Background: The scientific literature reports that children with celiac disease (CD) are more susceptible to developing physical, psychological and social problems, conditioning their healthy childhood development. Despite this scientific evidence, the knowledge about determinants of vulnerability for the development of such problems is not consistent. In order to search the literature, a scoping review was conducted to analyse and map the evidence on the sociopsychosomatic vulnerability of children with CD and identify the gaps in this topic. (2) Methods: The methodology proposed by the Joanna Briggs Institute will be adopted and aims to identify studies that meet pre-defined eligibility criteria. The survey will include a range of relevant electronic databases as well as grey literature using related terms such as vulnerability, child and celiac disease. (3) Results: This review will consider any type of quantitative, qualitative and mixed studies and systematic reviews, focusing on dimensions of vulnerability in children with CD. The process of selection of studies, data extraction and analysis will be developed by two independent researchers. A third and fourth researcher will be involved in the study when there is no consensus between the previous researchers, as well as for resolving issues regarding the methodological process. (4) Conclusions: Identifying the determinants of vulnerability in children with CD will help nurses to understand the impact on their childhood development and trace possible gaps. This research is registered on the platform Open Science Framework (OSF).(1)  Being a developing child with a chronic health condition is a complex experience which implies constant (re)adaptation. A child with celiac disease (CD) is more likely to develop health problems, since they have a condition that can hinder their healthy childhood development in several aspects , due to the genetic condition predisposition ,2,3,4,5.It became evident that CD is a common disease occurring at all ages and with a variety of signs and symptoms. Celiac Disease (CD) is a multifactorial, systemic immune-mediated disorder, in which the HLA immunogenetic background  and environmental trigger (gluten) are well established. Indeed, both factors are necessary, but not sufficient to develop CD ,4,6.The ingestion of gluten induces a state of chronic inflammation of the intestinal mucosa that reverts when gluten is excluded, relapsing after its reintroduction in the diet. The only effective treatment is strict adherence to a gluten-free diet (GFD) for life. Adherence to GFD results in the remission of symptoms and intestinal lesions that can re-emerge with non-compliance or involuntary contamination of food ,4,5,7,8.Currently, the scientific community considers CD to be a public health problem, given its pervasiveness across all nationalities, ethnicities and age groups. CD has been described in the literature as one of the most common chronic diseases in the paediatric population, with an estimated prevalence of 1–2% despite varying prevalence between different countries ,9,10,11.Especially in the school setting, where they spend most of their time, children with CD are in a position of greater vulnerability compared to their peers, thus experiencing health inequalities. The disease limits their autonomy  as they It is noted that some individuals are subject to adverse conditions and develop health problems, while others do not get sick. Each individual must have a vulnerability threshold which results from the interaction between their individual and environmental determinants which, when exceeded, results in the appearance of health problems. Thus, there is an interest in approaching the concept of vulnerability as it precedes the appearance of health problems.The concept of vulnerability has evolved over the last thirty years. From the analysis of the literature, the relevance of some theoretical frameworks on the definition of the concept of vulnerability is notable ,15,16,17The authors will use the definition of vulnerability by Rogers: a set of conditions that makes a person more susceptible to adverse health outcomes  as a result of individual and, also, social aspects . The modThe literature refers to a considerable number of health consequences of CD in individuals ,2,5,11. This mapping will clarify these aspects, hence the decision to conduct a scoping review. By providing a detailed description and summary of the available information, this scoping will contribute to dissemination of research results and also identify possible gaps in knowledge, providing conclusions about the overall state of research activity in this area and need for future research .This scoping review is guided by the Joanna Briggs Institute’s (J.B.I.) methodology for scoping reviews. It aims to map and analyse published scientific evidence on vulnerability in children with CD in different care settings. An initial search of MEDLINE (PubMed), the J.B.I. Evidence Synthesis, the Cochrane Database of Systematic Reviews, PROSPERO and Open Science Framework (O.S.F.) revealed that, currently, there are no scoping reviews or systematic reviews (published or in progress) about this subject ,24,25.The final review will be reported according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) ,27.This has been registered on the Open Science Framework (OSF) platform.What evidence has been published regarding the vulnerability of children with CD in different health care settings? for the scoping review, the inclusion criteria are related to:participants—studies looking at children with CD ;concept—this review will consider studies that explore vulnerability;context—this review will consider studies, regardless of the country of study, conducted in any clinical practice setting;Based on the JBI recommendations in the PPC mnemonic guide What is the published evidence on the dimensions/issues/characteristics of vulnerability in children with CD?What other concepts are related to the concept of vulnerability in children with CD?Is there evidence on tools to assess vulnerability?Is there published evidence on the situations, circumstances and conditions/factors/determinants that positively or negatively influence vulnerability in children with CD?Furthermore, this review intends to answer the following sub-questions:The body of the literature will be composed of any study designs with quantitative, qualitative and mixed methodology editorial letters. Mixed studies as well as grey literature (theses and dissertations) are also expected to be included. Furthermore, all types of systematic reviews will be considered in the proposed review.Only documents in Portuguese, Spanish or English will be considered, without limitation as to the period of publication.Other published manuscripts that the authors consider relevant to include in this analysis may also be included, provided that they meet the eligibility criteria.The search strategy will find published and unpublished primary studies and reviews. Two reviewers will develop the search strategy, which will be peer reviewed by the third expert reviewer the basis of the Peer Review of Electronic Search Strategies (PRESS) .The three-step search strategy recommended by J.B.I. was applied ,24.A limited preliminary search was initiated in MEDLINE (via PubMed) with the aim of investigating the words in the text included in the title and abstract, as well as the index terms used to describe the selected studies. Subsequently, a full search strategy was developed . The seaIt is emphasized that the search strategy will be adapted to the specificities of each information source. Finally, the reference lists of the articles included in the review will be selected for supplementary articles.The languages of the articles will be restricted to those understood by the authors—English, Spanish and Portuguese—to ensure a good quality selection and data extraction procedure. Articles written in other languages will be excluded on the basis of language. However, they will be reported on for transparency in the scoping review report.The full search will include the electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL) (via EBSCOhost), Medical Literature Analysis and Retrieval System online (MEDLINE) (via PubMed), Cochrane Library, Scielo, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus and Web of Science, as these are databases with peer-reviewed publications , thus enabling the attainment of the proposed objective. An electronic search of dissertation and thesis abstracts will also be conducted in the Scientific Open Access Scientific Repositories of Portugal (RCAAP) and ProQuest Dissertations and Theses, Biblioteca Digital Brasileira de Teses e Dissertações (BDTD) databases, since they relate to unpublished studies.Note that all identified citations will be exported to EndNote Web software . Duplicates are removed in this process.Article titles and abstracts will be screened for eligible criteria by two independent researchers using the Rayyan QCR platform.A pilot test will be conducted to verify that the inclusion criteria are being met. At this stage, full-text articles will be read and examined according to the defined criteria.From the identification of relevant articles, data will be extracted using a standardised form and assessed.Subsequently, the list of references of all studies selected for critical appraisal will be further analysed. This step aims to check for the existence of additional studies not previously identified. It may be necessary to contact specialists in the area to collaborate in the search, in order to contribute their expertise. It may also be necessary to contact the authors of the studies identified for possible clarifications or to provide references.The reasons for exclusion of studies that do not meet the eligibility criteria will be recorded and reported.Each phase of the research will have the participation of two independent reviewers to systematize this review and reduce research bias, taking into account the pre-established inclusion criteria and the research question. In the case of a disagreement between them, a third reviewer will be consulted in order to at least establish agreement between two reviewers regarding the selected articles.The data extraction of the articles included will be undertaken by two independent reviewers, using a form that considers specific details about the population, the concept, the context and the research methods relevant to the question and the stated objective of this scoping review, as indicated by the methodology developed by JBI .It is worth noting that the authors will conduct a pilot test of this form before starting extraction, and adjustments may be made to the data extraction tool during the review process .Data will be presented graphically or in schematic or tabular form. A narrative summary of the findings of the studies included will be prepared. This summary will provide information on the mapping of the studies carried out around this theme, taking into account the purpose of this review ,24,26 anConsidering that the concept of vulnerability has evolved and is expanding, it is considered important to conduct a brief historical review of its evolution.In the 1980s, vulnerability referred to the term applied within the epidemiological concept of risk that consisted of the probability that an individual had to become ill within a period of time . These rLess well known is that the vulnerability theory proposed by Lessick and collaborators admits that the level of vulnerability of individuals is dynamic and can be altered according to changes in the person, in the environment (or in both), and that each individual has a threshold of vulnerability that, when overcome, results in the appearance of the disease .In the 1990s, the concept of vulnerability was expanded, with the contributions of Aday. He emphasized the health care needs of nine population groups, identifying those who are at increased risk for poorer physical, psychological and/or social health . His worProgressing in the chronological evolution, in 1997, Ayres considered that risk and vulnerability have a close relationship and are important in the interpretation of the health–disease process: risk indicates probabilities, and vulnerability precedes risk and determines the different risks of falling ill for an individual, thus expressing its potential for (non) illness as a carrier of specific characteristics ,21.In the same year, Rogers proposes that the degree of vulnerability results from the interaction of personal and environmental resources, based on the contributions of Aday, Rose and Killien, Aday and Lessick and collaborators for defining the personal and environmental determinants of vulnerability .In the literature, the Conceptual Model of Nursing for Vulnerable Populations that stood out the most was the one developed by Flaskerud and Winslow, defining vulnerability as the complex interaction between risk, susceptibility, availability of resources and health status .In 2003, Dorsey and Murgaugh proposed a middle-range theory, entitled Self-Care Management Theory for Vulnerable Populations, which suggests an alternative approach to the concept of vulnerability, focusing on the management of self-care and intrapersonal factors to manage diseases, with this management being dependent on contextual factors. Individuals with chronic disease find modifiable and non-modifiable factors that can increase their vulnerability .As the concept is clarified, the more it becomes fluid in the literature, witnessing a shift to a more open, less stigmatizing, potentially expansive meaning  and acquThis overview was essential in determining key search terms, given that the concept of vulnerability has been studied for the past 30 years, so that many articles addressing aspects of vulnerability were included in this review. Publications will be considered, with no limitation in time, in the search strategy.The scoping review will only consider studies in English, Portuguese and Spanish, which may be registered as a potential limitation of the study. To address this limitation, abstracts of articles published in other languages considered relevant may be included, through translation in Google Translator and Linguee, to avoid restrictions to specific programs for certain cultures.It is agreed that the concept of vulnerability is expanding, which makes its assessment difficult. In this sense, this review will help researchers to identify which factors/characteristics/dimensions of vulnerability have been studied in the academic literature. All information will be important for the development of the knowledge and growth of the nursing discipline. This analysis and systematization will allow the identification of gaps for future investigations.In conclusion, this scoping review will examine emerging evidence and provide an overview of this important topic. It makes sense to consider that, at the end of this review, relevant data will emerge  that can contribute to the development of a tool to stratify the vulnerability risk, as well as their potential for coping and for directing nursing interventions.


