Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce.The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step .This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial . Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period.This study was approved by the Kyoto Medical Center Institutional Review Board . Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year  with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently.This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future.UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9wDERR1-10.2196/38626 Smoking is a major risk factor for noncommunicable diseases (NCDs), such as cancer, chronic obstructive pulmonary disease, diabetes, cerebral infarction, and myocardial infarction . There iSmoking is known to cause or exacerbate negative emotions . MoreoveAromatherapy involves the use of essential oils extracted from flowers, leaves, seeds, pericarps, and resins for the treatment and prevention of diseases, physical and mental health, relaxation, and stress relief . AromathRegarding the efficacy of aromatherapy as an adjuvant therapy for smoking cessation, it has been reported that black pepper reduces the urge to smoke , and pepThere are various aromatherapy devices, such as aromatherapy inhalers, which are simple and cost-effective for incorporation into daily life. An aromatherapy inhaler is a portable, plastic, lipstick-like container that houses a cotton wick soaked in essential oils. The inhaler enables users to smell the aromas without getting their hands dirty or spilling the oils. Similar “aromasticks” have been used in British hospitals to control symptoms of nausea, insomnia, and anxiety, and to induce relaxation ,32. We aDepression may temporarily worsen during smoking cessation treatment . This stThis is a pre-post single-arm clinical trial conducted at the National Hospital Organization Kyoto Medical Center in Japan. Patients in this study who visited the smoking cessation clinic at the medical center to receive smoking cessation treatment were assessed using the Zung Self-Rating Depression Scale (SDS) and were classified into two groups: the healthy group (SDS score ≤38) and the depressed group (SDS score = 39-59). Patients in the depressed group are considered to have depressive tendencies. Patients who provide consent will be included in this study, with a target sample size of 100. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. Changes in the SDS score and the Profile of Mood States (POMS) score from pretreatment screening to 4 and 12 weeks after the start of aromatherapy will be evaluated. This study will also compare the aromatherapy group with the standard treatment group from a previous study entitled “A Randomized, Multi-center, Double-Blind, Placebo-Controlled Trial for the Effects of Yokukansan on Depressive or Neurotic Smoking Patients during Smoking Cessation Therapy” ; this group will act as a control group . In both studies, only smokers with SDS scores of 39 to 59 were included in the study, and the study subjects were randomly assigned to either the yokukansan group  or the control group , with 220 subjects in each group. Changes in SDS and POMS scores from pretreatment screening to 4 and 12 weeks after the start of treatment, as well as the rate of successful smoking cessation, will be evaluated. Furthermore, an exploratory analysis on the efficacy of aromatherapy will also be conducted .In Japan, smoking cessation treatment is covered by health insurance if it is the patient’s first time undergoing the treatment or if more than 1 year has passed since the last treatment. Accordingly, this study included patients covered by health insurance  and who Smokers with nicotine dependence (Fagerström Test for Nicotine Dependence [FTND] score of 5 points or more) who wish to quit smoking.Patients with depression with SDS scores of 39 to 59, based on the self-report questionnaire for assessing propensity to depression.Patients aged 20 to 79 years at the time of the informed consent procedure.Outpatients.Patients whose informed consent has been obtained in writing.This study aims to include 100 participants in the analysis.Patients will be excluded from this study if it is determined that they meet any one of the following exclusion criteria based on their diagnosis or test results prior to the start of the study:Patients whose condition is inappropriate for aromatherapy, that is, those suffering from shock, severe disease states, poor respiratory status, feeling of nausea, or vomiting, etc.Patients who habitually practice aromatherapy.Patients who are unable to smell the aromas of essential oils due to olfactory dysfunction.Patients with a history of epileptic seizures.Patients who are currently on medication for a psychiatric or psychosomatic condition.Patients with an SDS score of 53 points or higher, which is indicative of underlying depression and need for psychiatric consult, and those prescribed medication for a psychiatric and psychosomatic condition .Patients with current symptoms of drug allergy.Patients who are pregnant, are lactating, or intend to become pregnant during the study period.Other patients who are deemed to be unsuitable according to the attending physician .A subject will discontinue their participation in the study if any of the following occurs:If a subject informs us of their withdrawal from the study or requests withdrawal of consent.If the attending physician determines that it is inadvisable for the subject to continue participation in the study due to an adverse event  .If the attending physician determines that continuation of participation in the study is clinically inappropriate due to the exacerbation of a comorbidity or complication.Death.If the attending physician determines that the subject is ineligible to continue the study.If the subject is unable to visit the medical center where the study is being conducted due to relocation or other reasons.The attending physician will provide a complete written explanation and obtain written consent from patients who meet the inclusion criteria. Subsequently, the attending physician will perform subject registration after confirming that the patients meet all the inclusion criteria and none of the exclusion criteria by performing prespecified medical tests.An eligibility screen will be conducted and informed consent will be provided to those who are eligible. The following assessments will be carried out: the SDS  and phyWe will commence the following standard smoking cessation and aromatherapy programs for patients who have provided informed consent. In principle, a sufficient amount of time will be allowed for briefing the subjects to facilitate a complete understanding of the content of this study. Subsequently, their informed consent will be obtained. The maximum duration of obtaining informed consent after briefing is 4 weeks. However, if it is confirmed that the subject has sufficiently understood the content of the briefing, their informed consent may be obtained on the day of the briefing. The standard smoking cessation program was administered according to the Standard Procedure Manual for Anti-Smoking Treatment, which was originally issued in March 2006 by the Japanese Circulation Society, the Japan Lung Cancer Society, and the Japanese Cancer Association. Treatment consists of pharmacotherapy with transdermal nicotine patches and oral varenicline as well as nonpharmaceutical therapy with counseling by doctors and nurses. The patients were examined on their first visit and after 2, 4, 8, and 12 weeks  while being treated with transdermal nicotine patches or oral varenicline.The following aromatherapy program will be provided in this clinical trial. Subjects will choose from four essential oils: black pepper, lavender, peppermint, and citrus . These essential oils have been used in previous smoking cessation studies, were reported to have antidepressant and anxiety-reducing effects, and are readily available. Black pepper has been used in previous smoking cessation studies , while lWe will collect the POMS self-assessment sheets completed by the patients. The short version of the POMS is a tool that facilitates understanding of subjects’ current moods, emotions, and changes, with little effort required from the subjects . Self-as1c, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, uric acid, sodium, potassium, creatinine, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, alkaline phosphatase, g-glutamyl transpeptidase, creatine phosphokinase, C-reactive protein, and complete blood count). We will determine whether or not patients are taking antihypertensive drugs, dyslipidemia drugs, oral diabetes drugs, insulin, sleep medication, or other drugs, specifically anticancer drugs, drugs