Despite several guidelines published by the World Health Organization (WHO) and national authorities, there is a general increase in the number of healthcare workers (HCWs) contracting tuberculosis. This review sought to evaluate the compliance of the HCWs toward tuberculosis preventive measures (TPMs) in their workplace. Both electronic databases and manual searches were conducted to retrieve articles regarding the compliance of HCWs in the workplace published from 2010 onwards. Independent reviewers extracted, reviewed, and analyzed the data using the mixed methods appraisal tool (MMAT) 2018, comprising 15 studies, 1572 HCWs, and 249 health facilities. The results showed there was low compliance toward TPMs in the workplace among HCWs and health facilities from mostly high-burden tuberculosis countries. The failure to comply with control measures against tuberculosis was mainly reported at administrative levels, followed by engineering and personnel protective control measures. In addition, low managerial support and negative attitudes of the HCWs influenced the compliance. Further studies are needed to elucidate how to improve the compliance of HCWs toward the preventive measures against tuberculosis in order to reduce the disease burden among HCWs worldwide. Tuberculosis is a chronic communicable infectious disease with a long history. Tuberculosis is a major cause of ill health and among the top 10 causes of death globally . HoweverThe WHO have published several guidelines on infectious diseases prevention controls in the workplace in order to reduce the risk of HCWs contracting nosocomial infection diseases in health facilities. Given the fact that HCWs are considered as a high-risk group in contracting tuberculosis based on their occupation, a specific guideline in preventing and reducing the risk of contracting occupational tuberculosis disease among HCWs was produced worldwide ,18,19. AAdministrative control aims to prevent HCWs and patients from being exposed to tuberculosis and reduce the transmission by ensuring rapid diagnosis and treatment of presumptive tuberculosis patients. Environmental control aims to prevent the spread of tuberculosis by reducing the concentration of infectious respiratory aerosols in the air. Environmental control should be in place together with administrative controls, as it requires budgeting and financial supply for the measures to be appropriately implemented. On the other hand, respiratory protective measures aim to double protect HCWs individually, especially those working in a high-risk workplace . By ruleNotwithstanding the several guidelines published in different countries to either regulate the activities or control measures required to reduce tuberculosis burden among HCWs, most of these guidelines focus on the policies, management, and infrastructure. None of these guidelines include the behavioral parts of the HCWs to create a complete and effective template to minimize their exposure to the disease. Adherence and compliance to tuberculosis prevention guidelines in the workplace are very important and crucial to reduce the burden of tuberculosis disease among HCWs. Furthermore, compliance of HCWs toward the control measures in the guidelines may contribute to the success of the preventive measures in reducing the burden of tuberculosis among HCWs. In addition to other issues such as financial constraints and high managerial involvement, weak implementation with less monitoring and no compliance to the guideline were the main contributors toward increasing incidence of tuberculosis among HCWs in most countries ,21,22. There is an existing review that analyzed the effectiveness and the need for implementation of TPMs according to the guideline provided by the WHO ; howeverA systematic literature search strategy was employed in this review to retrieve complete and comprehensive articles related to the research topic. A detailed protocol was used for the systematic review, whereby all the relevant studies obtained from the literature search were extracted and examined. This procedure step was run systematically in seven steps as follows: develop a research question, select suitable keywords in relation to the topics, define the databases that are relevant for the search process, determine the limitations of the search , the languages used and the nature of the documents, developed a review strategy, screening and examine the desired literature, and analyzing the selected articles.The research question in this study was formulated using the Population, Intervention, Control, and Outcomes (PICO) strategy. PICO is a tool that assists an author to developed suitable research questions for a review ,25. In tIn order to select the number of articles relevant to the research topic, the identification of keywords was conducted, which aimed to provide more options and selection of databases to search for more related studies. All similar terms to the keywords were identified using an online Thesaurus dictionary and through past research articles. The main databases comprising Scopus, Web of Sciences (WOS), and PubMed were first searched for articles relevant to the topic. Thereafter, articles were manually selected using other databases such as Google Scholar and manually picked or hand-picking techniques. The search process was executed using advanced searching techniques such as Boolean operators, phrase searching, truncation, wild cards, and separate field code functions, followed by combining these searching techniques into a full searching string, as shown in All the identified articles were sorted, and duplicates were removed. Subsequently, the articles were screened for eligibility according to the inclusion and exclusion criteria. For studies to be included in the review, the articles must have been published between 2010 and 2020 and focused on TPMs in the workplace. The relevant articles published in this timeframe were selected as TPMs in the workplace were changed rapidly following the latest technology with rapid progression on new drugs, new interventions, and new diagnostic tools. The other inclusion and exclusion criteria are listed in All selected articles fulfilling the inclusion and exclusion criteria were then independently and manually read and analyzed by the authors. Specifically, the title and abstracts and were discussed to ensure their eligibility in the review for the objective to be achieved. All studies were considered and included in the analysis, irrespective of whether qualitative or quantitative methods were employed in the articles. The electronic database search was conducted from October 2020 to April 2021, and the review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) .For the assessment of the risk of bias and quality evidence, the authors verified whether the relevant articles met the objective and inclusion criteria. All the articles were individually analyzed based on the objective of the study, and quality appraisal was performed using mixed method quality appraisal (MMAT) 2018 . These tA total of 88 articles were retrieved from the literature search. Upon data sorting, 33 duplicated articles were removed from the initial analysis, while the remaining 55 articles were eligible for further assessment. All articles were then screened by assessing their abstracts to determine if they fulfilled the study objectives. A total of 21 articles were found to be eligible to be included in the final and detailed analysis. From the 21 articles, six were excluded due to one or more of the following reasons: 1. the study only assessed the HCWs’ perception regarding their compliance toward TPMs; 2. focused on one or two selected control measures, such as screening of HCWs using tuberculin skin test (TST) and treatment of latent tuberculosis infection (LTBI); and 3. the study only described the situational status of HCWs’ adherence toward TPMs using a case scenario. In this review, excluding one study , the remThe majority of the studies (80%) concluded that the compliance of HCWs toward TPMs was poor, whereas three studies inferred that the HCWs’ compliance was good ,37,45. OThis review summarized three main control measures: 1. administrative and managerial control measures focusing on present tuberculosis guidelines or policies in the workplace, present committee or person in charge of TPMs in the workplace, HCWs’ training and surveillance measures, tuberculosis education activities, and any other relevant control measures pertaining to management decision or plan; 2. engineering control measures; the factors regarding ventilation system in the workplace that is suitable and manage to halt or reduce the contaminated air with tuberculosis bacteria and additional equipment, such as ultraviolet germicidal irradiation (UVGI); and 3. the last preventive strategy is personal protective measures or respiratory protective measures, which are mainly based on the availability and usage of respirators provided to HCWs and conducting a fit test before use. All the studies included in the final analysis evaluated the TPM focused more on administrative levels, as it is the most important level of control measures in preventing tuberculosis infection in all areas. Basically, administrative measures comprise all plans and activities executed in order to ensure that the existing TPMs are properly adhered to by HCWs. All the eligible studies employed different assessment methods, either based on the guideline provided by the WHO or the local authority. From the 13 studies that evaluated existing TBIC guidelines at the workplace, only seven of them ,43,44,46Further analysis revealed that four studies ,39,44,47A total of 12 studies assessed engineering control relating to ventilation in workplace facilities; seven of them ,42,44,47A total of 14 studies assessed activities relating to PPE measures. More than 50% of HCWs surveyed in eight studies stated that their workplace had PPE available, but only three studies reported that more than 50% of respondents practiced good PPE usage ,36,42. LThe overall findings from the reviewed studies revealed poor compliance or inadequate implementation of TPMs in the workplace. This may contribute to the continuous increment of the prevalence of tuberculosis among HCWs worldwide ,48,49. TThe first step in the prevention and control hierarchy as per guided by WHO is administrative control measures. It is recommended that all policymakers should implement various strategies in administrative control measures, especially in countries with high tuberculosis burden. For TPMs at the administrative level to be successful, strong commitments from the higher level of organization and political will and effective leadership are important. A basic requirement of the implementation, such as a guideline or policy about the implementation of control measures in the workplace with the involvement of all HCWs, should be emphasized and well distributed to the knowledge of all the HCWs. This is because all the subsequent strategies and planning activities will follow the recommendations in the guideline. Several studies reported the importance and the need for effective administrative control measures to reduce not only the risk of tuberculosis transmission but other hospital-acquired infections in the workplace . This reThe establishment of a committee in controlling the transmission of infection in the workplace, including tuberculosis, was important to ensure that the proposed measures were properly implemented. A study by Godrey (2016) showed that the establishment of a committee was significant to oversee the compliance of HCWs to disease preventive measures. Specifically, the presence of such a committee enhanced the results of HCWs’ compliance compared to facilities where no committee manages the affairs . The preTraining of HCWs is very important and should be carried out persistently in order to continuously update them about the latest and current policies. In this review, training was noted to be provided minimally to HCWs. A similar finding was also reported in one study as the training of HCWs was not considered important . HoweverFrom this review, only one study evaluated the issue of budgeting or financial allocation to tuberculosis prevention programs . FinanciThere is also the need to strengthen the surveillance system of tuberculosis among HCWs. This will assist in protecting the HCWs by early identification of occupational diseases, initiation of prompt treatment, and necessary interventions among the staff and facilities. Surveillance systems for HCWs regarding TPMs are executed using various available methods in the facilities, such as tuberculin skin test (TST), chest X-ray, or even IGRA. It is pertinent to comply with the screening activities, but it is less highlighted. This review reported low compliance of HCWs in the surveillance system, either by individual or organization. This finding corroborates the reports by Joseph (2004) , whereasEducation on tuberculosis should be delivered in all health facilities with or without the presence of tuberculosis patients since HCWs were exposed to the patients who hail from unknown health backgrounds. This review showed that various factors contributed to the minimal implementation of delivering tuberculosis education in the workplace. Tuberculosis education was noted to be provided most to patients compared to HCWs. Although the HCWs were expected to be knowledgeable about tuberculosis, their overall practice in relation to TPMs was still poor. Most of the HCWs in the interview