Both massage and topically administered NSAIDs are safe and effective treatments for knee osteoarthritis (KOA); however, different massage technique sects in China caused assessment difficulties for the treatment of KOA. In order to standardize the massage techniques and procedures, we organized multi-disciplinary experts in China to acquire an evidence-based traditional Chinese medicine massage treatment of knee osteoarthritis. The purposes of this study will be to provide clinicians a complementary and alternative therapy for patients and to evaluate the efficacy and safety of evidence-based traditional Chinese medicine massage treatment of KOA compared to External Diclofenac Diethylamine Emulgel.A randomized controlled trial in which 300 participants diagnosed with KOA will be recruited and randomly allocated to either the experimental group or the control group in a ratio of 2:1. Two hundred participants will receive evidence-based traditional Chinese medicine massage 2 sessions per week for 10 weeks as the experimental group, and 100 participants will receive External Diclofenac Diethylamine Emulgel 3–4 times per day for 10 weeks as the control group. The patients in the two groups will receive follow-up at two time points at 5 weeks and 10 weeks from the beginning of treatment, respectively. The MRI scans and X-ray will be performed at baseline and at the end of the intervention. The primary outcome will be the changes in the Western Ontario and McMaster Osteoarthritis Index (WOMAC). Secondary outcomes will be measured by the PRO scale for knee osteoarthritis based on the concept of traditional Chinese medicine ), X-ray evaluation, and MRI scan evaluation. The data of WOMAC and CSKO will be analyzed at the baseline, 5 weeks, and 10 weeks from the beginning of treatment. The data from MRI scans and X-rays will be analyzed at baseline and at the end of the intervention. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session.This study will provide clinicians with much-needed knowledge for the treatment of KOA through a controlled trial.ChiCTR1800014400. Registered on 10 January 2018Chinese Clinical Trial Registry  Knee osteoarthritis (KOA) ranks highly among global causes of disability and chronic pain, particularly in people over 50 years of age . StructuMassage is a safe and non-pharmacological treatment with limited contraindications and no known serious adverse events . TraditiTopically administered non-steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac solution attained significantly greater improvement in pain reduction in patients with KOA and are widely used in the world –14. HoweIn order to provide clinicians a complementary and alternative therapy for patients with KOA, and to determine whether evidence-based traditional Chinese medicine massage is a safe and effective therapy, we design and conduct the trial. Compared to topical NSAIDs , which is strongly recommended (level 1a), massage is conditionally (level 3) recommended by the OARSI guidelines . In the http://www.chictr.org.cn/showproj.aspx?proj=24457). The registration number is ChiCTR1800014400. The protocol will be reported following Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement.The main purpose of this study is to compare the safety and efficacy of evidence-based traditional Chinese medicine massage and External Diclofenac Diethylamine Emulgel in KOA patients. Three hundred participants will be recruited for the study. Clinical data measurements, X-rays, and MRI scans will be evaluated at baseline and the end of treatment Fig. . The stuThe study will be carried out at the five hospitals: Guang’anmen Hospital, Beijing’s Capital Medical University Traditional Chinese Medicine Hospital, Dongfang Hospital of Beijing University of Chinese Medicine, Xuan Wu TCM Hospital Beijing, and Beijing Fengsheng Trauma-Orthopedic Hospital of Traditional Chinese Medicine. The study will recruit participants with KOA who meet the diagnostic criteria of the American College of Rheumatology through hospital outpatient . WeChat Meet the diagnostic criteria of knee osteoarthritis according to the American College of Rheumatology (ACR) criteria .Patients who have WOMAC pain scores of 25 or more out of 100 will be included.K-L classification ≥ 1 .Age 40–80 years, male or female.Signed informed consent.If the patient has two affected knees of which only one meets the ACR criterion and Kellgren-Lawrence grade II or III , only thThe following are the inclusion criteria:Patients with secondary osteoarthritisPatients with obvious unstable knee joint  –20Patients who have received intra-articular injection of sodium hyaluronate or hormoneList excluding comorbidities: severe osteoporosis, diabetes, lower extremity vascular disease, limb malformation or nerve system disease, severe mental illness, unable to understand others’ intentions or express themselves correctlyPregnant women and those trying to conceive or currently breastfeedingPatients who have combined heart, lung, brain, liver, kidney, and hematopoietic system and other serious diseasesPatients who have a contraindication for MRIPatients who have an allergy history for investigational products and have an allergic constitutionPatients who are participating in other clinical trialsPatients who have been used to alcoholic and/or psychoactive drug substances, drug abuser, and relierAccording to the researchers’ judgment, other diseases or conditions that may reduce the possibility or complicate the inclusion, such as frequent changes in the work environment and unstable living environment, which may easily lead to loss of follow-upThe following are the exclusion criteria:The patient quits (poor efficacy or adverse reactions).Loss to follow-up.Researchers remove the patient (poor compliance or serious adverse events).Participants who do not complete the clinical protocol for the following reasons should be considered as dropped out:The investigators discover a significant safety problem.The therapeutic effect is poor (we will assess the therapeutic effect in week 5).There is a major mistake in the plan.The sponsor has a huge problem in funding or management.The trial will be suspended if:Participants will be required to sign an informed consent and have the same chance to receive appropriate treatment. The safety of participants will be monitored in every visit. Two attending physicians and two responsible joint care specialists will be responsible for the collaboration and guidance of clinicians during each clinical trial and implementation. The two chief joint surgeons constitute the endpoints Adjudication Committee, which is responsible for the overall supervision of the clinical trials.During the treatment, any adverse events, such as local skin dryness, skin irritation, fracture, dislocation, or increased pain should be recorded and reported to the relevant responsible unit and the ethics committee in time. If the adverse events such as death, fractures, and organs injury are confirmed to be related to the study, the Ethics Committee of Guang’anmen Hospital, China Academy of Chinese Medical Sciences, has the right to discontinue or modify allocated interventions. If an adverse event occurs during the clinical trial, medical experts will be engaged to assess and investigate the actual cause, and medical and financial compensation will be made to participants. If the participants cannot tolerate these adverse reactions, treatment will be discontinued and the participants will be withdrawn from the study.In this study, this clinical research adopts randomized blocks, and cases will be randomly assigned to each center. The results of the random groups will be placed in sealed envelopes, which are numbered consecutively. When the patients are enrolled, they take the envelopes in the order of enrollment and will be grouped according to the contents of the envelopes. In the waiting list group, in a ratio of 2:1, there are 200 cases in the experimental group and 100 cases in the control group. The random sequence will be generated by an independent professional statistician who is not involved in the study with the SPSS software . The random numbers will be stored by a fixed non-involved person.Due to the operation characteristics of massage therapists, the massage therapists and the participants cannot be blinded who will be informed of the grouping of participants before treatment; however, massage therapists will be blinded to pain and function scores, as well as baseline imaging results. Participants will be told that they will randomly receive one of the interventions after enrollment. The outcome evaluators and data statisticians will be blinded to the group allocation, and their responsibility is to collect and analyze the data.n = 85.49. Considering expulsion case and getting significant results, at the same time, in order to implement layered research in the experimental group, we planned the ratio of the cases in the experimental group and the control group is 2:1, and the number of included cases was 300. There were 200 cases in the experimental group, and 100 cases were in the control group.According to the literature, the average effective rate of treating knee osteoarthritis only through massage is 95.6% and 79.8% by application of external diclofenac diethylamine emulsion latex . AccordiTwo hundred patients in the experimental group will receive 20 sessions of manual massage treatment . Use the