating role in the relationship between STS and WA. VPTG describes the set of positive changes that can occur as a result of experiencing traumatic events directly and indirectly. A distinguishing feature of the construct is the necessity of urvivors . The stuurvivors . MoreoveThese results are also in line with the proposed theoretical framework. We have seen that occupational exposure to trauma is one of the typical work demands in death care. This psychosocial risk factor may lead to an increase in perceived work ability where there is growth of the individual. This confirms the protective role of resources in relation to job demands as supported by the JD-R model, as well as the gain spiral created by acquiring new resource, as postulated by the COR model.These findings highlight the importance of supporting personal growth processes in a work environment where individuals are constantly exposed to traumatic events.Death care is a professional sector that has received little research attention, making it essential to better understand the protective factors that can maintain employee wellbeing.The findings of the present study provide new insights into the role of vicarious posttraumatic growth in work environments with daily trauma exposure and suggest that workers who develop these positive changes may improve their wellbeing and their work ability.These results are particularly interesting in light of recent events related to the COVID-19 situation, where workload and trauma exposure have increased exponentially, severely scarring all workers involved in the frontline management of the emergency, including death care workers ,86. IdenAlthough the present study has brought new insights to the field of death care research, it is also important to note its limitations. Firstly, the sample size is not very large and a convenience sample was used. In addition, due to of the cross-sectional design, it was not possible to test causal relationships between variables.Some other information, such as socioeconomic status, health status, access to psychological, social, medical and structural resources, perceived severity of working with trauma survivors and personal trauma history, was not collected; future studies could also include these variables, which could play an interesting role in the proposed model. Furthermore, because the sample was not evenly distributed across professional groups, it was not possible to examine differences in the association between the model variables in the death care professional groups. Future studies could examine these differences. Another limitation is that the instrument used to measure secondary traumatic stress, namely the STSS, is based on the DSM-4 PTSD symptomatology. However, it is also important to note, that the literature argues that the DSM-4 symptoms can still approximately measure the DSM-5 diagnosis .Finally, in the future it would be interesting to use samples from different countries to also investigate cross-cultural differences and to think about longitudinal models to also explore the dimensions of causality.S1 File(PDF)Click here for additional data file.S1 Dataset(SAV)Click here for additional data file.


Osteoarthritis (OA) is a long-term condition that causes significant impairment, and because of the increasing prevalence of OA, the demand for arthroplasty will continue to rise. However, the demand will not be matched by availability, because of prioritisation of trauma-related surgeries. Implementing prehabilitation could assist physiotherapists in having an impact on improving access by reducing the length of stay.The aim of our scoping review was to explore, map and identify trends and gaps to better inform the content of a prehabilitation programme.In our scoping review, studies between 1995 and 2020 were identified and included based on inclusion and exclusion criteria and study methodology described by Arksey and O’Malley. The results were collated and summarised as a narrative synthesis.A total of 200 articles were identified and exported from four databases of which 48 articles were included in the final analysis. Regarding the efficacy of prehabilitation interventions, 21 studies reported significant results supporting prehabilitation, whereas 11 studies reported non-significant results.Prehabilitation could be a valuable adjunct in reducing length of hospital stay and improving functional outcomes in adults undergoing total joint replacement.The scoping review described the information available on prehabilitation in lower limb arthroplasty patients and could potentially inform the design of a prehabilitation programme suitable for use in the South African public health context. Osteoarthritis (OA) is a long-term condition that causes significant impairment of physical function in individuals. Globally, prevalent cases of OA increased by 113.25%, from 247.51 million in 1990 to 527.81 million in 2019  reported that there was an increase in the burden of OA from 1990 to 2019 in the MENA region with a reported increase in the incidence of OA by 9.4% from 1990 to 2019 , arthritis imposes a potential additional burden by creating a vicious cycle that subsequently worsens poverty  and total knee arthroplasty (TKA) as a treatment of choice for OA will continue to increase . In terms of the content of the education provided in a South African setting, the overview of the literature highlights a lack of pain neuroscience education , and our study protocol is being reported in accordance with the reporting guidance provided in the PRISMA extension for scoping reviews (PRISMA-ScR) (Online Appendix 1). The scoping review methodology, steps in defining