claimed to adhere to TPMs, but it was not reflected following the researcher’s observation at the facility level. Disseminating the guideline and tuberculosis prevention plan alone to HCWs will not change them in practicing proper TPMs. They need to be educated to improve their understanding of the importance of practicing the control measures and the possible consequences of doing the opposite ,54,56,57Engineering control measures are the second level of TPMs that should be strengthened, especially in health facilities where there is a higher risk of cross-infection between patients and susceptible HCWs. Although outdoor transmission of tuberculosis is possible, indoor transmissions are more efficient due to limited air dilution and the proximity of occupants. Among environmental controls, natural ventilation and UVGI air disinfection are the most cost-effective choices in reducing the transmission of contaminated air with tuberculosis bacteria in the workplace . This reIn facilities with ineffective control measures, specifically managerial measures and incomplete or neglected environmental measures, the responsibility to protect the HCWs lies on the individual. PPE measures must be fully established and made available for HCWs at all times. Nevertheless, this review showed that most HCWs were less informed about PPE prevention measures, not adequately trained on proper PPE usage, and most of them did not undergo proper fit-testing to ensure they were fully protected. According to Jones (2017), an increment of about 95% of compliance to respiratory disease preventive measures would eliminate about one-third of pulmonary tuberculosis infections . HoweverThe findings of this review were only confined to a selected search engine that had been chosen by the authors given the most common articles related to the research topic. The possibility of missing other papers that were not included in the selected database cannot be ruled out. Therefore, the searching process was complemented using a manual search method. Likewise, studies written in languages other than English were not included in this study, which might be a source of selection bias. Other limitations included the fact that qualitative studies are mostly designed to assess HCWs’ perception toward compliance to specific activities executed in their workplace, thereby reducing the chances of generalizing the results. However, the strengths of this study are well-acknowledged. In addition to employing the PRISMA guidelines in the study selection process and reporting, articles involving the use of mixed-method design  were included in this review. This was performed to generate results as generalized as possible. Another limitation is that this review may be limited to African countries as 13 studies selected were conducted in Africa within a developing country with a high burden of tuberculosis disease. Thus, it may not represent other developed countries or other developing countries from other regions. Whenever possible, a self-admitted study design should be accompanied by direct observation to retrieve robust data. The results of this review could be employed as a guide to improving the current implementation of the national TPMs, especially regarding the prevention of occupational tuberculosis. In addition, to improve the existing guidelines or policies, it should be followed by strategies to change HCWs’ attitudes and behavior to strengthen the prevention measures. The other co-findings in the reviewed articles, such as economic burden either at national levels or specific health facilities, human resources, and individual policies, were rarely explored. This knowledge gap should be considered in future research. This review revealed low compliance of HCWs toward TPMs in the workplace, especially in countries with a high burden of tuberculosis disease. A total of 15 studies with 1,572 HCWs and 249 health facilities, mostly from countries with high tuberculosis burden, reported low compliance of HCWs toward TPMs in their workplace. The administrative level of control measures was identified as the main aspect where HCWs showed a high degree of poor compliance, followed by engineering and personnel protective control measures. Most studies reported that low managerial support is an important factor influencing HCWs’ compliance besides their negative attitudes. Factors affecting the implementation of necessary control measures in health facilities included lack of funding and financial support. Urgent plans and improving existing guidelines regarding TPMs are required in order to face the challenges and reduce the burden of tuberculosis among HCWs in the workplace. Ignoring these recommendations may impair the sustainability of the health system as a whole. To the best of our knowledge, this is the first attempt to perform a systematic review evaluating the compliance of HCWs toward TPMs in workplaces with the aim to identify the gap in the implementation of the measures. This review may provide guidance and be an eye-opener to policymakers in countries struggling with the tuberculosis burden among HCWs.


The use of machine learning algorithms for facial expression recognition and patient monitoring is a growing area of research interest. In this study, we present a technique for facial expression recognition based on deep learning algorithm: convolutional neural network (ConvNet). Data were collected from the FER2013 dataset that contains samples of seven universal facial expressions for training. The results show that the presented technique improves facial expression recognition accuracy without encoding several layers of CNN that lead to a computationally costly model. This study proffers solutions to the issues of high computational cost due to the implementation of facial expression recognition by providing a model close to the accuracy of the state-of-the-art model. The study concludes that deep l\earning-enabled facial expression recognition techniques enhance accuracy, better facial recognition, and interpretation of facial expressions and features that promote efficiency and prediction in the health sector. Facial expression is a nonverbal way of communication among humans. Facial expressions are representation of the emotional state of a human and have a huge impact on conveying emotions. The technique of recognizing a person's facial expression category is known as facial expression recognition. Facial expression recognition is utilized in a variety of applications, including the identification of mental disorders, depression analysis, and health forecasting and criminal detection. The seven universal facial expressions that are recognized in humans are “Happy, Sad, Fear, Anger, Surprise, Disgust, and Neutral.” This study focused on the classification of aforementioned facial expression with the help of deep learning techniques. In recent time, several techniques have been devised for automatic facial expression recognition with the help of deep neural networks. Deep neural networks are the subfield of machine learning that involve neural networks for figuring out solutions for the problems dealing with artificial intelligence . Deep neConvolutional neural networks (CNN/ConvNet) are used for application based on image classification, object detection, image processing, and so on. ConvNet has several layers and each layer has a different purpose. The layers in a CNN are input layer, convolutional layer, detector layer, pooling layer, and output layer. The input layer of ConvNet is the layer in which the input, for instance, an image, is given. This image is converted into discrete values of pixels corresponding to the coordinates of an image. The output of this layer is passed to the detector layer to convert linear data into a nonlinear data with the help of rectilinear activation. The feature map of this layer is passed as purpose of providing input to the pooling layer. This layer is utilized for the dimensionality reduction of the feature map and enables invariance upon small translations on the input. These layers comprise the basic architecture of convolutional neural networks –8.Since CNNs help in 2D representation of an image, one can leverage this feature of CNN to locate positions of features of the input image and further can implement required translation on the images for the purpose of image processing. Modification in traditional architecture of convolutional neural network leads to better solutions of several problems that could not be catered by existing traditional models. Some of the architectures that are designed using traditional CNN models are LeNet, AlexNet, and GoogleNet . These aThe researchers in this study employed ResNets to automatically classify facial expressions using the fer2013 dataset –17. FaciHussain and Al Balushi  proposedSuryanarayana et al.  exploredZhang et al.  proposedDevries et al.  developeKhan et al.  stated tMollahosseini et al.  presenteFabian Benitez-Quiroz et al.  introducZhang et al.  presenteStorey et al.  presenteWang et al.  investigGeorgescu et al.  show thaAlelaiwi  discusseMuhammad et al.  proposedPikulkaew et al.  stated tPrevious research , 36 showIn this section, we will discuss the models and methodologies used by us for facial expression recognition. There are different data augmentations applied to FER2013 dataset in order to increase the samples in the dataset. Along with data augmentation, we have designed the convolutional neural network model by introducing a residual block in the existing ConvNet model. We have chosen different sets of parameters for optimizing the model and to improve the learning of the model. The methodology used in this study is depicted in The purpose of the data augmentation is to resolve the issue of limited samples in the dataset to some extent along with increasing the diversity of the data. Commonly used data augmentations are flip, rotation, scale, crop, translation, and Gaussian noise along with some advanced data augmentation techniques. In this paper, we have used data augmentation technique that randomly crops the image into 4 parts along with the center crop and each cropped image is padded with the mirror of the cropped image. We have also applied random flip data augmentation technique , 39–41.The convolutional neural network  model imParameters used: to calculate the loss generated at the time of training the model we have incorporated the cross-entropy loss as our loss function. To optimize the loss generated during training the model, we have implemented in the Adam optimizer. The proposed approach has used one-cycle learning scheduler with the maximum learning rate of 0.001. We trained the model using these parameters for maximum 40 epochs. With these parameters, we could attain the maximum accuracy of our model on FER2013 dataset.CK+MMIJAFFEFER2013There are several datasets that exist for the facial expression recognition systems. Few most commonly used datasets are mentioned below.In this section, we will mention the results deduced on implementation of the methods mentioned in the proposed work. A combination of ResNets and standard convolutional neural networks was used for facial expression identification on the FER2013 dataset, as illustrated in As indicated by This accuracy level of the proposed model plays very good role in the patient monitoring situations and prediction of their activities through their facial expression. The technique presented in this study would assist physicians to improve their services and also the computer to make accurate health predictions .Facial expressions offer a wealth of nonverbal information that can be used in the study to better comprehend human emotions and intentions. The approach we presented in this study proved effective in patient facial expression recognition performance and provided a new way to solve problems in the existing ones as presented earlier in the literature. Our new approach enables face expression to be recognized and classified effectively with more accurate thereby reducing the computational cost and time consumption and improving the image recognition rate. The model is developed to improve the accuracy of patient face image classification. Our result shows that deep learning-enabled facial expression recognition technique enhances accuracy, better facial recognition, and interpretation of facial expressions and features that would promote efficiency  and predFacial expression emotion identification is a fascinating area of the study that has been applied in a variety of contexts, including safety, health, and human-machine interfaces. Researchers in this area are working to improve computer predictions by developing ways for interpreting, coding, and extracting facial expressions. Because of deep learning's exceptional success, several sorts of architectures are being used to improve performance.Since our presented model is computationally cheaper, it can be incorporated with other models in order to improve the accuracy of facial recognition systems using FER2013 dataset. Though FER2013 dataset is a very complex dataset with a limited number of samples per class, in order to improve the accuracy, the number of samples in each class can be increased by an optimal amount. Facial expression recognition can be combined with the concept of natural language processing (NLP) in order to increase the dimensionality of automatic facial expression recognition systems. If the future scope is implemented, it can play more important roles in e-Health system and health service delivery.