definite evidence-based traditional Chinese medicine massage technique for knee osteoarthritis to do the massage treatment [During the treatment period, other Chinese and Western drugs and treatment methods  for knee osteoarthritis are not used. In cases of intolerable knee pain, the patients will be instructed to take loxoprofen sodium tablets  as a rescue medication. The use of other treatments, such as injections of any kind, moxibustion, acupuncture, or cupping, will not be allowed.When combined with other diseases, the drugs and treatments must be continued, and the drugs and treatments need to be recorded in detail in the combined medication list.One hundred patients in the control group will receive External Diclofenac Diethylamine Emulgel  treatment (3–4 times per day for 10 weeks). Other interventions will be similar to the experimental group.The personnel participating in the clinical trial shall accept the coincident training and then conduct the clinical trial after passing the examination. The radiologists and doctors will accept the training in filmmaking and reading. All MRI examinations and measurements are completed by Guang’anmen Hospital, Chinese Academy of Traditional Chinese medicine. The main investigator refers to the drug administrator who specifically supervises the study. The drug administrator shall keep records of drug receipt, distribution, and return. The quality inspectors will monitor the drug tablet return and laboratory tests, then write the audit report and submit it to the project team leader every month. The project management group is responsible for checking the research quality and progress of the subcenter every 3 months. Modifications to the protocol will be submitted to the Ethics Committee of Guang’anmen Hospital to review, and audits will be held annually by the Ethics Committee. The above process will be independent from investigators and the sponsor.X-ray and MRI.The efficacy between the two groups will be assessed by primary outcome measure: change in WOMAC score three times   score was performed for each follow-up , with thTaking X-ray of the double knee joint with weight loading is at the adem position. The Kellgren and Lawrence classification criteria will be used on AP film to evaluate the degree of degeneration and the width of medial and lateral tibiofemoral joint space . At the Using Siemens 3.0T MRI to obtain the patient’s knee T2 mapping sequence. Using the Recht criteria to evaluate cartilage degeneration . MeasureAfter the end of treatment, MRI images were taken of the affected limb for the MRI score of cartilage defect.(1) Vital signs: body temperature, resting heart rate, respiratory, and blood pressure after 10 min of rest . (2) Laboratory examination: blood routine , urine routines , stool routine+occult blood, and liver function , and renal function . (3) Manipulation-related adverse events, such as ecchymosis, subcutaneous hemorrhage, fracture, and dislocation. (4) Drug-related adverse events, such as gastrointestinal tract response. (5) Other adverse events.The safety of each therapy was evaluated by comparing the changes in blood and urine routine, liver and kidney function, electrocardiography before and after the treatment, and the incidence of adverse events during the treatment.http://www.chictr.org.cn), where the electronic data management system will be used for real-time tracking and monitoring of test data from the Research Office of Guang’anmen Hospital.The outcome assessors will use the CRFs to collect the data which consists of treatment effects, adverse events, and safety evaluations. Then, two data administrators who do not belong to the research team and are blinded to group allocation will independently receive the completed CRF and enter it into the Excel database . They must complete rigorous data monitoring training. Then, they enter the real-time data into the China Clinical Trial Registry  by statisticians who are independent of the research team and blinded to the group allocation. Data analysis will be based on the intention-to-treat (ITT) principles. All numerical data will be presented as the mean ± SD, and categorical variables will be described with percentages (%). All the statistical tests are bilateral inspection; t-test or the Wilcoxon rank-sum test is used for comparison between the groups. The χ2 test or Fisher’s exact probability method is used for participants’ dropout and adverse events rate analysis.The secondary outcome includes CSKO score, X-ray data, and MRI data, which are all measurement data, and a group The protocol was designed following the principles of the Helsinki Declaration. Participants will be informed of the study protocol, possible risks, and other related matters before entering the study and sign the informed consent before randomization.All original medical record test results  will be confidential within the law. The results of the trial will be shown in tables and figures only, and no individual will be identified. All data collected from this study can only be used for this research. All members of the research team have ethical principles of confidentiality.The results will be published in peer-reviewed academic journals and disseminated through conferences.Massage treatments through pressing, pinching, flexion-extension, stretching, plucking, rubbing, and other bone-setting manipulations are all recommended. According to traditional Chinese medicine (TCM), massage on the epidermis of the body can stimulate and adjust the distribution of meridians, qi, and blood. According to modern medicine, massage may improve systemic immune and inflammatory profiles in healthy individuals . As a suAlthough some studies shown effectiveness and safety for all patients with KOA treatment by traditional Chinese massage or Diclofenac solution, however, as far as we know, our study will be the first randomized controlled and multicenter clinical trial. In this study, evidence-based traditional Chinese medicine massage treatment VS External Diclofenac Diethylamine Emulgel will be conducted in participants with KOA to observe the correlation between clinical manifestations and changes in X-ray and MRI, so as to further understand and identify the effectiveness and safety of both treatment methods.In order to avoid the bias of results and improve the reliability of clinical results, we try to keep the baseline consistency as much as possible. Participants will be screened strictly according to the inclusion and exclusion criteria. All the researchers will be trained to understand the design of the study. To achieve blindness in the course of the intervention, the sealed envelopes should be attached to massage and External Diclofenac Diethylamine Emulgel before the intervention. In order to maintain the consistency of massage techniques, all Chinese massage therapists involved in the study have achieved strict massage training. In the study, MRI images of the affected limb were taken for MRI score of cartilage defects in both groups. All participants will be carried out in the above five hospitals. This study also has several limitations. First of all, Chinese massage therapists and participants in the waiting list will not be blinded due to the nature of the intervention. Secondly, the long-term efficacy of massage therapy will not be observed due to the observation treatment period of the study is only 10 weeks.The study protocol was approved by the Ethical Committee of Guang’anmen Hospital on 08 January 2018. The study is currently in the recruitment phase, and the first participant was included on 1 June 2018. We predict that recruitment will be completed by September 2021.


Keloid is an abnormal healing process of the wound, which is often secondary to the traumatic site, surgical incision, and even the needle path –3. Due tIn recent years, advances in bioinformatics techniques have made it possible to explore keloid genomics, proteomics, and the immune microenvironment in depth. In our previous paper “Single-Cell Sequencing Analysis and Weighted Co-Expression Network Analysis Based on Public Databases Identified That TNC Is a Novel Biomarker for Keloid” which was published on 22 December 2021 in Frontiers in Immunology, the genomics of keloid was explored to a certain extent and tenascin-c(TNC) was identified as a robust marker of keloid by single-cell sequencing analysis and WGCNA . This arIn this response, we further explored the regulatory mechanism of TNC in keloid and its role in the immune microenvironment. First, we constructed the TNC’s competitive endogenous RNA (ceRNA) regulatory network in keloid by Mirtarbase and Starbase (Tenascin-c (TNC), as an extracellular matrix protein, plays an important role in the maintenance of normal physiological functions and various pathological processes. In recent years, TNC has been widely studied for its important role in wound healing and the pathogenesis of keloid. In 1999, Dalkowski et al. found that TNC was highly expressed in keloid compared with normal tissues . That saJX and LC designed the study. LC was involved in database search and statistical analyses. LC and JX were involved in the writing of manuscript and its critical revision. MW and JX was responsible for the submission of the final version of the paper. All authors approved the final version. All authors agree to be accountable for all aspects of the work.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.