for hormonal treatment, and steroids.We will analyze subjects’ baseline clinical data by performing blood tests . Aromatherapy adherence status will be rated as follows:Good: the aromatherapy inhaler is used nearly every day (approximately 80% of the days)Somewhat poor: the aromatherapy inhaler is not used on some days (approximately 60% of the days)Poor: the aromatherapy inhaler is not used on most days (approximately 30% of the days).SDS scores, physical examination findings , smoking status, and exhaled CO levels will also be monitored. Further, in weeks 4 and 12, we will collect the POMS self-assessment sheets completed by the patients. At 12 weeks, we will perform the blood tests and perform a confirmation of smoking cessation. We will determine whether or not patients are taking antihypertensive drugs, dyslipidemia drugs, oral diabetes drugs, insulin, sleep medication, and other drugs, specifically anticancer drugs, drugs for hormonal treatment, and steroids. If a subject does not arrive for a scheduled visit, the reason for their absence will be discussed via a phone call. When the reason is hesitation or the unwillingness of a subject to visit the smoking cessation clinic, they will be requested by medical doctors or nurses to visit the hospital. This strategy is described in the Standard Procedure Manual for Anti-Smoking Treatment, which was originally issued in March 2006 by the Japanese Circulation Society, the Japan Lung Cancer Society, and the Japanese Cancer Association .The observation period  will last 3 months after the enrollment of the last subject, and the total study period will amount to 2 years and 3 months; the scheduled period was expected to run from July 2019 to September 2021. Since the number of subjects decreased due to the COVID-19 pandemic, the study period was extended to 3 years and 3 months on May 17, 2021, with the approval of the Institutional Review Board (IRB); the study is now expected to run until September 2022.The primary outcome is the change in SDS and POMS scores ,41 . Successful smoking cessation refers to a report of smoking cessation for the past 7 days and an exhaled CO level below 7 ppm .Changes in body weight, abdominal circumference, and glycolipid metabolism .Adverse events during the period of aromatherapy.Blood cell counts and biochemical tests by blood sample collection.Other laboratory findings or symptoms.Correlation between essential oil preference and smoker information items at first-time visit . Smoker information items include the following subject background data: age, sex, BMI, number of tobacco pieces consumed or smoked per day, FTND scores, and SDS and POMS scores. These items will be compared among different essential oil types.Changes in essential oil preferences over time.Research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. Further, based on our research, the size of the effects of aromatherapy on psychological tests as measured by the SDS and the POMS in smokers has never been reported. Therefore, this study was designed as a pre-post single-arm clinical trial in which the sample size has been determined by considering the feasibility of registration. We will perform a comparison of the aromatherapy group with the standard treatment group from our previous study, “A Randomized, Multi-center, Double-Blind, Placebo-Controlled Trial for the Effects of Yokukansan on Depressive or Neurotic Smoking Patients during Smoking Cessation Therapy” (UMIN ID: 000027036). Similar to this aromatherapy study, the yokukansan study targeted the population of “depressed smoking patients.” For the yokukansan study, 100 patients were registered in our hospital.t tests in the aromatherapy group of this study and in the standard treatment group of our previous study. Statistical significance was set at P<.05. Furthermore, concerning changes in data from baseline to the 12-week time point, a two-way analysis of variance will be used analyze the interaction between the standard treatment group and the aromatherapy group. The same will be used to compare changes in SDS and POMS scores before and after smoking cessation between the historical control group and the aromatherapy group of this study.Assuming that the registration number of this aromatherapy study would be comparable to that of the previous yokukansan study, this study planned to register 100 patients. The SDS scores and POMS subscale scores at baseline and at the 12-week time point will be compared using paired-samples We will also compare the successful smoking cessation rates for a period of 12 weeks from the start of treatment between the standard treatment group and the aromatherapy group. Successful smoking cessation refers to a report of smoking cessation for the past 7 days and an exhaled CO level below 7 ppm. The successful smoking cessation rate was calculated by dividing the number of subjects who successfully stopped smoking 12 weeks after smoking cessation treatment by the total number of subjects who provided consent and received the treatment, multiplied by 100 to give the percentage. Descriptive statistics on subjects’ background data will be generated. No interim analysis will be performed.All parties involved in this research shall strictly protect the personal information of the subjects in accordance with the Personal Information Protection Law. Personal information will be used to identify subjects so that accurate data can be obtained for each subject, and the personal information obtained will be managed appropriately. When information obtained from the research is published by the principal investigator or others, sufficient care will be taken to ensure that subjects are not identified.The Data and Safety Monitoring Committee will recommend discontinuation of the study to the principal investigator if the experimental treatment is deemed unsafe based on safety information, including reports of serious adverse events and information outside of the study. If the committee reports to the principal investigator that the study needs to be discontinued due to safety issues or for other reasons, the principal investigator will deliberate the report and will promptly inform the secretariat in writing about the results of the deliberation. In addition to the head of the institution where the study is conducted and the IRB, the subjects will also be informed.This study was approved by the Kyoto Medical Center IRB on June 17, 2019  and has been registered in the UMIN Clinical Trials Registry (UMIN000043102).Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year  with the approval of the IRB on May 17, 2021. The observation period  will last 3 months after the enrollment of the last subject, and the study period will last for 3 years and 3 months (July 2019 to September 2022). The corresponding author will have complete access to the study data and will submit the report for publication. The results of this research will be published in international peer-reviewed journals. Both positive and negative results will be reported. In addition, the study results will be shared on the UMIN Clinical Trials Registry. Our findings will be posted on the hospital website and will be made publicly available.This study is the first clinical trial study to examine the psychological effects of aromatherapy on smokers with depression. Hence, we believe that this study is of major significance. If aromatherapy can inhibit an increase in a transient propensity for depression, it can be expected to increase the rate of successful smoking cessation, which will not only reduce the risk of NCDs, but will also lead to a reduction in future medical expenses. Moreover, as aromatherapy has been reported to reduce insomnia , alleviaThis study was designed to confirm the efficacy and safety of aromatherapy. The control group included patients in the usual care group of a previous study. This study was a pre-post single-arm study and not a double-blind randomized controlled trial. In addition, the aromatherapy survey was based on patient self-report, which may lead to inaccuracy in the frequency of inhaler use.Smoking can cause or exacerbate negative emotions  and incrThis is a pre-post single-arm study. In this study, the group treated with aromatherapy will be compared with the group that received standard treatment in a previous randomized controlled trial as the control group. If this study shows that aromatherapy has psychological benefits for patients with depression who are undergoing smoking cessation treatment, then aromatherapy could be used to improve the success rate of smoking cessation, thus reducing the risk of NCDs and lowering future medical care needs. A phase III trial is intended to be conducted to confirm the findings and correct the limitations of this study.