The purpose of this article was to systematically review and organise the available literature devoted to the topic of depressive symptoms and burnout in football players. A systematic search was conducted in Web of Science, Scopus, SPORTdiscus, PubMed, and Psychinfo for articles published up to June 2020. The searches yielded 1589 articles, and after the screening process, a total of 18 studies met the eligibility criteria and were included for review. Playing position and conflicts with coach/management seems to have a direct influence on the prevalence of depressive symptoms in current players as do the injuries and life events of former players. During the pre-competition phase, most of the athletes displayed reduced rates, indicating burnout. An exploration of the mental health of football players will help to create models of care and guide professionals so that they may help players achieve better performance while also having better wellbeing. Understanding how to prevent and cope with the emotional wellbeing of football players will be possible to guide players and coaches. Football is one of the world’s most popular sports. Millions of amateur and professional players are involved. For a player to become an elite performer, they need to have exceptional skills and abilities involving the investment of large amounts of time, effort, and dedication .Football is linked to a multitude of different emotions, some of them experienced very markedly both by fans and players. Hence, there has recently been an interest in understanding the impact of the game on the physical and mental health of fans and players .This is particularly important considering that football puts intense mental pressure on the players, which may increase their susceptibility to certain mental health problems . Losing Depression is a disturbance of mood characterized by constant feelings of sadness, hopelessness, despair, and a loss of interest in formerly appreciated activities . It may The cause of depression and the appearance of depressive symptoms are not fully understood. Apart from biological and genetic predisposition , severalBurnout is a state of mental, emotional, and physical exhaustion due to a constant commitment to ambitious goals . It has Whereas burnout and depression share several common features, such as loss of interest, loss of energy or fatigue , there hIt is also worth mentioning that both athlete burnout and depression are often conceptualized in a stress-based model . In factThis systematic review was conducted according to PRISMA  guidelines . The stuA systematic review strategy was conducted according to PRISMA guidelines . ElectroA data extraction sheet, adapted from the Cochrane Consumers and Communication Review Group’s data extraction template , was usehttp://www.casp-uk.net/ accessed on 15 September 2021).An appraisal tool to assess the quality of cross-sectional studies (AXIS) was used to classify the methodological quality of the articles . AdditioAll the articles related to burnout were cross-sectional. Of the 11 articles related to depression, seven were cross-sectional. The scale includes 20 items, in which one is related to the introduction, 10 are related to methods, five are related to results, two are related to discussion, and two consider other factors. Two of the authors (FMC and HS) independently screened and rated the included full articles. The agreement of both authors was tested using the k agreement rate. The Cohen’s kappa coefficient (k) was executed and revealed a k agreement of k = 0.94.n = 121), the fact that they were conference abstracts (n = 27), they presented data from other sports (n = 14), and they were written in languages other than English (n = 5). Following this trimming, 18 articles were accepted for the systematic review . Duplicates (1388 references) were subsequently removed either automatically or manually. The remaining 1342 articles were screened for their relevance based on titles and abstracts, resulting in the removal of a further 1157 studies. The full texts of the remaining 185 articles were examined diligently. After reading full texts, a further 167 studies were excluded owing to several reasons including a lack of relevance to the research topic , four of them included former players, three included youth players, five included elite/professional players, and two of them included amateur players. Seven of the studies exclusively analysed men, two included both men and women, and two analysed women only. Considering the studies on depression and depressive symptoms, the majority assumed a cross-sectional design (n = 7). Considering the studies on burnout (n = 7), five of them were focused on elite or professionals and two on youth players. All of the studies (n = 7) on burnout were conducted on men and had a cross-sectional study design.The characterization of the included studies can be found in n = 6). An establishment of the relationship between depression and depressive symptoms and factors that contribute to the occurrence of symptoms was also recurrent among the studies (n = 3). One study tested the effect of a controlled intervention to reduce depressive symptoms. Considering the instruments to assess the main outcome, the Center of Epidemiologic Studies Depression Scale was the most used (n = 5), followed by the 12-item General Health Questionnaire (n = 2).The qualitative synthesis of the studies related to depression and depressive symptoms can be found in The prevalence of depressive symptoms found in male and female players as well as in current and former players assumes an important relevance for public health ,27,28. PSince terminology is important in the studies developed in this context, The analysis of burnout in football players has been on the agenda of sport scientists in the last decade . All of The prevalence of depressive symptoms was analysed in current and former players (both men and women). Depressive symptoms varied from 16.7%  to 39% . Severe Some of the studies have tried to justify the causes of such prevalence. In the case of former players, the main reason to justify depressive symptoms was having to retire because of injury  or live A randomized clinical trial  tested tFinally, a result worth noting relates to sex differences. In one study, no significant differences were found between sexes . HoweverThe reviewed studies demonstrated the existence of a great dispersion of objectives. In this sense, the study of Verardi et al.  demonstrThe other studies included in this review always sought to establish relationships between burnout and other moderating variables, namely perfectionism , bullyinSpecific techniques may apply, depending on the particularities of burnout. Nonetheless, typical techniques that may help reduce anxiety may also be used with these players, such as: imagery techniques, relaxation, and problem-solving techniques. Considering the association found between anxiety and burnout , it is pIt is important to note that from the studies selected for the review that met the inclusion criteria, only one study  referredThe studies found in this review revealed some interesting results in terms of practical implications and possible future directions in research. However, there is still a long way to go.First of all, the results highlight the importance of talking about depression and depressive symptoms. Depression is a serious disease, and the results of this review suggest that the prevalence of depressive symptoms in football players is very high. It is imperative to talk about depression, the symptoms, and the consequences, as well as the early signs of burnout. Improving open communication between players and football staff may be important. It is essential not to hide it, especially considering that depression and depressive symptoms can often be linked to irreversible issues such as suicide . HoweverMoreover, clinical sport psychological approaches are still scarce . ConsideThe study’s result demonstrated the existence of a great dispersion of objectives on studies. Thus, more studies are needed. It is imperative to develop a comprehensive understanding of the mental health of football players and to create models of care and management which will have an impact on the performance of players and their wellbeing . By bettAnother important recommendation relates to social support. Considering the nature of football, and the constant travel and possible disillusions related to the game, social support may be an important preventive strategy. Social support may also be an important protective factor , helpingFinally, future investigations should take into account the level of professionalism of footballers. The evolutionary tendencies of the game  can have a significant influence on depressive symptoms and burnout.Future studies should consider not only the use of self-reports but also more accurate methodologies. Self-report measures are of utmost importance in screening and measuring progress. However, when we are interested in studying the diagnosis of diseases such as depression it is important to include a professional structured clinical interview by professional psychiatrists/psychologists and to have a confirmed diagnosis.A possible limitation of this systematic review is that it only includes studies in English from the Web of Science, Scopus, SPORTdiscus, PubMed, and Psychinfo databases. Additionally, the fact that the selected studies are mostly cross-sectional may result in a limitation of the existing research to date, along with the level of evidence (as explained in Although there are many studies in this area, little attention has been paid to the psychological component. When looking for information about depression, and depressive symptoms or burnout and sport, there is a clear primacy with respect to the beneficial effects of sports and exercise on symptoms of depression and anxiety, while there is little on the levels of depression and burnout of players. Recently, however, there has been a greater openness to this topic.The reviewed studies showed that depressive symptoms in football players are more prevalent when compared to the general population. During the pre-competition phase, most of the athletes displayed reduced rates of indicating burnout. Considering the constant travel and possible disillusions related to the game, social support might be an important preventive strategy and protective factor. This type of intervention would help players dealing with critical problems such as injury and loneliness, while serving to minimize a host of negative behaviours. By better understanding how to prevent and cope with the emotional wellbeing of football players, it will be possible to guide all sports staff.