Aims To explore experiences and perceptions of students and staff regarding decolonisation of the curriculum in a dental undergraduate programme.Methods  Participants were invited to respond to an online survey on decolonisation of the dental curriculum. The target population included current students on the Bachelor of Dental Surgery and Bachelor of Dental Therapy and Hygiene programmes, as well as dental staff at a university in the South West region of England. The common items for student and staff versions of the survey were focused on six themes: representation; content; peer engagement; assessment; language and communication; and culture. All responses were anonymous. Data on programme, year of study, age, sex and ethnicity were captured on a voluntary basis.Results In total, 34 staff members and 120 students from two different programmes participated in the survey, yielding a response rate of 87.17% for staff and 45.28% for students. A comparison showed that average student responses were lower compared with average staff responses. Of the 24 survey items, 17 showed significantly lower scores reported by minority ethnic (ME) students. ME students were, when compared with white counterparts, less likely to report that their programme included opportunities for group discussions about ethnicity and privilege. Similar comparisons of staff responses did not show significant differences between white and ME staff. Nevertheless, responses by staff and students across the board highlighted the need for further steps to improve the representation of ME groups in the curriculum.Conclusions This study provides useful insights into the perceptions and experiences of students and staff regarding the decolonisation of the dental curriculum in an undergraduate dental programme. Responses by the participants across the board identified several areas which could benefit from better representation of ME groups. Significant differences were noted between staff and student scores and also between white and ME students, indicating the latter group demonstrated more awareness regarding issues of representation. The findings underscore the need to take further steps to decolonise dental curricula. Explains the rationale for the decolonisation of educational curricula in higher education.Reports perceptions and experiences of students and staff regarding decolonisation of the dental curriculum at a British university.Underscores the need for further actions to encourage better representation of minority ethnic groups in dental education. Decolonisation then, as a political and social agenda, remains relevant. Among a range of definitions, Von Bismark (2012) describes decolonisation as 'the reversal of the process of European imperial expansion with all its political, economic, social, cultural and linguistic consequences'.3Colonisation is a historic and global phenomenon stemming from the subjugation of Indigenous populations by a small number of European governments in the fifteenth century. By the nineteenth century, more than 80% of countries and 750 million people worldwide lived under colonial rule. However, continued challenges to colonial empire, the advent of world war and the creation of the United Nations instigated a sustained period of international decolonisation.4 The campaign challenged the Eurocentric hierarchies of race, social class and gender in South Africa. Since then, this movement spread further afield and was mirrored in the UK as the 'Rhodes Must Fall' Oxford campaign. Student bodies and staff in UK universities are actively campaigning for decolonising curricula in higher education (HE) institutions. Student unions at leading universities, including Oxford, Cambridge, London, Kent, Leeds and many more, are already part of this movement.5Although implicit, colonial influences may still persist in universities and shape our assumptions about how society needs to work, what needs to be taught and how it needs to be taught. The quest for non-Eurocentric paradigms triggered a 'decolonising the curriculum' movement at the University of Cape Town to remove influences of colonialism and provide representation to the knowledge and perspectives of Indigenous people. In what became known as the 'Rhodes Must Fall' campaign, students advocated for the removal of the statue of Cecil John Rhodes from the University's campus.3 Such discourse requires deconstruction, rethinking and reconstruction in order to make curricula inclusive and representative of different communities, voices and perspectives. A contextual approach to curriculum design and delivery may allow the universities to evaluate how curriculum - and therefore education - influences social relations, practices and culture.6 Such steps can help build an education culture where every human being has an equal right to contribute and influence creation of knowledge.'Decolonisation' of the curricula is a complex concept which is shaped by different social, political and educational interpretations. More importantly, however, it needs to be viewed as an approach which is contextual to different disciplines and subject areas. Decolonisation of the curricula may be described as the 'creation of spaces and resources for a dialogue among all members of the university on how to imagine and envision all cultures and knowledge systems in the curriculum and with respect to what is being taught and how it frames the world'.7 Some evidence suggests the gap is partly structural, attributable to 'disadvantaged' backgrounds, pre-HE experiences and entry qualifications .8 However, where factors including prior attainment have been controlled for, differences remain between minority ethnic (ME) and white students:9 'controlling for entry qualifications, Black students are between 6 and 28 percentage points less likely than white students to get a higher classification degree, while Asian students are between 3 and 17 percentage points less likely. The differences exist at all levels of entry qualifications, so are even apparent among students who enter higher education with very high prior attainment'.10 It appears that inequalities within HE mirror those in wider UK society: 'broader political and social realities are evident on campuses affecting the experiences and actions of staff and students'.11 Once in HE, contributing factors, such as relationships with and between staff and students; the curriculum; social, cultural capital; and identity factors, all come into play and there is evidence of inequality remaining through to graduate outcomes, where unemployment for ME groups is double that of those who are white.12Decolonisation of the curriculum also needs to be viewed in the context of attainment gaps in HE. While there is compelling evidence of an ethnicity attainment gap in HE in the UK, debate continues regarding the cause.13While further research is required to evaluate the impact of decolonisation on addressing attainment gaps in HE, racial inequalities have intensified debate on decolonisation in HE. There are growing calls for a nuanced approach to addressing cultural, social and political structures that reinforce and reproduce racially motivated differences in attainment. Potentially, decolonisation can help mitigate the attainment gap by questioning and then transforming these meta-structures to add value to the student experience. It is helpful to distinguish decolonisation from inclusivity. The inclusivity mission is to improve the educational experience for all (including students with protected characteristics) and aims to remove political/power relationships from the curriculum. Conversely, decolonisation seeks to challenge dominant forms of thought and practice and to radicalise, not de-politicalise. The aim of a decolonised curriculum extends beyond the attainment of individual students at a given university, important as that is. Ultimately, it is about transforming society and breaking down structural inequalities and institutional racism. As centres of knowledge production, universities should be at the vanguard of these efforts.14Beyond issues of representation, decolonisation demands deeper critique of the construction and content of the curriculum and the canons of disciplinary knowledge. Decolonisation highlights how knowledge is socially and temporally situated, with the current dominant social paradigm being Eurocentric and rooted in colonial epistemology. Decolonisation of HE involves liberating curricula from these selective narratives, instead providing students with 'diverse academic learning environments, curricula and approaches to research, within which Indigenous cultures, histories and knowledge are embedded'.15 Despite growing representation of ME students in dentistry, white men continue to dominate academic positions. Approximately 76% of academic faculty members identified as white, 9% as Asian and 2% as Black. Moreover, in UK dental schools, the proportion of ME groups in senior posts remains low.16 Limited representation of ME groups in institutional power structures and decision-making processes may impact on the educational experiences of ME students, potentially erecting barriers to attainment and career progression.17Like other healthcare professions, dentistry has, historically, been conceptualised as a 'white' profession in the UK.Dental institutions need to be proactive and take appropriate steps to address racial inequalities in dental education. For example, effective use of platforms such as Health Education England, which commissions dental education in the UK, and the Dental Schools Council, can facilitate sharing the data on student attainment and collaborate to address any gaps.18 Universities in the UK already have a committee structure in place to address issues of equality, diversity and inclusion and these committees can facilitate engagement with ME students and staff. Similarly, lay members on dental committees should include ME group representation. Together with student voice, public representation should be used to inform curriculum development, teaching and assessments. Moreover, the reading lists in dental courses can be revisited by engaging with ME students and staff to ensure that they are inclusive and people from under-represented groups are represented appropriately.19The Race Equality Charter by Advance HE provides an excellent framework for the HE institutions to identify and self-reflect on institutional and cultural barriers faced by ME staff and students.20,21 It is acknowledged that racial inequalities in dental education are not solely related to curriculum content and require a combination of awareness and knowledge of the ethnic demographics of the local communities to effectively address the oral healthcare needs of culturally and lingually diverse populations.22 Biomedical foundations of dental care need to be integrated with social determinants of health to improve the experiences of ME patients.23 Dental institutions need to develop faculty resources and effective educational strategies to boost students' knowledge, understanding and skills to achieve a minimum cultural competence standards.24Equally, under-representation of ME groups in healthcare curricula can translate into disparities in patient care for these groups, with far reaching implications for their health and wellbeing, as observed during the COVID-19 pandemic.25 Nevertheless, calls for decolonisation of dental curricula are growing.26,27 This paper details a survey on decolonisation of the dental curriculum, which explored experiences and perceptions of students and staff at a dental school in South West England.The impact of medical curricula on patient health inequalities and lower attainment among ME students have not been researched adequately.28,29,30 Scrutiny of the toolkits indicated consistent themes regarding decolonisation and the curriculum: representation; content; peer engagement; assessment; language and communication; and culture. Synthesising across toolkits, the educational development team developed a draft survey featuring four items for each of these six themes. Staff and student versions were produced featuring subtle wording changes where appropriate.Google searches, utilising the terms 'decolonisation' and 'ac uk', were conducted to identify materials relevant to a UK HE context. No existing survey tool was found. Nonetheless, three comprehensive 'toolkits' were identified at SOAS SOAS University of London, University College London and Kingston University.Ethical approval for the study was