Henderson et al. evaluated the effect of miR-377 on DOX induced cardiotoxicity in mouse model and reported that inhibiting miR-377 results in changes in pathways regulating cell proliferation, inflammation, apoptosis and differentiation.Heart disease remains the leading cause of morbidity and mortality worldwide. The loss of functional cardiomyocytes after an ischemic or non-ischemic injury leads to permanent damage to the heart muscle as cardiomyocytes are terminally differentiated and are not able to replace the damaged cells. The currently available pharmacological therapies are able to provide temporary relief and improve life span of cardiac patients. However, these interventions are not able to offer permanent solution to the problem. Thus, there is an urgent need for new and more effective approaches that can provide permanent treatment options for the heart disease. In this regard stem cell-based therapies have emerged as promising solution  1, 2). , 2. 1, 22 (PGE2) and fibroblast growth factor (FGF) that promote survival of stem cells in the myocardium  based biomaterials can act as bulking agents and are also reported to prevent inflammatory response in heart due to their ECM like structure  in exosomes. This review covers the role of ncRNA contained in MSC derived exosomes in cardiac, bone and cartilage tissue regeneration. They have also highlighted miRNA mediated applications of exosomes in neurodegenerative disorders as well as in cancer. Based on the type of cells EVs are derived from, these vesicles can differ in their contents, thus, resulting in different effects at the injection site. This phenomenon is demonstrated in research conducted by Ranjan et al., where exosomes sourced from myofibroblasts were responsible for induction of apoptosis and reduced proliferation of endothelial cells. Moreover, these exosome treated endothelial cells also exhibit reduced angiogenesis and cell migration.In addition to stem cells as source of cell therapy, in some of the recent studies, stem and progenitor cells derived extracellular vesicles (EVs) or exosomes have garnered a lot of attention by acting as cell free systems for cardiac repair following myocardial injury . A detai tissues , 22. PanJayaraman et al.)  , 25. TheSome of the recent studies have suggested that delivery of EVs using biomaterials prevents their wash out at the site of injection . FurtherThe goal of this focused issue was to bring together state-of-the-art original research and review articles from experts in the field of cardiovascular disease, stem cells, nanomaterials, extracellular nanovesicles and microRNAs, with special focus on translational aspects of these approaches. Our hope is that in future the readers would benefit from the articles in this special issue and come up with more effective state-of-the-art tools to repair injured myocardium in patients.The study was conceptualized and designed by VL and SD. VL, NS, and SD carried out literature search, and prepared manuscript and figure. All authors have read and approved the final manuscript.This work was supported by funding from the Canadian Institutes of Health Research to SD and by funding from Fondazione Pisa  to VL. NS was supported by Go for IT Project of Fondazione CRUI .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.


For decades, the German sports policy mission statement “Sport for All” has been aimed at attracting women to voluntary work in the sports sector. Nevertheless, women are consistently underrepresented in volunteering within sports organizations and especially on boards. One-dimensional gender analyses that exclude other factors like class and ethnicity cannot, however, adequately describe different modes of disadvantage. In order to analyze the unequal access to volunteering and leadership positions in sport, we refer to inequality theory and intersectional approaches, which include different factors of disadvantage. Our study is based on a quantitative population survey on volunteering in Germany with more than 25,000 respondents conducted in 2014 and 2019. We examine factors and interactions that can predict women's volunteering and leadership in sport. The results show that the proportion of women who volunteer is lower than the proportion of men and that fewer women than men take on leadership positions. The gender differences were not as pronounced in 2019 as they were in 2014. Independent of gender, the likelihood of volunteering increases with higher income, A-levels, no immigration status, marriage and the presence of children in the household. Part-time and marginal employment is more often associated with volunteering among women than among men; however, the likelihood of volunteering decreases more for women than for men when they are not employed at all. Moreover, higher income for women is less likely to be associated with voluntary work than for men while volunteering in other areas has a more positive effect on volunteering in sports for women than for men. Independent of gender, the likelihood of holding a leadership position increases with higher income, with marriage, and decreases with immigration background and with the presence of children in the household. Part-time and marginal employment increase the likelihood of having a leadership position to a greater extent for men than for women. In terms of leadership positions men benefit more than women if there are no children in the household. The results suggest that practical and policy efforts should focus more on improving the conditions for women to gain voluntary leadership positions. For decades, the sports policy mission statement “Sport for All” has been aimed in particular at addressing and attracting women to sports activities, as well as to voluntary work in the sports sector  in Germany. “Frauen an die Spitze” (“Women to the top”) was, for example, an initiative of the German Sports Confederation (DSB) and the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (BMFSFJ) in the early 2000s, and was intended to contribute to the equal participation of women and men in voluntary leadership positions in sports organized by clubs and associations BMFSFJ, . For a nSuch programs and initiatives to promote women in sport and voluntary work can also be found in other countries and international organizations  and youth leaders (37.4%), but least often as chairpersons (16.0%)  women's volunteering and (b) women's likelihood of taking on a leadership position and to what extent do differences with men emerge?RQ3: What differences in (a) volunteering and (b) leadership positions can be identified in subgroups of women (as opposed to men)?In order to be able to analyze the unequal access to volunteering and leadership positions in sport, reference is made to inequality theory and intersectional approaches. The process model of Solga et al. , with foIn our contribution, volunteering is considered to be a dimension of social inequality. At the same time, sports clubs as organizations provide a context for the genesis and reproduction of social inequality Rameder, .1 The unGender, class, immigration status, age and family status, among others, are conceived as determinants of social inequality. Belonging to these social groups is the basis for advantages and disadvantages in certain conditions of action and life  and vertical level (holding a leadership position). Secondly, due to the gender and diversity strategies implemented in recent decades to recruit volunteers in sport, the longer-term trend is likely to show a narrowing of the gender gap in access to volunteering and the assumption of leadership positions. Thirdly, social structural determinants like gender, class or immigration status emerge as significant predictors of access to volunteering and leadership positions. Finally, it is assumed that socio-structural determinants are interwoven and that interaction effects between gender and other social features make an independent contribution to the variance explanation of the two dimensions of social inequality.Volunteering is defined as engagement that is (1) voluntary and (2) not aimed at material gain. The commitment (3) is oriented toward the common good, (4) takes place in the public sphere and (5) is usually carried out on a joint/cooperative basis , for example, in an association, initiative, project, or self-help group” in the past 12 months .The explanatory variables used in the analyses are the respective indicators for the ascribed features of gender, age and immigration status, as well as for the acquired features of level of education, employment, income and family status .Given the complexity of volunteering in modern societies, the inequality theory approach is only one possible approach. Different theories should thus ideally be linked  develop a social strategy for promoting civil society on the basis of comprehensive data. A broad-based population survey was designed, which began in 1999 and has since been conducted five times. On the basis of the German Survey on Volunteering, it is possible to examine the scope and structure of voluntary engagement in the sports sector—in sports clubs as well as in self-organized projects and initiatives—on a cross-sectional basis, to map changes on a longitudinal basis and to discuss challenges faced by sports clubs with regard to human resources in the provision of services. The corresponding survey results have become an important tool for policy advice, especially in the field of “engagement policy”.A large number of application-related problems played a relevant role in the conception of the German Survey on Volunteering and the construction of the corresponding survey instruments. Theoretical conceptualizations are therefore rather marginal. The process model of Solga et al.  is intenDue to some fundamental methodological changes  who took part in the interview was 21.3%  or 19.3%  based on the fully realized and analyzable interviews  took part and 18.6%  of 149,053 contacts resulted in analyzable data  took place both via landline and mobile phone. In the