Statistical data are necessary to inform public debate on effective animal protection legislation. This retrospective study of 254 animal cruelty complaints recorded by the SPCA (Hong Kong) between 2013 and 2019 identified the gender and age of abusers, their relationship with the owner of the animal (where the owner was not the suspect) and the circumstances of the abuse. Animals are primarily at risk of harm from their male owners and owners’ family members. Most cases involved traumatic physical injury to dogs, with 30% of cases involving animals being killed by the defendant or having to be euthanised within 24 h of rescue, due to the level of cruelty inflicted upon them. The second most common typology of abuse involved neglect, with 27% of cases involving animals that had died from neglect or required euthanasia within 24 h of rescue. Most neglect cases involved animals being abandoned inside private premises without food/water. Abuse motivated by commercial profit was dominated by the breeding of dogs and cats for the pet trade. Dogs collected from strays were the most commonly hoarded species. Recognising the types of abuse and the species most at risk can inform legislation intended to protect animals.We conducted a retrospective study of 254 suspected cruelty offences recorded by the Hong Kong Society for the Prevention of Cruelty to Animals (SPCA) between January 2013 and December 2019. Cases were categorised into four types of abuse: active maltreatment, passive neglect, commercial exploitation and hoarding. Attributes of defendants, relationship with the owner of the animal (where the owner was not the defendant) and the circumstances of the abuse  were recorded for each case. The majority of prosecuted cases involved traumatic physical injury to dogs, with 30% causing the death of animals. The second most common type of harm prosecuted was neglect, with 27% of cases causing death. The majority of neglect cases involved dogs abandoned inside private premises without food/water. The median number of animals hoarded was 47, with dogs the most common species. The majority of hoarders had collected their animals from strays. The largest hoarding cases  were operating as animal rescue shelters. Strategies to address cruelty to animals in Hong Kong can be informed by an understanding of which species are at greater risk of harm and in what circumstances this harm might occur. The treatment of animals is a matter of widespread and significant public concern . Its effHong Kong’s legal protection for animals is unique in China. Hong Kong’s Prevention of Cruelty to Animals Ordinance, Cap 169, based on the United Kingdom’s Protection of Animals Act 1911 , has been in place since 1935. Despite calls for reform, legislators in Mainland China have yet to introduce anti-cruelty legislation but, in 2018, the Hong Kong government’s public policy address recognised the need to introduce more comprehensive legislation to safeguard animal welfare. The Chief Executive of Hong Kong announced that calls for the introduction of a positive duty of care on persons responsible for animals to provide for their animals’ welfare needs, enhanced enforcement powers to prevent cruelty and increased penalties for offending would be considered in a public consultation process. In April 2019, Hong Kong’s Agricultural Fisheries and Conservation Department (AFCD), under the Food and Health Bureau, commenced a public consultation focused on enhancing enforcement powers under the Prevention of Cruelty to Animals Ordinance to strengthen the protection of animals through the introduction of a duty of care, raise the maximum penalty for cruelty and introduce a new indictable offence for the most serious cases of cruelty. After public views of government proposals were assessed, the AFCD reported the need for reform to Hong Kong’s Legislative Council [While widespread public concern for animal welfare provides a legitimate basis for legislation to be critically assessed on a regular basis, empirical research provides a constructive platform from which proposed legislative reforms can be objectively assessed. Statistical data are necessary to inform public debate as to how the law should be amended to most effectively combat animal abuse . ConcernWith a view to informing public debate and making recommendations for the reform of animal protection legislation in Hong Kong, we conducted a retrospective study of 254 suspected cruelty offences recorded by the SPCA (Hong Kong) between January 2013 and December 2019. In order to ensure that each case involved a substantiated allegation of cruelty, each of the cases selected for study was required to have been referred by police to the SPCA for assistance and involved the seizure of at least one animal (in some cases deceased) on the basis of suspected cruelty.Since its inception in 1921, the SPCA (Hong Kong) has played a significant role in assisting the investigation of animal cruelty offences. As a longstanding NGO partner to the AFCD and the Hong Kong police force in the investigation and prosecution of animal cruelty offences, the Society has been able to develop an extensive database of case investigations. The purpose of our study was to develop insights into the scope of animal abuse in Hong Kong by determining the species of animal being harmed, they ways they are harmed, offenders’ motivations, reasons for offending and patterns of offending. In the 1990′s, Vermeulen and Odendaal utilised human victim typologies as a guideline for the construction of the first typology of animal abuse . These wIn Hong Kong, the primary legislation protecting animals from cruelty is the Prevention of Cruelty to Animals Ordinance, Cap 169. The Ordinance provides for the offence of cruelty to an animal, which is defined as causing unnecessary suffering to it. The Ordinance also provides for subsidiary regulations concerning how captive animals are to be treated, confined and transported . None ofThe Public Health  (Trading and Breeding) Regulations, Cap 139B, supplement the Prevention of Cruelty to Animals Ordinance, Cap 169, by regulating the breeding and sale of companion animals. In 2017, due to widespread problems with puppy farming, the Regulations were amended to improve controls on dog breeding. The Regulations currently require that any person selling a dog requires a licence (or a permit) and impose a duty of care for the welfare of the animals on those who breed and sell dogs. Cap 139B’s controls on those who trade in dogs is the only legislation imposing a duty of care for animals to have been introduced in Hong Kong to date. While shelters, trainers and groomers are not regulated, Cap 139B also provides for licensing controls on pet shops, requiring licencees to be suitable persons to be in charge of animals, and for staff to have training in animal welfare. Boarding establishments must also be licensed to operate.While Cap 169 does not include abandonment of an animal as a stand-alone offence, the Rabies Ordinance, Cap 421, notes that it is an offence to abandon a mammal . Under tMutilations such as ear-cropping, de-clawing and tail-docking may only by performed by registered veterinary surgeons for proper medical or generally accepted animal husbandry reasons .From January 2013 to December 2019, all cases classified by the police as suspected cruelty which involved the seizure of at least one animal, requiring SPCA assistance, were analysed. Cases were categorised into four types of abuse: active maltreatment , passive neglect or ignorance , commercial exploitation and hoarding. Where cases fell into more than one category, they were categorised into the predominant category, according to the strength of evidence available at the time of investigation. Known attributes of the suspect, the relationship of the suspect to the owner of the animal (where the owner was not the suspect) and the circumstances of the abuse  were recorded for each case. Where cases proceeded to prosecution, available mitigation relied on at court was analysed. Only cases which proceeded to prosecution were analysed in this paper. Future papers will consider those cases investigated but not proceeded with.The analysed database did not capture all cases of suspected cruelty where animals were seized by authorities in Hong Kong during the seven-year period studied. On suspicion of animal cruelty, members of the public in Hong Kong have the choice to report their concerns to the SPCA, the AFCD or the police. All 22 police districts in Hong Kong have a criminal investigation team designated to investigate animal cruelty cases. In some cases, the police or the AFCD seize animals without involving the SPCA in the investigation or an assessment of the animals concerned. These cases were not recorded in the SPCA database. Despite these shortcomings the data captured in the SPCA database provide a reliable indicator of the types of abuse in Hong Kong between 2013 and 2019. By limiting the study to only those cases in which police suspected cruelty and animals were seized, cases lacking prima facie evidence of cruelty were excluded.Categorising the 254 suspected cruelty cases in the SPCA database into the four typologies of abuse, the largest category reported and investigated included 117 cases of active maltreatment  to animals. Of these 117 cases, 61 proceeded to prosecution. Decisions to prosecute are made on a case-by-case basis by the Hong Kong Department of Justice, after investigations are completed by the police. The main reasons cases of active maltreatment were not proceeded with were that a suspect could not be identified or evidence of physical injury was not detected at the time of a given animal’s clinical examination. The next largest category included 105 cases involving passive neglect or ignorance . Of these 105 cases, 62 resulted in prosecution. Most cases of neglect that did not proceed to trial were curtailed by police on the basis that the animals showed insufficient signs of harm to justify prosecution. In some cases, police could not locate the suspect or did not send cases for legal advice confirming the correct charges to be laid within sufficient time and the time bar was missed. During the studied period, 20 investigations involved the commercial exploitation of animals used for profit, with 16 proceeding to prosecution. There were 12 cases related to the hoarding of animals, of which 10 were prosecuted. Hoarding, for the purposes of the study, was defined as persons keeping more animals than they can care for adequately in circumstances in which the animals’ most basic physical and social needs, including food, water, shelter, veterinary care and sanitary living conditions, are unlikely to be met.For the purpose of making recommendations for law reform in Hong Kong, the cases were analysed for species of animal abused, background of offenders and human relationships/circumstances of abuse. As can be seen in As can be seen in Body corporates were very seldom prosecuted, with only one case for cruelty (involving neglect) recorded in the seven-year study period. The defendant company controlled a temple inside of which had been built an artificial pond. The pond contained 43 terrapins, including some endangered species. The turtles attracted ‘luck’ donations from the public. On receiving a complaint, investigators found the pond water had been allowed to dry up, and five animals had died. The other 38 animals were found to be suffering from poor body condition and showed signs of neglect including starvation/decreased nutrition, failure to provide adequate care, and likely dehydration. In mitigation, the company directors stated that the temple was a charity organization, with 35 unpaid directors, all of whom were over 75 years of age.In the majority of cases, the animals were harmed by people who knew the animal prior to the offence. In 24 of the 61 cases involving traumatic physical injury, the owner/person in charge of the animal was prosecuted for inflicting the harm directly. This category included one case of deliberate harm to the dogs of her employer by a domestic helper. Another case involved the killing of a dog by inmates in a drug rehabilitation centre who had been entrusted to care for it. One cat was abused by a friend of the owner who had left it for safekeeping while he travelled. In a further nine of the 61 cases, the animals were alleged to have been harmed by family members of the owner. In another eight