granted by the Research Ethics Committee, Plymouth University. The draft survey was piloted, first among staff and student interns attached to the institutional education development team and then among staff (n >40) and students (n >90) in two university schools. Response rate, item completion rate and open comments taken form the surveys indicated good participant comprehension. Following deliberations between the educational development team and dental faculty, an additional item relating to teaching on presentation of skin diseases in ME patients was added to the questionnaires for staff and students. Consequently, the surveys were finalised for use in the dental school (Appendix 1).au fait with the rationale and dynamics of decolonisation. To mitigate against the relatively limited understanding, the lead author delivered separate presentations on decolonisation of dental curricula to faculty staff and students and signposted them to relevant resources. Moreover, the participation information sheet accompanying the invites to the participants included a description of decolonisation of dental curricula, scope and purpose of the research and contact details of the research team for any queries by the participants.Decolonisation of educational curricula is a complex and evolving concept and many students and faculty staff may not be In Spring 2021, invites and electronic survey links were emailed to all current Bachelor of Dental Surgery (BDS) students (n = 227) and Bachelor of Dental Therapy and Hygiene (BDTH) students (n = 38), and all dental ataff (n = 39). A reminder was sent to all participants two weeks later. Participants who responded to the invite were required to provide an online consent before recording their responses to the survey questions anonymously. Data on programme, year of study, age, sex and ethnicity were captured on a voluntary basis.In total, 34 staff members participated in the study, yielding a response rate of 87.17%. Among staff, 31 reported affiliation with the BDS programme, and three with BDTH. Among the students, 120 responded to the survey, showing an overall response rate of 45.28%. Among students, 89 reported being on the BDS programme , which translated into a response rate of 39.20%. Finally, 31 BDTH students responded to the survey , giving a response rate of 81.57%. No information on sex was provided by staff. All 31 BDTH students identified as women. Among the BDS students, 57 identified as women, 30 as men and two preferred not to say. All items featured the response options 'not at all', 'to some extent' and 'very much' . Items LC1 and CU2 were reverse scored where combined with other items but not where examined individually.Reported p-values are based on 10,000 Markov chain Monte Carlo simulated replicates, to minimise impact of small subgroup/cell sizes, though some categories remain empty.Of the 24 items given to staff and students, there were significantly different average ratings for 15 . NotablyUsing the same approach to statistical analysis, student responses to each question were analysed further, to compare the scores for white and ME students. The results are depicted in Of the 24 surveys items, 17 showed a significant difference in responses between white and ME students. In all cases of significance, the direction of the scores suggested less favourable responses among ME students. Scrutiny of Positively, it appears that white and ME students report less divergent perspectives around the pivotal domain of 'assessment', which can be so impactful on educational and career outcomes. This outcome does, however, highlight the importance of appraising results from the 'intra-student' analyses , alongside the staff versus student analyses. Despite the relative consistency of white and ME students' views on 'assessment', student perspectives on this domain were, overall, substantially less favourable compared with all staff .Finally, scores for individual items in each domain were combined to produce a single, average score. These scores were then analysed to establish any significant differences according to group  and ethnicity . The findings are shown in The current study is a response to growing interest in this field. To our knowledge, it represents the first effort to explore the perceptions and experiences of stakeholders regarding decolonisation at a dental institution in the UK. Significantly, over 50% of student respondents identified themselves as from ME backgrounds. Consequently, the dataset properly represents ME students; obtaining sufficient responses from students can be challenging on some courses, especially at universities in the South West of England. Overall, average responses from ME students were lower compared to white students. These findings indicate that students from ME backgrounds may have a less optimal educational experience, with potential implications for wellbeing, attainment and subsequent employment. These results underscore the need for such audits in HE institutions to inform urgent initiatives.There was a recognition of the need to enhance representation of all ethnicities in the curriculum by participants across the board. However, significant differences were also noted in the perceptions of staff versus students. These may be driven by several factors. First, in contrast with the student data, staff data were almost entirely made up of white respondents; only a single staff member identified themselves as from a ME background. Extrapolating the apparent trend in the student data to the staff data, it may be the predominantly white dental workforce who are not finely attuned to shortcomings in the curricula, relating to ethnicity. Additionally, the overall less favourable perceptions of students may reflect limited knowledge of positive 'hidden' practices aimed at addressing inequity. For example, in the current dental school, attainment in all assessment is closely monitored to pick up differential attainment related to demographic factors, including ethnicity. While staff are involved in these processes, students may not be aware. This raises the question whether there should be more transparency between departments and their students around practices that seek to address inequities in student experiences and outcomes. While the less favourable student results may in part reflect genuine shortcomings in the curricula, a fuller understanding of the work being undertaken by departments around these agenda may have a bearing on student perceptions. Compared to their white counterparts, ME students appear to be more sensitive to the issues related to inclusion and representation of ME groups in dental learning environments. These findings highlight that although implicit, colonial influences still persist in universities and shape the experiences and assumptions of successive generations of people from ME backgrounds. There is a need to raise awareness regarding sub-optimal experiences of ME students for a meaningful debate on ethnic disparities in dental education.24 The introduction of the Race Equality Charter by Advance HE is a positive step and apart from promoting equality, decolonisation of curricula in HE institutions is a core component of this initiative. The number of HE institutions offering staff training on decolonisation is growing following recent interventions by the Office for Students (OFS), an independent public body which was established by the Higher Education and Research Act in 2017.7 OFS encourages and values difference in people, thought and the provision of higher education, and predicts that a 'decolonisation agenda is on its way to becoming embedded into institutional goals'.31 Already, 96 universities have signed up to the Race Equality Charter by Advance HE, underscoring a growing commitment to racial equality by universities in the UK.The number of institutions actively pursuing decolonisation as an institutional priority in the UK has been low in the last decade.Indeed, findings from surveys like the current example can help raise awareness of disparities in educational experiences and outcomes relating to ethnicity and act as a catalyst for change. For example, based on the feedback by the participants in this study, our institution has identified and initiated several areas of enhancement. We now have an active equality committee in place to address issues of equality, diversity and inclusion, with representation of ME students and staff. The committee meets regularly to identify and mitigate suboptimal experiences of stakeholders. Approximately 30 students from a range of ethnic and cultural backgrounds work as equality ambassadors to champion equality across all activities at the institution. The school is now working with equality champions to organise cultural events to celebrate students and staff from diverse backgrounds, showcasing their music, dress, etc. A clear commitment to collecting data from staff and students and then sharing it in forums like these may help address the disparity in staff and students' responses to the current surveys, as discussed earlier. To demonstrate a clear commitment to equality, our university has also signed up to the Race Equality Charter of Advance HE.20 Enhancing the cultural competence of the future dental workforce is important to cater for the dental health needs of underserved communities in the UK and improve patient experiences. This is relevant to the 'assessment' theme from the survey. It is also hoped that these steps, related to curricular and co-curricular activities, may generate peripheral improvements to the perceptions of ME students, in terms of the themes of 'representation', 'peer engagement' and 'language and communication'. We aim to repeat the surveys in the next 12-15 months to evaluate the impact of institutional initiatives on the experiences of the stakeholders.Of direct relevance to the 'content' theme of the current surveys, the students and staff at our institution have created bespoke learning resources for recognition of pathological skin conditions in ME patients. These resources have received excellent feedback from students and staff across the board and are now being shared with other dental schools across the UK, demonstrating an example of good practice. The reading lists for BDS and BDTH programmes are being updated to include diverse learning resources not limited to white authors from Europe and the USA. Moreover, we are focused on developing assessment items encompassing the differential presentation of disease in ME groups, to facilitate the cultural competency of students. Prevalence of dental disease is higher while access to dental treatment and patient satisfaction rates are lower among ME populations in the UK.It is important to acknowledge limitations of the current surveys. They were devised to gain preliminary insight to staff student experiences/perspectives of decolonisation and the curriculum, in response to frontline developments . Further validation of the survey instrument is required with larger groups of respondents from multiple institutions. Given the data reported in this study is from a single institution, with relatively low response rates by BDS students, the findings need to be interpreted with caution due to potential effects of non-response bias and lack of generalisability. Nonetheless, to the authors' knowledge, this remains the only staff and student survey tool regarding decolonisation and the curriculum. Consequently, the current data have considerable novelty. While the current authors themselves aspire to use and refine the surveys further, other investigators are also encouraged to work with them as they see fit, be it in verbatim form, as a basis for inspiring bespoke local instruments contextualised to healthcare curricula and use in conjunction with other approaches, such as qualitative data collection.This study provides useful insights into the perceptions and experiences of students and staff regarding decolonisation of dental curriculum in two undergraduate programmes. Significant differences were noted between staff and student scores and also between white and ME students. The findings of this study underscore the need to take further steps to decolonise the dental curricula. Regular auditing by institutions appears to be an important tool for identifying factors which contribute to racial inequalities in HE. Results can then inform initiatives and practices that facilitate positive experiences for ME students and staff in their educational and work environments.


