COVID-19 infection has high transmissibility and several measures have been adopted for controlling its dissemination. To identify and summarize the evidence from Cochrane systematic reviews (SRs) regarding measures for controlling the dissemination of COVID-19 infection. This review of Cochrane SRs was carried out in the Division of Vascular and Endovascular Surgery and in the Division of Emergency Medicine and Evidence-Based Medicine of Universidade Federal de São Paulo, Brazil. A comprehensive search in the Cochrane Database of Systematic Reviews retrieved all Cochrane SRs directly related to measures for controlling COVID-19 dissemination. The main characteristics and results of all the SRs included were summarized and discussed. Three Cochrane SRs were included in the qualitative synthesis. These evaluated population-based and individual measures for controlling the dissemination of COVID-19. Low-certainty evidence shows that quarantine for people exposed to confirmed or suspected COVID-19 cases prevented 44% to 81% of incident cases and 31% to 63% of deaths, compared with situations of no measures. Moreover, the sooner the quarantine measures were implemented, the greater the cost savings were. High-confidence evidence showed that clear communication about infection control and prevention guidelines was vital for successful implementation. Low-certainty evidence showed that healthcare professionals with long gowns were less exposed to contamination than were those using coveralls. In addition, coveralls were more difficult to doff. Further SRs on controlling the dissemination of COVID-19 infection are desirable. COVID-19 is a disease caused by a new type of coronavirus (SARS-CoV-2), which was identified in December 2019 in Wuhan province, China. Many patients develop only moderate symptoms without complications. However, approximately 14% of infected people develop a severe form of the disease that requires hospitalization and oxygen support and 5% of patients need treatment in intensive care units. SARS-CoV-2 disseminates among people mainly through the respiratory route, through coughing and sneezing, but it can also be transmitted by means of contaminated surfaces. Although the incubation time varies from 5 to 6 days in most cases, this time can reach up to 14 days. The infection period is not precise, varying from 24 hours to 48 hours before the manifestation of the symptoms. The viral load detected in the upper respiratory tract at the onset of the disease is high.When a new respiratory infection becomes widespread, as has occurred with the COVID-19 pandemic, healthcare professionals must adhere to prevention protocols in order to avoid contamination and infection. The prevention protocols recommend a variety of strategies: both personal measures, relating to the professionals, and measures that concern the environment. For the professionals, the protocols suggest that a mask, face shields, gloves and aprons, known as personal protective equipment (PPE), should be used. Concerning the environment, the protocols suggest that patients with respiratory diseases should be isolated and that cleaning routines should be more rigorous. Given that, in practice, adherence to these strategies can be challenging, healthcare authorities and facilitators need to support their professionals in implementing them.In epidemics and pandemics of highly infectious diseases such as Ebola, COVID-19 and severe acute respiratory syndrome (SARS), healthcare professionals’ contact with the body fluids of contaminated patients means that these professionals are the group at the highest risk of infection.The World Health Organization (WHO) recommends quarantine and isolation, in association with other public health measures, as measures for controlling the spread of infection. Both quarantine and social isolation are epidemiological interventions to mitigate infectious disease and reduce the potential for transmission. However, the effects of these and other measures for controlling the pandemic still generate discussion.Different countries have been using both individual and collective interventions for controlling the dissemination of infection, such as use of PPE, social isolation and compulsory quarantine, but the impact of these measures still needs to be studied in order to bring out robust evidence.The aim of this study was to identify and summarize the evidence from Cochrane systematic reviews (SRs) regarding measures for controlling the dissemination of COVID-19 infection, in an overview.This review of Cochrane SRs was carried out in the Division of Vascular and Endovascular Surgery and the Division of Emergency Medicine and Evidence-Based Medicine of Universidade Federal de São Paulo, Brazil.We included full Cochrane SRs published in the Cochrane Database of Systematic Reviews (CDSR), with no restrictions on the date of publication. Withdrawn or outdated versions of SRs and protocols for SRs were considered not relevant.All participants at risk of contagion, with suspected or confirmed clinical status of COVID-19 infection were considered relevant, i.e. males and females of all ages, with no restrictions as to the severity of the condition or place of treatment .We considered SRs that evaluated any intervention to control the spread or reduce the contagion of COVID-19 infection, compared with standard care or another intervention, in at least one arm of the study.Any epidemiological, clinical or laboratory results relevant to patients were considered, as assessed by the authors of the SRs included.We performed a sensitive systematic search in the CDSR, via Wiley, on April 26, 2020, using the MeSH terms ‘Coronavirus Infections’ and ‘Coronavirus’, and all related variants, along with free terms in ‘titles, abstracts and keywords’. The detailed electronic search strategy is shown in Two researchers (LCUN and RLGF) independently assessed the titles and abstracts to analyze whether the SRs met the inclusion criteria, using the Rayyan software (rayyan.qcri.org/welcome).We presented the search results and the SRs that were included as a qualitative synthesis (descriptive approach).,,Nineteen references were retrieved from our search strategy and, after screening the titles and abstracts, six SRs were preselected. After evaluating the full texts, three reviews were found to meet the inclusion criteria and were included in the qualitative summary.,,The most recent versions of all the SRs included were published in April 2020 in the CDSR. Details regarding the review design, characteristics of the interventions, comparisons, results and the certainty or confidence of evidence are presented in A rapid review was carried out to support WHO quarantine-related measures that were implemented subsequent to WHO’s declaration of the COVID-19 pandemic in March 2020. Nussbaumer-Streit et al. conducted a SR with abbreviated methods (rapid review) in order to evaluate two key questions (KQ): 1) the effects of quarantine  for individuals who had been in contact with confirmed cases of COVID-19; and 2) the effects of quarantine on individuals who had travelled from countries with a declared pandemic or who were living in regions with high transmission of the disease.The authors of this SR included 29 studies as follows: 15 modelling studies on SARS and Middle East respiratory syndrome (MERS), four observational studies and 10 modelling studies on COVID-19 . BecauseSimulated quarantine measures showed a benefit, as reported through the modelling studies. Quarantine measures for people exposed to confirmed or suspected cases prevented 44% to 81% of incident cases and 31% to 63% of deaths, compared with no measures. This low-certainty evidence was based on four modelling studies on COVID-19 in SARS (incident cases), and two modelling studies on COVID-19 in SARS . Two modelling studies on SARS suggested that the earlier the quarantine measures were implemented, the greater the cost savings would be (low-certainty evidence). Two modelling studies on SARS indicated that the effect of quarantine measures for travelers from a country with a reported outbreak was small, with regard to reducing deaths and the incidence of the disease (low-certainty evidence). Other prevention and control measures used in combination with quarantine, including travel restrictions, social distancing and school closures, showed a more significant effect in reducing deaths, transmissions and new cases, than did individual measures alone. Modelling studies on COVID-19 provided this low-certainty evidence: four studies relating to incident cases, two relating to subsequent transmission and another two relating to mortality. The studies on SARS and MERS were consistent with the results from studies on COVID-19.This SR focused on transmission, reduction of mortality and use of quarantine resources because WHO selected these as outcomes of interest. The authors of this SR did not include any consideration of the psychological impact of quarantine on individuals. There may be other adverse economic and health effects resulting from quarantine that were not assessed by this review . For these reasons, this SR was unable to address the issue of when quarantine and other public health measures aimed at reducing the dissemination of COVID-19 should be relaxed or limited. It is also important to note that the authors of this SR did not subject the two modelling studies that reported on use of resources to specific critical economic assessments and did not attempt to come to any conclusions regarding the relative costs or efficiency of quarantine alone or in combination with other measures, compared with these public health interventions or measures in isolation.Although the evidence was limited to modelling studies, this SR showed that quarantine was essential for reduction of the incidence of COVID-19 and consequent mortality. Early implementation of quarantine and combination of quarantine with other public health measures seemed to be essential for ensuring effectiveness. Decision-makers