cases, neighbours were prosecuted for attacking dogs over social issues: nuisance, barking, attacking livestock and biting. In the other 20 cases, the animals were alleged to have been attacked by strangers. In five of the 61 cases, the defendant was acquitted after trial for a lack of evidence. Two cases where cruelty was alleged against the owner resulted in acquittals due to the lack of an eye witness to support the prosecution. One of those cases concerned a dog which had been thrown from a roof and one involved a dog which had had its jaws bound shut with elastic. One family member was acquitted after his girlfriend retracted her statement made to police, and two cases involving allegations against a stranger and a neighbour resulted in acquittals for a lack of sufficient evidence as to who had attacked the dogs in the street. All cases of neglect involved the owner or a friend of the owner entrusted to care for the animal concerned. In only one neglect case was the defendant acquitted, as his claim that he had intended to seek more aggressive medical treatment for a wound to his dog was accepted by the court. None of the commercial or hoarding cases resulted in an acquittal.A significant number of cases involved serious harm. Of the 61 cases in the active maltreatment category, 18 involved animals that were killed or had to be euthanised within 24 h of rescue due to the trauma inflicted upon them.Of the 62 cases that involved neglect, 17 involved animals that had died from neglect or required euthanasia within 24 h of rescue due to the advanced state of their suffering. A total of 41 of the 62 neglect cases involved animals found inside private premises without food/water. Twelve of these cases involved the abandonment of more than one mongrel dog. In 36 of the 41 cases involving animals abandoned in private premises, the animals were discovered inside village houses in rural Hong Kong. In the course of the study, the locations in which the suspected offending had occurred were categorised and checked for association with types of offending. Locations were categorised as private housing, public housing, village housing, non-residential and unknown. 53% of cases involving the neglect of dogs and 80% of hoarding cases occurred in villages in rural Hong Kong. No other associations between offence and type of housing were observed.In cases of commercial exploitation, it appeared from in court mitigation that the primary motivation for offending was profit. As can be seen in In four of the 10 hoarding cases prosecuted during the period of study, the defendants refused to surrender their animals voluntarily, claiming they were better off staying with them than being re-homed.Contrary to reported cases in the USA , active It is unsurprising that dogs and cats were the primary victims in all four categories. A 2019 survey by the Census and Statistics Department of Hong Kong found 241,900 households keeping dogs/cats (representing 9.4% of households in Hong Kong). According to the census data, 5.7% of households in Hong Kong keep dogs and 4% keep cats . Studies in the USA, Australia and Italy have shown the most consistent factor related to animal abuse is gender. Typically, offenders are male and under 30 years of age . The excThe circumstances in which hoarding is practised in Hong Kong also varies from that reported in western countries. In 80% of cases prosecuted for hoarding, during the study period, the defendants were not living with the animals concerned but had rented village properties in rural Hong Kong to house the animals (often strays) they had collected. In Hong Kong, nearly 50% of the population live in public housing. The keeping of pets in public housing is limited to small animals. Dogs may only be kept with special permission and, in most social housing situations, are effectively banned . In two Hong Kong has a significant number of stray and feral animals, including dogs and cats. The feral cat population has largely been reduced through the setting up of a Trap, Neuter, Return programme (TNR) for cats, run by the SPCA since 2000. The programme was formally recognised by the AFCD in 2002 and, by mid-2020, the SPCA had neutered over 75,000 cats . The aniThe feral dog population is also supported by the abandonment of reproductively viable pets.Abandonment of pets in Hong Kong is a significant problem, with 75% of the stray dog population considered to have arisen from abandonment . Three oIn 2003, the Housing Authority of Hong Kong also increased its control on pets in public housing and re-enforced its ban on the keeping of dogs  . From 20Government reclamation, under the Lands Resumption Ordinance, Cap 124, of private farmland to meet the shortage of land for housing in Hong Kong has also contributed to significant pet abandonment. When farming villages are closed, their inhabitants are moved to public housing, where any dogs the villagers have been keeping are prohibited. In the Northeast New Territories alone, up to 4000 animals (90% dogs and cats) are reported to be at risk of abandonment when their owners are moved from villages spanning across 68 hectares in Kwu Tung North and Fanling North, close to the Chinese border, to public housing throughout 2021 .The reality of accommodation size in Hong Kong also impedes the keeping of animals. Hong Kong has a population of 7.5 million people. Private flats are small, with an average square footage of 681 square feet , and theHistorically, many private estates have prohibited the keeping of any dogs on their property, even when the flat is owner-occupied . The inaWhile properties in rural areas are more isolated than those in the built-up areas of Hong Kong, the keeping of animals in villages does not necessarily ensure their safety from neighbourhood disputes. In four of the 61 cases involving traumatic physical injury, neighbours attacked dogs living in their village. Three of these cases involved dogs being attacked for causing annoyance to neighbours by barking or worrying livestock. One defendant attacked a dog permitted to roam the village by the owners, as he regarded it as a biting threat. In all four cases, the defendants reported to the court having urged the owners to manage the animal’s behaviour. In one case, a dim sum chef who had to wake up at 4 a.m. every morning for work had complained to the dog owner and the AFCD regarding the dog’s barking for almost six years prior to the offence.An ongoing problem for Hong Kong authorities has been the reluctance of owners of village dogs to take proper responsibility for their pets. Dogs in rural areas are significantly less likely to be microchipped for ownership, despite the legal requirement that all dogs over 5 months of age are chipped on vaccination for rabies. Nuisance barking, roaming and incidents of biting are all exacerbated by a lack of control over dogs. Hong Kong’s Rabies Ordinance requires that all dogs should be leashed or otherwise under proper control when in a public place or in a place where they might wander into a public place ; howeverOther relevant factors leading to the abuse of companion animals which are known to present difficulties for regulators include mental illness, childhood abuse and domestic violence, with dogs in the home being the most common victims of abuse . The corIn cases of commercial exploitation, it appeared from in court mitigation that the primary motivation for offending was profit with 50% of cases in this category related to breeding. In March 2017, Hong Kong brought in amended regulations requiring all breeders of dogs for commercial purposes to hold a licence . Only onIn five commercial exploitation cases, animals were seriously injured by those entrusted to care for them by their owners. In one case, a dog was hit with a metal pipe by a trainer and, in two cases, dogs were deliberately injured by groomers. In the fourth case, an unqualified person performed surgery on a dog’s ear in a grooming centre. In the fifth case, the owner of an illegal boarding establishment failed to care adequately for the dogs placed in his charge. In Hong Kong, grooming parlours and dog training operations are not regulated. Boarding establishments are required by licence to provide protection from disease, escape and fire, but there is no requirement to assess the suitability of the licencee to care for animals or for staff to be trained in animal welfare. In 2017, the amended regulations on dog breeding required pet shop operators and their employees, along with breeders, to undertake training in animal welfare to continue to operate. The Hong Kong government should consider requiring boarding, grooming and training operators to ensure staff are trained to care for animals as licencing conditions for operation. The total number of animals hoarded per case ranged from 3 to 146. The median number of animals in the ten hoarding cases prosecuted for cruelty was 47, with dogs being the most commonly hoarded species. Five cases related to the hoarding of dogs only, three to cats only, one to a mixture of dogs and cats and one to a mixture of turtles and rabbits.In six of the ten cases, the defendants told the court that they had collected the animals from strays. This predominant characteristic of acquisition is consistent with studies in western countries . In two In two cases, the defendants were hoarding pedigree dogs. In one of these cases, the fact that only one breed was present suggested breeding as the possible motivation for hoarding. In two cases, both involving more than 40 cats, the animals had resulted from unplanned breeding.Hoarders commonly make excuses for their behaviour and deny that the animals they keep are suffering due to their environment . In fourIn another case, a defendant refused to surrender eight animals which had been found locked in crates in an alley without food or fresh water. The defendant had collected four rabbits and four turtles from others living in the neighborhood, and claimed their housing was ideal. The cages were dirty and filled with excrement. Two of the animals were observed to be suffering from obvious skin diseases caused by bacterial infection.In one of the two shelter cases, the defendant was hoarding 102 dogs and 44 cats. When people who had placed animals in the shelter raised the alarm with authorities, the shelter was raided. 28 dead dogs and 8 cats were found across the facility, with other animals rescued from confinement in cages and rooms without food and water. The owner of the shelter had been running shelters for ten years and had been at the present site for one year. He said he generally received HKD4000–8000 in donations each month. The rent on the shelter was HKD8000 per month, and he told the court in mitigation that he could not afford to pay other bills.In another case, a woman running a shelter with volunteers had confined 95 dogs to a 2100 square foot village house and yard. The dogs had not been fed for a very long period and 20 of them had died. Some of the bodies had been consumed by other starving dogs. The shelter was raising money from the public. The defendant initially tried to blame her helper for the deaths of the animals and the unhygienic environment in the shelter (the dog excrement was one inch thick in parts of the property).One of the proposals to improve the cruelty protection of animals in Hong Kong is the imposition of new duty of care legislation which would allow enforcement authorities to take early interventionist action against owners and keepers of animals who fail to provide a reasonable standard of care for their animals. Early intervention/improvement notices are designed to allow authorities to improve welfare through education and in situ enforcement before issues progress to a point requiring animals to be seized for their own safety and protection. Use of early intervention mechanisms is known to result in fewer cases needing be brought to prosecution . While mThis study also demonstrated the need for shelter legislation to be introduced in Hong Kong. Were shelters licensed and inspected, welfare problems for animals could more easily be identified and early action could be taken to avoid the need for large scale seizures and prosecutions. A further reason to regulate shelter conditions is the lack of financial transparency as to how public donations to shelters are used.With regard to grooming and training establishments, licensing requirements resulting in regular inspections of