Scientific diasporas have been identified as valuable resources to strengthen science, technology, and innovation in their countries of origin. In this context, our paper seeks to contribute by addressing the following research questions: What are the main features of the Costa Rican scientific diaspora, and what policy lessons can be extracted from their experiences abroad? Toward this goal, we analyzed ten years of diaspora perspectives as collected by TicoTal, an online database and network of Costa Rican scientists studying and working abroad created by the National Academy of Sciences (ANC) in 2010. Our study reveals the main features of the Costa Rican scientific diaspora using 121 interviews published over a ten-year period: we identified the academic areas in which the diaspora has specialized, the countries where they were trained, their current location, the most frequent funding mechanisms and sources that enabled professional opportunities abroad, the level of engagement and collaboration they maintain with the Costa Rican STI ecosystem, along with the incentives they consider important to support and harness the potential of this community to advance STI goals in the country. Results from this analysis can inform national policies and investment strategies in R&D infrastructure and resources, by providing a roadmap to engage with scientific diasporas and benefit from their training and talent, as well as guide future scholarship and exchange programs. The migration of human capital from low-income countries to higher-income economies (known as “brain drain”) has been shown to affect the local consolidation of science, technology, and innovation (STI) in low and mid-income countries and can have significant impacts in specific fields  was created by the National Academy of Sciences (ANC) in 2010. This database compiles information from Costa Rican scientists and engineers who study or work abroad either permanently or temporarily. The main goal of TicoTal is to connect this diaspora with the Costa Rican STI establishment in order to foster alliances and cooperation that can strengthen and advance STI goals in the country.TicoTalvia a listserv with all subscribers. Each interview covers the interviewee's pathway to STI opportunities abroad and highlights key challenges faced, incentives they value in the consideration to return or to collaborate with Costa Rican-based STI stakeholders, as well as perceived needs to bolster STI in the country.Every month, ANC publishes an interview with a member of the TicoTal network, which is shared publicly HipatiaHipatia carries out a comprehensive and systematic mapping of the scientific diaspora. This resource contributes particularly by facilitating contact between Costa Ricans abroad and local startups so that they receive mentoring in different areas of expertise.A second platform that quantitatively tracks the Costa Rican scientific diaspora is While these resources collect and maintain up-to-date information on Costa Rican scientists abroad, experts have emphasized the importance of analyzing the perspectives of scientific diasporas when designing policies of interest to these populations  published as part of the monthly ANC newsletter, with the purpose of highlighting Costa Rican students and researchers in STI fields who are living abroad. Their personal motivations and challenges, research interests, disposition, or preconditions to return home, and professional recommendations for Costa Rica to advance STI are valuable sources of information and encouragement for other young Costa Ricans who also wish to seek opportunities to study or work abroad. In addition, this platform also serves as a tool for members to connect among themselves across different parts of the world, learn about each other's research projects, and establish collaborative efforts.The selection of the featured “Outstanding Talent” individuals is made by the ANC staff following no specified criteria, although gender equity is sought by alternating profiles from men and women. A sample of interviews was selected for this analysis, encompassing 121 interviews published in the newsletters between December 2011 and December 2021. The eight survey questions remained consistent across the decade covered by the analysis for all interviewees.The work of systematically reviewing these eight answers from 121 interviewees was divided among three of the coauthors , who codified 62 variables out of these responses into a database. Variables were grouped into four main domains related to an interviewee: (a) identity and background, (b) funding conditions, (c) contact with Costa Rica, and (d) incentives to return and challenges abroad.The first domain covers variables such as name, gender, month of the interview publication, and STI area of research, which can be chosen from a predetermined menu of options. Additionally, we extracted what undergraduate degree they reported and from which university it was obtained, as well as which country it is located in. We also codified if they reported having a Master's, a Ph.D., and/or a postdoctoral position (as binary variables), and the universities and countries each of these occurred in.Identity and background variables were set on two temporal frames of reference: (i) the moment of the interview  and (ii) the present, when the analysis is being performed (fixed as February 2022). Most identity and background variables are taken as reported at the moment of the interview. The few variables fixed in the present were extracted from other public sources, such as the interviewees' LinkedIn profile or their academic department's website. These updated variables include their current job position, the organization where they work, and the country of residence at present. Based on their full name, their birth date was extracted from the public database of the Costa Rican National Registry  or personal funds, or a combination of these sources. Another variable related to funding codified if the financial sources were public or private money or a mix of the two. Finally, two variables registered whether the person reported having been part of an exchange or internship program abroad (binary variable), and the detail of how it served as a mechanism to enable the continuation of their studies.Variables in the third grouping report if the person maintains contact with various sectors in Costa Rica, among them academia, industry, decision-makers, and colleagues in the diaspora (as binary variables). In the event that contact is reported, the detailed means of engagement is noted as an open, non-codified variable. This category also documents if the person is willing to establish a collaborative effort with Costa Rica (binary variable) and the details of that offering, for example hosting visiting students.The final collection of variables registers the types of incentives the interviewees listed (as binary variables) as a precondition to returning to Costa Rica. They are grouped into three types:Infrastructure .Networks .Cultural .Open variables about the specific incentives requested from each category were annotated. Finally, there is a variable that registers, in a non-codified format, the challenges reported by the individual while abroad.Given the relatively open frame of the interview questions, which in most cases do not specifically inquire about our target variables, we relied on the interviewees having directly reported each variable. The absence of a variable may simply reflect the failure of the person to document it in their answer, imposing a significant source of uncertainty on our analysis. Variables were not exclusively extracted out of predetermined questions, but in general variables about identity, background and funding were mentioned in the answers to questions 1. and 2., variables about contact with Costa Rica were predominantly inserted in answers 2. through 7., and variables about incentives were contained in answers 5. through 8.It is also recognized that this study, by the original design of the raw dataset, is limited in scope to the Costa Rican scientific diaspora, which is defined as individuals who are studying and researching in areas from the natural and hard science fields. We acknowledge a significant gap in tracing and documenting valuable insights from the Costa Rican diaspora that work and study in the fields of social sciences, humanities, and arts. Furthermore, certain sample biases are implicit by way of the process through which the TicoTal network is generated. ANC relies in large part on mechanisms such as word of mouth, friends of friends, and media visibility to recruit new TicoTal members, biasing the pool of people from which the “Outstanding Talent” profile is then “hand-picked,” adding yet another bias. Some results presented here, for example, geographical representation may reflect these biases, as ties with certain groups of the diaspora are stronger due to geographical access or cultural proximity. Another limitation is that the data was collected over a 10-year period. It is therefore likely that interviewees may have been impacted by specific events and circumstances at the time of the interview, which may mean significant change between interviews conducted a decade ago compared to more recent ones. This has been addressed in the Results section with an analysis of responses over time.The database was processed using Excel and R software, in order to compute statistics and trends and to generate the figures presented.The development of STI in Costa Rica has been characterized by twists and turns since the dawn of its independent life in 1821. The first stages were primarily influenced by foreign naturalists, who studied the rich biodiversity of the country. Then, the appearance of local scientists seeded endogenous efforts in several fields, bolstered by liberal reforms that dominated the political landscape of the country in the last decades of the XIXth century and the beginnings of the XXth century, including the foundation of several research institutions focused on science and technology . Besides offering novel opportunities for Costa Ricans to obtain professional degrees, scientific and technological research flourished in this institution in several fields over the next decades  in 1972 marked a turning point, as part of regional efforts in Latin America promoted by international organizations such as the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Organization of American States (OAS) and the Inter-American Development Bank (IBD) Sagasti, .Building on this progress, the Ministry of Science and Technology  was created in 1986, the National Academy of Sciences (ANC) in 1992, and the Costa Rican Promoter of Innovation and Research in 2021, among other important developments . In 1974, his return to Costa Rica was actively promoted by CONICIT and the UCR. As part of his return, a new research institute  was created at UCR in 1975 and Mata Jiménez was appointed as its first Director. He remained in the country for the rest of his career. Similar cases occurred in different areas of knowledge, thus resulting in the creation of different research centers and the strengthening of others.Despite these developments, the country has significant limitations in incorporating STI as a dynamic element in its social and economic development. A detailed diagnosis of STI in Costa Rica was presented by the “State of the Nation program” in 2014 , particularly what their academic trajectories have been and what funding mechanisms and network resources they used to train abroad. The analysis shows that 53% of interviewees identified as male, and the average age at the time of the interview was 36 years (age range: 23–64). At the moment of the interview, the vast majority (57%) of interviewees had already obtained a Ph.D., 34% were in the process of pursuing doctoral studies and an added 9% held a Master's degree but were not pursuing an additional degree. Notably, 11 individuals departed Costa Rica for STI employment opportunities abroad and did not pursue any further graduate studies.In terms of STI fields, 41% of the sample were originally trained in basic sciences, 34% in engineering, 20% in health sciences and medicine, and 5% in food sciences at the undergraduate level . HoweverWe also aimed to answer what proportion of the diaspora returned to Costa Rica over the 10 years covered by our sample. Our data shows that only 23% of interviewees returned by the time of analysis (2022). More specifically, In contrast, other Latin American governments have deployed official programs to repatriate their diasporas. Two well-known and well-characterized repatriation programs are RAICES (Network of Argentine Researchers and Scientists Abroad) and the CONACyT