should continuously keep the outbreak situation and the impact of the measures implemented under surveillance. To assess the true prevalence of infection and reduce the uncertainty of modelling assumptions, testing representative samples in different contexts might be of some help.This was a rapid review to synthetize the evidence relating to factors that influence healthcare professionals to follow infection control and prevention (ICP) protocols for respiratory diseases. These strategies include the use of PPE such as masks, face shields, gloves and aprons; isolation of patients with infectious respiratory disease; and stricter cleaning routines. The review authors searched only the MEDLINE database via OVID and included all types of primary studies, with no limits on date or language of publication. The review authors used the GRADE-CERQual approach  to assess the level of confidence in each result.The authors of this SR found 36 relevant studies, and 20 studies were included in the qualitative analysis of this review. There was no meta-analysis, and the results were reported narratively . Two of The following factors (barriers or facilitators) that were ascertained were based on results that were assessed as presenting a moderate to high level of confidence.Lengthy and ambiguous guidelines or those that did not reflect national or international guidelines made the healthcare professionals insecure about how to follow local guidelines. Continual changes to the local guidelines left the healthcare professionals feeling overwhelmed. They also described how ICP strategies led to increased workloads and fatigue; for instance, because they had to wear PPE and do additional cleaning. The level of support that the healthcare professionals felt that they received from their management team was described as a point that influenced their responses to ICP guidelines.Clear communication about ICP guidelines was considered vital. The healthcare professionals pointed out that there was a lack of training on how to use PPE and on the infection itself. They also considered it to be a problem when training was not mandatory.Sufficient space to isolate patients was also considered essential. The lack of isolation rooms, antechambers and showers was a problem. Other critical practical measures described by the healthcare professionals included rapid screening of infected patients, minimization of overcrowding, easy access to handwashing facilities and restrictions on visitors.The healthcare workers and managers pointed out that the lack of PPE and inadequate quality equipment were serious concerns, and that there was a need to adjust the volume of supplies as outbreaks of infection continued.The healthcare professionals believed that they followed ICP guidelines more carefully when they understood their value. Some of the healthcare professionals felt motivated to follow the guidelines because they felt responsible for their patients or because they were afraid of infecting themselves or their families. The healthcare workers identified that there was some trouble in using masks and related PPE when it made patients feel isolated, scared or stigmatized. The healthcare professionals also found that the masks and other equipment were unpleasant to use. The culture of the workplace also possibly influenced whether the healthcare professionals followed ICP guidelines or not.In many of the conclusions, the healthcare professionals pointed out the importance of including all employees, including cleaning, doorkeeping, kitchen and other support staff, when implementing ICP guidelines.Some factors possibly constitutes barriers against infection control and prevention strategies, such as lack of alignment between national and international protocols, which led to insecurity among health professionals with regard to following these protocols. Another critical factor was the lack of personal protective equipment or the availability only of inferior material, which caused discomfort among professionals. In some situations, although healthcare professionals were aware of the regulations, it could be challenging to adhere to the protocols, especially when working under critical conditions.The review authors pointed out several factors that influenced the ability and willingness of healthcare professionals to follow ICP guidelines when managing respiratory diseases. Those factors included points associated with the guidelines themselves and how they were disclosed, support from managers, training, workplace culture, physical space, access to and confidence in PPE and the intention to provide excellent patient care. The review also highlighted the importance of including all staff at the facility, including the support team, when implementing the ICP guidelines.In situations of outbreaks of epidemics or pandemics, there is an increased risk of infection for healthcare professionals due to greater exposure to body fluids from infected patients. Use of PPE can reduce this exposure. This study was a SR that assessed which type of full-body PPE and which method of dressing and undressing presented the lowest risk of contamination and infection for healthcare professionals. The study also addressed training methods that had the capacity to increase adherence to protocols.The authors of this SR included 24 studies with 2,278 participants: 14 of these studies were randomized controlled trials (RCTs), nine had a non-randomized design and one was a quasi-RCT. Among the 24 studies included, eight compared dressing and undressing processes, eight compared types of PPE, three evaluated types of training and six evaluated adapted PPE. In 18 simulation studies on harmless microbes or fluorescent markers, the average contamination rates were 25% for the intervention group and 67% for the control group.The certainty of the evidence for all the results was very low, except when mentioned otherwise, because it was based on only a few studies, because it used indirect evidence (simulation) and because of the risk of bias in the studies included .Use of an energized respirator and air purifier with coveralls can better protect against the risk of contamination than a N95 mask and gown (relative risk (RR) 0.27; 95% confidence interval (CI) 0.17 to 0.43), but it was more difficult to wear . In an RCT (59 participants), long aprons (gowns) were better able to protect against contamination than overalls, and the overalls were more difficult to wear (evidence of low certainty). Long aprons (gowns) were also better able to protect against contamination than short aprons  -10.28; 95% CI -14.77 to -5.79). PPE made of more breathable material led to a similar number of stains on the trunk , compared with water-repellent material, but user satisfaction was possibly higher .The following modifications to the design of the PPE had the capacity to lead to less contamination, compared with the standard PPE: 1) a more suitable fit around the neck, wrists and hands ; 2) a combination of sealed gown and gloves ; 3) better coverage of the wrist interface ; and 4) additional tags to grab to facilitate the use of masks  or gloves .Use of the recommendations of the Centers for Disease Control and Prevention (CDC) had the capacity to lead to less contamination, compared with no guidance . One-step removal of gloves and gown did not enable lower contamination with fluorescence  than separate removal. However, this one-step removal strategy led to less bacterial contamination . Use of double gloves had the capacity to lead to less viral or bacterial contamination, compared with simple gloves , but not less contamination with fluorescence . Additional spoken instructions had the capacity to lead to fewer errors in execution  and fewer points of contamination .Computer simulation in addition to other measures had the capacity to lead to fewer errors in the process . A video lecture on PPE placement had the capacity to lead to better skill scores  than a traditional lecture. Face-to-face instructions had the capacity to reduce non-compliance with guidelines, compared with just providing folders or videos (odds ratio (OR) 0.45; 95% CI 0.21 to 0.98).The use of various elements of PPE created discomfort regarding its use, which gave rise to possibly higher risk of contamination of the healthcare professional at the time of undressing.Use of an energized respirator and air purifier with overalls was more challenging to wear .This SR found very low to low-certainty evidence that covering more parts of the body enabled better protection, but that protection covering more of the body was generally more difficult to wear or make and was associated with less user comfort and, therefore, would perhaps even lead to more contamination. More breathable types of PPE could lead to similar contamination but could also lead to greater user satisfaction. Modifications to the design of the PPE, such as incorporation of gripping tags, had the capacity to decrease the risk of contamination. Placement and manufacturing procedures that followed the CDC guidelines, the ability to remove the gloves and gown in one step, use of double gloves, use of verbal instructions during execution and disinfection of gloves had the capacity to reduce contamination and increase compliance. Face-to-face training in the use of PPE had the capacity to reduce errors more than training based on printed material such as folders.The authors of this SR concluded that there was a lack of RCTs with long-term follow-up; a lack of simulation studies with large numbers of participants to find out which PPE combinations and which procedures gave better protection; and a lack of evidence from real life. They considered that a consensus regarding simulation of exposure and evaluation of the results was necessary. Therefore, they considered that the use of PPE by healthcare professionals who would be exposed to highly infectious diseases needed to be recorded, and that these professionals should be followed up prospectively regarding the risk of