facilities, welfare training and competency assessments and registration of employees, alongside the application of new duty of care/improvement notice legislation, would likely reduce the risk of cruelty to animals.With the introduction of a duty of care, educational messages would need to be adapted to ensure those keeping animals or working with them understand their new responsibilities under the law. These messages should emphasise not only the need for animals to be treated properly but for those who keep them to show consideration to others in the way they are kept, reducing the opportunities for neighbourhood conflicts over nuisance. Promotion of care standards linked to the introduction of a duty of care should have both an educational and a deterrent effect on those keeping animals, and assist in the enforcement of both the current and proposed animal protection legislation.A significant proportion of the victims of animal abuse in Hong Kong are dogs. This problem is likely exacerbated by the current policy excluding dogs from public housing. The Hong Kong government’s long term housing strategy is to increase public housing by 430,000 units over the next decade . With thWhile the results of the ongoing trial dog TNR study are yet to be fully apparent, the initial results demonstrate a slow decline in population and a significant reduction in puppy production. Given the disproportionate number of hoarding cases involving rescued stray dogs, and the preference of a significant proportion of the Hong Kong population for abandonment over euthanasia for their pets, the AFCD should act to implement broad responsible pet ownership education programmes alongside introducing Territory-wide TNR for feral dogs in appropriate situations and in the interest of animal welfare. The problems of animal hoarding and cruelty in Hong Kong illustrate the need for the government to adopt the One Welfare approach in policy and legislative reforms. Our study has shown that animals are primarily at risk of harm from their owners and their owners’ family members. While the existence of correlations between attacks on family members’ pets and incidents of domestic abuse in humans were not explored in this study, the link between family violence and animal cruelty should be considered in protocols developed by the Social Welfare Department for dealing with at-risk families.This study demonstrates that Hong Kong’s animal cruelty protection legislation would significantly benefit from the introduction of a duty of care. This would allow enforcement authorities to take early intervention action against owners and keepers of animals who fail to provide a reasonable standard of care for their animals. Consideration should be given to the introduction of licensing controls on animal shelters, groomers and trainers. Adherence to legislative reforms requires societal acceptance of the need for change, and educational messages should emphasise the necessity for animals to be treated properly to protect their welfare. To combat the disproportionate number of stray dogs collected by hoarders, the government should implement educational programmes for dog owners that are focused on responsibility, alongside TNR programmes for feral dogs in appropriate areas. The link between family violence and animal cruelty should be considered in future studies in Hong Kong.


Xenohaliotis californiensis and Abalone viral ganglioneuritis caused by Haliotid herpesvirus-1 (HaHV-1). Research into the diseases of gastropods has often focused on those species that act as intermediate disease hosts, those that are used in research or those cultured for food. In this paper we review the viral, bacterial, fungal, parasitic and miscellaneous conditions that have been reported in gastropods and mention some of the factors that appear to predispose them to disease. The pathogenicity of a number of these conditions has not been fully ascertained and more research is needed into specifying both the etiological agent and significance in some of the diseases reported.Gastropods (class Gastropoda) form the largest of the classes in the phylum Mollusca and inhabit terrestrial, fresh water and marine environments. A large number of these species are of major conservation importance and are an essential component of ecosystems. Gastropods may be deemed as pests, having a negative impact in horticulture and agriculture, whereas others may be used as a food source for human consumption and therefore are beneficial. Gastropods are susceptible to primary diseases and also act as intermediate hosts for diseases which affect other animals, including humans. The diseases described include two that are notifiable to the World Organisation for Animal Health (OIE):  Gastropods  are comprised of more than 80,000 species and are differentiated from other classes of mollusca by the presence of a torsed body. They are separated into three subclasses: Prosobranchia, Opistobranchia, and Pulmonata. They are found in terrestrial, freshwater and marine environments. All gastropods possess a ventrally flattened foot that provides locomotion . Over 20Gastropods can be used in a number of different types of research including animal and human parasites and neurobiological research . With suHaliotis rubra, Haliotis laevigata and hybrid H. laevigata x H. rubra in Australia and cultured Haliotis diversicolor supertexta cohabiting with Haliotis cracherodii, in Taiwan. This disease is reportable to World Organisation for Animal Health (OIE) and the US Department of Agriculture (USDA) , has been reported in farmed and free-living abalone e (USDA) . High moe (USDA) . Histoloe (USDA) , 5.Theba pisana (an intermediate host in human and veterinary medicine), transmission electron microscopy (TEM) confirmed nuclear inclusions where unenveloped, roundish virus-like particles were observed , causes withering syndrome in abalone. This disease is notifiable to the OIE , and is claimed to be the first extinction caused by an infectious disease  infections have been described in the haemocoel of aquaria held gastropods  and in tSplanchnotrophidae are endoparasitic copepods and can affect nudibranchs by producing egg sacs under the external body wall, or which project through the host’s body wall . There iHaliotis iris  usually occurred , Ampullarius australis (papilloma of the epidermis and adenoma of the digestive gland) and Chiton tuberculatus   .Parry and Pipe  found thH. diversicolor infected with V. parahaemolyticus by reducing immune function  used as food for the abalone which led to a mortality event in H. asinina. This shows that good farming and management practices as well as appropriate husbandry are vital in reducing the spread of pathogenic diseases.Dang et al.  suggestem wheras  found thAs the number and variety of species of gastropod kept in captivity increases, and the conservation status of further wild populations becomes more critical, research into gastropod diseases, mitigation factors and greater depth of knowledge of those diseases already reported but not fully categorised will take place. This will benefit all gastropods, and hopefully in particular those of conservation importance.The two authors (MO’B and SP) have contributed equally to this work. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Discovery and variations of rectus sternalis muscle are occasionally seen in humans. However, during routine academic dissection of an adult male embalmed cadaver, a rare variant of the muscle was identified. The muscle had origin from the pectoral muscle and fascia and was inserted into external oblique aponeurosis along with the sixth rib and cartilage. It had double slips with the partial merging of the bellies. Knowledge regarding such unique muscle is important to anatomists for medical education as well as to surgeons during thoracic surgeries, in craniocaudal mammography where it can mimic breast mass and for using as muscle flap in the anterior chest wall, head and neck, and breast reconstructions. Rectus sternalis is a name that we might have come across but not dealt with commonly. Often referred to as by multiple synonyms like Mystery Muscle, Sternalis Brottrum Episternalis, Presternalis, Rectus Thoracicus Superficialis, etc., this muscle mostly lies as a variant of the anterior chest wall, subcutaneously over pectoralis major ,2. It haIn the present study, we report a unilateral rectus sternalis muscle with double slips to discuss its significance in clinical practice.The presence of the unilateral rectus sternalis muscle in a 69-year-old embalmed male cadaver on the left side was a serendipitous finding. It was found during routine undergraduate dissection curriculum at the Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, India. The muscle qualified the checklists required to be called rectus sternalis, being present in between superficial and deep layers of pectoral fascia. The position of the muscle was parasternal, anterior to the pectoralis major muscle with its fibers directed parallel to the sternum and perpendicular to that of the pectoralis major Figure . In the upper end, it showed two well-separated slips and two bellies that were semi converged till the lower end. The fifth intercostal nerve was found to be supplying both, running transversely along the muscle bellies Figure .Both slips were equally developed, and the origin of both slips was from the upper segment of pectoralis major muscle and pectoral fascia, inferior to the clavicle and paramedian to the sternum at the level of fourth costal cartilage.The insertion of both slips was at the sixth rib and sixth costal cartilage and external oblique aponeurosis. It measured 4 cm in length and 1.8 cm in width in the convergent part of the bellies. All measurements were done by digital vernier caliper with a precision of 0.01 mm.The rectus sternalis is a quirky muscle having multiple variations in origin, insertions, nerve, and blood supply. Although common in quadruplets, in humans the incidence of muscle is occasional, with unilateral manifestation in 4.5% and bilateral in 1.7% [As per the study by Getty, a rectus thoracis muscle in ruminants and horses that lies over the ventral chest wall and extends from the cephalad aspect of the rectus abdominis to the top of the sternum and which helps in the expansion of the chest and aggressive inhalation is described .A similar muscle in higher primates has been noted and Osman Hill referred to this additional muscle as rectus sternalis, while Diogo and Wood, only in hominids, referred to the muscle as M sternalis as found in Homo and Hylobates syndactylus (the siamang) ,11.Embryologically, it is postulated to be a derivative of hypaxial myotomes/dermomyotomes. In case the muscle is originating from adjacent muscles, like pectoralis major or sternocleidomastoid, rectus abdominis, panniculus carnosus, etc., the blastema is considered a source of origin . In the As per the classification system of Ge et al. , the musSternalis muscle does not follow the relationship between muscle ontogeny and innervation. External or internal thoracic nerve innervates the muscle in 55% of cases whereas 43% of cases are innervated by intercostal nerve and remaining by both [The role of the rectus sternalis muscle is debated. It is found to play a role in lower chest elevation and thus can act as an accessory muscle of respiration. Alterations in electrocardiograms are seen in individuals with this muscle. Sternalis muscle is often mistaken as a tumor in the craniocaudal view of mammography too. It may cause breast or chest asymmetry or ipsilateral nipple-areola complex deviation. Sometimes other pectoralis major defects like Poland syndrome may coexist with it .Nature loves variation. It is these little changes that give us unique things to discover. Sternalis is one such little unique one. Though several studies have tried to jot down the peculiarities of the muscle, it seems to be resilient to regularity, and thus, we can still find new variations in different studies. Moreover, proper identification of the muscle is only possible when we have an idea about it. Thus, to enlighten the medicos, anatomists, surgeons, physicians about the muscle, its thorough evaluation is important. Addressing the less known will also help in medical education, and undergraduates and postgraduates of medical school can form a habit of noting down the anatomical variations that are beyond simple descriptions or morphology.