Repatriation Program in Mexico. Both have been in place for more than 20 years and focus on repatriating scientists, especially in the early stages of their careers, when they are doing their postdoctoral research , a single person was identified working in the private sector, and two additional people in the public sector . Further studies are required to analyze the current efforts by the country's public and private sectors to attract scientific talent from abroad. An example of a national plan that attracted researchers back to civil service and industry was an Argentinian plan, which brought back 178 scientists between 1992 and 1994. Among this group, the largest share joined the private sector (31%), while 15% opted for public administration jobs Meyer, .Another goal of our study was to determine in which countries the interviewees pursued their academic degrees and at what point they decided to go abroad. An additional finding of A noteworthy finding of Another interesting aim of this study was to identify the funding sources used by Costa Ricans to carry out their training abroad. Of the 121 interviewees, 82% indicated that they mainly received financial support from public institutions, both foreign and national, with a large proportion directly funded by stipends provided by foreign public universities (61%)Of note, 11 people were co-sponsored by public universities of the home and the host country. This could present an important framework to be included in future scientific and international cooperation agreements: The practice of co-financing the training of scientists abroad may in fact be attractive to host universities. Previous studies have shown that -contrary to the so-called “return brain drain”-, once these students return to their countries of origin, they become potential scientific linkages to the host institutions , exchange programs (21%), and established or past scientific collaborations between investigators in the home and the destination university (18%). This result is relevant for decision-makers in academia, as it highlights that financing short-term research internships constitutes a platform for students and researchers to obtain additional training opportunities and funding opportunities abroad. For example, the Turkish American Scholars and Scientists Association (TASSA) allocates resources to send students to higher education institutions in the United States to work with diaspora members in specific laboratories Burns, .This study performed a qualitative analysis regarding the type of social interactions that the interviewed members of the diaspora indicated having with the home country, and specifically with STI stakeholders. This is particularly relevant given that the specialized literature on scientific diasporas has highlighted the importance of creating academic networks between scientists abroad and their country of origin, as well as facilitating platforms where the diaspora can advise decision-makers and advance scientific agreements between the home country and the local ecosystem where they are based  between foreign universities and academic institutions in the home country. This is the case of a scientist based at the Institut Pasteur in France, who has actively promoted cooperation and exchanges with the research community in the field of Microbiology, including a cooperation agreement between the UCR and this French institution.On a similar vein, only 13% of interviewees indicated having had some type of collaboration with the government or with decision-makers. A notable case is a scientist based in Europe who provided expert advice to the Costa Rican diplomatic delegation at the United Nations Framework Convention on Climate Change (UNFCCC). This example highlights the potential role of diaspora members in supporting diplomatic efforts, an especially critical function, considering that most Costa Rican embassies do not have a designated science and technology counselor , the Central Bank, the National Statistics and Census Institute, and the ministries of agriculture and science and technology, as well as individuals who have served as delegate members in national elections organized by embassies and consulates abroad. While our analysis suggests limited connections between the Costa Rican government and its diaspora, this is not generalizable to other countries in Latin America. Mexico, for example, created the Institute for Mexicans Abroad and established a Consultative Council where elected diaspora members can make recommendations to the government on a wide range of issues  and no concrete examples of collaboration with companies in the country were identified within our sample.Despite the limited interaction with the private sector and other STI stakeholders, a key finding of our analysis is that there is a significant number of members of the diaspora who expressed an interest in maintaining contact and contributing scientifically to Costa Rica. Previous studies have highlighted that research on the needs and perceptions of the diasporas has been lacking and might be key to determining future policies directed at engaging with them  is a key incentive, including funding and expanding training opportunities abroad, promoting collaborations among the Costa Rican scientific community, organizing events, and promoting international relations and collaborations with higher education institutions abroad. These ideas were persistently recurrent throughout the 10-year period of interviews.Some examples of specific demands in this area are: (1) the strengthening of existing or the creation of new databases with information about scientific talent abroad that can facilitate contact with ministries, as well as with public or private institutions and research groups; (2) the organization of online courses targeted to specific populations such as high school students, and (3) the establishment of pathways for the diaspora to receive Costa Rican students for internships and training.Building scientific networks involving Costa Rican research groups and members of the diaspora is a key task that should be fostered by multiple mechanisms. These networks should be fluid and versatile, away from bureaucratic formalisms, and based on the shared interests of members of the Costa Rican scientific community, the diaspora, and groups from other countries in complex networking dynamics, along the spirit of what has been called “the new invisible college” Wagner, . The strA significant number of interviewees mentioned incentives regarding the improvement and strengthening of infrastructure (86%). In particular, the majority of the diaspora demanded a higher budget allocation to STI, funded by both the government and the private sector. Strikingly, the budget-related demands remained constant regardless of the year in which the interview was conducted.Further infrastructure incentives stated by interviewees -especially in the early years from 2011 to 2016- are the creation of research centers with modern equipment and access to databases that can keep up with development in the discipline, as well as programs and pathways for those scientists who wish to start a small business. It is interesting to note that requests for new physical infrastructure diminished considerably in more recent interviews. This may imply that there is a perception among the diaspora that the country has invested in this area in recent years.Finally, there were additional demands related to the perception of science in society, as well as more job opportunities for the STI community and the redesign of the academic pathway within the country. In particular, 77% of people stated the importance of maintaining an updated listing of job offers in STI in Costa Rica, that is accessible to the diaspora. This need appeared continuously throughout the 10-year period. Additionally, many interviewees mentioned that clearer performance criteria and a merit-based academic system should be created.The diaspora also considered that reinsertion initiatives for professionals abroad should be managed in a structured manner and as part of a directive national plan with a long-term vision, facilitating certain processes such as creating salary ranks that are based on both experience and academic degrees. The variety of needs expressed by the interviewees can be viewed within a more general frame of cultural and institutional changes aimed at raising the status of STI in the imaginary of our society as a whole, well beyond the STI community. This is a long-term goal that should be based on concerted national policies at various levels and involving many stakeholders.Overall, these pressing demands call for a stronger commitment of public and private stakeholders to build a sustainable landscape for STI development, that not only will attract members of the diaspora, but will also retain young scientific talent by creating conditions for an expanding ground of international cooperation.This study was developed with two key objectives. First, to understand the main features of the Costa Rican scientific diaspora using TicoTal's 121 interviews published over a 10-year period. The second goal was to extract policy lessons from the diaspora experiences abroad. We studied their perspectives, resulting in an analysis that can inform national policies and investment strategies in R&D infrastructure and resources. The following policy recommendations emerged from this analysis:It is crucial to position scientific diasporas as key resources in the scientific and technological development of countries. They must be reflected as critical actors on a nation's short, medium, and long-term STI policies. Government institutions must perform a systematic and recurrent mapping of their diasporas and their capacities and, on that basis, promote active networking with the home community in STI.The latter has been China's strategy, i.e., positioning the diaspora as a national asset in its global policies. In the last 20 years, they increased opportunities for the diaspora by fostering collaboration, short stays, and joint appointments between Chinese scientists who work abroad and their local STI community. This agrees with the perspectives of the Costa Rican diaspora collected in these interviews. In fact, China's approach has been crucial to its global rise in multiple scientific fields Vogel, . New tecIn addition, as mentioned by interviewees, academia should foster knowledge circulation by developing a set of incentives to attract the diaspora back, either temporarily or permanently. For example, local universities could invite diaspora members to conduct workshops and short-term stays, as a way to build long-term relationships that can be converted into more permanent positions. Furthermore, as exhibited in the Results section, another challenge for local universities is to enroll diaspora members in graduate and postdoctoral programs offered within the country. Bolstering these programs could attract talent during the training process and be attractive to diaspora members, further strengthening brain circulation and mobility of ideas.Expert literature has additionally emphasized the importance of hiring researchers from abroad as a key indicator for the internationalization of research institutions  Increased access to new technological developments and (2) Increased production and improved knowledge circulation across the local scientific community and industry in the country. In the long term, these strategies could result in the strengthening of the nation's bilateral and multilateral relations using science and technology as a vehicle, an objective at the very core of science diplomacy.Our paper provides new evidence about scientific diasporas. The biggest contribution is that it fills a gap in the literature providing more research into the needs and unique perceptions of diasporas. Despite the limitations, this study provides valuable information in order to build a roadmap to engage with scientific diasporas and benefit from their training and talent. Future research is crucially needed to better grasp the current efforts deployed in both public and private sectors and assess their efficacy and impact. This represents many methodological challenges; however, efforts should be made to collect this information in order to expand on the evidence presented in this paper.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.MJ-S, MG, and EL-S designed the research and database. KC, MJ-S, and EL-S collected the data and prepared the database. MS made the figures. MS and JG drafted the first manuscript. MJ-S, JG, EL-S, MG, and DM contributed to the subsequent writing and editing of the manuscript. All authors contributed to the article and approved the submitted version.