infection.The COVID-19 pandemic is right now the most significant global health threat. Its dissemination has been rapid, with at least 146 countries affected.One of the WHO guidelines for disease control is quarantine, which means separation of healthy people who might be infected by the virus and have the potential to spread the disease. Other similar recommendations are isolation  and social distancing .In massive pandemics with a highly infectious disease such as COVID-19, there is higher contamination among healthcare professionals. These individuals may develop infectious conditions earlier, due to their more significant contact with infected people. Therefore, it is a matter of urgency to determine strategies and develop protocols for these professionals so that there is greater adherence to safety regulations. When PPE such as masks, glasses, face shields, gloves, aprons and coveralls is routinely used within the care provided for these infected patients and the guidelines for dressing and undressing are followed, cases of contamination will be more significantly mitigated. However, these strategies often become difficult to follow in practice, and so there is a need for more significant support for these professionals, for them to be implemented.Several measures have been taken in the light of this pandemic. These have included combinations of case isolation, domestic quarantine and social distancing among at-risk groups . These are the most effective combined policies for reducing the epidemic curve.Through these Cochrane SRs, it was possible to identify the effects of the strategies that have been used to clarify how PPE should be best used among healthcare professionals and how valuable this is. When the care protocols for avoiding contamination were used correctly, these professionals were safer. Also, it was possible to determine the effects of quarantine  for reducing the incidence of COVID-19 and the resultant mortality. Early implementation of quarantine was found to be essential for the effectiveness of this action.Nonetheless, the success of these approaches comes not only from the effectiveness of their implementation, but also especially from the natural and biological history of the COVID-19 pathogen, its transmissibility and the feasibility of interventions within the context of the country’s public health organizations.The number of Cochrane systematic reviews that directly address the COVID-19 pandemic is still limited, but efforts are being made to rapidly produce high-quality syntheses of evidence that are of interest for decision-makers within healthcare and healthcare policies.After a comprehensive systematic search, three Cochrane SRs were included in this review. They contributed evidence regarding population-based measures (such as quarantine and isolation) and individual measures  for controlling the spread of COVID-19.Low-certainty evidence showed that quarantine for people who had been exposed to suspected or confirmed cases prevented 44% to 81% of incident cases and 31% to 63% of deaths, compared with no measures. Moreover, the earlier that the quarantine measures were implemented, the higher the cost savings were.Evidence with high confidence showed that clear communication about ICP guidelines was considered vital for their implementation. In addition, evidence of moderate confidence showed that healthcare professionals felt insecure about how to follow local guidelines when these did not reflect national or international guidelines or when they were lengthy and ambiguous. Sufficient space to isolate patients was also seen as essential for the implementation of the guidelines.Low-certainty evidence showed that people with long aprons received less contamination than those with coveralls, and that the coveralls were more challenging to wear. Furthermore, there was low-certainty evidence that better coverage of the wrist cuff interface had the capacity to lead to less contamination, compared with standard PPE. Uncertainty remained regarding the best use of PPE for controlling COVID-19 dissemination because the evidence relating to this was of very low certainty.


The Thoroughbred racing industry is constrained by three major moderators: economics, horse biology and social licence to operate. The role these three moderators play in regulating the industry and the relative interaction of these components differs between racing jurisdictions. Most attention to date has been focused on addressing a single aspect of one moderator in isolation to improve industry performance. However, this review has identified the complexity of the interaction between these three moderators and the need to consider the overall effects of a change on each individual jurisdiction. Based on the data presented within this review, the authors propose that injury risk and wastage of racing horses need to be considered within the context of each jurisdiction operating as a unique bio-economic model.The Thoroughbred racing industry faces new and competing pressures to operate within a modern, changing society. Three major moderators drive the focus and productivity of the industry worldwide: economic sustainability, horse biology and social licence to operate. This review proposes that despite the apparent homogeneity in the structure of racing across jurisdictions due to international regulation of the sport, there are significant differences within each jurisdiction in each of the three moderators. This creates challenges for the comparison of injury risk factors for racehorses within the industry across different jurisdictions. Comparison of the relative distribution of racing and gambling metrics internationally indicates that the Asian jurisdictions have a high focus on gambling efficiency and high economic return of the product, with a high number of starts per horse and the highest relative betting turnover. In contrast, the racing metrics from the USA have proportionally low racing stakes and fewer horses per race. These differences provide insight into the sociology of horse ownership, with a shift from the long-term return on investment held by most jurisdictions to a short-term transitional view and immediate return on investment in others. Wastage studies identify varying risks influenced by the predominant racing culture, training methods, production focus and environment within individual jurisdictions. Increasing societal pressure to maintain high racehorse welfare and reduce the negative impact of gambling poses fluctuating risks to each jurisdiction’s social licence to operate. Based on the data presented within this review, the authors propose that the use of a bioeconomic model would permit consideration of all three moderators on industry practice and optimisation of the jurisdiction-specific production cycle with a horse-centric welfare perspective. The horse occupies a unique place in modern society. The traditional or historical role of the horse was as a utility or production animal. During the latter half of the 20th century, the predominant use of the horse transitioned from a working animal to one solely for sport and recreation. With this change in role came a shift in the perception of acceptable welfare standards for horses, with most of society now identifying the horse as a companion animal or pet ,2. This Horse racing and breeding is an important industry in at least 71 countries, involving over half a million horses and offering over 3.3 billion EUR in prize money worldwide . RevenueBetting turnover, and thus the majority of industry revenue, is dependent on the number of races offered, the quality” of the race (the rating of the horses) and the number of participants within each race. These are constrained by the relative size of the racing population and the replacement rate of the racing population. In recent years, there has been increasing public scrutiny on the replacement rate and the issue of life after racing, i.e., what happens to horses once they leave the racing production system ,8. The rIn recent times, the popularity of horse racing has diminished, with 70% of adult Australians professing little or no interest in the sport ,11. As sThis review examines the three primary moderators within the horse racing industry . The need to consider all three moderators within a holistic framework when exploring changes in industry management or practice is explored. It is proposed that all three moderators interact differently within the separate racing jurisdictions, and thus, jurisdiction-specific socio/bioeconomic models are required to model the effect of industry change.The racing industry cannot be defined as a simple biological process. There is a need to balance the economics of the industry with society’s expectations of the acceptable or ideal use of animals in both sport and production. These bioeconomic approaches are common within other animal industries, such as the dairy industry. Within the New Zealand dairy industry, the production system can be modelled to maximise output (milk yield) based on the relevant (and differing levels of) constraints peculiar to each region, using a framework of production economics. From these models, five farm system classifications have evolved, in simple terms, describing the relative contribution of grazed grass (low input) vs. imported feed types (high input) in relation to milk yield . Though Population level research, both within and between racing jurisdictions, is vital to provide reliable independent data to inform discussion around the key community concerns that threaten the Thoroughbred industry’s social licence to operate. Improving welfare standards for horses as well as economic returns for industry participants is a key focus for the Thoroughbred industry, therefore, research to better understand both individual horse-level and industry-level determinants of a horse’s career duration and success is important. The key drivers of race programming, retirement, injury and economic returns for owners and trainers are important