The aim of this integrative review is to determine the effectiveness of integrated heart failure (HF) care in terms of patient-, service- and resource-related outcomes, and to determine what model or characteristics of integrated care work best, for whom and in what contexts.Integration of health and social care services is a significant driver in the development of better and more cost-effective health and social care systems in Europe and developed countries. As high users of health and social care services, considerable attention has been paid to the care of people with long-term conditions. HF is a progressive, prevalent and disabling condition, requiring complex management involving multiple health and social care agencies.An integrative review was conducted according to a framework by Whittemore and Knafl (2005). A literature search was undertaken using the databases: Medline, CINAHL, Embase, PsychINFO and the Cochrane Library, using key words of ‘heart failure’ OR ‘cardiac failure’ AND ‘integrated’ OR ‘multidisciplinary’ OR ‘interdisciplinary’ OR ‘multiprofessional’ OR ‘interprofessional’ OR ‘collaborative care’. Application of the inclusion and exclusion criteria resulted in 17 articles being included in the review. Articles were screened and coded for methodological quality according to a two-point criteria. Data were extracted using a template and analysed thematically.Integrated HF care results in enhanced quality of life (QoL), and improved symptom control and self-management. Reduced admission rates, reduced length of hospital stay, improved prescribing practices and better care co-ordination are also reported. There is more limited evidence for improved efficiency although overall costs may be reduced. Although findings are highly context dependent, key features of integrated HF models are: liaison between primary and secondary care services to facilitate planned discharge, early and medium term follow-up, multidisciplinary patient education and team working including shared professional education, and the development and implementation of comprehensive care pathways. Significant policy initiatives in recent years have created a platform for integrated health, social care and support services in the United Kingdom and internationally. The Health and Social Care Act . The Cardiovascular Disease Outcomes Strategy  is one of a number of diseases that sit within the umbrella term of cardiovascular disease. HF is a common, progressive, life-limiting condition affecting around 550 000 people in the United Kingdom in 2014 BHF, .The clinical management of heart failure is based on established national and international guidelines NICE, . The BHFAn integrative review methodology was used according to the approach of Whittemore and Knafl . This coa complex clinical syndrome of symptoms and signs that suggest impairment of the heart as a pump supporting physiological circulation’  relating to methodological rigour and relevance , case studies (n=5) and comparative designs (n=4). Two articles presented analysis from several different case studies  was widely reported  and medium term (6 months) follow-up, patient self-management education provided by a multidisciplinary team, medication optimisation, multidisciplinary team working; shared education and the development and implementation of comprehensive patient pathways across settings.et al. (Jaarsma et al.  developeMultidisciplinary teams most commonly consisted of doctors and nurses, both specialist and non-specialist. Dietician and pharmacist input is also cited, most specifically in providing patient education in relation to diet and medication management. This is not an unsurprising finding given the importance of a low sodium diet and fluid management and adherence to complex medication regimes NICE, . Howeveret al. (A few studies detailed either the severity or type of HF. Although Riegel et al.  differenet al.  functionet al. , it seemThe search for effectiveness and clearly defined patient outcomes through integrated care service delivery in general remains elusive, due to patient multi-pathology, multiple integrated care configurations and methodological design challenges (Billings and Leichsenring, The management of HF presents complex challenges for individuals, their families and caregivers, society and health and social care economies. To address this, a number of countries have implemented integrated HF services either involving multidisciplinary team working in primary and community care, or across primary, community and secondary care settings. Multidisciplinary teams most frequently include specialist nurses and doctors but also pharmacists and dieticians. There is good evidence to suggest integrated HF care produces better outcomes for patients and improved care co-ordination across services and organisations. There may also be a reduction in costs, primarily due to reduced hospital admission rates and length of stay. A number of features of integrated HF care models are identified which are most likely to result in improved outcomes. These include liaison between primary and secondary care to facilitate planned discharge, early and medium term follow-up, multidisciplinary patient education and team working including shared professional education, medication optimisation and the development and implementation of comprehensive care pathways across settings.There is considerable heterogeneity of integration models, methodologies and outcomes so that meta-analysis is not possible. However, an integrative review does allow conclusions to be drawn. Only articles published in English were included which may limit both the scope and the generalisability of findings. Although some authors reported the challenges of implementing integrated HF care, outcomes were exclusively positive which may suggest some publication bias.Service commissioners and provider organisations should develop integrated health and social care services for HF, including at end-of-life. This includes the development and implementation of agreed care pathways spanning primary and secondary care with consideration given to a core set of interventions. The effectiveness of these pathways, within specific contexts, should be evaluated. There is not a one-size fits all model; effective integration depends on the availability of resources and the context within which health and social care systems operate. Patients and carers should be involved in the co-design of services.