landline interviews, the target person was selected from the household using the last-birthday method. In the cell phone interviews, the person who primarily uses the phone was interviewed  in terms of changes in the proportions of women and men volunteering or taking up leadership positions in sport (RQ1) are only presented descriptively due to the reported methodological problems. The changes between 2014 and 2019 are examined in the regression analyses.The data were processed and analyzed in the statistical software IBM SPSS 25.0. In a first step, descriptive characteristics are calculated and statistical tests are conducted to identify gender differences. The analysis was carried out depending on the measurement level of the variables, in the case of categorical variables using contingency tables (cross-tabulations) and ChiTo be able to answer the second question on the prediction of access to volunteering in sport and taking up leadership positions, binary-logistic regression models are calculated with the determinants of social inequality as predictors, controlling for contextual and personality features. To examine how gender and other variables jointly affect volunteering and the distribution of leadership positions, interaction effects were included. Appropriate prerequisites were previously tested and multicollinearity analyses were conducted. Ignoring the interactions, all of the correlations between the predictors are less than the threshold of r = 0.80, which is often used in regression analysis . Just over half of the respondents indicate that the impetus came from leaders within the club or group and in just as many cases the impulse came from family members, friends or acquaintances who were already active there. Family experiences—and as a tendency this applies also to family members, friends or acquaintances—are indicated more often from women as impetus, whereas voluntary service and the employer were more important for men .From a comparative gender perspective, the reasons people who are active in sports do not take on voluntary work are also interesting. Most respondents overall, and women a little more often than men, consider time reasons to be decisive, while professional reasons are frequently cited by both sexes. Moreover, women mention family reasons and health reasons more often than men and state more often that they do not want to take on any commitments .With regard to the volunteers with the most time-consuming voluntary activity in sports, there are more similarities than differences between women and men in the content of their activities . PracticIn 2019, women named families significantly more often than men as a special target group for their volunteer work. In 2014, this applied to families and also to older people, people with a handicap and people who need help or care. In 2014 and 2019, women were more involved with women and men more with men .In 2014 and 2019, 84.1% of the women and 87.6% of the men with the most time-consuming voluntary activity in sports are involved in  sports clubs. Women spend an average of 3.0 h and men more than 4.2 h per week on their most time-consuming voluntary activity. Men have been doing this for an average of 12.1 years, women for 10.2 years.Trend analyses of the German Survey on Volunteering show that women have caught up with men in terms of the proportion of people volunteering. Whereas, in 1999 6.4% of women were volunteering in sport, 20 years later the figure was 11.5%. The proportion of volunteers among men was 14.2% in 1999 and 15.0% in 2019, with major fluctuations in between . Some meWomen continue to be underrepresented in volunteer leadership positions in sport. The gender gap was around 15 percentage points before 2014 and around 10 percentage points since 2014, to the disadvantage of women in leadership positions .To examine how gender and other variables jointly affect volunteering, interaction effects between the gender variable and the other variables were included in Model 2. The results show that part-time and marginal employment are more likely to be associated with volunteering among women than among men , 7. HoweIn order to find out which variables  predict a volunteer leadership position in sports, motives, requirements and impetus for volunteering are used, among others . For theAgain, Model 2 contains interaction effects. When predicting leadership positions, considering interaction effects has a greater impact than when predicting volunteering. The increase of explained variance to 15.4% and the odds ratios for the significant interaction effects are higher. This suggests that gender differences as a function of other variables are larger for leadership positions than for volunteering. Here, the scope of employment seems to be of particular importance. Part-time and marginal employment increases the likelihood of having a leadership position to a greater extent for men than for women whereas it is the other way around for volunteering. In the context of leadership positions, men benefit more than women if there are no children in the household. Furthermore, women seem to be moving more into leadership positions, if they have the impression that specific training is necessary for voluntary work and that social skills can be acquired through voluntary work. Getting the impetus to do voluntary work from family or friends worsens the odds of occupying a leadership position more significantly for women than for men , 9.First of all, gender differences still exist both at a horizontal level  and on a vertical level (assumption of leadership positions). The proportion of women who volunteer and who take on leadership positions is lower than the proportion of men. In 2014, gender-stereotyped tasks and responsibilities were still evident. Gender differences are also evident in the impulses and motives for taking up volunteer work in sport. Although men and women consider the same motives important  or unimportant , their level of agreement differs. The situation is similar when it comes to impulses. However, family and friends as well as family experiences are mentioned more often by women, while voluntary service as well as the employer are mentioned more often by men as impulses. Nevertheless, every second woman and every second man are recruited for a volunteer position by older members of the club.The gender differences were less pronounced in 2019. In the long-term trend, too, the gender gap seems to be narrowing somewhat, at least as far as access to voluntary work in sport is concerned. However, this trend is not yet apparent when it comes to taking on leadership positions in sport clubs. Moreover, the narrowing of the gender gap can rather be attributed to the fact that the proportion of men volunteering is declining. The proportion of female volunteers, however, has barely increased.In the context of social inequality, ascribed characteristics such as gender, age and immigration status, as well as acquired characteristics such as education level, employment and income are of central importance for the reproduction of unequal living conditions of women and men. This applies in particular to access to volunteering. The determinants identified for gainful employment and also mechanisms for the (re)production of social inequality also seem to be at work in access to volunteering in sport. Once access to volunteering in sport has been mastered, socio-structural characteristics seem to have less explanatory power than contextual and personality characteristics in predicting leadership positions in sport. But even in the already selective sub-sample of volunteers in sport, indications of classic patterns of hierarchization in the occupation of positions can be found. A high income increases and an immigration background decreases the probability of taking on leadership positions in sport. However, motives, perceived requirements and the source of inspiration, among other factors, also differ according to gender, so that social inequalities can also be reproduced via these features.Recent studies point to the relevance of interdependencies between gender and other socio-structural characteristics in explaining unequal access and unequal positions in voluntary work  political reporting. Up to now, it lacked a theoretical basis. With Solga's model, we have attempted to conceptualize volunteering as a dimension of social inequality. We investigated the question of which determinants cause unequal access to voluntary engagement and to leadership positions in sport. Gender differences and interactions between gender and other determinants of social inequality were of particular interest. Mechanisms of reproduction of social inequality and the effects of unequal access to volunteering or leadership positions in sports clubs were only plausibilized in the paper. This needs to be addressed in future studies.We believe, however, that the findings provide a basis for deriving more targeted strategies for attracting (and retaining) women in volunteer activities and especially in leadership positions. The benefits of greater gender diversity in leadership positions have already been highlighted in various studies , provided by the Research Data Centre of the German Centre of Gerontology (FDZ-DZA). FWS microdata are available free of charge to scientific researchers for non-profitable purposes. The data is available at the Research Data Centre of the DZA: Ethical review and approval was not required for the study in accordance with local legislation and institutional requirements. The participants gave their consent to participate in this study by telephone. Further explanations can be found in the method reports on the German Volunteer Survey  received a research grant from the Federal Institute for Sport Science based on a resolution of the German Bundestag. The article processing charge was funded by the Deutsche Forschungsgemeinschaft  - 491192747 and the Open Access Publication Fund of Humboldt-Universität zu Berlin.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.