factors for investigation.A conceptual schema for the three major moderators within a racing jurisdiction is presented in The economic impact of the racing industry includes employment, export income and gambling, and in the US is estimated to be 26.1 billion USD . Racing Externally, the international racing industry appears relatively homogeneous with the structure and regulation of racing for the major racing jurisdictions coordinated via the International Federation of Horse Racing Authorities (IFHRA) . HoweverThere are large differences between both broad racing regions and individual jurisdictions in racing population size and the number of horses competing in a race. As field size increases, there are more betting opportunities and funds gambled on the race, with ≥12 horses per race needed to optimise the betting pool  in any given race. Optimisation of the betting pool is important, as a percentage of all money gambled is returned to the industry in the form of race stakes, providing the revenue stream for owners, trainers and jockeys ,23. The Australasian region has a similar sized racing population to the Americas (39% of the worlds racing population of horses), but the average number of starters per race is higher in Australasia, with 10.2 horses per race, compared to a mean of 7.4 horses per race in the Americas. Asia and Europe have a lower total number of horses  but maximise betting opportunities with a mean of 11.1 and 10.7 horses per race, respectively . These mThe categories of betting turnover per race start and per horse in the industry provide some comparative metrics on the relative ability of the different industries to provide economic return on their respective horse and racing populations. The betting turnover relative to the number of starters, and perhaps more so with the betting turnover relative to the number of horses in the industry, clearly demonstrates that some jurisdictions such as Hong Kong, Great Britain and Korea are very effective at optimising gambling opportunities . Hong Kong and Singapore are unique populations with a high economic return of product, averaging 12 horses per race, with an average of 7.7 starts for a horse each year. Europe has the lowest frequency of horses racing, with 4.9 starts per horse per year. However, the European flat racing season is mainly truncated to the summer months , whereas in Hong Kong, racing is conducted for 11 months of the year, with a compulsory 1 month break in racing during August. Therefore, the shortened season in Europe provides fewer opportunities for horses to race. In the USA and Australasia, racing is conducted year-round, with 5–6 starts per horse per year. This difference in race starts potentially reflects industry constraints from the environment  as well as cultural traditions or training practices. However, the “off-season” may have other industry benefits, such as providing a yearly “revitalisation” of the industry as fans, horses, and industry participants start each season after the rest period fresh and eager to succeed. These breaks may additionally help to increase and revitalise interest in gambling, and thus, maximise betting turnover, as evidenced by the high betting turnover relative to number of horses racing in both Asia and Great Britain.Most racing jurisdictions have some form of vertical integration where the domestic breeding sector generates enough horses to meet the replacement rate within the racing industry. Between jurisdictions, there is considerable variation in the number of foals produced per year relative to the domestic racing population, which reflects the differences in production focus. Some countries breed only for domestic supply, and others have a large export focus for the racing product . The jurThere are also some unique racing jurisdictions, such as Hong Kong and Singapore, with no domestic breeding programme and are dependent on importing 100% of their Thoroughbreds from overseas nations . This contrasts with self-supporting nations such as the Americas and Japan that largely maintain their racing population through foals born domestically. Ireland is a highly export-focused nation, breeding more than twice the required replacement rate to sustain domestic racing . New ZeaThe genotype and phenotype of the Thoroughbred racehorse is relatively homogeneous due to over 300 years of selection for racing ability from a relatively narrow genetic base . There aIn 1982, Leo Jeffcott and colleagues published the first epidemiological study to examine wastage within the Thoroughbred racing industry . Since tWelfare concerns for the Thoroughbred racing industry focus not only on the catastrophic injuries that may be reported within the media but also on the loss of horses from the industry ,40. WhenWhen examined as a supply chain, there are similar rates of attrition in racing and other equestrian sports such as show jumping, dressage and eventing. Within any given year cohort, about one-third to one-half of horses born will not enter sport or racing ,35. Of tThose horses which do not enter racing or are voluntarily retired are collectively labelled “voluntary losses”. Some of the loss of horses before entering training, and voluntary loss within training, can relate to industry structure and economics. The majority of flat racing is focused on horses aged 2 to 5-years old ,44. HoweThese metrics imply that there is early identification within the industry of horses who lack ability or are unsuited to the sport. Voluntary retirement allows for the option of early repurposing in other disciplines , with voFor those horses that enter training, musculoskeletal injury (MSI—fracture and soft tissue injury) is the most common reason for involuntary loss from the horse racing industry, accounting for 80% of involuntary interruptions to training and 25% of horses exiting from the industry ,48. For The risk factors for MSI, and those for other injuries, and even the holistic measures of racing industry integrity (such as failure to finish a race) can be broadly grouped into horse-, race-, management- and environment-level factors. Despite the homogeneity of racehorse genotype and phenotype, there are subtle differences between jurisdictions in horse-level risk factors (such as age and sex). The interaction of the racing jurisdiction  on risk factors for catastrophic musculoskeletal injury was elegantly demonstrated within the meta-analysis conducted by Hitchens, Morrice-West, Stevenson and Whitton . This stIn most jurisdictions, Thoroughbred racing is regarded as “drug-free”, with extensive restrictions on permitted medications and administration of medications relative to race day . HoweverHorse racing is conducted mainly on turf or synthetic  surfaces, apart from in the USA and Canada, where 75% of tracks are dirt or sand based . The majA number of studies have shown a positive association of cumulative amounts of high-speed exercise with fracture risk and MSI ,60,61,62Differences in the average career length of Thoroughbred racehorses may change the risk profile of horses within a jurisdiction. However, there are few comparative metrics on the average career length of Thoroughbred racehorses. Average career lengths for horses in New Zealand have been reported as 15 months, 18 months in Turkey and 21 months in Australia ,73. A reSocial licence considers the role of wider society in sanctioning or censuring an activity. It can differ according to the reference frame in which the sport is presented   and is aLevels of public interest in racing and the public’s ease of access to and interaction with racing as a sport are important factors in maintaining or undermining social license. Changes in the technological environment  may intersect with the social licence aspects in terms of accessibility to the industry and a sense of commitment to its continuation. In horse racing, the social norms that people place a bet on feature races such as the Melbourne Cup in Australia or the Grand National in the UK may build a connection with the sport and, consequently, interest in its continuation ,79. HoweAn increase in public awareness of animal welfare issues changes the perception of what may constitute acceptable loss in Thoroughbred racing. A catastrophic musculoskeletal (MSI) rate of 1.2 per 1000 race starts  may be vAddressing the animal welfare concerns of Thoroughbred horse racing may be viewed as a niche concern. For most people, the heavy regulation or abolition of horse racing is unlikely to require any change in habits in the way that changes in farming or companion animals might alter patterns of general consumption or personal behaviour. However, changes for the participants within the industry could come with large financial and emotional costs.Complicating the social license of Thoroughbred horse racing is the industry’s integration with and reliance on gambling. There is widespread recognition that gambling causes social harm, and only the offsetting of social harm with social good can justify its existence. Gambling concerns provide a different focus for undermining Thoroughbred horse racing. These are contradicted by libertarian principles of individual choice, however, there are arguments for gambling harm initiatives to include socio-cultural approaches which may impact on the broad culture of gambling within the racing industry . This woThe racing industry is not a simple linear process, as can be seen by the biology of fracture risk and quadratic relationship with high-speed exercise . Single An example of the difficulties faced in racing industry optimisation has been observed in Keeneland, USA. In 2014 the synthetic racetrack was replaced with dirt, seemingly due to industry pressures from racehorse trainers and the wish to reduce the costs of track maintenance. This was despite a fatality rate on the previous synthetic track half that was reported on dirt tracks. By improving the economic factor, there was an adverse effect on horse biology with increased odds of catastrophic MSI. This impacted