The relationships between land cover characteristics in riparian areas and the biological integrity of rivers and streams are critical in riparian area management decision-making. This study aims to evaluate such relationships using the Trophic Diatom Index (TDI), Benthic Macroinvertebrate Index (BMI), Fish Assessment Index (FAI), and random forest regression, which can capture nonlinear and complex relationships with limited training datasets. Our results indicate that the proportions of land cover types in riparian areas, including urban, agricultural, and forested areas, have greater impacts on the biological communities in streams than those offered by land cover spatial patterns. The proportion of forests in riparian areas has the greatest influence on the biological integrity of streams. Partial dependence plots indicate that the biological integrity of streams gradually improves until the proportion of riparian forest areas reach about 60%; it rapidly decreases until riparian urban areas reach 25%, and declines significantly when the riparian agricultural area ranges from 20% to 40%. Overall, this study highlights the importance of riparian forests in the planning, restoration, and management of streams, and suggests that partial dependence plots may serve to provide insightful quantitative criteria for defining specific objectives that managers and decision-makers can use to improve stream conditions. Land development in watershed and riparian areas can significantly alter hydrology, hydraulics, pollution loading, and the transport mechanisms of pollutants, which substantially contribute to poor stream water quality and the degradation of stream ecosystems ,2. As exRiparian buffers can manage stormwater by mitigating surface runoff processes, such as decreasing flow velocity and increasing residence time ,9. It isDifferent statistical methods have been used to study the relationships between land cover characteristics and stream ecosystems, including multiple regression, regression trees, and redundancy analysis. Such conventional statistical methods assume the normality and spatial independence of the observed datasets, as well as linearity and non-multicollinearity between dependent and independent variables ,21. In mAs the relationships between landscape indicators and aquatic ecosystems are nonlinear and complex , the resThis study aims to improve the understanding of the effects of riparian land cover on the biological integrity of streams using machine learning algorithms to handle the associated complex and nonlinear datasets. The overall objectives of this study are as follows: (a) to investigate the relative importance of land cover characteristics in riparian buffer zones on the biological indicators of streams, and (b) to analyze the critical change points and visualize the average effects of riparian land cover proportions and their spatial patterns on biological indicators. The results of this study provide essential insights for establishing management strategies and restoration plans in riparian buffer zones, in order to enhance ecological functions and mitigate the negative effects of stormwater runoff. Additionally, identifying the threshold responses of aquatic ecosystems to riparian land cover can provide objective quantitative criteria for land use zoning regulations and restoration programs.2 in area). The Han River is located between 36°30′ and 38°55′ N latitudes and between 126°24′ and 129°02′ E longitudes. The Han River system covers the middle region of the Korean Peninsula and flows from east to west  of Korea has hierarchically divided watersheds to manage the water environment across the entire country, including the national watershed management regions (NWMRs), base watershed management regions (BWMRs), and sub-watershed management areas (SWMAs). There are six NWMRs, 29 BWMRs, and 265 SWMAs in the Han River basin. The Han River basin is the largest basin in South Korea, which includes Seoul, the capital of South Korea, and the land development pressure and population growth are concentrated, with approximately 53% of the entire population living in the basin. Accordingly, maintaining the water quality and aquatic ecosystem functionality in the Han River basin are essential, as it is a primary water source for human development.Achnanthes convergens, Baetis fuscatus, and Zacco platypus, respectively. The NAEMP has adopted the following three indicators to evaluate the status of streams , the Korean MOE monitors rivers and streams using different indicators to evaluate habitat condition, biological community integrity , and other biochemical conditions across the entire nation twice a year. Aquatic organisms, as key indicators of overall basin integrity, can be used to assess the long-term effects of anthropogenic disturbances on streams and overcome the limitations of applying chemical parameters ; therefo streams : the TroWe selected the proportions of land cover type (% land cover) and their spatial patterns to measure the land cover characteristics of the riparian area. To acquire % land cover and spatial patterns in riparian buffer zones, we used a land use/land cover (LULC) dataset obtained from the Korean MOE. The LULC map of the riparian buffer zones was converted into raster data (10 × 10 m), and the land cover pattern metrics were calculated using the FRAGSTATS  software . The oriAs the proposed buffer width varied considerably in previous studies ,16,19, sMultiple metrics should be considered to describe the different spatial characteristics of landscapes ,41. We sAs indicated in the previous introduction, machine learning algorithms, such as artificial neural networks (ANNs), support vector machines (SVMs), and random forests are preferred, as they go beyond traditional statistical methods, owing to their ability to handle non-parametric datasets and nonlinear relationships ,24,42. IWe developed three random forest models for each biological indicator using 12 explanatory variables, including proportions of land cover  and land cover spatial patterns . We employed the “randomForest” package for the statistical language R . We set The general results of the biological indicators, percentage of land cover types, and their spatial patterns are displayed in Random forest models were developed for each biological indicator, and their performances were compared. The RMSE values for TDI, BMI, and FAI were 23.47, 17.07, and 20.73, respectively, while the MAE values were 19.06, 13.08, and 15.99, respectively . The resThe random forest algorithm ranked the relative importance of land cover characteristics in the riparian buffer zone for the TDI, BMI, and FAI . Higher We show PD plots for the proportions of forest, urban, and agricultural areas, which are identified as common important predictors of the biological indicators in the random forest models . The PD Many previous studies have researched the influence of land cover characteristics on biological communities in streams ,48,49. RThe results of this study suggest that the predictive capabilities of macroinvertebrate and fish models were better than those of diatoms in assessing the impacts of riparian land cover on the biological integrity of streams in the Han River basin. Diatoms are more sensitive to local perturbations than to watershed and riparian-scale land cover changes, likely due to their lower mobility, although they are sensitive to nutrients and organic pollution ,52. ConvThe influence of land cover characteristics on stream-based biological communities differs depending on the aquatic organisms under consideration ,54,55. EAmong the proportions of riparian land cover, riparian forest areas had the greatest effect on the three considered biological communities, followed by riparian urban areas and agricultural areas. These results are consistent with those of many studies that have shown that riparian forests play an important role in sustaining biological integrity in streams ,15,19. CUrban and agricultural areas in the watershed and riparian zone negatively influence the quality of aquatic organism habitats, affecting their structure and composition . Urban aMany previous studies have shown that the responses of stream conditions to land cover characteristics are nonlinear and that abrupt change points exist, which are called thresholds ,29,30,64Our results demonstrate that the proportions of riparian land cover types offer a more powerful factor of stream-based biological community integrity than riparian land cover patterns. Conversely, when evaluating the impacts of land use, models informed by macroinvertebrate and fish have been shown to have greater predictive power than the diatom-informed model. Studies have also shown that fish could be considered the most efficient indicator when evaluating riparian land cover impacts. Our results clearly indicate that riparian forests play a significant role in determining the biological integrity of streams. We observe thresholds in the relationships between riparian land cover characteristics and stream-based biological indicators. Specifically, thresholds in riparian urban areas were lower than those in riparian agricultural areas, and more riparian forests had a positive influence on the biological indicators. Our results suggest that the proportions of riparian land cover should be considered as a quantitative criterion for riparian zone management and restoration. In particular, threshold analysis provides a quantitative standard for riparian land cover planning. Our results also imply that an ideal approach could involve restoring riparian forest to mitigate the impacts of urban and agricultural land use and protect the biological integrity of stream ecosystems. The results of this study provide essential insights which may help inform decision-making processes where riparian land cover planning, management, and restoration is concerned.


Mood disorders like major depressive (MDD) and obsessive compulsive (OCD) disorders affects 300 million people worldwide, and 20–30% are refractory to drug therapy . OCD couDeep Brain Stimulation (DBS) has been proposed to treat patient's refractory to drug treatment of these disabling disorders in the same surgical target's network . Using pEarly neurophysiological reports described two systems within the central nervous system, the one linked to transmit single sensory modalities named specific and the other to facilitate the perception of all sensory modalities named non-specific systems . SimultaIn contrast, lesions of the OFC plus the ventral caudate nucleus render the cat hyperactive, with compulsive walking and eating and without orienting reaction. Lesions restricted to mesial OFC, or cooling of fibers connecting OFC with NST in the inferior thalamic peduncle (ITP) blocked recruiting responses and induced methodic walking, with animals unable to switch directions in the presence of an obstacle and remaining pawing the cage, they persevered following a visual stimulus regardless its information content , 13. In Pathways between OFC and NST, cortical  and basal ganglia (caudate and putamen) are bidirectional and their inactivation produce similar effects on recruiting responses, spindle burst and motor behavior –21. Sub Paroxetine, a serotonin re-uptake inhibitor, improves OCD and MDD, which provides evidence of relationship between serotoninergic dysfunction in these disorders. In an experimental model of perseverative behavior induced by chemical OFC lesions in rats, associated to a paradigm of luminous signal indicating food rewarding by pressing a lever , ThereafSeveral neurotransmitters, neuropeptides and hormones are involved in the physiopathology of MDD . Low lev18FDG-PETstudies  , that haBeyond the selected target to treat OCD and TRD there are questions that need to be resolved for improving DBS in the treatment of mental illness:Stimulation Parameters: DBS for the treatment of TRD and OCD in different targets has been performed with HFS  derived from experience of DBS in movement disorders. As mentioned before, HFS increases alertness and hyperkinesia when applied to non-specific reticulo-thalamic system, while LFS  is required to induce cortical synchronization and hipokynesia. Lesions and HFS applied in the white matter fiber bundle between red nucleus and sub thalamic nucleus, within the prelemniscal radiations (Raprl) for the treatment of Parkinson's disease on a white matter fiber bundle connecting mesencephalon with the OFC, reduced hipokynesia  if posterior medial and anterolateral OFC are connected with cortical and subcortical structures by different fiber tracts, running in parallel and mediating depressive vs. obsessive compulsive behaviors. 2. If in the same fiber tract low frequency high amplitude improves OCD and high frequency low amplitude improves TRD, in the same way that non-specific thalamic nuclei low frequency high amplitude stimulation induces sleep and high frequency low amplitude induces awakening. Optimization of therapy will include probabilistic and/or deterministic tractography guiding electrode implantation, high amplitude low frequency vs. low amplitude stimulation and size and location of the target, away from structures where DBS could induce undesirable side effects.FV: original idea, manuscript writing, and surgeon in charge of the mood disorders (OCD and TRD) patients that underwent to surgery. RM-F: probabilistic tractography analysis and manuscript writing. JC-R: surgeon in charge of the mood disorders (OCD and TRD) patients that underwent to surgery. AV: neurologic evaluation and neurophysiological recordings of patients that underwent to surgery for mood disorders (OCD and TRD). All authors contributed to the article and approved the submitted version.RM-F is a doctoral student from the Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM) and has received from the Consejo Nacional de Humanidades, Ciencias y Tecnologías (CONAHCYT) the fellowship number 939081.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Machine learning has been extensively used in analyzing big data and in conditions where the number of parameters is much bigger than the number of observations. Recently, there have been an increasing number of successful applications of machine learning in genomic prediction as this method makes weaker assumptions, is capable of dealing with the dimensionality problem, and can be more flexible for describing complex relationships. In this study, we evaluated the predictive ability of three machine learning methods, namely, random forest (RF), extreme gradient boosting (XGB), and support vector machine (SVM), when predicting the carcass traits of Hanwoo cattle. These machine learning algorithms were compared with the standard linear method (GBLUP). Our results revealed that XGB method had the best predictive correlation for carcass weight and marbling score. Meanwhile, the best predictive correlation for backfat thickness and eye muscle area was delivered by GBLUP. Moreover, in terms of mean squared error (MSE) of prediction, GBLUP delivered the lowest MSE value for all traits.Hanwoo was originally raised for draft purposes, but the increase in local demand for red meat turned that purpose into full-scale meat-type cattle rearing; it is now considered one of the most economically important species and a vital food source for Koreans. The application of genomic selection in Hanwoo breeding programs in recent years was expected to lead to higher genetic progress. However, better statistical methods that can improve the genomic prediction accuracy are required. Hence, this study aimed to compare the predictive performance of three machine learning methods, namely, random forest (RF), extreme gradient boosting method (XGB), and support vector machine (SVM), when predicting the carcass weight (CWT), marbling score (MS), backfat thickness (BFT) and eye muscle area (EMA). Phenotypic and genotypic data  from 7324 commercial