The features of the main models of spiking neurons are discussed in this review. We focus on the dynamical behaviors of five paradigmatic spiking neuron models and present recent literature studies on the topic, classifying the contributions based on the most-studied items. The aim of this review is to provide the reader with fundamental details related to spiking neurons from a dynamical systems point-of-view. Spiking is a fundamental feature of neuronal dynamics, intrinsically ensuring efficiency and low-power consumption. The control and communication processes in natural environments are often driven by spiking signals. Spiking signals can be generated by elementary physical phenomena and, therefore, mathematical models and simple logic rules can be adapted to efficiently mimic their characteristics. For these reasons, spiking systems are receiving interest from the scientific community. This review paper summarizes the fundamental properties of commonly adopted neuron models and their dynamical characteristics; we present a compact overview of the recent literature results, organized according to the model.Spiking signal features essentially reflect the mechanisms of accumulation and fast energy release, characterized by slow–fast dynamics. An example of a spiking signal is presented in This model represents the dynamics of a coil rotating around its axis, thanks to the interplay between a magnetic field and the current flowing through it , as in tX represents the phase of the coil, Y the angular speed, J the angular momentum, and K the friction factor. I is the current flowing into the coil and is given byS the coil area, B the magnetic field, and Referring to Equation , X repreConcerning the dynamic friction factor, the following nonlinear characteristics can be consideredThe experimental setup leads to the voltage trend reported in z reported in Another example of a spiking signal can be obtained by considering the Rössler oscillator , describa is called the sensitivity of the neuron. Therefore, a spiking signal is analogous to an impulse train, with the latter consisting of pulses of infinitesimal duration and the former consisting of spikes of finite duration.Spiking signals are, therefore, ubiquitous as they are present in very different scenarios. They are the bases of neural information transfer. In order to provide a formal characterization of a spiking signal, an analogy with the Dirac impulse erformed . The DirThis contribution is motivated by the actual intense scientific activity related to spiking signals and spiking neural networks, and from the consequent intense activity in realizing spiking neuronal systems, with appropriate hardware and software tools.In this paper, we present an overview of five paradigmatic mathematical models of neuron dynamics and their related bifurcation scenarios. The behavior of this class of neurons is a rich recipient of emerging dynamical behavior.We present a complete overview of recent studies regarding the considered neuron models. In particular, papers related to the following main items involved in the study of neuron models are considered: parameter estimation, bifurcation and chaos, synchronization, stochasticity, noise, non-integer  order dynamics, implementations, and memristors.In the conclusion, we present a discussion on the main hardware/software platforms involve spiking neurons, both for research studies and educational aims; we remark on the intense activities of spiking neurons that are evident from the studies reported on in the scientific journals.fires, generating further electrical activity that will contribute toward inducing other connected neurons to pass the activation threshold. The described mechanism is called integrate and fire.Spiking neural networks are artificial networks that work similarly to natural neural networks. They are based on the concept that the network propagates information based on the principle of threshold levels. This means that each neuron activity is activated by other neurons, only if a given level for the membrane potential, called activation threshold, is passed. Under this condition, it is said that the neuron Therefore, essential element spiking networks are proper choices in mathematical models for neuron dynamics, keeping in mind that, due to threshold behaviors, a neuron is the stereotype of a nonlinear dynamical system.Researchers have focused on obtaining suitable models since the beginning of the last century. In fact, Lapique, in 1907 , developC plays the role of integration, while the resistor R ‘conducts’ when the switch is closed, i.e., the switch is controlled by the voltage The capacitor This simple model is effective in emulating the neuron’s activation behavior. At the time of its publication, the Lapique model was successful in investigating the frequency response of a nerve coupled to a stimulating electrode. The simple and useful Lapique model has been widely used to represent an impressive example of a membrane activation mechanism. The concept of the Lapique model is still gaining interest, as witnessed in  and a reStudies by Hodgkin and Huxley (HH)  allowed The FitzHugh–Nagumo model (FHN) is a simplified second-order model of the HH model. It was proposed in 1961 [The Hindmarsh–Rose model (HR) was described as a further simplification of the HH model in 1984  where thA very simple behavioral model of a neuron that allows emulating spiking and bursting  phenomena, for more classes of cortical neurons, was proposed by Izhikevich in . The simV and the recovery variable N that gives the probability that the potassium channel conducts. Both the simplicity and the biophysical meanings of the variables make this model appropriate for more relevant studies [Another appreciated mathematical model for spiking neurons is the Morris–Lecar model (ML) proposed in 1981 . It give studies .We now outline the mathematical equations governing the dynamics of the previously discussed neuron model. To this aim, we summarize the main parameters and their physical meanings. All parameters are reported as dimensionless quantities. In order to uncover the role of the driving current, we focus on the bifurcation diagrams with respect to the current parameters. To this aim, the dynamics of spiking neurons are often characterized in terms of the interspike interval (ISI), i.e., the time span between two subsequent spikes. When a chaotic spiking arises, it is more convenient to observe the bifurcation route by plotting the local minima and maxima, a strategy adopted for chaotic nonlinear dynamical systems .Let us consider the HH model; it is described by the following set of differential equations:I and the currents related to the sodium and potassium channels.The model consists of four differential equations, the first consisting of the membrane’s potential dynamics and the other consisting of the dynamics of the probability of the potassium channel activation, the sodium channel activation, and the sodium channel inactivation, respectively. To this aim, the functions s, as in . The curI is a constant value, a transition toward a spiking behavior occurs, as reported in When the input current I is a sinusoidal signal with constant frequency, varying the amplitude A leads to the bifurcation diagram, as reported in When the input current v is the membrane voltage, w is the recovery variable, and The FHN model is characterized by the following set of differential equations:x is the membrane potential, and y and z are simplified variables accounting for the sodium and potassium channel activation probabilities. The bifurcation scenario, being a third-order nonlinear dynamical system, with respect to a constant value of I, is sufficient to the emergence of chaotic spiking, as shown by the ISI reported in the bifurcation diagram in The dynamics of the Hindmarsh–Rose (HR) model are reported as follows: :(6)x˙=I+The Izhikevich model is based on the following equations:d when the input current In this case, the bifurcation diagram was obtained by varying the parameter Finally, the mathematical model of the Morris–Lecar (MS) neuron is reportedV is the membrane potential and N accounts for the probability of potassium channel activation. The bifurcation diagram was obtained by varying the amplitude of the sinusoidally varying current I as In this model, This section explains how the papers were selected. We considered an equal distribution of papers that dealt with the considered mathematical models for spiking neurons. Moreover, the selection included very recent papers (at most published in the last ten years).The research on spiking neurons includes more items. We focused on items more related to nonlinear dynamical systems. The problem of parameter estimation was considered an important point to discuss. Moreover, looking at the intrinsic nonlinear behaviors of neuron models, papers dealing with the important and multidisciplinary topics of bifurcation and chaos were selected. Indeed, the synchronization aspects were considered fundamental, as synchrony in spiking networks leads to information transfer. Attention was devoted to the role of stochastic processes and the positive aspects of noise in spiking neurons. The fundamental issues concerning the implementation of spiking neural models drove the choices of some authors to deal with this aspect. Recent and timely studies on non-integer  order systems led us to select a series of studies on non-integer order spiking neuron models. Memristors and memristive devices  opened uIn The recent bibliography (organized according to the scheme) is presented in The problem of parameter estimation in a spiking neuron model can be approached with several techniques, including nonlinear autoregressive models . In FiguThe discussion in this subsection refers to recent papers that looked at the problem of parameter identification and the techniques adopted for various spiking neuron models. The various approaches cover different techniques and allow one to successfully determine the model parameters.In , the estThe signal representation in  allows tContribution  is also  used in , this isThe actual interest in neuron parameter estimation was shown in reference  where thThe results included in reference  regard aThe four papers discussed above are quite different in their methods and approaches; moreover, parameter identification techniques of more neuron models were dealt with. Indeed, in ,20,21, cThe occurrence of chaotic spiking in neuron models, as in the Hindmarsh–Rose model attractor reported in Reference  is referThe rich dynamical behavior of spiking HH neurons is further shown in reference . The intIn reference , the HR Spiking neuron models are useful in information technology. Recently, the active use of chaos has achieved a fundamental role in encryption techniques. Reference  shows hoThe essential items related to the complex behaviors of the Izhikevich neuron model are studied in reference . The stuIn reference , the autSynchronization is a general concept that explains how a single unit located in an ensemble can work in phase with others thanks to coupling. As an example, synchronization can be observed in an electromechanical system made of spiking elements, such as that reported in We will now discuss the selected papers that focused on the synchronization of spiking neuron networks. Various techniques were considered; moreover, synchronization approaches are mainly theoretically based on the Lyapunov function of the error and the network topology analysis.The synchronization of spiking neuron networks is a key area of research. The synchronization of arrays of FHN neurons is presented in reference . The autIn reference , a 2D neReference  considerReference  mainly cReference  focused In , the autTwo Morris–Lecar diffusively coupled neurons were considered in reference . The couThe discussion in this subsection is arranged around a strict number of contributions that show how chaotic spiking neurons are supported by stochasticity and noise. This is to emphasize how one theory can reinforce the other.Reference  focused Reference  includedIn , the autThe selected papers discussed here are focused on the timely subject of spiking system dynamics generated by non-integer order dynamical systems. This aspect is, in general, correct, due to the fact that the complexity of spiking neurons cannot be fully covered by integer-order nonlinear models. Non-integer order dynamics actuate the information compression, as emphasized by non-integer order linear system Bode diagrams (reported in Reference  focused The reaction–diffusion (RD) equation is one of the most important equations in science. One of the most popular regards the FHN system, which includes two differential RD equations. Instead of these two equations, a model with only one fractional order differential equation was introduced in , where tq. The results include the bifurcation diagrams in terms of the parameter q, the study of synchronization in terms of the similarity function, the conditions under which synchronization occurs, and the quantitative analysis of the electromagnetic radiation related to the synchronization.Reference  reports The memristor was conceived in 1971 by Leon Chua  who poinThe state equations are nonlinear They have bipole memories, called ReRAM;More implementations were recently proposed, yielding different technologies, including titanium dioxide , siliconThey are prone to creating neural synaptic memories, as shown by Crupi et al. Further characteristics of memristors are:A memristor is considered to be the key element linking neural networks with nonlinear dynamical circuits, as schematically reported in The previous items are the main ’ingredients’ that have led researchers to consider the memristor as a truly innovative device that can conceive new generations of neuron models. The selected papers discussed herein will focus on this subject, even if the literature on this topic is widely extended.Reference  is the c3/PEDOT:PSS/Pt technology. The property of resistive switching of this component was attributed to the migration of protons. The circuit was particularly suited for neuromorphic computing applications.In reference , the autThe authors of  referredThe state-of-the-art memristor-based neurons and networks were reported on in (the very recent) reference , where tBesides memristors, other memristive devices were introduced, including existing components. In this context, memcapacitors, i.e., capacitors with nonlinear characteristics, are used in innovative spiking neuron models. In , memcapaImplementing large-scale networks of spiking neurons is a fundamental topic in view of practical real-time applications. Solutions based on analog devices, such as the network reported in Even if there has recently been a lot of activity in realizing HH neurons, due to the advances in CMOS technology , referenImage encryption by using chaotic signals is a timely topic. In reference , the autIn reference , the autReference  focused In , the autReference  concernsThe Morris–Lecar neuron model is proposed in . The autAccording to the authors of , the MorThe motivation for this review was to provide the reader with a recent scenario of the fascinating topic of spiking neurons. Moreover, we were motivated by the recent papers related to in silico neuron implementation, with low-cost platforms, such as references ,70, whicThere was impressive research made in recent years related to the topic. Regarding the theoretical aspects, the following topics are still considered of further interest: the interaction between spiking membrane dynamics and random processes and the active role of noise in spiking regularization and describing impressive dynamical behaviors.The analytical aspects related to the synchronization conditions reveal the important role of the Lyapunov theory and the LMI techniques. Indeed, more activities on synchronization involve the network theory. The practical implementation of the various spiking neurons involves more advanced electronic hardware techniques. The implementation research involves both analog and digital components. This means that both simple analog discrete component devices and VLSI analog technology were used. Moreover, techniques both on VLSI digital design and FPGA platforms are proposed for digital implementations. To encourage the reader, it is important to understand that more spiking neurons and their applications only require low-cost laboratory equipment.Memristor systems will open up the way to further robust spiking neuron implementations. The spiking neuron subject includes more topics from biophysics and physics. The theme is quite open and includes a wide range of disciplines from chemistry to mathematics; in the area of mathematics, it includes everything from applied mathematics to differential geometry.Spiking neurons involve new techniques and theories that can be seen as challenging topics in the next century in neuroscience–computing science. Spiking systems are robust, in the sense that they are noise-insensitive, even if this noise can be useful in regularizing their behavior . MoreoveSpiking systems can be used for implementing pattern generators for bioinspired robotic systems . Indeed,


The recognition of dementia as a multifactorial disorder encourages the exploration of new pathways to understand its origins. Social health might play a role in cognitive decline and dementia, but conceptual clarity is lacking and this hinders investigation of associations and mechanisms. The objective is to develop a conceptual framework for social health to advance conceptual clarity in future studies.We use the following steps: underpinning for concept advancement, concept advancement by the development of a conceptual model, and exploration of its potential feasibility. An iterative consensus-based process was used within the international multidisciplinary SHARED project.Underpinning of the concept drew from a synthesis of theoretical, conceptual and epidemiological work, and resulted in a definition of social health as wellbeing that relies on capacities both of the individual and the social environment. Consequently, domains in the conceptual framework are on both the individual  and the social environmental levels . We hypothesize that social health acts as a driver for use of cognitive reserve which can then slow cognitive impairment or maintain cognitive functioning. The feasibility of the conceptual framework is demonstrated in its practical use in identifying and structuring of social health markers within the SHARED project.The conceptual framework provides guidance for future research and facilitates identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions. We highlight the paradigm of social health in dementia as a priority for dementia research. Dementia is an urgent problem affecting 57.4 million people in 2019 worldwide . Also thWe aim to explore the role of social health in cognitive decline and the onset of dementia. Social health has been defined by the World Health Organization in 1946 as the social domain of health, alongside mental and physical health . Our hypAssociations between social characteristics or markers and cognitive decline and dementia are well-documented –18. MarkSince social health is an umbrella concept, combinations of social health markers might provide added value to knowledge of the development of dementia. Several studies show that a combination of social health markers including social isolation, living alone, inability to help (feelings of not being able to help others), limited social participation and not talking to others every day, is associated with both the development of dementia and reduced cognitive functioning –23. A coThe current associations only address a limited scope of potentially relevant social health markers, underscoring the lack of clarity of the concept of social health. Social health requires a clear definition to advance research into its associations and mechanisms. Currently, many terms are used interchangeably, including social network , social Conceptual advancement is needed. This requires a strategic concept–driven effort, that incrementally builds from a conceptual meaning to a more precisely defined unit of meaning . In thatA conceptual framework with an overarching definition of social health, that covers the spectrum of social health domains and potential markers can advance the definition of social health to facilitate the identification of modifiable risk and protective factors, which may in turn shape new avenues for preventive interventions.Our aim is to develop a conceptual framework for social health to aid conceptual clarity and more comprehensive assessment of social health in future studies.1 profiled social health in the context of dementia , Poland (n = 5), Germany (n = 4), Australia (n = 2), UK (n = 1), and Italy (n = 1), that were from the disciplines of: psychology (n = 5), public health/health services and nursing research (n = 4), medicine: geriatrics, psychiatry, neuropsychiatry, and family practice (n = 4), epidemiology (n = 3), and sociology (n = 2).The INTERDEM network (pan-European multidisciplinary network of dementia researchers)dementia –40 and i studies , 42, a s studies , a Group studies , a curreOur effort to profile social health started with the conceptualization of Huber et al.  focusingWe synthesize theoretical models, conceptualizations, and epidemiological evidence.The theoretical models that constitute our knowledge of how associations between social health and cognitive functioning and dementia might work through social activity and brain mechanisms are the Social Network Model  and the The Cognitive Reserve Hypothesis suggests that the brain actively attempts to cope with age-related pathological changes by using preexisting neurobiological capital  to enhance brain network efficiency and flexibility, thus enabling the individual to cope with neuropathological changes . This reFor the conceptualization, we build on the basic sociological description of the term “social” , the WHOThe key sociological definition refers to social phenomena as a consequence of human interactions, and the influence of one person on another . Huber eEpidemiological evidence reveals markers that refer to the social environment and to the participation of the individual in social life –17.From the social network model, the conceptualizations and the epidemiological evidence we learn that both the individual and the social environment have an active role. Therefore, our conceptualization includes both individual and social environmental levels.Social health is essentially a relational concept in which wellbeing is defined on the one hand, as the impact that an individual has on others , and on the other hand as the impact that the social environment (others) has, in turn, on the individual.These underpinnings have consequences for our past work on social health and we therefore refine our hypothesis as follows: Social health acts as a driver for stimulating the development and the use of cognitive reserve through active facilitation and utilization of the individual’s capacities and those of their social environment. This slows cognitive impairment or maintains cognitive functioning in old age.The underpinnings outlined provide us with a concept that is built on theoretical, conceptual and empirical work. Yet, conceptual advancement is needed since the concept remains abstract and hard to operationalize. Therefore, we developed a conceptual framework where meaning is elaborated into more precisely defined domains. The first step is the distinction between the levels of the individual and the social environment. Second, to further facilitate operationalization, we also distinguish domains at both levels. This now allows use of the conceptual framework to identify social health markers and instruments to measure these markers.The individual level represents the competences of the individual to act in social life. For the elaboration on this level, we use the domain-related definition of Huber et al. . They de- The capacity to fulfill one’s potential  and obligations . This refers to compliance with social norms . Epidemi-The ability to manage life with some degree of independence . Autonomy refers to acting according to one’s own free will, following own norms and habits to some degree . Epidemi- The ability to actively participate in social activities refers to joining activities with others and there is both theoretical and epidemiological evidence for markers in this domain , 8, 18.The immediate social environment has structural and functional domains that are well-established in social network research. As shown below, we added the domain of appraisal of the quality of relationships, as our consortium discussions concluded that appraisal can differ from what can be actually observed. We distinguish the following domains:-Structure refers to the social ties between persons in networks  .-Function refers to actual exchanges between network members, e.g., emotional support and instrumental aid , 53. A m-Appraisal of the quality of the relationship and interaction refers to perceptions and interpretations. These might differ from actual interactions. An example of its markers is loneliness . Social Important novelty value of this conceptual framework is its emphasis on the fact that in the case of dementia an individual’s functioning depends not only on their own capacities. The behavior of their social environment which may support but also hinder them using their capacities may be equally important. This effort now provides a framework for identifying social health markers. Future research could study the inter-relationships within the framework. See The conceptual framework was developed as an aid to identify social health markers in the SHARED project. But does it work like that? We explore the feasibility, meaning the applicability, of the conceptual framework through its use in the following studies of the SHARED project: the review of epidemiological studies , the epiThe review of reviews includes 314 studies with social factors constituting 10% of all identified factors . The epiSince epidemiological research only provides information on what is available in databases, we applied other methodologies to get information on the broad spectrum of social health markers.In the Group Model Building (GMB) study, a participatory method for involving experts in developing models, we used the systematic review and SHARED’s experts consensus . The newThe conceptual framework is currently being used to classify measures  and in tIn sum, the conceptual framework facilitated identification of domain related markers in the SHARED project, thus showing its potential feasibility. Without this framework it would have been hard to systematically identify social health markers or gaps in social health data in current epidemiological research.We developed a conceptual framework for social health and fine-tuned our hypothesis. The synthesis of theoretical, conceptual and epidemiological resources, led to the recognition of social health relying on the impact of capacities of both the individual and the social environment. This is reflected in the conceptual framework with domains at the individual level referring to aspects of functioning of the individual in social life e.g., being able to fulfill social obligations, while preserving a certain amount of independence and actual participation in social life. The domains at the social environmental level refer to its structure, to social ties that are in place; its functions (what people do), and to the appraisal of the social environment . These domains resonate with recent work which outlines three similar social environmental life course domains .Our hypothesis linking neuropsychiatric and social sciences extends thinking beyond a predominantly biological concept and touches upon the complexity of dementia etiology.The proof of the pudding is in the eating. Feasibility exploration demonstrates proof of concept through practical use of the framework in identification of social health markers in the SHARED project’s studies. Our exploration broadened the scope of social heath in the context of cognitive decline from focus on the capacities of the individual  to a conNew knowledge is required regarding the interrelationship between the constituent domains at each level and between the individual and the social environmental levels. For now, social health acts as the sum of constituent domains. However, there may be compensation within and between the levels. At the individual level balancing between adaptation to norms, self-management and independency are aspects that require study. We hypothesize that at the environmental level the structural and functional domains are interrelated because they depend on each other. The social structure provides the base for social interaction and social functioning maintains the social structure. Appraisal, personal perception, provides the linking pin between the two levels. The perception of the quality of social environment by the individual offers a key target for intervention research into the interplay between cognitive and social health.The ultimate goal is to address modifiable social health risks and protective factors in preventive interventions. Interventions can take place at a clinical level and should adopt an individually tailored approach , since “Our conceptual framework describes what constitutes social health; it does not suggest pathways to social health. We see social health from the perspective of the immediate social circle. We consider socioeconomic and cultural characteristics as factors influencing social health. Likewise personal characteristics  are considered as internal psychological factors that influence social health but are not a constituent part of social health. While our focus is on the onset of dementia, we acknowledge the important role of social health in living with dementia .The epidemiological studies included in the development of our conceptual framework used associations, so causality cannot be imputed. The study of possible causal mechanisms will be a major challenge. The databases of the epidemiological studies do not include the full spectrum of social health domains, as only social participation is noted at the individual level. Additionally, studies do not always use validated measures . A broader spectrum of social health markers should be included in epidemiological databases and valid tools for measuring domain-related aspects are needed. Another limitation is that this conceptual framework is a based on western studies. A more diverse perspective is needed for future work .This conceptual framework has scope for identifying and structuring social health markers relevant in the context of cognitive decline and dementia. Our SHARED project demonstrates its potential feasibility and highlights gaps for relevant future epidemiological research. This is an important first step toward the identification of modifiable risks and factors, which may in turn shape new avenues for preventive interventions.We therefore suggest that social health is recognized and included in future  studies as one of the factors influencing cognitive functioning and dementia. It is now time to highlight the paradigm of social health in dementia as a priority for dementia research.MV-D, MP, and KW-O designed the study. MV-D coordinated the study and drafted the manuscript. SS, ML-B, DS, A-KW, JM, IV, HW, and AM applied the conceptual framework. All authors contributed to the manuscript and agreed with the submitted version.


Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor. The use of intrapartum ultrasound has been widely reported as an additional tool for predicting the evolution of successful labor.Differentiated normal and abnormal sonographic postpartum findings can also be an extra implement for the patients' well-being when the clinical evaluations are doubtful.The aim of this article is to present a revision of all ultrasound applicability in the delivery room, considering the main stages of labor.Placenta and cord anomalies are associated with 30% of intrauterine death risk factors and a high risk of cerebral palsy.thpercentile) and hypercoiled cords  are associated with unfavorable neonatal outcomes,stand 5thminutes of life.The umbilical cord is protected from trauma and compression through the presence of the Warthon jelly and spiraling of blood vessels.in vitrofertilization pregnancies, placenta previa, placenta with accessory lobe, velamentous cord insertion, and multiple gestations.While 97% of vasa previa cases are diagnosed during prenatal scanning,stand 5thminutes of life, fetal distress, and meconium  which is the angle between a line in the midline of the pubic symphysis and a line running tangentially from the anterior edge of the symphysis to the fetal skull evaluated through transperineal ultrasound ; the heA systematic review has shown that ultrasound is superior to digital VE for evaluation of fetal head position in the first stage of labor, in addition to the great agreement between the two methods in the assessment of cervical dilatation and a moderate correlation for fetal head station.Kameyama et al.Chan et al.Birth weight is an important predictor of neonatal morbidity and mortality and has a strong influence on obstetric and neonatal management.Yang et al.A different use of ultrasound during the labor is by creating a sonopartogram, which is a conformation of the conventional partogram, with the use of ultrasound parameters of recording assessments during the labor.Considering postpartum hemorrhage is the leading cause of maternal death worldwide,thcentile) measured by abdominal ultrasound within 24 hours postpartum is 22 mm,The main cause of postpartum hemorrhage is uterine atony, which can be identified by the loss of at least 500 ml of blood after vaginal delivery or 1000 ml after c-section, associated with the lack of the Pinnard security globe, which represents the uterus involution and can be diagnosed by physical exam, through palpation of the uterine height.Another possible cause of postpartum bleeding is the presence of retained placental tissue, which can happen in approximately 1% of term deliveries.As for the placenta accreta spectrum, the diagnostic should preferably happen prenatally, so the best time and place for delivery can be arranged, as an intraoperative hysterectomy might be necessary.A rare, but serious situation of postpartum hemorrhage, is the uterine rupture. Its prevalence is less than 1% after a vaginal delivery after one c-section, increasing to up to 2% when the vaginal delivery occurs after more than two previous c-sections.Lastly, an unusual but possible cause of hemodynamic instability in the delivery room is the presence of a vulvar or paravaginal hematoma.The performance of ultrasound in the delivery room is still a poorly explored resource in maternity hospitals. However, with the potential to improve the diagnosis and interpretations of situations and allow for more timely interventions, since it is a tool with the potential to complement (and not replace) clinical practice. There is still little evidence-based medical research on the several possibilities of its intrapartum use, but we expect that further studies could provide improvements in the quality of maternal-neonatal health during the labor.


This article aims to evaluate different methods and techniques published in the literature for tripodization in removable partial dentures. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases like PubMed, Cochrane Library, and Science Direct were searched for manuscripts published till August 15, 2021. An electronic search was restricted to the English language of the publications to identify the relevant articles on tripoding techniques in removable partial dentures. A hand search was also carried out. A total of 18 articles were included in this systematic review. The documented 18 articles associated with the tripoding techniques were reviewed systematically. Accurate repositioning of a cast on the surveyor is a critical step in the fabrication of a removable prosthesis. Based on the ease of use and no modifications to the existing cast, the "tripoder attachment" and "swiveling device" can be concluded to be superior to others. Once constructed, these devices are easy to use, can be operated for various patients, do not modify or damage the cast, and can be stored and disinfected for repeated use. Surveying the partially dentate casts is an indispensable step while fabricating a removable partial prosthesis. The surveying of models is to determine the path of insertion of the removable prosthesis. This insertion path must be decided before a prosthesis design. Casts are surveyed to determine the favorable and unfavorable undercuts that will contain the future clasp assemblies. The casts' tilt can be altered until we get a position where all undercuts are in a favorable position for fabricating the prosthesis. This tilt of the cast has to be preserved for future use; hence, tripoding is performed ,2.Tripoding is performed traditionally by marking the cast surface with an undercut gauge, also known as the "tripod-marks method". However, this is time-consuming and requires basic skills to perform the reorientation ,4. The sMany proposed methods for re-establishing the cast surveyor relationship in the literature have included various devices and techniques. Therefore, the objective of this article was to evaluate, compare, and find the best possible technique among multiple strategies and procedures published in the literature for tripodization in removable partial dentures and to conduct a systematic review of the innovations made in the genre.Materials and methodsThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The focus question was framed in PICO format , Seema Sathe (SS), and Aditee Apte (AA). All of them searched three electronic databases  for manuscripts published until August 15, 2021. Full texts of the reviewed articles which fulfilled the inclusion criteria were obtained. The last search was done manually from the cross-references of the selected articles and citations to include all the pertinent articles. There was no disagreement between the reviewers.The total number of articles displayed with search terms "tripoding", "tripodization", "reorienting", "cast surveyor relation", and "tilt of cast" in the advanced search resulted in 157 articles in PubMed, zero articles in Cochrane Library and 60 articles in Science Direct. After removing duplicates, screening titles, and abstracts, 23 records were eligible. One article identified during cross-referencing of included studies was also included. A total of 24 papers were included. Five articles were found to be comparative studies; thus, they were excluded. Consequently, 18 articles were included in the analysis  by adapting modeling wax after doubling its thickness on any completely dentate cast . A . A 14]. Tripoding of removable partial dentures is an absolute necessity for the success of the final prosthesis. The conventional tripoding methods, although convenient, have the disadvantages of not being sustainable, the requirement of skill of the operator, and consumption of time. For simplification of the same and streamlining tripoding, many authors have suggested either customized techniques or devices. All these techniques and devices proposed by the authors were to simplify the recording of the cast tilt. The literature regarding these techniques and devices was studied thoroughly, and the advantages and disadvantages were weighed and compared Table . While sAccurate repositioning of a cast on the surveyor is essential for the success of a removable partial prosthesis. The techniques and devices put forth for the purpose of simplification of tripoding were evaluated in terms of their conceptual accuracy in repositioning, as suggested by the authors. The "tripoder attachment" and "swiveling device" can be concluded to be superior to others in terms of their accuracy and ease of cast reorientation. Once constructed, these devices are easy to use, can be operated for various patients, do not modify or damage the cast, and can be stored and disinfected for repeated use.