the industry’s social license to operate due to public outrage for the apparent lack of welfare concern by industry participants. This highlights the different weights given to each of the three different moderators in different jurisdictions.Determination of the acceptable level of risk, injury and wastage within the system may become the dominant driver of the processes within the industry. Proponents of horse welfare may argue that no risk is the only acceptable level, however, this would be an impossibility within any biological system without the complete cessation of horse racing. Within every biological system, there must be loss and replacement. However, the focus of sustainability of the Thoroughbred industry may need to shift from viewing the horse as part of a production system, to optimisation of the system with a horse-centric welfare perspective .A bioeconomic model could provide an indication of what could be done to balance system efficiency with horse welfare to meet the socioeconomic factors peculiar to each jurisdiction. In agricultural systems, these bioeconomic models are extensively used to predict changes in farm-level systems to the biology of the system and the flow-on effects. It would combine the physiological limitations of the horse  with the optimal economic returns to the industry , and the welfare concerns , to give an indication of the optimum biologically feasible number of horses required to race within the system. Necessary biological constraints would include both training and racing metrics such as spell length, preparation length, number of starts and days between races to determine the optimal physiological preparatory load. However, each factor does not operate independently of the others but rather interacts, resulting in fluctuating pressures on the industry. Therefore, it is suggested that the industry is modelled as an open ecological system, following the approach used for complex questions such as climate change and dairy farm systems ,17,84. TThoroughbred racing as a sport and industry is constrained by the requirement for economic sustainability, horse biology and obligations to meet society’s expectations in relation to social licence to operate. To date, much attention has focused on addressing these three moderators, and components of these moderators in isolation. This review has identified the complexity of the international racing industry, the interaction of economics, horse biology and social licence to operate, and the need to consider the separate racing jurisdictions as open ecological systems. The use of a bioeconomic model would permit consideration of the moderators on industry practice and optimisation of the production cycle with a horse-centric welfare perspective.


Cardiovascular medicine patients have complex conditions and rapid progress. They will cause a variety of complications during the illness and are difficult to care for. In addition, the above departments have many treatment tools, complex nursing points, and nursing risks. Scientific risk management should be carried out to avoid the occurrence of adverse events. Existing studies incorporating nursing risk management into cardiovascular health care are incomplete. This paper aims to explore the analysis and research methods of nursing cardiovascular medicine applications and effects evaluation based on nursing risk management and deep learning. Through the observation and experiment of grouping 100 cardiovascular medicine patients in a hospital, the total satisfaction degree of the experimental group reached 90%, and the control group was only 48%, which is quite different in comparison. The factors affecting the occurrence of nursing risk have the characteristics of multiplicity, instability, and uncertainty. Therefore, in order to improve the nursing effect and the rescue rate, it is imperative to strengthen the nursing risk management and, at the same time, reduce the patient's physical pain and nursing risk. In today's rapidly developing society and gradually improving people's living standards, medical and nursing resources have become limited in their utilization. This has become an urgent need in today's society. This “approach to health care,” including prevention, treatment, and rehabilitation, has a very important impact on the recovery of diseases in the elderly. In particular, older adults suffer from cardiovascular disease, which has a higher rate of recurrence after recovery from surgery. It has become an important way to improve the quality of professional nursing by changing nursing methods, improving nursing quality, and strengthening scientific management. The application of elderly health care in the process of cardiovascular treatment can effectively relieve the anxiety and depression of the elderly. It effectively reduces the frequency of postoperative adverse reactions in the elderly with mortality. Cardiovascular disease in the elderly often leads to a number of related diseases, so their care is particularly important. Early psychological counseling and reasonable dietary arrangements after cardiovascular surgery in the elderly are of great significance for the recovery of hypertension in the elderly.In recent years, research on nursing risk management has increased year by year. Shinchi et al. proposed a disaster medical education model for practicing risk management and disaster care . The DioAt the same time, many researchers have conducted in-depth research on deep learning. Shen et al. analyzed the success of deep learning in image recording, anatomical and cellular structure detection, tissue segmentation, and more. He used computers to diagnose and predict diseases . Chen etIn this study, 100 patients who met admission criteria in a hospital's neurology department were divided into experimental and control groups. The experimental group adopted the nursing risk management model, and the control group adopted the routine nursing function. The results showed that multiple outcome indicators of nursing risk management in the experimental group were better than those in the control group, and the application was worthy of promotion. The innovation of this paper is the integration of nursing risk management with cardiovascular nursing medicine. This paper introduces the theory and related methods of deep learning in detail, which mainly introduces the BP neural network and SVM.Cardiovascular care is relatively complex and painful. This is because the time, type, and physical condition of the patient's disease are different, and clinicians have many uncertain risks or unexpected events in the course of treatment. Therefore, preventing and managing emerging risks requires an overall improvement in the quality of care. When analyzing, preventing, and responding to nursing risks, the awareness of nursing risk management must be incorporated into the entire nursing plan, which has become the focus of attention in hospitals and society as a whole .Nursing risks are uncertain or dangerous events that may lead to injury and disability events throughout the care process. The board alludes to the recognizable proof, appraisal, treatment, and evaluation of existing and potential nursing risks and the coordinated and methodical disposal or decrease of the events, harm, and financial loss of nursing risk occasions. It minimizes losses to patients and hospitals through a scientific management approach to financial security. This project aims to research a set of nursing risk management index systems suitable for hospitals and assist managers to identify nursing risk factors. It provides a scientific basis for premonitoring and implementing future risk management.Good nursing risk management not only ensures patient safety but also protects the health and safety of nursing techniques and personnel. The level of risk management is directly related to patient safety. Medical risk and medical care and safety are causal relationships. When the medical risk factor is low, the medical insurance factor is high. Otherwise, the medical insurance factor decreases. The level of risk management directly affects the social benefit of the hospital. Poor health care risk management prolongs the course of disease and complicates treatment and care. It increases material consumption and the financial burden on the patient. The level of risk management directly affects the effective operation of the hospital. Good medical risk management not only protects the physical and mental safety of patients but also protects the health and safety of medical staff , 12.An artificial neural network is a physical model that simulates and reflects the structure, principles, and functions of the human brain's neural network. It consists of a large number of neurons arranged in a specific way to form a complex dynamic network. It is mathematically proven that artificial neural networks can approximate any function that characterizes the regularity of sample data, no matter what form those functions take. The good nonlinear approximation, fault tolerance, generalization ability, and self-learning characteristics of artificial neural networks make them have a place in various fields such as pattern recognition, speech recognition, and signal processing .The BP neural network is the most widely used model in ANN, which started in 1985. It usually consists of an input layer, one or more hidden layers, and an output layer. Each layer contains multiple nodes; the nodes within the plane are not connected to each other, and the nodes between the planes are fully interconnected . The netxa they are both the input and output of the layer; the hidden layer consists of p neurons, hl represents the exit of the hidden layer. The output layer consists of n neurons, yb represents its output; wla represents the connection weight between the input layer and the hidden layer, and vbl represents the connection weight between the hidden layer and the output layer.Among them, the input plane consists of m neurons, The BP neural