Hanwoo cattle that were slaughtered at the age of around 30 months were used. The results showed that the boosting method XGB showed the highest predictive correlation for CWT and MS, followed by GBLUP, SVM, and RF. Meanwhile, the best predictive correlation for BFT and EMA was delivered by GBLUP, followed by SVM, RF, and XGB. Although XGB presented the highest predictive correlations for some traits, we did not find an advantage of XGB or any machine learning methods over GBLUP according to the mean squared error of prediction. Thus, we still recommend the use of GBLUP in the prediction of genomic breeding values for carcass traits in Hanwoo cattle. The Korean native cattle (Hanwoo) was originally raised for draft purposes, but the increase in local demand for red meat turned that purpose into full-scale meat-type cattle rearing; it is now considered one of the foremost economically important species and a vital food source for Koreans . This brUp to date, different genomic prediction methods based on linear models have been developed, such as genomic best linear unbiased prediction (GBLUP) , single-Machine learning methods, such as random forest (RF) , boostinThe objective of this study was to compare the predictive performance of three machine learning methods, namely, RF, XGB, and SVM, with the conventional genomic prediction model (GBLUP) when predicting the carcass weight (CWT), marbling score (MS), backfat thickness (BFT) and eye muscle area (EMA) of Hanwoo cattle. Comparisons in terms of predictive correlation and mean squared error were used as metrics.The data on four carcass traits were collected from 7234 Hanwoo cattle slaughtered at the age of around 30 months. Carcass weight (CWT), marbling score (MS), backfat thickness (BFT), and eye muscle area (EMA) were the traits under study. The animals in this study were produced through the purebred mating system done using artificial insemination of semen collected from bulls initially selected on the basis of their performance and progeny carcass traits. All of these animals were gathered from different herds in nine provinces across South Korea. The ethics approval for this study was given by the Animal Care and Use Committee of the National Institute of Animal Science, Rural Development Administration, Korea 2018-293). The descriptive statistics for each trait are presented in 18-293. Tp-value lower than 0.0000001, and situated on the sex chromosomes were removed from the genotype data. After quality control, 45,624 SNPs were retained for genomic prediction.A total of 7324 animals were genotyped for 53,866 SNPs using the customized Hanwoo 50K SNP Chip  according to the manufacturer’s protocol. The genomic DNA was quantified from tissue samples using the DNeasy Blood and Tissue Kit . The following threshold levels were applied for quality control using PLINK : SNPs wiIn this study, three machine learning algorithms, namely, random forest (RF), extreme gradient boosting (XGB), and support vector machine (SVM), were evaluated. These machine learning algorithms were compared with the standard linear method, GBLUP. The predictive performance of the different methods was assessed using a fivefold cross-validation scheme composed of five subpopulations that were randomly split into more or less equally sized groups. In cross-validation, each subpopulation (~1446) was given a chance to be used as the validation set and the other four subpopulations were used as the training set. The predictive correlation was calculated as a Pearson correlation between predicted and observed phenotypes. Furthermore, the mean squared errors of prediction were calculated. y is a vector of observed phenotypes, μ is the overall mean, 1 is a vector of ones, is is a vector of genotypes for SNPi , g is a vector of the genomic breeding values of all individuals G is the marker-based genomic relationship matrix [Z is an incidence matrix linking g to y, and e is the vector of random residual effect The general animal model could be expressed asp matrix , Z is anion 2.21  was usedRandom forest is a type of bagging method which is also known as bootstrap aggregating, and it was first proposed by Breiman . It is aThe extreme gradient boosting (XGB) method  is a kinThe support vector machine (SVM) is a supervised regression method that supports linear and nonlinear regression. Generally, SVM is used for classification or regression problems. It works on the basis of enlarging the feature space using various kernels such as linear, polynomial, and sigmoid Gaussian RBF .Linear kernels are mainly used for linear problems, whereas RBF kernels are used for nonlinear problems. A thorough guide and review on this method can be found in Smola and Schölkopf . In thisVariance components and heritability estimates for each trait are presented in The random forest method has been used in many genomic prediction studies. González-Recio and Forni  comparedThe SVM method is a popular machine learning algorithm used in genome-enabled prediction due to its capability to handle potential nonlinearity between features and target traits in both animals and plants ,30,31. PAmong machine learning methods, only the boosting method XGB outperformed GBLUP for some traits (CWT and MS) in terms of predictive correlation, as shown in Among machine learning methods, there is no universal prediction model. Predictive ability depends on the trait and is affected by many factors. In the machine learning field, the “no free lunch theorem”  states tOur results indicated that machine learning method XGB had the best predictive correlation for CWT and MS. Meanwhile, the highest predictive correlation for BFT and EMA was achieved by GBLUP. Although XGB presented higher predictive correlations for some traits, we did not find an advantage of XGB or any other machine learning method over GBLUP in terms of mean squared error of prediction. Therefore, we still recommend the use of the conventional statistical method GBLUP in the prediction of genomic breeding values for carcass traits in Hanwoo cattle.


Understanding how biological communities change over time is of increasing importance as Earth moves into the Anthropocene. A wide variety of methods are used for multivariate community analysis and are variously applied to research that aims to characterise temporal dynamics in community composition. Understanding these methods and how they are applied is useful for determining best practice in community ecology.We reviewed the ecological literature from 1990 to 2018 that used multivariate methods to address questions of temporal community dynamics. For each paper that fulfilled our search criteria, we recorded the types of multivariate analysis used to characterise temporal community dynamics in addition to the research aim, habitat type, location, taxon and the experimental design.Most studies had relatively few temporal replicates; the median number was seven time points. Nearly 70% of studies applied more than one analysis method; descriptive methods such as bar graphs and ordination were the most commonly applied methods. Surprisingly, the types of analyses used were only related to the number of temporal replicates, but not to research aim or any other aspects of experimental design such as taxon, or habitat or year of study.This review reveals that most studies interested in understanding community dynamics use relatively short time series meaning that several, more sophisticated, temporal analyses are not widely applicable. However, newer methods using multivariate dissimilarities are growing in popularity and many can be applied to time series of any length. A hallmark of the Anthropocene Epoch is the increasing pace and variance of environmental change . Thus, mSimple community measurements, such as the number of taxa (‘species richness’), are frequently used to monitor and predict change in biodiversity; these measures, however, offer no insight into more complex community changes, such as in the relative commonness and rarity of the species present . For exaKnowledge of the types of multivariate analyses being applied in the temporal community dynamics literature is crucial because this is a constantly evolving field at the challenging interface of biology, statistics and bioinformatics . A firstIn this paper, we take a cross-disciplinary approach to review empirical studies published up until the start of 2019 that have conducted analyses of multivariate temporal community datasets to gain insight into how researchers have applied analysis methods over the past several decades. We summarise trends in the use of multivariate methods to analyse compositional community temporal dynamics and provide a summary of the available methods. Specifically, we asked: (1) have different taxa, habitat types or spatiotemporal scales been investigated more or less comprehensively over the past three decades; (2) which analysis methods are applied most often, and has this changed over time; (3) does the level of temporal replication affect the analyses applied; and (4) are analyses applied differentially across research questions? The answers to these questions will assist us to identify both the methods used in temporal community analysis and gaps in our understanding of community change using data collected from diverse combinations of spatiotemporal scales, taxa and habitats.We examined the literature for studies investigating changes in ecological communities over time. Specifically, we searched the ISI Web of Science Core Collection for articles published until 31 December 2018 using the following search statement: ). We refined this search to include only document types listed as ‘articles’ and published in ‘English’. This search yielded 820 articles for review. Of these, we excluded 257 papers that lacked community data (i.e. those that included fewer than three taxa), had no temporal replication or pooled all temporal data, used only artificial communities or simulated datasets, or used space-for-time substitution . Although we constrained the search to the end of 2018, we did not constrain the search window for the beginning date. However, our search terms only returned papers after 1990, reflecting that the specific terms we used were not part of the compositional change literature prior to the 1990s. We also note that this also excluded a great deal of the literature on ecological succession, which uses more specific terminology.We extracted and collated key attributes relating to each study in the remaining 539 papers from the ISI database . Specific study attributes were determined from the body text of each manuscript, including information on (i) habitat type ; (ii) continent ; (iii) taxonomic identity ; (iv) manipulation ; (v) spatial extent ; (vi) temporal grain and extent ; and (vii) the key perceived research aim . We categorised organisms being studied into the following taxonomic groups: plants (Kingdom Plantae); vertebrates (Phylum Chordata); invertebrates ; microeukaryotes ; prokaryotes (Domains Bacteria and Archaea); and viruses (non-cellular pathogenic organisms). Spatial extent was determined relative to the dispersal ability of the taxa involved, e.g., a ‘local’ study would be across a larger area for birds than for soil invertebrates. The categories were (1) small scale: micro, point, and local scales (within-populations) and (2) large scale: regional (among sites), continental and global scales. Research aims were classified broadly using statements in the abstract and introduction regarding the authors intentions. If hypotheses were tested, these were used to classify the study aims as relating to environmental interactions, taxon interactions or spatiotemporal variation at different scales.a.k.a. coefficient of variation) and multiplicative change. Multi-taxon papers were analysed separately as independent data points if the taxa were sampled and analysed independently. The full list of papers reviewed and collated review data are provided in the We recorded the types of multivariate analysis used in each study, that is, analyses that use the taxon-sample matrix as an input . The sean to 548). The majority of studies (68%) were conducted within North America and Europe  contained more than one independent dataset; those instances were treated as multiple studies that were analysed as separate data points  compared to large spatial extents . Across the 16 habitat categories identified from the articles, and the most frequently-sampled (69%) habitats were freshwater (141 studies), marine (106 studies), forest (72 studies) and grassland (69 studies) habitats. At small spatial extents, there were more studies in forest, grassland, freshwater, estuarine, intertidal and artificial habitats .Across all communities, the most common temporal extent  of individual studies was years (46% of studies), and only a minority of studies, predominantly on plant and vertebrate communities extended over a period of one decade or longer . Smallern = 375) applied more than one analysis method and 36% of studies (n = 196) used three or more methods. ‘Descriptive’ methods  were used most widely , with ordination (25% and 57%), raw dissimilarity (20% and 47%), time-lag analysis (9% and 21%), and cluster analysis (7% and 15%) comprising the next most common types of methods; the remaining 10 methods were used infrequently , environmental effects (n = 107), disturbance and/or succession (n = 92) and species interactions (n = 47). For the vast majority of research aims and analysis types, community dynamics analyses were based on fewer than 25 temporal samples, with many based on ten or fewer samples . This is consistent with a previous review of experimental field studies  and a geThe ecological literature applying multivariate methods of temporal community dynamics literature is large and diverse, covering a multitude of taxa, habitats, and research questions. Datasets collected encompass all spatial and temporal scales. There is little consistency across taxa, habitats or research questions in the analysis methods that have been applied; however, the majority of studies were focussed on primarily detecting patterns in temporal dynamics and, unsurprisingly, smaller, short-lived organisms were more likely to be studied at finer temporal scales than longer-lived organisms. Our understanding of patterns and drivers of changes of biological communities would benefit by having more longer-term studies  conducten = 183) used only descriptive methods to analyse compositional community dynamics. However, restricting analyses to interpretation of descriptive and visual patterns limits the ability of researchers to either quantify or predict future ecological data trends. Indeed, it was clear that many researchers recognised the limitations of these descriptive analyses; 28% of studies used a descriptive method in combination with at least one other analytical method, which would enhance the ability to understand the complexities of any observed temporal patterns. Given the complexities inherent to temporal community dynamics datasets, we suggest that this type of multi-analysis approach better-enables researchers to reveal nuances of temporal change in their datasets (e.g., Our understanding of temporal dynamics in biological communities and the methods available to investigate them have diversified over the past 29 years, ostensibly because of increases in computational power and in dataset size. A multitude of different data visualisation and statistical methods are available for understanding community change, many of which offer different sets of advantages and disadvantages. Descriptive methods that only visualise trends in the data, such as bar graphs or tables, and ordination remain the most commonly used analyses, regardless of the research aim. About one third of studies (ts e.g., .The increased use of methods based on raw compositional dissimilarities since the early 2000s may be because, like ordination and descriptive methods, these techniques work with community time series of any length. Methods based on raw community dissimilarity scores are flexible and can be used to analyse spatial and temporal variation simultaneously. For example, Our review confirms the need for more long-term studies in ecology  and the 10.7717/peerj.11250/supp-1Supplemental Information 1Click here for additional data file.


Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results.The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR  reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups.In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy.The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023.The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population.ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047DERR1-10.2196/30711 Suicide is the second leading cause of death among those aged 10-29 years and the ninth leading cause of death overall, with reports of 4000 completed suicides per year in Canada -9. AmongThe psychological and neurobiological consequences of adverse or traumatic experiences may moderate the development of suicidal thoughts and behaviors . The neuEye Movement Desensitization and Reprocessing (EMDR) is evidence-based therapy, initially developed for PTSD, that desensitizes painful memories, so that present reminders no longer provoke overwhelming emotional responses . EMDR isEMDR is guided by the Adaptive Information Processing (AIP) model, in which present symptoms are seen as unprocessed explicit and implicit memories stored in the brain that lead to maladaptive information processing and present as posttraumatic and other psychiatric symptoms. In theory, EMDR facilitates the accessing and processing of traumatic memories to an adaptive resolution, after which the disturbing affective distress is relieved, physiological arousal is reduced, negative beliefs are reformulated, and alternative ways of responding to future similar situations are considered .Suicide researchers have hypothesized that suicidal thoughts and behaviors may emerge when environmental triggers activate dimensions of risk in individuals who have been exposed to past adverse experiences and trauma. Two relevant theories include the Escape Theory and the Fluid Vulnerability Theory ,23. The suicidal mode, a time-limited suicidal state with individual characteristic features related to the person’s suicidal belief (cognitive) system, affective system, physiological system, and behavioral  system, which together work in synchrony. This theory proposes that the risk state and suicidal mode can be activated by either external or internal triggers, and usually ends in a state “characterized by specific or core cognitive themes , acute dysphoria and related physiological arousal , and associated death-related behaviors” ) or nonparametric  tests, where appropriate. For multiple comparisons in the analysis, the error rates will be adjusted appropriately using Bonferroni corrections. ANOVA followed by multiple comparison tests will be applied where the number of within-subject test times k>2 (t tests or nonparametric equivalents, as appropriate. The statistical criterion for type one errors will be a 2-tailed probability of P≥.05, after appropriate adjustment for multiple comparisons. The main statistical contrast will compare measures for the EMDR versus the TAU group; particular emphasis will be placed on the primary outcome variables of severity of SI before and after treatment in each group. Pre- and posttreatment effects on rating scales will be analyzed using parametric (2-tailed imes k>2 . For sinIt is anticipated that the active recruitment, psychotherapy treatment, and data collection phase of this study will take 18 months to complete. We expect to report the primary and secondary outcomes by mid-2023. The primary outcome will be changes in SI; secondary outcomes will include changes in reported depressive, anxious, dissociative, and PTSD symptoms, as well as changes in emotional dysregulation. In addition, we will report on dropout rates and adverse effects that emerge during EMDR treatment. Study participants will be informed about the trial results via a plain language summary that will be sent to them. Academic papers and summary reports will be provided to the Mental Health Foundation for knowledge dissemination. Evidence regarding the safety and efficacy of EMDR in the context of SI will be discussed with Alberta Health Services and presented in clinical academic settings to support knowledge translation and knowledge implementation.There exists a significant body of literature demonstrating that childhood and adult adverse experiences are strongly associated with SI, suicide attempts, self-injurious behavior, and the development of a wide range of psychiatric illnesses -9. If thCurrent treatment of SI usually focuses on treating comorbidities such as depression and teaching new ways of coping, thinking, or behaving. None of the currently recommended treatments for suicidality target memories directly. EMDR desensitizes the emotionality of traumatic memories, followed by reprocessing the associated negative core belief with a more adaptive one. A recent RCT using EMDR for suicidal thoughts in inpatients with depression offers the first RCT evidence that EMDR can specifically reduce suicidal thoughts . This adIf the study results support the use of EMDR as a safe and effective treatment for people with SI, it would challenge current clinical norms. The PTSD literature suggests that treating PTSD with TFTs reduces SI, even after controlling for depression and hopelessness ,71. Howe


This quality improvement study evaluates the electricity costs associated with the use of oxygen concentrators for home oxygen therapy among Medicare beneficiaries in the US. Although there are several technologies available to deliver home oxygen, including compressed gas cylinders, liquid oxygen technologies, and oxygen concentrators, oxygen concentrators remain highly used due to their ease of use and no need for refills. Although the cost of oxygen concentrators and other durable medical goods is covered by Medicare, the cost of operating these devices is not. Despite the high prevalence of oxygen concentrators and expected increase in use due to the COVID-19 pandemic, minimal information is available about the financial burden of these devices and potential impact on device adherence.3 The number of total Medicare beneficiaries per state was obtained from the Kaiser Family Foundation.4 Annual electricity cost data were obtained from the US Energy Information Administration Electricity Data Browser for each state at residential delivery prices.5 Data regarding average watts used per hour were obtained by reviewing common user manuals from various oxygen concentrator models.6 For the purposes of generating estimates, concentrators were assumed to run 24 (continuous), 12, or 8 hours per day, 365 days per year. Annual electricity cost estimates were generated by multiplying the kilowatt-hour price of electricity by the wattage of the concentrator and the annual number of hours used. Analyses were conducted between March 4 and August 4, 2021, using R software. The Standards for Quality Improvement Reporting Excellence (SQUIRE) reporting guideline was followed in the preparation of this manuscript. As an analysis of aggregate and deidentified public use data, this study was not human subject research as defined by 45 CFR 46.102.For this quality improvement study, we obtained the most recent Durable Medical Equipment data from 2018 for fee-for-service Medicare beneficiaries from the Centers for Medicare & Medicaid Services data warehouse. Data were filtered to retain only those Healthcare Common Procedure Coding System descriptions that included “oxygen concentrator,” which were combined for analysis.The cost of electricity varied substantially by state, resulting in wide variation across simulated oxygen concentrator costs in 2018 . Hawaii,This study’s findings suggest that, depending on the needs of the patient, local electricity prices, and the flow rate of oxygen prescribed, the cost of running electric oxygen concentrators can vary substantially and potentially result in financial hardship or suboptimal use of therapy because of cost concerns. Concentrator prescription patterns were highly variable by state. Factors such as altitude, prevalence of pulmonary disease, air quality, occupational exposures, and average age of beneficiaries likely contribute to prescribed oxygen flow rates and oxygen concentrator use patterns. Limitations of this study include lack of patient-level data, including concentrator use, health outcomes, utility service information, and nonelectricity costs to patients. Further study is needed to better characterize the relationship between durable medical equipment with persistently highly variable costs, such as oxygen concentrators; patient use patterns; and health outcomes.State and federal policy makers should consider the implications of high-cost durable medical equipment and consider policy solutions to offset the cost of these devices. Particular consideration should be given to individuals with fixed or low income who receive these medical devices through Medicare and Medicaid programs. These patients are less likely to possess the resources to use the devices as intended without serious financial or health consequences, particularly if electricity is shut off due to nonpayment.