Building one’s own identity and finding meaning in life are important tasks for emerging adults. Although many agree that both are essential in terms of the well-being and proper functioning of an individual, there is little empirical data concerning the relationship between the way young people process information about themselves and the feeling that their life has a purpose and value. Therefore, the aim of this study was to explore how identity processing styles  and two dimensions of meaning of life (presence and the search for meaning) are related. It was also assumed that identity commitment could play a mediating role between those variables. 183 emerging adults who participated in the study completed Identity Style Inventory (ISI-5) and Meaning in Life Questionnaire. The cross-sectional study design was used. Using Structural Equation Modeling revealed that commitment mediated the relationship between two of three identity styles  and presence, but not search for or meaning in life. Normative identity style also negatively predicted the search for meaning in life. It seems that commitment might play an important role in meaning-making process, and as such, should be strengthened and encouraged when working with individuals at this stage in life. Emerging adulthood, between the ages of 18 and 29, is a period of intense changes, discernment and testing various possibilities . In the One of such approaches is the model of identity formation proposed by Berzonsky ,9, focusPeople who prefer a normative style tend to process identity issues fairly automatically, internalizing beliefs and values of significant others and adhering to established norms . As reseIn addition to developing a sense of identity, another important task faced by emerging adults is finding meaning in life. Development of sense of meaning in life is considered as a parallel process to development of sense of identity . ContempAs the research results show, true self-knowledge and being in touch with one’s real self play an important role in the meaning-making process . It seemIt is known that both the identity processing style and meaning in life are related to psychological well-being ,31. RyffThe present study aimed to examine the relationship between the sense of meaning in life (both in presence and searching dimensions), and each of the three identity processing styles among emerging adults. It was assumed that, as in the case of psychological well-being, identity commitment will be a significant factor, influencing the relationships between other variables. In line with the main objective of the current study, a hypothetical path model assuming the above-mentioned relationships between the variables was created see .age = 20.81, SD = 1.84). All research participants were students or university graduates. Most of the participants (72%) lived in a large or medium city, while the remaining 28% lived in small towns or villages. None were married, but almost half declared having a partner (43%). None of the respondents had children. Recruitment took place via e-mail and through advertisements posted at universities and student forums. The study included people who were not treated psychiatrically, were not undergoing therapy and did not experience traumatic events in their lives in the last year, as it could significantly affect their level of sense of meaning in life. Participation in the study was voluntary, and the participants were informed in advance that they could resign from it at any time. Participants gave their written consent to participate after receiving oral and written information about the study. The study was conducted in accordance with the principles of the Declaration of Helsinki. The project was approved and financed from the funds earmarked for young scientists and doctoral students at the Faculty of Philosophy of the Jagiellonian University in Krakow.The study was planned as a cross-sectional study. The STROBE checklist for cross-sectional study was used  entire . The resThe study used Polish language versions of the scales: Identity Style Inventory (ISI-5) , MeaningIdentity Style Inventory (ISI-5) consists of 48 items (36 of which are diagnostic) that make up three subscales regarding identity styles: informational, normative and diffuse-avoidant, and a fourth scale that measures commitment (9 items in each). On a 5-point Likert scale, the respondents assess to what extent a given statement describes them . The Polish version of this scale was adapted by Senejko and Łoś . The CroMeaning in Life Questionnaire (MLQ) consists of 10 items that measure two dimensions of meaning in life: presence and search. Responses are provided on the 7-point Likert scale (from “absolutely untrue” to “absolute truth”). The Polish version of this scale was adapted by Kossakowska, Kwiatek and Stefaniak . Cronbacp-value in χ2 test; the comparative fit index (CFI) above 0.95; the root mean square error of approximation (RMSEA); and the standardized root mean squared residual (SRMR) smaller than 0.08. To evaluate indirect relationships from identity styles to meaning in life dimensions through identity commitment, we used bias-corrected accelerated 95% confidence intervals (CI) calculated using 5000 bootstrapping re-samples . As shown in The hypothesized model of the predictive relationships between normative identity style, commitment, presence of meaning and search for meaning in life was found to be a good fit for the data . As shown in The hypothesized model of the predictive relationships between diffuse-avoidant identity style, commitment, presence of meaning and search for meaning in life was also found to be a good fit for the data . As shown in The hypothesized model of the predictive relationships between informational identity style, commitment, presence of meaning and search for meaning in life did not fit as well with the data as the two previous models [χpositive relationship between normative identity style and both the presence of meaning and search of meaning in life [The current research shows that first, there is a negative relationship between the normative identity style and both dimensions of meaning in life: presence and search. However, as shown by structural equation modelling, normative identity style negatively predicts only search of meaning in life. It is inconsistent with previous research that indicates a  in life . Neverth in life ,9, and t in life ,9. The d in life , includi in life ,24. Peop in life . No rela in life . The lat in life . Thus, t in life . This atMoreover, the obtained results showed that there is a positive relationship between commitment and presence of meaning in life. Commitment also has proven to be a good predictor of this dimension of meaning in life. This result seems to be particularly interesting, as in previous studies concerning the relationships between identity styles and sense of meaning in life, commitment was only used in correlation analyses, and was not included in the tested models . Here, iThe obtained results suggest that it is commitment that may be of great importance for establishing meaning in life. Researchers indeed note that it is vital for meaning-making in a life-time perspective, although they focused primarily on the elderly . Such obSo far, there have been only few studies that focus on the relationship between identity processing style and meaning in life. As there are some discrepancies between the results reported here and obtained in the previous studies, more research is needed to define more precisely and further explore the relationships between the above-mentioned constructs. Both the current and previous studies were conducted on a relatively small sample of emerging adults (less than two hundred people), so it would be advisable to repeat it with a larger group of participants. Another limitation of the current study is the uneven number of women and men, which made conducting multi-group analyses impossible. It cannot be ruled out that that gender might be a factor affecting the studied relationships, and therefore it should be considered in future studies. The group taking part in the study was also quite homogeneous, as it consisted of students and people who graduated from university, so it would be worthwhile to check whether the obtained pattern of relationships will be observed in a group of emerging adults who did not choose to pursue higher education. It should also be noted that the research was conducted only on the Polish sample, which means that caution should be exercised in order to generalize the results for the entire population of emerging adults. This is because social and cultural conditions may influence the studied variables . Due to There is a negative relationship between normative identity style and both dimensions of meaning in life: presence of meaning and search for meaning in the group of emerging adults. Normative identity style negatively predicts search for meaning in life, but not presence of meaning.There is a negative relationship between diffuse-avoidant identity style and the presence of meaning in life in the group of emerging adults.There is a positive relationship between informational identity style and both dimensions of meaning in life in the group of emerging adults. Informational style positively predicts search for meaning in life.Normative identity style negatively predicts search for meaning in life, and informational style positively predicts this dimension of meaning in life in the group of emerging adults.Commitment predicts presence of meaning in life. What’s more, commitment partially mediated relationship between diffuse-avoidant identity style and the presence of meaning in life and a fully mediated relationship between informational identity style and presence of meaning in life.Commitment seems to play a significant role in meaning-making among emerging adults.Based on the data collected and analyzed, the following conclusions can be drawn: