N = 471, 54% women). Participants performed a manipulation task that increased their perception of the experience dimension of the animal mind and completed online questionnaires as part of a manipulation check to measure acceptance and intentions of instrumental violence against animals. Regression and mediation analyses revealed that increasing perception of the experience dimension of animal mind decreases instrumental violence against animals, particularly intentions to commit such violence, and this effect is unique and distinct from the effect of perception of the agency dimension, i.e., anthropomorphization. The key capacities in lowering violence were homeostatic emotions  which indicate suffering that humans would want animals to avoid. However, when people perceive homeostatic emotions, increased perception of more complex capacities  and anthropomorphization do not result in an additional reduction in violence. We interpret these results to mean that people limit violence by using perception of animal experience capacities as pre-violation justification. These findings expand our knowledge about the functions of perception of experience capacities and demonstrate that people diminish animal experience capacities not only to rationalize violence but also as pre-violation justification to facilitate instrumental violence against animals.In this study, we investigated whether the perception of animal experience capacities, enabling individuals to recognize animals as moral patients, decreases instrumental violence against animals. Additionally, we aimed to distinguish this effect from the influence of perceptions of agency capacities, referred to as anthropomorphization. To achieve this, we conducted an online experimental study ( Violence towards animals has remained a persistent and unsettling issue, presenting ethical and moral challenges. Despite the importance of this topic, the field is far from reaching a comprehensive understanding of the psychological mechanisms that underpin these relationships. In the current literature, authors –5 have dTherefore, there is still a gap in our knowledge. It is unclear whether (1) the perception of experience capacities alone reduces violence against animals while controlling for anthropomorphization, (2) they both simultaneously reduce violence, or (3) the perception of experience capacities is only correlated with instrumental violence against animals.This study fills this gap and expands our understanding of whether perceptions of animals’ experience capacities to feel basic psychological states , emotions, and possess consciousness and personality  –17 influFollowing Waytz, Gray et al. , we antiPeople have been using animals for their purposes since the domestication of animals –25. The The second set of individual factors linked with violence against animals contains those that are more susceptible to change over time due to varying situational or social influences. This includes aspects like individual or collective goals or the perception of animal attributes. Goals serve as the catalyst for social interaction, and when these goals are instrumental and focused on acquiring benefits, they can trigger violence –51. IndiAccording to the literature, early research focused on the assumption that people’s beliefs about animal minds are constant and on analyzing these with regard to animal consciousness, feelings, emotions, thinking, and ability to solve problems , 28, 59.Another perspective shows the instability of our beliefs , 17, 65.A slightly different perspective is proposed in research on anthropomorphization or personification. Both refer to capacities stereotypically and traditionally understood as unique to humans , 22. AntWithin the context of moral typecasting, as delineated by Gray & Wegner  individuHowever, in our study, we leverage the theoretical framework proposed by Waytz, Gray et al. , which eIn summary, we argue that regulation of perception of animals’ experience capacities precedes decision-making and limits animal harm  since, fHowever, there are two contending explanations for pre-violation justification concerning two-dimensional mind perception : grantinTo address the research question, we implemented an experimental study. We argued that enhanced perception of an animal’s capacity for experience reduces instrumental violence towards animals. This is based on the assertion by Waytz, Gray et al.  that an We controlled for all moral foundations , 95 sincWe tested one (preregistered) hypothesis: that increasing perception of the experience dimension of the animal mind (perception of experience) reduces instrumental violence against animals, and this effect is distinct from the effect of perception of the agency dimension (anthropomorphization).https://doi.org/10.17605/OSF.IO/6JKST (database: https://doi.org/10.17605/OSF.IO/XMYV8). Sample size estimation was performed using MedPower or welfare " to be "  or welfare ".Line 75. Please rewrite " Authors highlight " to be " The authors highlight ".Line 76. Please rewrite " worldviews including " to be " worldviews, including ".Line 77. Please rewrite " facilitate such instrumental " to be " facilitate the instrumental”Line 78. Please rewrite " categories –" to be " categories:”.Line 84. Please rewrite " [46], values " to be " [46], and values”.Line 84. Please rewrite " obedience and security " to be " obedience, and security”.Line 90. Please rewrite " industry as well as " to be " industry, as well as”.Line 99. Please rewrite " constant, and" to be " constant and”.Line 100. Please rewrite " thinking and ability.” to be " thinking, and ability”.Line 103. Please rewrite " fish and" to be " fish, and.”.Line 105. Remove unnecessary spaces " 65] —people fit their “to be " People fit their”.Line 106. Please rewrite " perception of animal " to be " perception of the animal”.Line 106. Please rewrite " intention and socially “to be " intention, and socially”.Line 109. Please rewrite " pasture[6]. " to be " pasture [6].”.Line 111. Please rewrite " entities which have less capacities to feel “to be " entities that have less capacity to feel”.Line 113. Please rewrite " perception of animal " to be " perception of the animal”.Line 116. Change the preposition “unique for humans” to be “unique to humans”.Line 117. Please rewrite " nonhumans”, “to be " nonhumans ,”.Line 118. Please rewrite " phenomena and" to be " phenomena, and”.Line 119. Please rewrite " defined in similar fashion—mainly in law, philosophy or in literature “to be " defined in a similar fashion—mainly in law, philosophy, or literature”.Lines 122, 123. Please rewrite " important is anthropomorphization’s role in limiting violence, it is certainly not the only aspect of the animal mind perception regulating our moral choices " to be " important anthropomorphization’s role in limiting violence is, it is certainly not the only aspect of animal mind perception regulating our moral choices”.Line 136. Please rewrite " Gray et al. [17] which “to be " Gray et al. [17], which”.Line 138. Please rewrite " observer—as is " to be " observer, as”.Line 141. Please rewrite " compensation, " to be " compensation”.Line 144. Please rewrite " " to be " ”.Line 148. Please rewrite " moral agents and" to be " moral agents, and”.Lines 151, 152. Please rewrite " victim to make a shift from moral act  to not moral act " to be " victim by making a shift from a moral act  to a non-moral act .”.Line 153. Please rewrite " dismissing of moral" to be " dismissal of moral”.Line 158. Please rewrite " since from the perspective of moral agent " to be " since, from the perspective of moral agents”.Line 164. Please rewrite " religion and" to be " religion , and”.Line 172. Please rewrite " dimension," to be " dimension”.Line 177. Please rewrite " [17], that" to be " [17] that”.Line 178. Please rewrite " thus, " to be " thus”.Line 181. Please rewrite " [12], " to be " [12]”.Line 185. Please rewrite " animals, " to be " animals”.Line 188. Please rewrite " of animal mind, and" to be " of the animal mind and”.Line 191. Please rewrite " of animal mind " to be " of the animal mind”.Line 192. Please rewrite " animals and " to be " animals, and”.Lines 196, 197. Please rewrite " and expected that manipulation would increase perception of experience capacities in Experience1" to be " and it was expected that manipulation would increase perceptions of experience capacities in the Experience1”.Line 207. Please rewrite " 2/2022 – “to be " 2/2022;”.Line 212. Please rewrite " adult people " to be " adults”.Line 214. Please rewrite " survey, description " to be " survey, a description”.Line 216. Please rewrite " was displayed." to be " were displayed.”.Line 217. Please rewrite " on the question" to be " to the question”.Line 219. Please rewrite " electronically and" to be " electronically, and”.Line 221. Please rewrite " Warsaw approved" to be " Warsaw, approved”.Line 222. Please rewrite " Experience1, Experience2, and" to be " Experience 1, Experience 2, and”.Line 223. Please rewrite " they performed " to be " performed”.Line 225. Please rewrite " Authors" to be " The authors”.Line 235. Remove the redundant word “in in the country,” to be " in the country,”.Line 236. Please rewrite " education, other" to be " education, and other”.Line 237. Please rewrite " years and " to be " years, and”.Line 241-243. Please rewrite " which were assigned to their specific experimental condition. In the Control group, the text was about colors. In Experience1, it was about cows’ and pigs’ capacities to feel pain, fear, hunger." to be "that were assigned to their specific experimental condition. In the control group, the text was about colors. In Experience 1, it was about cows’ and pigs’ capacities to feel pain, fear, and hunger.”.Line 244-248. Please rewrite " joy, pleasure, and about the animals' personality. Next, the participants were asked to write a short post for Facebook or Twitter about the text they read and to complete the Animal Mind Questionnaire  to verify the effectiveness of the manipulation and the Agency subscale (a = 0.89) to control for Anthropomorphization. " to be " joy, and pleasure, and about the animals' personalities. Next, the participants were asked to write a short post for Facebook or Twitter about the text they read and to complete the Animal Mind Questionnaire (AMQ-PL) based on the Mind Survey [15]. We used the AMQ-PL subscale of experience (a = 0.90) to verify the effectiveness of the manipulation and the agency subscale (a = 0.89) to control for anthropomorphization.”.Line 250-256. Please rewrite " The Agency subscale uses items on morality, memory, emotion recognition, planning, self-control, communication, and thought. Participants instructions were following: “Using a scale of 0  to 6 (very much), please tell us how capable do you think horses, cows, goats, sheep are of:” and provided with descriptions of 18 mental capacities from the original scale, e.g., “understanding how others are feeling”, “feeling afraid or fearful”, “telling right from wrong and trying to do the right thing”. " to be " The agency subscale uses items on morality, memory, emotion recognition, planning, self-control, communication, and thought. Participants instructions were the following: “Using a scale of 0  to 6 (very much), please tell us how capable you think horses, cows, goats, and sheep are of:” and provided with descriptions of 18 mental capacities from the original scale, e.g., “understanding how others are feeling”, “feeling afraid or fearful" and “telling right from wrong and trying to do the right thing”.”.Line 259. Please rewrite " We measured intentions" to be " We measured the intentions”.Line 261. Please rewrite " [98] and" to be " [98], and”.Line 265. Please rewrite " maintenance and providing food, facilities, veterinary care and " to be " maintaining and providing food, facilities, veterinary care, and”.Line 271. Please rewrite " item " to be " items”.Line 273. Please rewrite " cost–profit ratio" to be " cost-profit ratio”.Line 283. Please rewrite " consumption”," to be " consumption" and”.Line 289. Please rewrite " by according" to be " according to the”.Line 290. Please rewrite " 102]," to be " 102]”.Lines 291, 292. Please rewrite " a = 0.75, in order to increase Fairness subscale reliability, item 27 was excluded, " to be " a = 0.75; in order to increase fairness subscale reliability, item 27 was excluded”.Line 295. Please rewrite " we calculated means " to be " we calculated the means”.Line 237. Please rewrite " in OLS model for Perception of Experience, Anthropomorphization" to be " in the OLS model for perception of experience, anthropomorphization,”.Lines 300-304. Please rewrite " Perception of Experience in the experimental groups (Experience1 + Experience2) versus Control, however, this is accompanied by higher Anthropomorphization (Contrast1). A contrast test between the experimental groups (Contrast2) revealed higher Perception of Experience in Experience2 than in Experience1, without differences in Anthropomorphization. " to be " perceptions of experience in the experimental groups (Experience 1 + Experience 2) versus control; however, this is accompanied by higher anthropomorphization (Contrast 1). A contrast test between the experimental groups (Contrast 2) revealed a higher perception of experience in Experience 2 than in Experience 1, without differences in anthropomorphization.”.Line 309. Please rewrite " Contrast1 = both experimental groups together (Experience1 and Experience 2) vs the Control group, contrast2 = Experience2 vs Experience1." to be " Contrast 1 = both experimental groups together (Experience 1 and Experience 2) vs. the control group; contrast 2 = Experience 2 vs. Experience 1.”.Line 311. Please rewrite "  which" to be " , which”.Line 315. Please rewrite " model 1 and " to be " model 1, and”.Line 317. Please rewrite " (Experience1 + Experience2) with the Control group (X1) and the experimental groups with each other ." to be " (Experience 1 + Experience 2) with the control group (X1) and the experimental groups with each other .”.Line 290. Please rewrite " 102]," to be " 102]”.Lines 291, 292. Please rewrite " a = 0.75, in order to increase Fairness subscale reliability, item 27 was excluded, " to be " a = 0.75; in order to increase fairness subscale reliability, item 27 was excluded”.Line 295. Please rewrite " we calculated means " to be " we calculated the means”.Line 331. Please rewrite " " to be " ”.Line 332. Please rewrite " animals and " to be " animals, and”.Line 334. Please rewrite " upon revealing the total and indirect effects for the outcome variable Violence Intentions " to be " by revealing the total and indirect effects of the outcome variable Violence Intentions ”.Line 338. Please rewrite " Y , Fig 2), " to be " Y, Fig. 2)”.Line 341. Please rewrite " Y - Figs 1 and 2) " to be " Y, Figs. 1 and 2”.Line 346. Please rewrite " Moral Patient," to be " moral patients,”.Line 347. Please rewrite " have less moral" to be " have fewer moral”.Lines 356-358. Please rewrite " [77 – 79] maintain their self-perception as moral, avoid social punishment even if they engage in instrumental use of animals [73 - 76] " to be " [77–79] maintain their self-perception as moral, avoid social punishment even if they engage in the instrumental use of animals [73-76]”.Line 360. Please rewrite " constant, and differences in Perception of Experience were " to be " constant and differences in Perception of Experience are”.Lines 364-366. Please rewrite " Experience2 group versus Experience1  since the perception of homeostatic emotions  " to be " Experience 2 group versus Experience 1 , since the perception of homeostatic emotions ”.nor, Can they talk?Line 368. Please rewrite " nor, Can they talk? " to be " Nor, can they talk?)”.Line 374. Please rewrite " strongly," to be " strongly”.Line 376. Please rewrite " absence of difference” to be " absence of a difference”.Line 381. Please rewrite " . " to be " .”.Line 386-387. Please rewrite " Agency, (2) lead to stronger effects of manipulation " to be " agency; (2) lead to stronger effects of manipulation;”.Line 392. Please rewrite " animals" to be " animals.”.Line 396. Please rewrite " Perception of Agency” to be " the perception of agency”.Line 397. Please rewrite " [12] " to be " [12],”.Line 401. Please rewrite " propose anthropomorphization" to be " propose that anthropomorphization”.Line 404. Please rewrite " [109 -111].” to be " [109-111].”.********** <font color="black"> 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. </font> Yes: Yudi AdinataReviewer #1: Reviewer #2: No**********https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, AttachmentPONE-D-23-19973.docxSubmitted filename: Click here for additional data file. 27 Oct 2023Responses to Editor:1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found athttps://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdfResponse:This has been checked. The supporting information has been changed in manuscript.2. Thank you for stating in your Funding Statement: (…)http://journals.plos.org/plosone/s/submit-now. (…) Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf. Please provide an amended statement that declares *all* the funding or sources of support  received during this study, as detailed online in our guide for authors at Response: https://researchfund.animalcharityevaluators.org/. Since funder may have a vested interest in the research reported in the enclosed paper to eliminate any role of this organization in the research, analysis, or paper preparation process, the study was preregistered before collecting data, and funding was not contingent upon results. All funds or sources of support received during this study have been described in accordance with the requirements in the online author's guide at http://journals.plos.org/plosone/s/submit-now. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study.Yes. This work was supported by the Animal Advocacy Research Fund, funded by Animal Charity Evaluators. Agnieszka Potocka  was the author who received the award. Agnieszka Golec de Zavala and Maksymilian Bielecki were declared as key collaborators. The grant does not have a specific grant number and was signed on September 10, 2020. Funder name: Animal Charity Evaluators 3. Thank you for stating the following in the Competing Interests section: "I have read the journal's policy and the authors of this manuscript have the following competing interests: To conduct this study Agnieszka Potocka received Animal Advocacy Research Fund, funded by Animal Charity Evaluators."Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials.Response:I have read the journal's policy and the authors of this manuscript have the following competing interests: To conduct this study Agnieszka Potocka received Animal Advocacy Research Fund, funded by Animal Charity Evaluators.This does not alter our adherence to PLOS ONE policies on sharing data and materials. The data and protocol are licensed under CC-By Attribution 4.0 International.4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.Response:The DOI for prerefistration and database has been added in paper:https://doi.org/10.17605/OSF.IO/6JKST (database: https://doi.org/10.17605/OSF.IO/XMYV8)”“The study was preregistered on OSF: Data Availability statement:https://doi.org/10.17605/OSF.IO/6JKST, database, and syntax: https://doi.org/10.17605/OSF.IO/XMYV8, licensed under CC-By Attribution 4.0 International.All data are fully available on OSF: study preregistration: 5. Please review your reference list to ensure that it is complete and correct.Response:All references has been checked to be complete and correct.Responses to Reviewers’.The manuscript has been checked and the necessary changes have been made in accordance with the reviewers’ suggestions. The responses to all comments have been prepared and given below.Reviewer #11. Abstract: The abstract should offer a concise summary of your study, including the research question, methodology, key findings, and implications. Ensure that it highlights the significance of your research. Make sure your abstract provides a clear overview of the study.Response:The abstract provides a clear overview of the study including the research question, methodology, key findings, and implications.2. Introduction: Clearly state the research problem and research questions in the introduction. Provide a brief literature review to establish the context and importance of your study. Simplify the introduction for better readability. Provide a brief literature review to establish the context and importance of your study.Response: The introduction meets these requirements.3. Methods: Explain your experimental design in detail, including participant recruitment, the procedure they followed, and the manipulation task. Provide a clear rationale for your choice of measures and questionnaires.Response: The methods meets these requirements.4. Results: Present your results in a clear and organized manner. Avoid overwhelming the reader with excessive statistical details. Focus on the most critical results that address your hypotheses.Response: The results meets these requirements.5. Discussion: Discuss the effect sizes and practical significance of your findings. Explore the implications of your findings for the field and for addressing the issue of instrumental violence against animals. Address potential limitations of your study, such as sample size, generalizability, or other methodological concerns. Suggest areas for future research or extensions of your work.Response: The discussion meets these requirements.6. Conclusions: Conclude your paper by summarizing the main findings and their significance. Discuss the practical implications of your research and how it contributes to the broader understanding of the topic. Please provide a description of the scientific novelty presented in the study, including a section on the study’s limitations and research perspectives in the conclusion.Response: The conclusion meets these requirements.7. Lastly, it’s advisable to include the most recent references, primarily those published between 2017 and 2023, except in the method section where older references might be more relevant.ResponseThe relationship between humans and animals is not a central area of study in social psychology, which is why it may not be comprehensively covered in the most recent publications:50% references are published 2007-202311% references are published 2019-2023Reviewer #21. We have considered the following comments, and as a result, the text has been revised in accordance with the reviewer's suggestion:Line 4. Add an article to be " dimension of the animal mind".Line 20. Please rewrite “perception of agency " to be " perceptions of agency".Line 22. Please rewrite " task which increased perception of the experience dimension of animal" to be "task that increased their perception of the experience dimension of the animal".Line 23. Please rewrite "check and to measure " to be "check to measure".Line 29. Please rewrite " hunger, thirst) which " to be “hunger, and thirst), which ".Line 34. Please rewrite " about functions " to be " about the functions ".Line 35. Please rewrite " of the experience "to be "of experience".Line 36. Please rewrite " rationalize violence," to be " rationalize violence".Line 55. Please rewrite " still gap" to be " still a gap ".Line 57. Please rewrite " nthropomorphization, or (2) they " to be " nthropomorphization, (2) they ".Line 62. Please rewrite " against animals, and" to be " against animals and".Line 72. Please rewrite " dairy products or eggs " to be " dairy products, or eggs “.Line 74. Please rewrite " attitudes toward animal" to be " attitudes towards animal".Line 75. Please add space " or welfare " to be "  or welfare ".Line 75. Please rewrite " Authors highlight " to be " The authors highlight ".Line 76. Please rewrite " worldviews including " to be " worldviews, including ".Line 77. Please rewrite " facilitate such instrumental " to be " facilitate the instrumental”Line 78. Please rewrite " categories –" to be " categories:”.Line 84. Please rewrite " [46], values " to be " [46], and values”.Line 84. Please rewrite " obedience and security " to be " obedience, and security”.Line 90. Please rewrite " industry as well as " to be " industry, as well as”.Line 99. Please rewrite " constant, and" to be " constant and”.Line 100. Please rewrite " thinking and ability.” to be " thinking, and ability”.Line 103. Please rewrite " fish and" to be " fish, and.”.Line 105. Remove unnecessary spaces " 65] —people fit their “to be " People fit their”.Line 106. Please rewrite " perception of animal " to be " perception of the animal”.Line 106. Please rewrite " intention and socially “to be " intention, and socially”.Line 109. Please rewrite " pasture[6]. " to be " pasture [6].”.Line 111. Please rewrite " entities which have less capacities to feel “to be " entities that have less capacity to feel”.Line 113. Please rewrite " perception of animal " to be " perception of the animal”.Line 116. Change the preposition “unique for humans” to be “unique to humans”.Line 117. Please rewrite " nonhumans”, “to be " nonhumans ,”.Line 118. Please rewrite " phenomena and" to be " phenomena, and”.Line 119. Please rewrite " defined in similar fashion—mainly in law, philosophy or in literature “to be " defined in a similar fashion—mainly in law, philosophy, or literature”.Lines 122, 123. Please rewrite " important is anthropomorphization’s role in limiting violence, it is certainly not the only aspect of the animal mind perception regulating our moral choices " to be " important anthropomorphization’s role in limiting violence is, it is certainly not the only aspect of animal mind perception regulating our moral choices”.Line 136. Please rewrite " Gray et al. [17] which “to be " Gray et al. [17], which”.Line 138. Please rewrite " observer—as is " to be " observer, as”.Line 141. Please rewrite " compensation, " to be " compensation”.Line 144. Please rewrite " " to be " ”.Line 148. Please rewrite " moral agents and" to be " moral agents, and”.Lines 151, 152. Please rewrite " victim to make a shift from moral act  to not moral act " to be " victim by making a shift from a moral act  to a non-moral act .”.Line 153. Please rewrite " dismissing of moral" to be " dismissal of moral”.Line 158. Please rewrite " since from the perspective of moral agent " to be " since, from the perspective of moral agents”.Line 164. Please rewrite " religion and" to be " religion , and”.Line 172. Please rewrite " dimension," to be " dimension”.Line 177. Please rewrite " [17], that" to be " [17] that”.Line 178. Please rewrite " thus, " to be " thus”.Line 181. Please rewrite " [12], " to be " [12]”.Line 185. Please rewrite " animals, " to be " animals”.Line 188. Please rewrite " of animal mind, and" to be " of the animal mind and”.Line 191. Please rewrite " of animal mind " to be " of the animal mind”.Line 192. Please rewrite " animals and " to be " animals, and”.Lines 196, 197. Please rewrite " and expected that manipulation would increase perception of experience capacities in Experience1" to be " and it was expected that manipulation would increase perceptions of experience capacities in the Experience1”.Line 207. Please rewrite " 2/2022 – “to be " 2/2022;”.Line 212. Please rewrite " adult people " to be " adults”.Line 214. Please rewrite " survey, description " to be " survey, a description”.Line 216. Please rewrite " was displayed." to be " were displayed.”.Line 217. Please rewrite " on the question" to be " to the question”.Line 219. Please rewrite " electronically and" to be " electronically, and”.Line 221. Please rewrite " Warsaw approved" to be " Warsaw, approved”.Line 222. Please rewrite " Experience1, Experience2, and" to be " Experience 1, Experience 2, and”.Line 223. Please rewrite " they performed " to be " performed”.Line 225. Please rewrite " Authors" to be " The authors”.Line 235. Remove the redundant word “in in the country,” to be " in the country,”.Line 236. Please rewrite " education, other" to be " education, and other”.Line 237. Please rewrite " years and " to be " years, and”.Line 241-243. Please rewrite " which were assigned to their specific experimental condition. In the Control group, the text was about colors. In Experience1, it was about cows’ and pigs’ capacities to feel pain, fear, hunger." to be "that were assigned to their specific experimental condition. In the control group, the text was about colors. In Experience 1, it was about cows’ and pigs’ capacities to feel pain, fear, and hunger.”.Line 244-248. Please rewrite " joy, pleasure, and about the animals' personality. Next, the participants were asked to write a short post for Facebook or Twitter about the text they read and to complete the Animal Mind Questionnaire  to verify the effectiveness of the manipulation and the Agency subscale (a = 0.89) to control for Anthropomorphization. " to be " joy, and pleasure, and about the animals' personalities. Next, the participants were asked to write a short post for Facebook or Twitter about the text they read and to complete the Animal Mind Questionnaire (AMQ-PL) based on the Mind Survey [15]. We used the AMQ-PL subscale of experience (a = 0.90) to verify the effectiveness of the manipulation and the agency subscale (a = 0.89) to control for anthropomorphization.”.we left [12] Line 250-256. Please rewrite " The Agency subscale uses items on morality, memory, emotion recognition, planning, self-control, communication, and thought. Participants instructions were following: “Using a scale of 0  to 6 (very much), please tell us how capable do you think horses, cows, goats, sheep are of:” and provided with descriptions of 18 mental capacities from the original scale, e.g., “understanding how others are feeling”, “feeling afraid or fearful”, “telling right from wrong and trying to do the right thing”. " to be " The agency subscale uses items on morality, memory, emotion recognition, planning, self-control, communication, and thought. Participants instructions were the following: “Using a scale of 0  to 6 (very much), please tell us how capable you think horses, cows, goats, and sheep are of:” and provided with descriptions of 18 mental capacities from the original scale, e.g., “understanding how others are feeling”, “feeling afraid or fearful" and “telling right from wrong and trying to do the right thing”.”.Line 259. Please rewrite " We measured intentions" to be " We measured the intentions”.Line 261. Please rewrite " [98] and" to be " [98], and”.Line 265. Please rewrite " maintenance and providing food, facilities, veterinary care and " to be " maintaining and providing food, facilities, veterinary care, and”.Line 271. Please rewrite " item " to be " items”.Line 273. Please rewrite " cost–profit ratio" to be " cost-profit ratio”.Line 283. Please rewrite " consumption”," to be " consumption" and”.Line 289. Please rewrite " by according" to be " according to the”.Line 290. Please rewrite " 102]," to be " 102]”.Lines 291, 292. Please rewrite " a = 0.75, in order to increase Fairness subscale reliability, item 27 was excluded, " to be " a = 0.75; in order to increase fairness subscale reliability, item 27 was excluded”.Line 295. Please rewrite " we calculated means " to be " we calculated the means”.Line 237. Please rewrite " in OLS model for Perception of Experience, Anthropomorphization" to be " in the OLS model for perception of experience, anthropomorphization,”.Lines 300-304. Please rewrite " Perception of Experience in the experimental groups (Experience1 + Experience2) versus Control, however, this is accompanied by higher Anthropomorphization (Contrast1). A contrast test between the experimental groups (Contrast2) revealed higher Perception of Experience in Experience2 than in Experience1, without differences in Anthropomorphization. " to be " perceptions of experience in the experimental groups (Experience 1 + Experience 2) versus control; however, this is accompanied by higher anthropomorphization (Contrast 1). A contrast test between the experimental groups (Contrast 2) revealed a higher perception of experience in Experience 2 than in Experience 1, without differences in anthropomorphization.”.Line 309. Please rewrite " Contrast1 = both experimental groups together (Experience1 and Experience 2) vs the Control group, contrast2 = Experience2 vs Experience1." to be " Contrast 1 = both experimental groups together (Experience 1 and Experience 2) vs. the control group; contrast 2 = Experience 2 vs. Experience 1.”.Line 315. Please rewrite " model 1 and " to be " model 1, and”.Line 317. Please rewrite " (Experience1 + Experience2) with the Control group (X1) and the experimental groups with each other ." to be " (Experience 1 + Experience 2) with the control group (X1) and the experimental groups with each other .”.Line 290. Please rewrite " 102]," to be " 102]”.Lines 291, 292. Please rewrite " a = 0.75, in order to increase Fairness subscale reliability, item 27 was excluded, " to be " a = 0.75; in order to increase fairness subscale reliability, item 27 was excluded”.Line 295. Please rewrite " we calculated means " to be " we calculated the means”.Line 332. Please rewrite " animals and " to be " animals, and”.Line 346. Please rewrite " Moral Patient," to be " moral patients,”.Line 347. Please rewrite " have less moral" to be " have fewer moral”.Lines 356-358. Please rewrite " [77 – 79] maintain their self-perception as moral, avoid social punishment even if they engage in instrumental use of animals [73 - 76] " to be " [77–79] maintain their self-perception as moral, avoid social punishment even if they engage in the instrumental use of animals [73-76]”.Line 360. Please rewrite " constant, and differences in Perception of Experience were " to be " constant and differences in Perception of Experience are”.Lines 364-366. Please rewrite " Experience2 group versus Experience1  since the perception of homeostatic emotions  " to be " Experience 2 group versus Experience 1 , since the perception of homeostatic emotions ”.Line 374. Please rewrite " strongly," to be " strongly”.Line 376. Please rewrite " absence of difference” to be " absence of a difference”.Line 386-387. Please rewrite " Agency, (2) lead to stronger effects of manipulation " to be " agency; (2) lead to stronger effects of manipulation;”.Line 392. Please rewrite " animals" to be " animals.”.Line 396. Please rewrite " Perception of Agency” to be " the perception of agency”.Line 397. Please rewrite " [12] " to be " [12],”.Line 401. Please rewrite " propose anthropomorphization" to be " propose that anthropomorphization”.Line 404. Please rewrite " [109 -111].” to be " [109-111].”.2. We have considered the following comments, and as a result, the text has been partially revised. • Line 311. Please rewrite "  which" to be " , which”.Response:https://journals.plos.org/plosone/s/submission-guidelines and PLOS ONE style templates: https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf it has been changed to:According to the author guidelines: “, which” • Line 334. Please rewrite " upon revealing the total and indirect effects for the outcome variable Violence Intentions " to be " by revealing the total and indirect effects of the outcome variable Violence Intentions ”.Response: https://journals.plos.org/plosone/s/submission-guidelines and the PLOS ONE style templates provided in https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, figures should continue to be cited as "Fig 1," "Fig 2,", so it has been changed to:As per the author guidelines found at “by revealing the total and indirect effects of the outcome variable Violence Intentions ” • Line 338. Please rewrite " Y , Fig 2), " to be " Y, Fig. 2)”.Response:https://journals.plos.org/plosone/s/submission-guidelines and the PLOS ONE style templates provided in https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, figures should continue to be cited as "Fig 1," "Fig 2,", it has been changed to:As per the author guidelines found at " Y, Fig 2” • Line 341. Please rewrite Y - Figs 1 and 2) " to be " Y, Figs. 1 and 2”Response: https://journals.plos.org/plosone/s/submission-guidelines and the PLOS ONE style templates provided in https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, figures should continue to be cited as "Fig 1," "Fig 2,", so it has been changed to: “Y, Figs 1 and 2”. As per the author guidelines found at 3. We have considered the following comments, and as a result, the text has not been revised. • Line 331. Please rewrite " " to be " .Response: https://journals.plos.org/plosone/s/submission-guidelines and the PLOS ONE style templates provided in https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, figures should continue to be cited as "Fig 1," "Fig 2,", so it has not been changed. As per the author guidelines found at  • Line 368. Please rewrite " nor, Can they talk? " to be " Nor, can they talk?)”.Response:The original spelling has been preserved as it is a quoted passage. • Line 381. Please rewrite " . " to be " .”.Response: https://journals.plos.org/plosone/s/submission-guidelines and the PLOS ONE style templates provided in https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf, figures should continue to be cited as "Fig 1," "Fig 2,", so it has not been changed. As per the author guidelines found at 4. In response to the reviewer's feedback, which recommended converting, name of control group, variables’ and subscales’ names to lowercase letters, we implemented a standard format, ensuring all variables and subscales were consistently represented in lowercase letters. • Line 222“Control, Experience 1” to be “control, Experience 1” • Line 249“Experience subscale” to be “experience subscale”  • Lines: 259, 315, 322, 336, 385“Violence Intentions to be “violence intentions” • Line 259, 281, 285, 287, 316, 328, 361, 383-384“Violence Acceptance” to be “violence acceptance” • Line 291-292   = 0.72, Authority �   = 0.70, Loyalty �   = 0.68, Purity �   = 0.73, Fairness 5-item scale �   = 0.75, in order to increase fairness”“Care �to be   = 0.72, authority �   = 0.70, loyalty �   = 0.68, purity �   = 0.73, fairness 5-item scale �   = 0.75, in order to increase fairness”“care � • Line 190, 304, 314, 322, 328, 333, 344, 348-349, 362, 365, 383, 389, 397, 409“Perception of Experience” to be “perception of experience” • Line 307“moral recipient” to be “moral patient” • Table 1, Figures 1 and 2“Perception of Experience ” to be “Perception of experience ”“Perception of Agency (Anthropomorphization)” to be “Perception of agency (anthropomorphization)” • Line 314, 334, Figures 1 and 2“Moral patient” to be “moral patient” • Line 314-315, 335, 389, 409“Perception of Agency” to be “perception of agency” • Line 192, 315, 322, 328, 335“Anthropomorphization” to be “anthropomorphization” • Line 352, Figures 1 and 2Perception of Experience” to be “Perception of experience” • Figures 1 and 2“Violence Intention” to be “Violence intention”“Anthropomorphization” to be “anthropomorphization” • Figures 1 and 2“Experience 1 + Experience 2 vs Control” to be “ Experience 1 + Experience 2 vs, control” • We have implemented a standard format in Appendix.5. On line 202, we have corrected 'path b M → X' to 'path b M→Y' as it was originally a mistake.AttachmentResponse.docxSubmitted filename: Click here for additional data file. 15 Nov 2023Increased perception of the experience dimension of the animal mind reduces instrumental violence against animalsPONE-D-23-19973R1 <span style="color: rgb; font-family: verdana, geneva, arial, helvetica, sans-serif; font-size: 11.2px; background-color: rgb;"> Agnieszka Potocka </span> ,Dear Dr. We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at onepress@plos.org.If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. 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If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. </font> The Reviewer #1: YesReviewer #2: Yes********** <font color="black"> 5. Is the manuscript presented in an intelligible fashion and written in standard English? </font> PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.Reviewer #1: YesReviewer #2: Yes********** <font color="black"> 6. Review Comments to the Author </font> Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. Reviewer #1: The authors have implemented substantial enhancements to the manuscript, effectively addressing the suggestions provided. I am pleased to acknowledge their dedicated efforts in significantly improving the quality of this paper. Their diligent work and commitment to excellence are highly appreciated.Reviewer #2: (No Response)********** <font color="black"> 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.If you choose “no”, your identity will remain anonymous but your review may still be made public.Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. </font> Yes: Yudi AdinataReviewer #1: Reviewer #2: No**********AttachmentPONE-D-23-19973_R1.docxSubmitted filename: Click here for additional data file. 21 Nov 2023PONE-D-23-19973R1 Increased perception of the experience dimension of the animal mind reduces instrumental violence against animals Dear Dr. Potocka:I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. onepress@plos.org.If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. 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A 51-year-old man presented to our hospital with hematochezia, melena, palpitations, and lightheadedness for 1 week. The patient was found to have anemia with a hemoglobin concentration of 73 g/L and a peripheral blood smear suggestive of hypochromic microcytic anemia. To confirm upper gastrointestinal bleeding, an esophagogastroduodenoscopy was performed, revealing a protruding lesion with surface ulceration and active bleeding at the inferior flexure of the duodenum . The leVideo 1 Esophagogastroduodenoscopy is performed for ulcerative tumor, including epinephrine injection, argon plasma coagulation, hemoclipping, and biopsy. The tumor was completely resected by laparoscopic pancreaticoduodenectomy and was confirmed as extraskeletal Ewing sarcoma of the duodenum on histology.EWSR1gene on chromosome 22q12 was found with the gene encoding the transcription factor ERG (exon 8 ofEWSR1fused to exon 9 of ERG) and a wild-typeKRAS/NRAS/BRAF.Postoperatively, the patient was treated with interval-compressed VDC/IE chemotherapy. Two months after surgery, the CT showed no sign of tumor recurrence or enlarged lymph nodes (The patient underwent a laparoscopic pancreaticoduodenectomy for a duodenal carcinoma. Gross examination was notable for an ulcerative tumor of approximately 3 × 3 × 2.5 cm in diameter at the inferior flexure of the duodenum, which had gray-white cup-like shape appearance with solid and cauliflower-like areas . Histolh nodes .Extraskeletal Ewing sarcoma of the duodenum is an extremely rare tumor with a poor prognosisEndoscopy_UCTN_Code_CCL_1AB_2AZ_3AB


Staphylococcus aureus can produce β-lactamases capable of hydrolyzing penicillins and first-generation cephalosporins. The propensity of type A and type C β-lactamase-producing S. aureus (TAPSA and TCPSA) to hydrolyze cefazolin at a high inoculum is termed the cefazolin inoculum effect (CIE). Strains with a CIE have a theoretical risk of causing treatment failure and are unable to be detected routinely by most laboratories. We developed a high-performing yet straightforward β-lactamase disc test that identifies and differentiates both TAPSA and TCPSA and is suitable for routine diagnostic laboratory workflows. Clinical isolates of S. aureus resistant to penicillin were identified, and their blaZ genes were sequenced. MICs were determined at low and high inocula (5 × 105 CFU/mL and 5 × 107 CFU/mL), and isolates demonstrating a CIE were characterized. A semimechanistic model was established to describe differential hydrolysis patterns, and candidate models were iteratively assessed using area-under-the-curve analysis from competitor receiver operating characteristic (ROC) curves. Biomarker thresholds were derived from Youdon index-derived optimal cutoff values. Genetic analysis of 99 isolates identified 26 TAPSA isolates and 45 TCPSA isolates. The model best differentiating TAPSA from non-TAPSA utilized cefazolin-to-cephalothin ratio analysis . The model best differentiating TCPSA from non-TCPSA incorporated cefazolin, cephalothin, and oxacillin . TAPSA and TCPSA can be differentiated using three antibiotic discs on a single agar plate. The test has potential value in typing the β-lactamase type from isolates from patients that are candidates for or have failed cefazolin therapy.IMPORTANCE The key significance of this article is that it details a straightforward method of performing a disc test that can differentiate Staphylococcus aureus isolates that are likely to be associated with a cefazolin inoculum effect and theoretical risk of cefazolin treatment failure from isolates that are less likely to be associated with a cefazolin inoculum effect. Staphylococcus aureus is a well-established pathogen that has developed numerous antimicrobial resistance strategies. β-Lactam-based drugs are a mainstay of treatment but can be rendered ineffective via β-lactamase production or penicillin-binding-protein modification . Four classes of staphylococcal β-lactamases are described , with expression being either constitutive or inducible (–S. aureus (TAPSA) and, to a lesser extent, type C β-lactamase-producing S. aureus (TCPSA) being noted for their propensity to hydrolyze cefazolin, particularly at high inocula . This effect, described as the cefazolin inoculum effect (CIE), has been variously described as either an MIC of ≥16 μg/mL at high inocula and ≤8 μg/mL at low inocula  have historically faced challenges detecting staphylococcal β-lactamase producers; both methods recommend careful assessment of penicillin disc zone edges . ChromogS. aureus isolate’s β-lactamase type, with differentiation of type being historically challenging  against cefazolin identifies strains producing a CIE. However, the method is time-consuming, and given the high- versus low-level expression of β-lactamase from different strains, it remains challenging to predict a strain’s β-lactamase type. While modified nitrocefin tests may have some value  that identifies and differentiates β-lactamase resistance for both TAPSA and TCPSA and can be performed using three antibiotic discs on a single agar plate.Given that cefazolin represents a therapeutic mainstay for ications , 38, then = 45, i.e., 45% of clinical isolates), followed by TBPSA  and then TAPSA . Only a single isolate of TDPSA was isolated .Sequence analysis revealed the presence of all four described classes of β-lactamase circulating in the hospitals tested, with TCPSA being most prevalent  was successful at predicting β-lactamase type, a clinical isolate which had a S. aureus showed little CIE . Given that only a single isolate TDPSA was detected, there was limited opportunity to assess its potential to cause a CIE. During data processing, it was noted that one isolate failed to grow in the control well, and this isolate was excluded from analysis.Cefazolin, cephalothin, cephalexin, and flucloxacillin showed variable hydrolysis profiles depending on β-lactamase type . Among tUsing the criteria of a CIE being an MIC of ≥16 μg/mL at a high inoculum and ≤8 μg/mL at a low inoculum , 12 of 2A Pearson correlation of changes in doubling dilution observed in test strains between antibiotic pairs showed a positive correlation for the majority of pairs, with the remainder being near zero . The strRadial zone sizes varied by β-lactamase and disc type . For eacFor differentiation of TAPSA from TCPSA, cefazolin (30 μg), cephalexin (100 μg), oxacillin (1 μg), and cefoxitin (10 μg) all demonstrated similar disc zone sizes . However, differing distributions were seen for cephalothin (30 μg) for , with TAPSA having demonstrably larger zones than TCPSA. For the differentiation of TCPSA from TBPSA, cefazolin (30 μg) and oxacillin (1 μg) demonstrated the greatest difference in zone size , with TBPSA demonstrating larger zones. Cephalothin (30 μg) and cephalexin (30 μg) demonstrated smaller zone size differences (1- to 2-mm median zone size difference), with TBPSA again demonstrating larger zones. Zone sizes for cefoxitin (10 μg) showed no discernible difference. These observations supported the possibility of using disc zone ratios to differentiate types.A Pearson correlation of changes in disc zone sizes versus changes in MIC doubling dilution stratified by β-lactamase type for cephalexin, cefazolin, and cephalothin demonstrated that, in general, strains that demonstrate a larger inoculum effect between low and high inocula are associated with smaller zones for doubling dilution increases in cephalothin and cefazolin, with the effect being less pronounced for cephalexin .Candidate models were established for TAPSA and TCPSA using the semimechanistic nested approach described below. Regarding TAPSA, univariate analysis of disc sizes revealed the greatest performance of cephalothin and cefazolin disc zone size . This coxA is test values predictive of TAPSA, XA+B+C+D represents test values for all β-lactamase-producing S. aureus isolates that are not MRSA, CZL represents cefazolin zone size, CLT represents cephalothin zone size, and the value 0.896 is derived from a Youdon optimal cutoff value. Test characteristics for detecting TAPSA were as follows: sensitivity, 0.962; specificity, 0.986; area under the receiver operating characteristic curve (AUC ROC), 0.962 , 0.962 ; positivxC is test values predictive of TCPSA, OX represents oxacillin zone size, and the value of 7.26 mm is derived from a Youdon optimal cutoff value. Test characteristics for detecting TCPSA were as follows: sensitivity, 0.886; specificity, 0.966; AUC ROC, 0.951 . Identifying a TBPSA strain would effectively rule out the CIE as a cause of failure.Beyond epidemiological interest, knowing the β-lactamase type of an We found that 26% of strains were TAPSA, which is consistent with other studies which have demonstrated values between 15 and 34% . The strblaZ-R disc test as follows. (i) Inoculate and incubate plates as described. (ii) Using Vernier calipers, measure the zone size from the disc edge to the edge of confluent growth for cefazolin , cephalothin (variable CLT), and oxacillin . (iii) Calculate CZL/CLT. Isolates with values of ≤0.896 are predicted to be TAPSA, and no further disc analysis is required. If the value is >0.896, proceed to step 4, as the isolate is unlikely to be TAPSA. (iv) Calculate OX × CZL/CLT. Isolates with values of ≤7.26 mm are predicted to be TCPSA. If the value is >7.26, the isolate is less likely to be TCPSA . As a demonstration, blaZ-R test using the strain ATCC 29213, which is known to produce type A β-lactamase.We recommend using and interpreting the S. aureus CIE with disc testing. Indeed, while previous studies have identified relationships between β-lactamase type and β-lactam hydrolysis profiles, to our knowledge, this is the first to consider biomarker performance of CIE from a mechanistic perspective.This study has several unique features. It provides the first assessment of a disc test capable of identifying TAPSA (and TCPSA) which are associated with the CIE. Previous methods of assessment have included NAT, enzyme kinetics, or serology testing, with the latter no longer being available. Second, it is the first study to assess the rate of TAPSA and CIE in an Australian context. Of note, the sample of isolates tested had a rate of TAPSA roughly equivalent to rates described elsewhere, although further interpretation is hampered by differing definitions of the CIE. Third, this is the first attempt to mechanistically relate the blaZ-R disc test, further assessment is required. Additionally, further analysis, including of test reproducibility, repeatability, and ruggedness would be beneficial . Isolates from all sample types were reviewed, cultured on blood agar (Oxoid), and identified using matrix-assisted laser desorption–ionization time of flight (MALDI-TOF) mass spectrometry (Bruker). Isolates that tested resistant to penicillin (0.5 U) but susceptible to cefoxitin  using calibrated dichotomous sensitivity (CDS) criteria were selected  were used to verify sequence interpretation (NG_052065.1 and AF086644.1).Published control isolates were obtained for each of the four described β-lactamase types (A to D) , 32, 47:blaZ gene was amplified with forward primer 5′-CAAAGATGATATAGTTGCTTATTC-3′ and reverse primer 5′-CATATGTTATTGCTTGCACCAC-3′ to produce a 355-bp product as previously published . The ublished . Sanger ublished , 48.S. aureus control and test strains were assessed to determine if a CIE existed. This permitted us to assess whether TAPSA circulating in the study population demonstrated a CIE and also to determine the relative importance of other β-lactamase types  regarding a CIE. MICs were determined for isolates using microtiter plates containing Mueller-Hinton broth with serial dilutions of reconstituted flucloxacillin, cefazolin, cephalothin, and cephalexin and inoculated at both low and high concentrations (5 × 105 CFU/mL and 5 × 107 CFU/mL). Plates were incubated at 35 to 37°C in ambient air. Low- and high-inoculum MICs were determined at 24 h through visual inspection. Two methods of characterizing a CIE were used, given the variations in the literature. The first method involved identifying isolates that had a cefazolin MIC of ≥16 μg/mL at the high inoculum and a cefazolin MIC of ≤8 μg/mL at the low inoculum , cephalothin , oxacillin , cefoxitin , penicillin , and cephalexin  for all isolates using a CDS-based method of inoculum preparation . Additioa priori information, including biologically plausible and published hydrolysis profiles  relate to the amount (a) of β-lactamase produced (e) of blaZ  of blaZ genes expressed  are also influenced by the β-lactamase type’s hydrolysis profile (p) (c) . Dysfunctional agr loci have been positively correlated with the CIE , and thnd TDPSA ). Differfile (p) , 10, 47,file (p) , and the the CIE , but givh) affect the MIC and alter disc zone size (z). Increasing h reduces z, with the degree of effect influenced by experimental factors (t), such as agar depth, antibiotic diffusion through the agar, and antibiotic disc potency. Hence, h ~ t × (1/z) ~ t/z. Consequently, the disc zone size (z) for any β-lactamase type and antibiotic combination can be generalized as t/nepc.Differences in β-lactam hydrolysis (z) may be used individually or in combination to differentiate β-lactamase types as a biomarker. Assessment of biomarker performance can be iteratively undertaken using receiver operating characteristic (ROC) curves and area under the curve (AUC) assessments. Where possible, testing of antibiotic combinations should be based on biologically and mechanistically meaningful associations .Given the above-stated relationship, disc zone sizes (1z and 2z), one can calculateHydrolysis ratios of two (or more) antibiotics have been used previously to predict β-lactamase type , 47. Conn1 = n2, e1 = e2 under standardized experimental conditions , organism count c1 = c2, and t1/t2 becomes constant for any antibiotic combination (denoted k). Hence, z1/z2 = k(p2/p1).The method permits β-lactamase type to be isolated by cancelling out factors such as plasmid count, β-lactamase expression, and testing-related factors such as organism count, accounting for variable zone sizes and MICs. Specifically, for a given strain, A nested approach to selecting specific β-lactamase types can be employed whereby a primary model can initially identify (and therefore permit exclusion of) a given type. The nested secondary model then selects from the remaining isolates those that match a secondary profile . This increases the pretest probability in the second-round model construction. The performance of resultant biomarker cutoff values can be evaluated by blindly applying them to new strains, such as control strains that represent well-characterized β-lactamase types, to determine if they provide an accurate and reproducible prediction.Using this basis, competitor combinations of disc zone size and indexes derived from ratios of disc zone sizes were iteratively compared using receiver operating characteristic curves, with the area under the curve being compared at each step. The selection of variables (and combination of variables) for testing was based on a combination of empirical assessment  and the assessment of results from disc testing and MIC testing data. For the first iterative step, all discs were assessed from an empirical standpoint. For the second iterative step , combinations of discs and MICs were considered based on the characteristics of their distribution. Specifically, ratios were established for discs or MICs that showed markedly different distributions based on their median value and range between (i) TAPSA and TCPSA for the TAPSA model and (ii) TCPSA and TBPSA for the TCPSA model. For the third iterative stage , combinations of the three top performing candidates from the preceding steps were assessed. For each candidate, the optimum test sensitivity, specificity, accuracy, positive likelihood ratio, and negative likelihood ratio from Youdon index-calculated optimum binary cutoff values were calculated.


British Columbia 8–1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers’ subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases.We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan–Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors  and call factors  with concordance as hazard ratios.We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68–0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46–0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01–1.62]) or within 7 days (1.23 [95%CI: 1.11–1.37]), were more likely to do so than urban callers.Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to “Go to ED” is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.The online version contains supplementary material available at 10.1186/s12913-023-09821-w. Many Canadian provinces have publicly funded, nurse-managed telephone services to support citizens with urgent health concerns. These services provide information on management and on whether, when, and where to seek appropriate care –5. In BrExisting research suggests that concordance between advice given on nurse-managed telephone triage services and subsequent health service use ranges between 62 and 75%,  with conWhen examining concordance, it is important to consider trends documented in the literature around the use of health services. Of particular interest are patterns around the “appropriate” use of emergency care among subpopulations we may see reflected in BC. Lower levels of education have been positively associated with likelihood of both high and low acuity visits, with income showing a similar pattern . PersonsA key concern for triage is that the ED often serves as a “safety net” for patients who lack access to appropriate primary care . LavergnResearch on the impact of the addition of VP consultation to nurse-managed telephone triage is extremely limited as few jurisdictions offer this service. Li et al. have published an evaluation of a similar program for veterans in the US which compares the clinical outcomes of telephone triage utilizing emergency physicians in addition to nurses versus nurses alone. However, the focus of this program was to better direct patients to in-network emergency departments rather than identify the most appropriate modality of care, precluding direct comparison to HEiDi . In a prThis exploratory, hypothesis-generating analysis uses population-based administrative data to examine concordance between virtual physician advice and subsequent health services use.We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases.We conducted a retrospective, time-to-event  analysis of routinely collected administrative health data. This study was approved by the University of British Columbia’s Clinical Research Ethics Board (H21-02209).The study was conducted in British Columbia, Canada. As of April 2021, BC had approximately 5.2 million residents  distribuWe used BC Ministry of Health’s Health Data Platform BC (HDPBC) to access anonymized, linked administrative health data in a secure environment. Linkage between datasets was conducted using anonymized Personal Health Numbers (PHN).HealthLink BC provided access to their 8–1-1 dataset to identify HEiDi callers during the study period. 8–1-1 data also included the level of nurse triage , health concern associated with call ”), time of call, and VP category of advice given (“disposition” – e.g. “Go To ED Now”). To mitigate potential confounding of concordance from multiple calls for the same or new issues, only the first call from each caller in a two-week period was used for this analysis. We used “cardiovascular” as the reference health concern for VP advice as this is widely understood as an urgent concern by both clinicians and the lay public. The most urban HA in BC, Vancouver Coastal, was used as the baseline for regional comparison. Finally, the 21–40 year-old age category was the most frequent and so used as the reference for comparisons across age.We used the Discharge Abstract Database (DAD)  and NatiThe NACRS dataset, only includes data for approximately 29 EDs, typically at larger, urban hospitals constituting 70% of BC ED visits .We used consensus-derived operational definitions of existing HEiDi VP advice categories assigned by VPs at the end of each call, and the interpretation in Table We have previously reported details of the 8–1-1 and HEiDi service and call-flow . All of We used the following definitions of concordance, developed through consultation with HEiDi virtual physicians, health service researchers and a patient partner from the BC Emergency Medicine Network’s Patient Council. Virtual physicians strongly indicated that concordance could only reliably be assessed over a one-week (seven day) time-horizon, as over extended periods the likelihood that service use stems from issues unrelated to the reason for the index call increases Table .Table 2OConcordance is considered achieved if the first service used by the caller subsequent to the call aligns with physician advice. Use of other services after this initial encounter is still considered concordant, but use of other services prior to the advised service does not. For example, for “Go to ED Now”: a caller who saw an FP or was hospitalized prior to their ED visit would not be counted as concordant. However, a caller who saw an FP and/or was hospitalized following their ED visit would be.We conducted a time-to-event (TTE) analysis using a Cox proportional hazard model  for eachWe used SQL Server Management Studio  to query and link records across databases. Eligible records were extracted and imported to R  for statistical analysis.We also conducted sensitivity analysis with expanded definitions of concordance, incorporating broader health services use, for the three dispositions Table .Table 3OVPs expressed concern that strictly “binary” definitions of concordance may be misleading as advice given to callers often includes conditional statements and may be layered “You should do X unless Y changes, then look into doing Z”. This means the patient-caller could be initially told to “Seek FP care now” unless a given symptom worsens, in which case “Go to ED now”. We can only observe the initial layer of advice, but this sensitivity analysis allows us to view patterns of callers’ behaviour with the allowance for conditional advice unobservable in the data.In this exploratory analysis, we examined sensitivity analysis results for any significant, systematic difference from primary analyses.n = 775, 4.0%) were also excluded, leaving 17,188 calls included in the analysis.From November 16, 2020 through April 30, 2021, the HEiDi service recorded 19,186 VP encounters with 8–1-1 callers. 1998 calls (10.4%) were excluded: 946 (4.9%) due to missing data, 24 (0.1%) corresponding to a deceased individual, 253 (1.3%) for being a repeat call within 14 days. The callers whose disposition was labeled as “Other”  over age 21, with age 21–40 being the most frequent age group and median age of callers ranging from 35.6 to 42.1 years by disposition. Callers were disproportionately high SES as compared to the general population reported in BC census data, with 25.1% in the top quintile. Rurality varied slightly by disposition but was generally slightly higher than from provincial population estimates of ~ 13% . Approxi.3% over Seventeen percent of calls triaged to VPs were advised to seek immediate emergency care, 48% were advised to seek care in the community, and 36% were advised to self-manage . Advice to “See FP now” was 49.6% and “Schedule FP Appointment” was 50.1%. Similarly, 48.9% of callers advised to “Self-Manage” did not use any additional services , or if their call was triaged by a nurse as “red-MD” rather than “yellow” (1.10 [1.01–1.20]). Individuals calling with an Obstetric/Postpartum health concern (0.62 [0.46 – 0.83]) or with a Gynecological concern (0.74 [0.56–0.98]) were less likely than those with a cardiovascular concern to be concordant.Callers over 65 years old were more likely (1.48 [1.16–1.88]) to be concordant with physician advice to “Seek FP care now” compared with individuals in the 21–40 age category. Those at the second lowest level of economic deprivation (1.35 [1.06—1.70]) and second highest level (1.32 [1.03—1.69]), as compared to the least deprived, were more likely to be concordant. We observed no difference in concordance by the nature of the callers’ health concern for this disposition.As with the “Seek FP care now” disposition, callers over 65 (1.30 [1.17–1.45]) and infants (1.19 [1.02–1.39]) advised “Schedule FP Appt” were more likely to be concordant than the 21 to40 year old reference category. Also, those with Obstetric /Postpartum (1.56 [1.23- 1.97]) or Pharmaceutical (Medication) (1.60 [1.03–2.46]) concerns were more likely to be concordant. Callers in this category without an attached FP were less likely to be concordant (0.76 [0.68–0.85]).For the “Self-manage” disposition, there was a varying relationship with age, with children aged 2 to 5 (1.48 [1.21–1.80]) and children/adolescents 6 to 20 years old (1.49 [1.25–1.77]) more likely than the 21–40 reference category to stay home. Older adults (0.89 [0.80–0.98]) and seniors (0.73 [0.64–0.83]) were comparatively less likely to do so. Callers without an attached FP were more likely to be concordant (1.22 [1.08–1.37]), as were those whose medical concerns were in the “First Aid” category (1.43 [1.07–1.92]). In contrast, callers with health concerns in the Obstetrics/Postpartum (0.40 (0.30—0.53)], Psychology (MH) (0.53 [0.30 – 0.93]), and Respiratory (0.75 [0.59 – 0.96]) categories were less likely to be concordant. Those callers triaged to “RED” by a Nurse (vs yellow) (0.89 [0.82–0.97]), calling in the evening (vs day) (0.85 [0.79–0.93]) and at the second lowest level of economic dependency (vs lowest) (0.89 [0.80–1.0]) are also less likely.We observed no significant difference in concordance by sex or weekends vs weekdays across any of the four dispositions Table .With expanded definitions of concordance that consider broader health service utilizations, we found higher rates of concordance over 48 h and seven days for the “Go to ED Now”, “Seek FP Care Now”, and “Schedule FP Appointment” dispositions. For the latter seven-day dispositions, we found a marked increase in events during the first two days, mainly due to the inclusion of ED visits. For the “Go to ED Now” disposition, there were increases at 12 and 24 h with the inclusion of physician encounters outside of the ED. We observed some additional small changes to the significance of independent variables in some models, but no changes in the direction of observed relationships  and lowest for those instructed to seek care in their community (41% and 47%). The rate of concordance with advice to seek ED care we found was consistent with or higher than those reported in previous studies of nurse-led telephone triage services that do not include virtual physicians – which suggests VPs may reinforce urgency. However, rates of concordance with advice to seek the care of a FP was low compared with previous studies .We found a significant effect of geography in all four models, with individuals living in rural areas  having a fundamentally different pattern of service use than urban areas, with ED use being lower and FP use higher. This may be because rural FPs in BC may be more likely to provide urgent after hours care and visits outside of office compared to their urban counterparts . Evidenchigh acuity, and so comparisons to the literature are not exact.Current literature on the general population level impact of rurality on ED use has mostly focussed on lower-acuity presentations and signals are not always clear, however they suggest that lower SES and rurality are associated with higher ED use , 13, whiConcordance with advice to “Seek FP care now” was below 50%, and there was little difference in concordance between the “Seek FP care now” and “Schedule FP Appointment” dispositions. Primary care access challenges are pervasive and persistent in BC , 33, 38 Lavergne et al.’s study on declining access to primary care in BC noted that within urban settings, encounters declined more rapidly in low-income areas while ED visits increased more rapidly. In this period, the percentage of physicians providing support for neighborhoods in the two lowest income quintiles declined from 30.6% to 26.3% . Hedden Concerningly, lack of attachment to a FP does not have a statistically significant effect on concordance for the most urgent FP advice category. This suggests that having a regular FP does not guarantee timely access to primary care, at least within the 7-day follow-up period we used. Additionally, if it is infeasible for patients to access an FP in the timely manner implied by the “Seek FP care now” disposition, we would suggest this advice category be modified, and possibly combined, with “Schedule FP Appointment” to reflect the real-world access to care of callers.We did not observe differences in concordance by health concern, with the exception of callers with obstetric/postpartum and gynecological issues. Such patients appear to be less likely to attend an ED, more likely to schedule an FP appointment, and less likely to stay home when advised, suggesting that this group of patients may require additional communication efforts by VPs when provided advice and perhaps additional care pathways.When conceptualizing potential strategies for HEiDi and Healthlink moving forward, we find some suggestions in the telehealth literature. In a 2016 systematic review of telehealth strategies in rural and remote Australia, Bradford et al. identified 6 key factors influencing success and sustainability: vision, ownership, adaptability, economics, efficiency, and equipment . “AdaptaA final consideration for how callers’ may consider their health service use in BC, but arguably throughout Canada, should be the 2020 “In Plain Sight” report on Indigenous-specific racism and discrimination in healthcare. While out of scope of for this population-level analysis, the report highlights concerns around the perception of EDs and/or hospitals as unsafe may deter Indigenous persons from seeking care . SimilarThis is a hypothesis-generating analysis using routinely collected provincial administrative data and is subject to all the limitations thereof including missing or incorrect data. We conducted this analysis during earlier phases of the COVID-19 pandemic when there were significant concerns about seeking in-person care, and this may have reduced ED and in-person physician visits; patients with access to virtual primary care  may have been more concordant.It merits consideration that health categories may be miscategorized due to overlapping symptomology or miscommunication. Furthermore, it is not possible to determine whether the reason for a HEiDi call is the same reason for which a patient ultimately seeks in-person care as the HEiDi/811 service is not able to clinically determine and capture a standardized diagnostic code.Furthermore, we did not have access to unique identifiers for nurse and/or VP providers in our data. This precluded the identification of baselines and trends within and across providers, including analyses such as clustering.Seventy percent of callers to a virtual physician triage service who are advised to go to an emergency department do so within 48-h, suggesting an overall high-degree of concordance with this advice. However, this is markedly lower in rural areas and the Northern health authority, which suggests the need for targeted assessment of access to emergency care, particularly with regard to distance and difficulty travelling from home to ED.Less than half of those advised to seek follow-up care with a physician in the community do so within seven days, and there is little difference between those advised to seek FP care now and those advised to seek such care within seven days. In conjunction with recent literature, this may be driven by long-term trends restricting access to primary care in BC. Qualitative analysis of patient-caller’s decision making from their perspective would be beneficial in further understanding these findings. The drivers for the low rates of concordance with advice, particularly with advice to seek care in the community, merit future research.Additional file 1: Supplementary Material.


Trifolium montanum L. Ecology and Evolution, 13, e10376. https://doi.org/10.1002/ece3.10376Karbstein, K., Römermann, C., Hellwig, F., & Prinz, K. (2023). Population size affected by environmental variability impacts genetics, traits, and plant performance in We apologize for the following errors:Karbstein et al., 2019; Kirschner et al., 2020).”‐ In the Introduction, the reference “Karbstein, Prinz, et al., 2020” must be replaced with “Karbstein et al., 2019,”: “However, highly genetically differentiated, niche‐pessimum/marginal range populations may still have sufficient genetic variation and can be valuable sources and important targets for nature conservation efforts due to site‐specific adaptations  and (d) contained typos , and thus Figure 3 needs to be replaced by the newly supplied Figure 3. 2 refers to the five plots recorded in each location: “Habitats are moderately species‐rich (19–33 species in 20 m2).”‐ In the Results, the term “transect” must be removed, as the 20 mhigher the variation  of soil depth (18%), altitude (10%), N (9%), and slope exposure (8%) the larger the population size, and the higher the variation of LAI (19%), K (14%), pH (12%), P (5%), and slope (5%), the lower the population size.”‐ In the Results, the effect direction of certain relationships was mixed up, so please replace the specific text part with “The ‐ In the Discussion section, the text part concerning environmental habitat variation in relation to population size needs to be replaced because the direction of effects was mixed up while interpreting the results.T. montanum populations are characterized by increased LAI, soil pH, K, and slope . Increased variation in these factors indicates habitats with patches of high and low light, specific nutrients, and biotic competition conditions that reduce the dominance of grass species and allow the presence of less competitive species like T. montanum. In contrast, reduced variation in slope exposure, slope, and soil N leads to large population sizes because T. montanum prefers north‐exposed, flat, rather nutrient‐poor habitats.”Old text: “For example, large T. montanum. Large populations of this species are also characterized by reduced variation  of LAI and soil pH, indicating the preference of T. montanum to grow under low light and biotic competition on rather calcareous soils.”New text: “For example, increased variation in soil depth and nitrogen, and altitudinal variation (Table 5) leads to large populations because different nutrient conditions on shallow to deep soils in hilly habitats reduce the dominance of grass species and enable the existence of less competitive species like


The COVID-19 pandemic may have increased the prevalence of psychiatric disorders, such as anxiety, depressive disorders, and post-traumatic stress disorder (PTSD), among healthcare workers.This study aims to investigate the prevalence of PTSD and its risk factors among residents in the standardized residency training programs (SRTPs) in Shanghai during the COVID-19 outbreak.An online cross-sectional survey was conducted between December 17, 2021, and January 7, 2022, among SRPT residents from 15 hospitals in Shanghai, China. Questionnaires comprising general information, medical-related traumatic event experiences, the PTSD Checklist (PCL-5), and the perceived social support scale (PSSS) were distributed to the participants using the online Questionnaire Star electronic system.p < 0.05), and perceived social support had a significant negative association with PTSD (p < 0.05).We included 835 valid responses for the analysis. In total, 654 residents (78.3%) had experienced at least one traumatic event, and 278 residents (33.3%) were found to have PTSD symptoms. The age 26–30 years old, female sex, and increased resident working hours were identified as the risk factors for PTSD (During the COVID-19 pandemic, there was a high prevalence of PTSD among SRTPs residents in Shanghai. The age 26–30 years old, female sex, and increased resident working hours were identified as risk factors for PTSD, while perceived social support was identified as a protective factor against PTSD. The present findings can be applied in STRPs management and provide useful information for designing special interventions and protocols for SRTPs residents. The prevalence of probable PTSD in HCWs is about three times than observed in the general population. This pattern is due to the long-term work-related stressors HCWs must endure . StudiesIn China, standardized residency training programs (SRTPs) were first implemented in Shanghai in 2010 to set quality standards for residency training . Since tStudies have found that young age, low work experience, heavy workload, working in unsafe settings, as well as a lack of training and social support