network is a supervised learning algorithm. The learning process is divided into two stages: forward propagation and back propagation. In the forward propagation process, the input information is transmitted from the input layer to the output layer through the processing layer of the hidden layer. If the output level does not receive the target output, back propagation returns the error between the actual output and the target output on the original path. It modifies the link weight value between nodes in each layer and adjusts the network parameters repeatedly until the error is minimized . This paInitialization: the initial value of its input weight vector and threshold vector sets the number of network levels, the number of nodes at each level, the activation function, network parameters, training functions, and training parameters  .Calculate the network output of each layer: it is set to have a total of Q modes, a set of input and target output forms a mode, and all mode pairs are normalized in the early stage. In the BP neural network, the state of the nodes in the next layer is only affected by the nodes in the previous layer.Hidden layer:φl):Input (with threshold Output:Output layer:θb):Input (with threshold Output:The function f(D) used in the above formula is designed as a nonlinear input-output relationship, which is called an activation function. It is also called an action function or a transfer function. The sigmoid function has both upper and lower bounds. It is a monotonically increasing curve and is continuously differentiable. These properties make it a popular function for activation functions. The specific formula is as follows:μ determines the degree of the sigmoid function.In the formula, the coefficient Calculate the output error: it sets the input mode of a network in advance, and this input mode goes from the input layer to the hidden layer. It is followed by hidden layer neurons processed by the activation function as new input, which is transmitted to the output layer and finally processed by the neuron activation function of the output layer to obtain the real output pattern , 18. It ybq − rbq)2 is the square value of the difference between the actual output of the Bth neuron on the output layer and the target output under the action of mode Q.Among them, , recomputed for all Q mode pairs . Accordiϑ represents the learning rate, which is a given constant and usually takes the value 0 < ϑ < 1.In the formula, It evaluates whether the adjusted E-error meets the requirements and determines the direction of the network.It judges whether the number of network iterations meets the set value and determines the direction of the network until error E meets the requirements. In general, the BP neural network takes learning samples as input. It adopts the error back propagation algorithm to continuously adjust the network weights and parameters until the optimal network for training is output.SVM is a machine learning algorithm based on VC dimension statistics and the principle of structural risk minimization. The VC dimension reflects the learning ability of the hypothesis space, as shown in The basic idea of SVM is to map two types of different points on the same level to other spaces through a special mapping relationship. It separates these points into other spaces. It is generally divided into two categories: linearly separable and linearly inseparable. It mainly analyzes the case of linear inseparability. For the linearly inseparable case, the linearly inseparable samples in the low-dimensional input space are transformed into the high-dimensional feature space by nonlinear mapping, which becomes a linear separator. This makes it possible to use linear algorithms to linearly analyze the nonlinear features of samples in high-dimensional feature spaces, as shown in In the current research, there are four commonly used nonlinear mapping methods, namely, kernel functions. The following are the four commonly used kernel functions:Linear kernel function:The linear kernel function can optimally classify the samples in the space, with fast calculation speed and few setting parameters. It is the simplest kind of kernel function.Polynomial kernel function:d addresses the distance. Assuming the choice of d is too enormous, the aspect will become higher, the computation sum will expand, and it is not difficult to overchange.The polynomial portion capacity can perform symmetrical standardization of the information, which influences the entire world. Radial basis kernel function:y represents the center of the core function, and ɛ represents the width parameter, which is used to control the radial extent of the function.The most commonly used radial function is the Gaussian function. Among them, Multilayer perceptron kernel function:The Sigmoid kernel function solves the problem of the global optimal solution and can make better predictions for unknown samples. It is mainly a class of kernel functions used to solve problems in deep learning and machine learning.The most basic two-class classifier algorithm of SVM is as follows:xm, ym)}m=1M,xm ∈ RN, ym ∈ {−1, 1}. ym=1 means xm belongs to D1 class, ym=−1 means xm belongs to D2 class.Given a learning sample set {.A total of 100 cardiovascular clinical patients admitted from January 2021 to December 2021 were chosen as study subjects and haphazardly separated into two groups of 50 years old. There were 50 cases in the trial group and 50 cases in the benchmark group. The exploratory group included 26 men and 24 ladies aged 43–78 years, and the benchmark group included 28 men and 22 ladies aged 45–80 years. There was no huge distinction in overall information like age and orientation between the two groups . It very well may be seen that nursing risk management executives can really lessen the event of unfriendly occasions.It can be seen from It can be seen from P < 0.05). It may very well be seen that nursing risk executives can successfully work on quiet fulfillment and achieve a greater quality of life.In the benchmark group, a total of 52% of patients detailed disappointment, and the general fulfillment level of the benchmark group (48%) was a lot lower than that of the exploratory group (90%). The group fulfillment of the patients in the trial group was altogether higher, and the thing that matters was measurably huge (P < 0.05), and the thing that matters was measurably huge, as displayed in In the exploratory group, the fall rate, bed fall rate, occurrence of phlebitis, frequency of profound vein apoplexy, and dangerous exchange pace of patients were fundamentally lower than those in the benchmark group , as shown in This article looked at the clinical nursing impact of the two groups. The amazing and great rate was 98% in the trial bunch and 76% in the benchmark group. The superb and great pace of the trial bunch was essentially higher than that of the benchmark group, and the thing that matters was measurably critical (P < 0.05), as shown in The length of a medical clinic stay was analyzed between the two groups of patients. The results showed that the length of stay in the experimental group was 12.45 ± 2.12 days, and the length of stay in the control group was 17.07 ± 2.84 days. It can be seen that the average length of hospital stay in the experimental group was less than that in the control group, and the difference was statistically significant (It can be seen from The main factors in the risk factor analysis of cardiovascular nursing care are as follows (as shown in Cardiovascular and respiratory diseases are primarily treated with drugs. Cardiovascular patients require fewer drug doses, and infusion rates must be strictly controlled to avoid the risk of overdosing. In contrast, intravenous and oral drugs are more per day than oral drugs, and the timing, dose, and name of administration are more complicated, and attention should be paid to allocation. During the course of care, medication errors are likely to occur, and there is a risk of hospitalization.The human factor is mainly the factor of the nursing staff in rescuing the patient. Inadequate preparation of equipment, inadvertent use of specialized drugs, control tools during first aid, blood collection, and transfusion will be affected. Because all mistakes have happened, there is no strong sense of responsibility. It does not closely observe the patient's vital signs and condition.Insufficient attention to risk management increases the incidence of nursing risk, especially among less experienced nursing staff. Its lack of clinical skills and experience leads to more operational errors, significantly increasing disparities in care and nursing staff. There is greater mobility, which affects care management.This article mainly analyzes the application of nursing risk management in the nursing of cardiovascular medicine. From studies of cardiovascular and respiratory medicine patients, it seems that these patients are mainly concentrated in the age range of 45–80 years. The risk of occurrence increases when the patient is too old. This requires the attention of clinicians and clinical nurses. Nursing risk refers to adverse outcomes such as deterioration of the patient's condition and death, which are caused by various factors during the patient's hospitalization. Nursing risks exist in all aspects of the entire treatment process. The number of patients in the department of cardiovascular medicine is increasing year by year, and the patients are older, with severe disease, long treatment cycles, complicated medication, and a high risk of nursing work. In the management of cardiovascular disease, increasing awareness of risk is very important. In this study, the control group implemented standard nursing measures, and the experimental group implemented nursing risk management on the basis of standard nursing measures. It follows the “people-oriented” nursing concept. Patients should be treated with enthusiasm, thoughtfulness, and a meticulous work attitude. It makes patients feel comfortable and at ease.