This study examines how chief executive officer (CEO) overconfidence can influence the quantity, quality and direction of corporate innovation using Chinese firms for the period 2009–2016. Our results suggest that overall, CEO overconfidence has a positive impact on firm innovation productivity. Furthermore, this effect is significant for Chinese non-SOEs but not for Chinese SOEs. Specifically, an overconfident CEO can facilitate firm innovation in new technological areas but not in the firm’s existing areas. Additionally, we find that internal controls can regulate the relationship between CEO overconfidence and innovation. Interestingly, when the internal control level is too high or too low, the correlation between CEO overconfidence and innovation productivity is not significant. It is well recognized that innovation is vital for a firm’s growth and long-term competitive advantage . Chief EAs important firm activities, innovation activities could be heavily influenced by CEOs’ characteristics e.g., . Among vOur paper contributes to the literature in several dimensions. First, we add to the literature on the determinants of corporate innovation based on the Chinese context . CEOs are supervised by all the parties mentioned above, and enterprise innovation is an activity with high investment, high risk and a long return cycle, which also restrains the impact of CEO overconfidence on firm innovation.In contrast to their state-owned counterparts who are directly controlled and heavily influenced by SASAC, Chinese private enterprises are more independently operated. CEOs of Chinese private enterprises are in charge of the firms’ daily operations and have a more powerful influence on the firm’s decision-making process than CEOs of Chinese SOEs. Generally, a CEO of a Chinese private enterprise can make decisions more independently than that of an SOE. Therefore, CEOs’ personal characteristics are less constrained and are more influential on the firm’s decision-making process.In light of these arguments, we expect no association between CEO overconfidence and innovation in Chinese SOEs; in contrast, we expect a positive association between CEO overconfidence and innovation in Chinese private enterprises. Therefore, we develop the following hypothesis:Hypothesis 2a: Ceteris paribus, in Chinese SOEs, CEO overconfidence is not associated with firm innovation.Hypothesis 2b: Ceteris paribus, in Chinese private enterprises, overconfidence is positively associated with firm innovation.The empirical analysis is performed on firms listed on the Shanghai and Shenzhen stock exchanges in China between 2009 and 2016. CEO characteristics, corporate governance data, firm-level financial statement data and trading data are collected and merged from the China Stock Market and Accounting Research database (CSMAR) and Wind Economic Database (WIND). Patent data are manually collected from the Chinese Patent Database (CNPAT) and double-checked to ensure accuracy. We first eliminate observations with missing values and then exclude Chinese special treatment firms (ST firms) and financial firms. After winsorizing all continuous variables at their 1st and 99th percentiles, we obtain a final sample of 6,327 observations.Our dependent variable is innovation productivity, LN_CITATIONS. Prior empirical research on innovation has heavily relied on patent data, especially for patent accounts and citations e.g., , 2018. BIn our additional analysis, patents are classified into patents with citation rates in the top 1%, those in the top 2–10%, those below the top 10% but with at least one citation, and those with no citations. We believe that the higher a patent’s citation rate is, the higher its economic value and therefore the higher its quality. Meanwhile, according to whether the patents applied for by firms belong to fields familiar to the firm, this paper divides the patents applied for by firms into breakthrough innovation or conservative innovation. It is believed that breakthrough innovation can bring more development opportunities to enterprises than conservative innovation, so the quality of breakthrough innovation is also higher.According to Therefore, to operationally measure CEO overconfidence, we set the age indicator, gender indicator, formal education level indicator, professional business education background indicator and position duality indicator. If the CEO’s age is less than the average for the sample, the age indicator is assigned a value of 1, and 0 otherwise; if the CEO is male, the gender indicator is assigned a value of 1, and 0 otherwise; if the CEO has a bachelor’s degree or above, the educational indicator is assigned a value of 1, and 0 otherwise; if the CEO has professional management, business, or corporate law education background, the professional business education background indicator is assigned a value of 1, and 0 otherwise; and if the CEO is also chairman of the firm, the position indicator is assigned a value of 1, and 0 otherwise. We set up a dummy variable (OVER_CONFIDENCE) that equals 1 when a CEO is considered to be overconfident, that is, when the sum of the five indicators for the CEO is 4 or 5; otherwise, OVER_CONFIDENCE is 0.Based on prior literature, we control for firm size, financial characteristics, corporate governance characteristics, stock market trading characteristics, nature of ownership, and other characteristics of the enterprise. We add control variables to capture firm size, performance effects and other financial characteristics, such as asset size (SIZE), the asset liability ratio (LEV), capital intensity (INTEN), fixed assets (FIXED_ASSET), operating income before depreciation (ROA), net operating cash flow (CASH_FLOW), retained earnings ratio (RE_EARNING), the growth rate of operating income (GROWTH), annual earnings per share (RET), the annual volatility of the stock price (VOLATILITY), ownership concentration (OWNCON), and the executive shareholding ratio (EXCHH) . In addiTo test the impact of CEO overconfidence on the innovation of listed firms in China, this paper constructs the following measurement model:where LN_CITATIONS is the measure of innovation productivity: the logarithm of the number of patents eventually granted with citations for firm i in year t-1. Prior studies  have intThis paper adopts a step-by-step regression approach, focusing on the impact of CEO overconfidence on the productivity of corporate innovation. The first column of From the perspective of other control variables at the firm level, the first is company size. In the second and third columns, the correlation coefficient between company size and innovation productivity is 0.32 and is significantly positive at the 1% level. This indicates that the larger the asset size of listed companies is, the more obvious the competitive advantage and the higher the innovation productivity, which indicates that the company can use the scale effect to effectively improve its innovation output efficiency. There is a significant negative correlation between the company’s capital intensity and the productivity of enterprise innovation, which indicates that the productivity of innovation is relatively low among enterprises with larger fixed costs. The negative correlation between the size of the board and innovation productivity indicates that as board size increases, decision-making efficiency decreases, thus affecting innovation productivity. In general, the regression results for the control variables and the explained variables in this paper are generally consistent with the existing literature.Furthermore, we examine the differences in the impact of CEO overconfidence on the productivity of corporate innovation among firms with different ownership types. The more citations a patent has—in other words, the higher its citation ranking—the higher the quality of the patent, the greater its potential economic value, and therefore the higher the quality of the firm’s innovation. From the perspective of citation rate distribution, the patents applied for by listed companies are divided into patents with citation rates in the top 1%, those in the 2–10%, those below the top 10% but at least one citation, and patents with no citations. The higher the citation rate is, the higher the innovation quality. In addition, enterprises choose the direction of R&D innovation. It is an important channel for enterprises to break through the current development bottleneck, gain stronger bargaining power and broader market space to achieve breakthrough innovation in new fields and acquire new technology. Therefore, the choice of innovation direction will also have an important impact on enterprise value. As the CEO is the core of the top management team, the CEO’s personal qualities have a significant impact on enterprise innovation; However, the impact of these qualities on the enterprise is also significantly affected by various internal management processes and control measures . In ChinFurthermore, we examine the impact of CEO overconfidence on the productivity of corporate innovation under different levels of internal control. We calculate firms’ internal control level following Moreover, the results of Chow test show that the difference between the coefficients on OVER_CONFIDENCE of the two subgroups (below 25% vs. 25 to 50%) is significant. In addition, the results of Chow test show that the difference between the coefficients on OVER_CONFIDENCE of the two subgroups  is significant, which further supports our findings.In the main test of this article, the degree of CEO overconfidence is measured through the comprehensive scoring of five indicators of CEO overconfidence. To test the robustness of the main results in this paper, this paper selects four indicators out of these five, uses two combination methods for the 4 indicators, rerates CEO overconfidence and further tests the impact of CEO overconfidence on the productivity of enterprise innovation. The first method is to adopt the combination of the gender indicator, formal education level indicator, professional business education background indicator and position duality indicator, and the second method is to adopt the combination of the age indicator, gender indicator, formal education level indicator and professional business education background indicator. We take the average of the sum of the four indicators. OVER_CONFIDENCE equals 1 if the sum of the four indicators of the sample is 3 or 4; otherwise, OVER_CONFIDENCE is 0. The independent variable is lagged for two and three periods. In fact, it will take a period of time for the CEO to have a substantial impact on enterprise R&D innovation and promote the improvement of innovation productivity. Hence, in line with To further verify the robustness of the results of this paper, on the one