are predictors of stress-related symptoms . SRTP re2.2.1.The Department of Ethics Commission of Ruijin Hospital/Lu Wan Branch within the School of Medicine of Shanghai Jiaotong University  provided ethical approval (LWEC2020031) for our study protocol.www.wjx.cn/) was used, and questionnaires were distributed to participants as a link via the WeChat (www.wechat.com/), with the help of the education departments of selected hospitals. The inclusion criterion for participants was residents enrolled in an SRTP from 2019 to 2021.Online informed consent for participation was obtained upon completion of the questionnaire. Fifteen hospitals providing SRTPs in Shanghai were selected as research units using a multistage method based on stratified random-cluster sampling. The online Questionnaire Star electronic system , and the perceived social support scale (PSSS).The screening questionnaire was written in Chinese and comprised four main components: general information, medical-related traumatic experiences, PTSD Checklist for the 2.2.1.The general data of participants collected were hospital level, sex, age, education, medical specialty, training grade, marital status, average number of hours worked per week, and salary.2.2.2.The checklist for medical-related traumatic events in the questionnaire comprised nine common traumatic events: “criticism/bullying by senior doctors,” “criticism/bullying by other SRTP residents,” “failing an important examination,” “iatrogenic exposure/infection,” “conflict with patients/family members, being threatened or attacked,” “medical negligence and malpractice,” “patients died/deteriorated,” “medical isolation/separation,” and “yourself or hospital colleague fell seriously ill.” If participants had experienced traumatic events that were not included in this checklist, they could describe it as “other.” Furthermore, those who reported at least one traumatic experience were required to select the most affecting traumatic event and continue to PCL-5 and the PSSS. If they had not suffered a traumatic experience, the survey was terminated, and participants were excluded from the diagnosis of PTSD.2.2.3.PCL-5 is a self-reported screening measurement with 20 items to assess PTSD symptoms. The responses on PCL-5 are given using a Likert scale, and the severity of each symptom is divided into five levels: 0 = “not at all”; 1 = “a little bit”; 2 = “moderately,” 3 = “quite a bit”; 3 = “extremely.” The maximum score is 80. We used a cutoff score of 33 points  to deter2.2.4.The PSSS consists of 12 items, with four items measuring “family support,” four items measuring “friend support,” and four items measuring “significant other support.” The responses for each item are ranked on a seven-point Likert scale . The total score of perceived social support is the sum of all items, with a high score indicating a high level of perceived support.In the present study, social support was categorized into three levels according to the total score: “low” (PSSS score < 37), “moderate” (37 ≤ PSSS score ≤ 60), and “high” (PSSS score > 60) . The Chi2.3.A total of 867 online questionnaires from 15 hospitals were collected, and 32 questionnaires were excluded because of incomplete data (15 questionnaires) or response times of less than 90 s (17 questionnaires). Finally, 835 valid responses were included valid for analysis, the response rate was 96.3%, as shown in 2.4.p ≤ 0.10. p < 0.05 was considered significant unless stated otherwise.Statistical analyses were undertaken using SPSS 25.0 . Categorical variables are expressed as absolute values (percentages). The internal consistency of the total scores of PCL-5 and the PSSS was evaluated using Cronbach’s alpha. Analyses of descriptive statistics were conducted to examine the demographic and other selected characteristics of participants. Pearson’s chi-square test or Fisher’s exact test were used to compare differences among subgroups. Multivariate logistic regression was employed to assess the risk factors for PTSD variables that were significant in the univariate analysis at 3.n = 493, 59.0%). The prevalence of PTSD was higher in women (41.5%) than in men (27.6%). Respondents were between 20 and 30 years of age (n = 776). Respondents were mainly undergraduates . Specifically, 194 respondents were in their third year, 266 were in their second year, and the largest number of respondents were in their first year  of training. Most respondents: were medical practitioners ; were unmarried ; worked 50–60 h per week ; had a monthly salary of 5,001–8,000 yuan .n = 278, 18.6%) was lower than that for respondents with a low level of social support  or moderate level of social support   had a low level of social support (PSSS score < 37), 307 residents (36.8%) had a moderate level of social support (PSSS score ≥ 37 and ≤ 60), and 478 residents (57.2%) had a high level of social support (PSSS score > 60). Social support was negatively associated with PTSD. The prevalence of PTSD in respondents with a high level of social support ( < 0.05) .n = 147, 17.6%), surgery , gynecology , pediatrics , general practice , emergency medicine , anesthesiology , medical imaging , rehabilitation , and other . The specialties with the lowest prevalence of PTSD were general practice (20.7%), surgery (19.91%), and internal medicine (17.6%). Except for the specialties of pediatrics and rehabilitation, which had a small number of respondents, the medical specialties with the highest proportion of individuals screening positive for PTSD were surgery (40.4%), gynecology (37.1%), internal medicine (33.3%), and anesthesiology (33.3%). Overall, 33.3% of the sample (n = 278) screened positive for PTSD.p = 0.003), being aged 26–30 years , and working an average of 50–60 h per week , 60–70 h per week , 70–80 h per week , and > 80 h per week  were significantly associated with a greater probability of having PTSD symptoms. There were no significant differences (p > 0.05) in the prevalence of PTSD among residents based on their education, medical specialty, marriage status, or monthly salary.Overall, 654 (78%) residents reported experiencing at least one traumatic event. The most common traumatic stressors were “failing an examination” (47%), “witnessing death” (40%), and “bullying by superiors” (39%) . Traumatp < 0.001), “criticism/bullying by other SRTP residents (disharmonious relationship)” (OR = 2.366，p < 0.001), “failing an important examination” , and “medical isolation/separation”  were risk factors for PTSD (Multivariate analysis with adjustment for potential confounders showed that the medical profession-related traumatic events of “criticism/bullying by senior doctors” (OR = 2.269，for PTSD .4.A number of studies have confirmed the negative psychological impact of experiencing a disaster, suggesting that the subsequent risk of suffering from PTSD is substantial . The conOverall, 33.3% of SRTP residents were found to have PTSD symptoms. This prevalence is significantly higher compared with that in research on PTSD among HCWs in the three previous outbreaks of coronavirus-related diseases . For exaAmong the demographic characteristics of SRTP residents, age, sex, and long working hours were associated with PTSD prevalence. Studies have demonstrated a higher level of work-related stress and “burnout” among female physicians compared with that experienced by male physicians , 27. In Social support has been proposed to be the most efficacious way to alleviate the physical and emotional impacts of stressors . Social Failing an examination, witnessing death, and bullying by superiors were the most commonly reported traumatic stressors among all SRTP residents. In general, there were similar trends of reported traumatic stressors between SRTP specialties. In addition, traumatic stressors were related to the work content and context of the specialism. For example, the prevalence of “witnessing death,” “conflicts at work,” and “iatrogenic exposure” in the specialty of medical imaging was lower than that in the other medical specialties. More than 45% of SRTP residents specializing in pediatrics answered “yes” to experiencing five traumatic stressors, indicating the high pressure and workload of pediatric medicine in China .It is noIsolation is an effective form of public-health management to prevent the spread of infectious diseases. However, isolation is associated with negative psychosocial effects, including depression, anxiety, anger, and PTSD. Samrah et al.  reportedThe present study had two main limitations. First, we focused on the occurrence of and risk factors for PTSD among STRP residents instead of clinical diagnoses and therapy. Therefore, the self-reported screening measures of PTSD and social support were applied in our study, but clinician-administered measures may have led to different results. Second, our cross-sectional research showed a strong bidirectional relationship between PTSD and social support, but we could not determine the direction of causality between social support and PTSD symptoms. Further research may be needed to ascertain if our findings can be replicated using longitudinal data.5.The present findings demonstrate that there was a high prevalence of PTSD among SRTPs residents in Shanghai during the COVID-19 pandemic. The age 26–30 years old, female sex, and increased resident working hours were identified as risk factors for PTSD, while perceived social support was identified as a protective factor against PTSD. The present findings can be applied in SRTPs management for designing special interventions and protocols to protect the mental health of SRTPs residents.Publicly available datasets were analyzed in this study. This data can be found here: the datasets presented in this article are not readily available because the data includes sensitive and private information. According to the ethical approval we cannot share it with the third party.The studies involving humans were approved by the Department of Ethics Commission of Ruijin Hospital/Lu Wan Branch, School of Medicine, Shanghai Jiaotong University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.RH participated in conception, design of the work, data interpretation and analysis, drafting, and revision of the manuscript. CT, TL, LW, and CL participated in the acquisition and interpretation of data. JL and LC participated in the data analysis and revision of the draft. LC and SW made contributions to the concept and design of the study, acquisition of data, manuscript revision, and supervision. All authors approved the publication of this final version.