For children in middle childhood, the social world, particularly the behavior and attitudes of their school peers, has been shown to be an important factor in their educational and mental health outcomes. In the school environment, some children seem to influence the attitudes and behavior of their peers more than others. The behavior patterns of children, as reflected in temperamental traits, have been shown to drive peer perception in important ways and might play a role in identifying the individuals and social processes that operate in peer influence. It seems likely that temperamental traits will have different effects on school peers, dependent on characteristics of the school attended. Fourth and fifth grade children from four rural counties in the southeastern portion of the United States were studied. Temperamental characteristics were assessed based on teacher perception of six characteristics. Peer perceptions of the extent to which each child was perceived to influence others in five areas of school culture  was measured through a peer nomination procedure. Additional status-related perceptions and behaviors of participating children were also assessed by peer nominations. Teacher ratings of temperamental behaviors were submitted to latent profile analyses resulting in a seven-cluster model. Results indicated temperamental profiles were significantly and meaningfully associated with peer perceptions of influence as well as social status. Further, demographic differences between two groups of schools were found to moderate the effects that temperament profile had on peer influence. This sharpens the focus of the research on late elementary school. Second, the profile model in the current analysis focuses exclusively on teacher perceptions of temperament and does not include data from parents as was the case in prior analyses. Third, profile models used in the prior research included parental and teacher perception of academic ability (intelligence). The current research focuses exclusively on tradition temperament constructs in the development of profile models. In addition, several refinements are made in the current analysis to help control for gender factors in the peer nomination procedures as well as to control differences among schools in the way that peer nominations were done. When the best fitting temperament profile model has been developed and associations to peer influence determined, the second question to be addressed becomes, what social status and status-related behavioral characteristics are most strongly associated with the temperament profiles of influential children. This analysis is designed to set the stage for future researchers to determine the longitudinal pathways operating from temperamental characteristics and social status characteristics to influence. The characteristics investigated include peer perception of popularity, likability, aggression, a tendency to be sympathetic, to work hard in school, to be perceived as cool, and to be good at sports. The characteristics were selected to present aspects of the dominance versus prestige approach to status attainment. The third question to be addressed relates to the effect of the broader social-cultural environment of the schools studied in modifying the association between temperament profiles and influence. The specific question that is addressed is: Are the temperamental characteristics of influential children in schools located in counties with higher high school graduation rates in the adult population different from the temperamental characteristics of influential children in schools located in counties with lower high school graduation rates?Children in middle childhood are acutely attentive to their social world. They have emerged from living in a world of adult caretakers  into the complex social world of peers. A good proportion of the social interaction with peers takes place in schools where children must learn to adapt to a staggering array of individual differences in behaviors, attitudes, and expectations. How the child copes with this social environment has important consequences; it can determine acceptance into subgroups  than the county containing Group B schools (23.0% minority children). The populations in the county served by Group B schools had a higher median family income  than the counties served by Group A schools , but both were significantly below the United States median family income level in 2010 . Both sets of schools served populations with very similar levels of educational attainment. For example, the percentage of the population 25 years or older who did not graduate from high school or obtain a GED was 16.9% (Group A) and 16.8% (Group B), but both were above the national average of 11.6%. However, the minority population was significantly less affluent and had lower mean educational attainment than the White population in all counties. Educational attainment differences were particularly lower for minority males. In the counties containing the Group A schools, the mean percentage of minority males (25 years and older) who did not graduate from high school or have a GED was 40.9%, while in the county containing the Group B schools, this percentage was 19.8%. In summary, both groups of schools were in rural areas in which the median family income was lower than the national average as was the educational attainment for the adult population. However, the minority population was far less affluent and less formally educated than the White population of these counties. Group A schools were in a county with a much higher proportion of minority residents than was the case for Group B schools. Thus, children in Group A schools grew up in an environment in which the adults, particularly males, were less educated and had fewer material resources. This was particularly true of the minority children in Group A.For the original data collection from which the current participants were selected, approval was obtained from the superintendent of the school district. Then, individual school principals and staff were contacted; only one school declined participation. Active parental consent for student participation was required, and child assent was obtained prior to the administration of questionnaires. The roster of students used for peer nominations included only the names of students who had obtained parental consent to participate. Nonparticipating students were given the option of working quietly at their desks. All procedures were approved by a university Institutional Review Board.th and 5th grade children studied in this analysis were as follows: activity level , sociability , positive emotionality , negative emotionality , distractibility , and inhibition . The concurrent validity of the teacher form of the ICID has been documented through scale and profile similarities to parental ratings on the same instrument, as well as to important outcomes for children in elementary school such as behavior problem ratings and academic achievement  at the classroom level or at the school level, depending on which procedure was used. Standardization was used to control for the differing number of nominations possible based on the number of participating peers in the classroom or grade level. In addition, standardization was carried out separately for girls and boys. Gender plays a role in many aspects of peer relationship, particularly in middle childhood. Children interact with same-gender peers more often than opposite-gender peers . The R2 of 0.109 indicated that about 11% of the variance in peer perceived total influence was associated with temperament profiles. Children in Cluster 6  had the lowest average influence score, while children in clusters 1 and 2  and 7  had near average influence scores. The three most influential groups were children in Cluster 3 , Cluster 4 , and Cluster 5 , and of these three clusters, children in Cluster 5 were perceived to have the most influence on their peers. A post-hoc analysis using the Gabriel method (see p < 0.05) homogeneous subgroups of clusters with Cluster 5 being most influential and Cluster 6 being least. All other clusters were not significantly different from one another. Because children with different temperament profiles might be influential in different areas of child behavior, influence scores in each of five areas measured  were analyzed separately. In the area of academics, a significant effect for temperament was obtained  with Cluster 3 children  having the highest influence score, and Cluster 6  children having the least. There was a significant effect for influence in sports . Children in Cluster 5  had the highest influence, and again children in Cluster 6 had the lowest. Temperament had a significant effect on influence regarding cultural trends  with children in Clusters 5, 2 , and 7  having the most and children in Cluster 6 having the least. Regarding make-believe games, there was a significant effect , but the effect was small. Only Cluster 5 children were distinct from the remaining clusters, and they had the most influence. By far the strongest effect of temperament on influence was on inappropriate classroom behavior . For these types of behaviors, children in Clusters 5 active, distractible, negative had the highest scores, and children in Clusters 6, 2, and 1 had the lowest. In summary, children who exhibited a high activity level, distractibility, and high negative emotionality (Cluster 5) were clearly the most influential children in these schools, while children who were socially withdrawn exhibited low levels of positive emotionality, and had a low activity level had the least influence on their peers.To determine the relationship between temperament profiles and influence, the total influence score was entered into a general linear model univariate analysis of variance as the dependent variable and temperament profiles were entered as the independent variables (using SPSS version 28). There was a significant effect for cluster  had a different blend of status-related attributes as viewed by their peers see . ChildreF = 9.67; p < 0.001), no main effect for School Group , but there was a significant Interaction . To determine if there were significant differences within profiles, a one-way ANOVA across school groups for each profile was calculated and summarized in Children who attended schools in two different kinds of social environments were examined in this research. While the environmental contexts were similar for the two groups of schools in many ways , the educational attainment of the adult male population was different . This was the result of the differences in educational attainment among minority populations. The ethnic/racial composition of the county in which Group B schools were located was predominantly White, while counties in which Group A schools were located had a much higher percentage of minority