hand, this paper further controls for the fixed effect of the industry-year in the model to prevent the estimation error caused by the omission of variables; on the other hand, as the explained variables used in this paper are all greater than 0, they are typical left-censored data. To ensure the effectiveness of the estimation coefficient, this paper uses a tobit model for machine matching. The following table reports the regression results after the change in the regression model; the first column shows the regression results after adding the fixed effect of the industry-year cross product term, and the second column shows the regression results of the tobit model. As listed in The endogenous choice of overconfident CEOs could also affect our analysis. For example, companies with a strong willingness to innovate may be more likely to hire an overconfident CEO than other companies. To address this concern, we adopt a propensity score matching approach. For each firm with an overconfident CEO , we identify a matched control firm with a less overconfident CEO (below the median level) and calculate the average difference in innovation productivity for all matched pairs. To find the matched firms, we employ radius matching and nearest neighbor matching methods . Our matAs reported in columns 1 and 2 of Drawing on a sample of public firms listed on the Shanghai and Shenzhen stock exchanges in China between 2009 and 2016, the current study examines how CEO overconfidence could influence the productivity, quality and direction of corporate innovation. We find that CEO overconfidence is positively related to a firm’s innovation productivity, as measured by the number of granted patents with citations. This relation is statistically significant and consistent with those of studies on the Western context. This finding is robust after accounting for endogeneity. In addition, many Chinese firms are state-owned and controlled by SASAC . Using dFurthermore, our results show that CEO overconfidence can significantly promote the output of patents with medium to relatively high citation rates (patents in the top 2–10% of citation rates), which is an advantage of CEO overconfidence. However, it is difficult for enterprises with overconfident CEOs to obtain patents with the highest quotation rate (top 1% citations) in the market. In addition, we find that if the CEO of an enterprise has the characteristics of overconfidence, the enterprise is more likely to achieve R&D success in new areas, while the promotion effect of overconfident CEOs on the enterprise’s R&D success in familiar knowledge areas is not obvious.In addition, we examine the impact of CEO overconfidence on innovation productivity under different levels of internal control. Our results show that among enterprises with an internal control level between 25 and 75%, CEO overconfidence can significantly improve the productivity of innovation. When internal control is too high or internal control is too low, the relationship between CEO overconfidence and firm innovation productivity is not significant. The results show that strong internal control might constrain CEOs’ decision-making power since the firm’s decision-making process is highly standardized and lacks flexibility. However, if the internal control of a firm is too low, it may lead to an increase in agency costs, thereby hindering the efficiency and productivity of innovation.We acknowledge that our study has several limitations. First, we use only patent-based measures as proxies for innovation productivity, innovation quality and innovation direction. Second, since our sample covers relatively large Chinese firms, it is not clear whether these results are generalizable to small firms in China. Third, we acknowledge that the measure of CEO overconfidence used in this study is indirect and imperfect. Therefore, we suggest that future research contribute to the literature by exploring new measures of innovation and CEO overconfidence. In addition, considering the availability of data, qualitative studies, such case studies, on the effects of CEO overconfidence on firm innovation based on small Chinese firms could be conducted to determine the specific mechanisms of these effects.Publicly available datasets were analyzed in this study. This data can be found here: Anyone who wants to obtain the data should contact CSMAR directly since the original data is commercially available by CSMAR.YZ contributed to the writing and formatting of the research. ZL contributed to the editing and analysis of the research. Both authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Organic photovoltaic research is continuing in order to improve the efficiency and stability of the products. Organic devices have recently demonstrated excellent efficiency, bringing them closer to the market. Understanding the relationship between the microscopic parameters of the device and the conditions under which it is prepared and operated is essential for improving performance at the device level. This review paper emphasizes the importance of the parameter extraction stage for organic solar cell investigations by offering various device models and extraction methodologies. In order to link qualitative experimental measurements to quantitative microscopic device parameters with a minimum number of experimental setups, parameter extraction is a valuable step. The number of experimental setups directly impacts the pace and cost of development. Several experimental and material processing procedures, including the use of additives, annealing, and polymer chain engineering, are discussed in terms of their impact on the parameters of organic solar cells. Various analytical, numerical, hybrid, and optimization methods were introduced for parameter extraction based on single, multiple diodes and drift-diffusion models. Their validity for organic devices was tested by extracting the parameters of some available devices from the literature. Organic solar cells have been under massive research for almost two decades to compete with silicon solar cells in power conversion efficiency and stability. High power conversion efficiency had been achieved by incorporation of non-fullerene and small molecule acceptors, which exhibit high absorption spectrum resulting in high photo-current ,2. PowerPolymer materials are included in different types of solar cells according to their optical and electrical properties. The use of polymer materials in different layers is proposed to improve the efficiency of solar cells. For example, polymers like polyethylene terephthalate (PET) and polyethylene naphthalate (PEN) are used as a substrate due to their high flexibility, and transparency . An examAs the photovoltaic effect in organic materials is more complicated than inorganic semiconductors, more understanding and investigation of device physics and behavior is required to achieve better performance. Several factors affect cell performance, such as carrier mobility, traps, charge carriers densities, recombination, and parasitic resistances. Various measurement and characterization techniques should be done to study the behavior of the solar cell thoroughly. This is considered a costly and time-consuming process. In such situations, researchers incorporate simulation tools and theoretical studies in their work. Some of these studies come before taking the device into the lab to get insights into the optimal fabrication parameters to start the experiment. Others consider the parameters of the fabricated device, especially for devices based on newly developed materials. Theoretical studies consider several aspects of the device, including device physics, structure, selection of materials, and operating conditions. Several models for describing the device physics based on models developed for silicon solar cells have been introducing alongside their modifications to accommodate the differences between organic and inorganic devices. Recently, machine learning models have been used in the field to speed up development. For example, machine learning models are used for selecting the best donor-acceptor combination and for predicting the cell properties ,18,19,20One of the essential steps of the device design and improvements process is to extract its parameters to study the effect of each experimental condition or structure modification on the device physics for further enhancement, and optimization ,22. MostThis article provides information about several models of organic solar cells and a set of experimental and material processing techniques used to tune active and interfacial layers materials. The article summarizes several analytical, numerical, and optimization methods for parameter extractions concerning each method’s assumptions. In this work, theoretical methods with common experimental techniques are combined to offer a comprehensive review for studying organic solar cells in light of progress made in the field of photovoltaics on the perspectives of materials enhancement and experimental measurement methods such as current-voltage measurements, charge extraction by increasing voltage (CELIV) and time of flight technique. flatter ,24. Extr flatter ,28,29,30Due to its simplicity and it has been proved to be efficient for parameter extraction for different types of solar cells. Single diode model is commonly used to study photovoltaic devices. The single diode model shown in G therefore the cell current is linearly dependent on the solar irradiance. This assumption includes some inaccuracy and other nonlinear relations were introduced to improve the model. However, the model fits experimental data to an acceptable level of accuracy .. In this technique two light pulses with a time delay between them are used to measure the absorption, the first is a pump pulse which induces the charge carriers to the excitation state. The second pulse, is a weak one called the probe pulse. The process of measurement is repetitive and it must be done for different time delays. From the difference in absorption between the case in which the pump pulse exists and the other case without applying it, the change in absorption due to excitation can be determined. After repeating the process for different time delays between the two pulses, the relation between the change in the probe pulse energy and the delay time represents the sample kinetics from which lifetime can be determined .Impedance spectroscopy belongs to the small perturbation techniques for measuring carrier dynamics. In  IS is usIn this section extraction of organic solar cell parameters based on P3HT:PCBM active material is represented in Authors of  used AFMacKenzie . It is iIn this work, the effect of different materials, preparation conditions, device structure, and experimental techniques  for stud