the research question and selection of eligible studies have been described extensively in a previously published paper by the same authors  and their correlation to efficacy and outcomes of treatment. Papers with content on education as a preparation, either as the sole model for prehabilitation or as an adjunct for joint arthroplasty optimisation, were also included.n = 65) before screening. The three reviewers who were familiar with the study protocol were involved in the scoping review process. Title, abstract and keywords screening of all eligible articles were conducted by the first author (P.P.) and second reviewer (H.E.). Excluded citations were reviewed and confirmed by a third reviewer (V.C.). The next step was to obtain full texts of all the selected articles by undertaking a thorough and exhaustive search of the web. In those instances where the full text could not be obtained from the web, a concerted effort was made to obtain these full-text articles by engaging with the university subject librarian and/or contacting the author(s) as necessary. Full-text screening to ascertain whether the selected articles met the inclusion criteria was conducted by all reviewers  independently. Major discrepancies and lack of agreement among reviewers (P.P. and H.E.) for inclusion in the scoping review were resolved through discussion.The above principles formed the basis for article selection and the databases that were searched and articles identified from each have been represented in Data from the studies were charted according to the information from randomised controlled trials and descriptive studies (Online Appendix 2) to gather as much detailed information as possible on the metrics used to describe prehabilitation in arthroplasty and to describe the interventions in detail to inform the development of a prehabilitation programme.This article does not contain any studies involving human participants performed by any of the authors.A total of 200 articles were identified and exported to EndNote version 20.5. After the review of titles, and removal of duplicates, 103 articles were selected. Title and abstract screening resulted in 48 articles being included, while 55 articles were excluded, for reasons including that the articles were protocols, theses or commentary pieces, and had the wrong population or outcomes. Full-text articles were then retrieved and a final 48 articles were collated and charted to answer the research question at hand .The literature search revealed that there were 8 systematic reviews and 6 meta-analyses, with 3 papers on total knee replacement and 11 on joint replacement. Six of the studies reported improvements in length of hospital stay , and in the study by Saw et al. , particiA total of 12 studies described educational interventions as a part of the prehabilitation programme. The overarching themes in the content of preoperative education were analysed. The main themes included preoperative preparation, hospital information, discharge information, postoperative management, patients’ expectations, precautions and contraindications, transfers, ambulation and assistive devices, the home environment, goal setting, surgery information and OA information.There were four studies that included preoperative preparation as a part of the content and discussed with patients on how to prepare for surgery  in our review and the primary outcome focused on pain, measured by the brief pain inventory and an open-ended questionnaire assessing the patient’s experience , starting with the non-affected leg. Proprioceptive exercises were included in two studies, but these studies did not describe the exercises in detail (Desmeules et al. The most utilised intervention to improve outcomes was the use of strengthening exercises. However, from anecdotal experience and the profile of the patients accessing the arthroplasty services in the public sector, the inclusion of balance and proprioception exercises is an important component of a comprehensive prehabilitation programme. Two studies incorporated balance exercises as part of their programme (Calatayud et al. Balance and proprioception can also be impacted by foot pain and deformities and there has been a definitive link in the literature between these factors and OA. Prevalence and incidence studies have identified that severe foot pain is more common in obese women, aged 65–74 years, with hand or knee OA, who walk more slowly and perform the timed five sit to stand from a chair slower that the cohort average (Leveille et al. Prehabilitation could be a valuable adjunct in reducing the length of hospital stay and improving functional outcomes in adults undergoing total joint replacement. However, future studies must consider chronic pain neuroscience education, balance and proprioceptive training, as integral elements in the prehabilitation programme. In the South African public health context, which serves most of the population, the waiting lists for arthroplasty are extensive and there is certainly a huge need to optimise patients. Considering the economic challenges in communities, a hybrid approach of face-to-face therapy and telerehabilitation will serve to enhance compliance and patient activity, ensuring the successful implementation of the prehabilitation programme. Based on the scoping review, a possible ideal version of the programme is presented in Online Appendix 3. A potential limitation of the scoping review methodology is the fact that only English language papers were considered, notwithstanding further research is needed to determine the impact of language restriction on systematic reviews in particular fields of medicine.