adults (about one-third of the population). The percentage of minority children in the public schools was even larger in Group A schools, constituting about 50% of the public-school population. The children in Group B schools who live in an environment comprised a more educated adult population might value different behavior characteristics than those in the Group A schools, where educational attainment among the adult population is more limited. This social environmental difference might create difference in the types of children who are viewed as most influential by their peers. To investigate this notion, the total influence scores of children were submitted to a multifactor ANOVA in which temperament cluster and school group were conceptualized as independent variables and the total influence score as the dependent variable. The results are reported in Temperamental traits are important to psychological theory and in the practice of helping parents, teachers, and children because these traits can be observed very early in life and have been shown to relate to important outcomes for children throughout their developing years and even throughout the live span. These traits also have been shown to relate to various levels of the biology of the child . In the early stages of development of temperament theory, the biological underpinnings, particularly genetic influences, were viewed as one of the most important defining aspects of temperamental traits. As genetic research and its relationship to behavior and personality has progressed, it has become clear that almost all personality traits and behavioral responses have a genetic foundation . ResearcIn this study of approximately 800 rural public-school children in 4th and 5th grades, it was determined that one group of children (Cluster 5) was perceived by peers as having the most influence. Of the seven clusters of children defined empirically by their temperament profiles (assessed by teachers), a relatively small group of children (7.3%) was found to have the most influence on their peers. Children in this cluster were viewed by their teachers as highly active, with above-average ratings on sociability, but exhibited high levels of negative emotionality and low levels of positive emotionality. They were also above average in distractibility. This group can be conceptualized as having low levels of self-regulation of emotion and attention. Notably, this cluster was also rated as being among the least inhibited and fearful of all temperament clusters. We investigated what areas of peer interaction this temperament group (Cluster 5) had most influence. They were among the most influential of all profiles in peer cultural trends , and in what games were played with peers. They also had particularly strong influence on inappropriate behavior in the classroom . Their high activity level and distractibility, as well as their low level of fearfulness probably played an important role in their inappropriate behavior in the classroom. In addition to investigating which group of children was most influential, one aspect of this research investigated how temperamental profiles and influence was related to indicators of social status as assessed by peers. Peers perceived the children in Cluster 5 to be ‘cool’ more often than any other clusters and they had high scores on aggression. They were mildly above average in popularity and athletic skill. The influence of this group seemed to be based in part on their athleticism, on being socially aggressive, but also on their lack of inhibition and fearfulness. Perhaps most of all, they seem to be viewed as charismatic as indicated by being nominated frequently as ‘cool’. Thus, they can be thought of as using both domination and prestige forms of influence. Children who were perceived by peers as least influential across all five areas of school life were those belonging to Cluster 6 (6% of the sample). Their temperament profile was characterized by low activity level, low sociability, low levels of negative emotionality, and high inhibition/fearfulness. They had below-average scores on peer perceptions of likeability, popularity, trying hard at school, having sympathy for others, being cool, acting aggressively, and having athletic skill. Their lack of influence on others seemed to be a function of their withdrawal from social activities and being perceived as less skillful in sports. The two largest clusters  were average on all temperamental characteristics, with Cluster 2 being viewed as of more negative mood Cluster 1. They also had near average scores on all types of influence based on peer nominations. Further, peer nominations of status-related characteristics were all in the average range as well, with Cluster 2 children being perceived as having moderately higher status than Cluster 1. One of the most important findings from this research was that the social milieu of the school had a significant effect on the influence exercised by the most influential groups of children. The aspect of the broader social environment that we focused on was the educational attainment of the adult population of the counties in which the children resided. Children in temperament Cluster 3  were viewed as the second most influential group. When they lived in a county with higher adult educational attainment  they had more influence on academic behaviors  than Cluster 3 who lived in rural counties with lower educational attainment. The reverse was true of children in Clusters 5. For these children, they had more influence when they lived in the counties with lower educational attainment.Temperament researchers, spurred on by findings of significant stability of temperament traits, as well as long-term significant prediction of adult behavior from measures obtained in early childhood, have made major strides in the understanding of child behavior. However, they have not paid much attention to environmental factors that may alter the expression of temperamental traits. The major exception to the rule is the role of parenting on temperamental characteristics . All temn = 797). Having a sample of this size in conjunction with a detailed assessment of student social lives from two perspectives (teacher and student) is very rare in the temperament literature. Despite these strengths, the research had several limitations. The data analyzed in the current study were obtained from teachers and children during one development period, and on one occasion. Thus, temperament, the timing of effects of temperament on both social status and temperament remain unclear. Further, temperament was assessed from the point of view of a one teacher in each classroom. The research would have been strengthened if more than one teacher assessed the temperament of each student. Parental assessment would have also enhanced the temperament assessment. In addition, there was a confound between the interpretation of the social environment, described at the county level, and the minority status of the participants and their families. This occurred because ethnicity/race and school group were entangled to some extent. The Group B schools were less diverse than the Group A schools. The findings would have been stronger if the diversity of the two school systems were similar. This type of design would have clarified the effects of educational attainment independent of other cultural factors that are associated with rural southern culture. A further weakness of this study was the reliance on county-level educational attainment data. The results would have been much clearer if the educational attainment of each individual family had been assessed. The findings reported here clearly indicate the need for a longitudinal approach in which temperamental traits are measured at several time periods in different environments to determine effects of the environment (a) on the measurements of traits over time, (b) on the association of temperament with social status phenomena, and (c) the effects of environments and developmental level on social influence patterns. To enhance the understand of temperamental effects on peer influence in different environment, special care to measure the environments as precisely as possible is critical.The research reported here utilizes measures of individual differences that have been shown to appear in the first few years of life  to explore questions about which children have the most influence in the peer group in late elementary school. Temperamental individual differences were measured as individual traits based on teacher’s perceptions of their students. One of the strengths of this study is that temperament profiles have rarely been empirically developed based on teacher perception. These profiles were then used to investigate influence patterns that occur among peers in schools. A second strength of this research is that this is one of the first attempts to relate empirically derived temperament profiles to peer influence in a school setting. Further, the status characteristics of children as viewed by other children were studied in the context of temperament profiles, revealing that children with different temperament profiles manifest their influence through different sets of status-related characteristics  and behavior . These associations will help researchers in the area social processes understand some links between individual differences, status, and influence. Finally, the research demonstrated that the broader social context in which children live is related to how and by whom peer influence is exhibited. These findings were strengthened by having independent measures of behavior from teachers and students. A strong point of the research is that each type of measurement  were all measured in detail as well as globally. That is, six dimensions of temperament were assessed, influence was assessed in five areas of school life, and status was measured through global indices  as well as specific behaviors related to related to likeability and social stature. The availability of these more specific aspects of influence and status allowed for the determination of what type of status and influence was most affected by temperamental differences. Finally, the sample size was large enough to allow for an application of a modeling technique that requires relatively large samples  and to allow for a model of seven different profile types (mlease@uga.edu.The data analyzed in this study is subject to the following licenses/restrictions: The dataset was collected by the co-author and is still being analyzed for various publication. It is not available to the public. Requests to access these datasets should be directed to The studies involving human participants were reviewed and approved by University of Georgia Ethics Review Board. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.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.