Ovarian cancer is a serious threat to women's health; its early diagnosis rate is low and prone to metastasis and recurrence. The current conventional treatment for ovarian cancer is a combination of platinum and paclitaxel chemotherapy based on surgery. The recurrence and progression of ovarian cancer with poor prognosis is a major challenge in treatment. With rapid advances in technology, understanding of the molecular pathways involved in ovarian cancer recurrence and progression has increased, biomarker-guided treatment options can greatly improve the prognosis of patients. This review systematically discusses and summarizes existing and new information on prognostic factors and biomarkers of ovarian cancer, which is expected to improve the clinical management of patients and lead to effective personalized treatment. Ovarian cancer is the most fatal gynecological tumor, its incidence is next to cervical cancer and endometrial cancer, but its mortality rate is the first among reproductive system malignancies. According to the data of cancer statistics in 2020, the number of new cases is about 21750 and the number of deaths is 13940 The main contents of this review are divided into two parts: classic prognostic factors and novel prognostic factors. Classic prognostic factors included clinicopathologic factors  and serum CA125. New prognostic factors mainly include blood- or tissue-based biomarkers. The ovarian cancer field has lagged in incorporating targeted therapies into standard treatments, these novel biomarkers are expected to provide therapeutic targets for ovarian cancer, thus guiding clinical practice, improving patient prognosis and ultimately reducing the risk of death of ovarian cancer patients.Based on the topics discussed in this review, we systematically searched the recent medical literatures on novel prognostic biomarkers of ovarian cancer in PubMed and PMC databases by using our search strategy. All the literatures included in the study were published between February 1, 2015 and February 1, 2021. After excluding the duplicated literatures in the two databases, a total of 1,923 literatures met the restriction conditions. Then the retrieved literatures were imported into the literature management software Endnote. Preliminary screening was performed by reading the titles and abstracts of the literatures to exclude irrelevant studies, and then the full text of the included literatures was evaluated. In order to ensure the reliability of the research results, we only selected studies with more than 50 ovarian cancer patients, and the biomarkers studied in the literature were consistent with the clinical results. The inclusion and exclusion criteria and search strategy are provided in the appendix. Finally, a manual search was conducted in major journals and the reference lists of the selected papers to find other relevant citations that were missing by the electronic search.A total of 297 different novel prognostic biomarkers were reported in 296 studies that met the inclusion criteria Figure . These pClinicopathologic factors and serum CA125 level are independent factors affecting the prognosis of ovarian cancer patients, which have been widely used to guide accurate and reasonable clinical treatment, so as to improve the survival rate of patients.The clinicopathological factors that affect the prognosis of ovarian cancer mainly include: FIGO stage, degree of differentiation, degree of tumor reduction surgery, course of chemotherapy. Previous literature has reported the importance of ovarian cancer staging for prognosis and treatment options, ovarian cancer can be classified as stage I-IV according to FIGO staging criteria, and most patients have stage III disease. Studies have shown that patients with stage I ovarian cancer have a 5-year survival rate of more than 90%; when ovarian cancer is confined to the pelvis (stage II), the estimated 5-year survival rate is about 70%; when ovarian cancer has spread to the entire abdominal cavity (stage III) or to distant parts (stage IV), the 5-year survival rate is less than 30% Surgery is the most effective treatment for ovarian cancer, once suspected for ovarian cancer, should be performed as early as possible. Staging surgery is performed for early stage cancer, including resection of the tumor and definite staging. Tumor cell reduction was performed for advanced cancer, and the primary tumor and all metastases were removed as far as possible to minimize the number of tumor cells. Studies have confirmed that the degree of tumor cell reduction and the number of residual lesions after the first operation are important prognostic factors for advanced ovarian cancer P<0.0001). There was no statistically significant difference in median OS in patients with 6 courses of chemotherapy, 7 courses of chemotherapy, 8 courses of chemotherapy or more than 8 courses of chemotherapy (P=0.816) Chemotherapy is an important adjuvant treatment for ovarian cancer, and most ovarian cancer is sensitive to chemotherapy. Platinum-based drugs (cisplatin and carboplatin) and taxanes (paclitaxel and docetaxel) are chemotherapy drugs commonly used in the treatment of ovarian cancer CA125, encoded by the MUC16 gene, is a classic marker for the diagnosis of ovarian cancer and was first described in the study of Bast RC et al In order to develop a powerful predictive tool with both sensitivity and specificity to monitor ovarian cancer response to treatment, the research on prognostic biomarkers for ovarian cancer is continuously advancing.Blood test is minimally invasive, simple and easy to obtain specimens, and blood test results are widely used in clinic to assist the guidance of treatment. A variety of novel prognostic biomarkers derived from blood can provide a new tool for the clinical management of ovarian cancer. A total of 43 blood based biomarker studies met our selection criteria Table , of whicA large number of studies have shown that chronic inflammation is closely related to the occurrence and development of cancer, and a variety of inflammatory cells and inflammatory factors participate in and promote the proliferation, invasion and metastasis of tumor cells, and affect the prognosis of patients P<0.05). In addition, SATB1 may reprogram energy metabolism in ovarian cancer by regulating LDH and MCT1 levels to promote metastasis Alterations in energy metabolism are a decisive biochemical feature of tumor cells, in other words, abnormal activation of glycolytic pathway still exists in tumor cells even under the condition of sufficient oxygen supply, consume large amounts of glucose and eventually produce lactic acid in order to satisfy energy supply of malignant tumor cell proliferation, this phenomenon is called aerobic glycolysis of tumors, also known as the Warburg effect P=0.03), which predicted poor prognosis Mesothelial protein (MSLN) is a cell surface glycoprotein, which was found by Chang et al. Aurora A kinase (AAK) is encoded by the Aurka gene and is a member of the serine/threonine kinase family. And as an important mitotic regulator, it can participate in many processes of cell mitosis and maintain chromosome division and spindle stability together with centrosomes + T cell failure and induces proliferation of myeloid inhibitory cells by binding to T cell immunoglobulin mucin 3 (Tim-3), thereby participating in immune escape of tumor cells P=0.005), multivariate analysis further demonstrated that both plasma galectin-8 and galectin-9 could be promising biomarkers for poor prognosis in high grade serous ovarian cancer patients Galectin is an important member of the lectin superfamily, it is widely expressed in a variety of cell types and plays an important role in apoptosis, angiogenesis, cell migration, and tumor immune escape. Dysfunction or altered expression of galectin is associated with a variety of cancer types P=0.015). Moreover, the VEGF-A level of patients was correlated with FIGO stage. Multivariate analysis showed that serum VEGF-A could be an independent prognostic factor for OS of patients Angiogenesis plays an important role in tumor growth and metastasis. Neovascularization provides oxygen and nutrients to tumor cells, which can enhance cell proliferation and invasion ability MicroRNAs (miRNAs) are a class of single-stranded small RNAs encoded by endogenous genes, which regulate the expression of target genes by acting on target mRNA to promote its degradation or inhibit its translation The overwhelming majority of selected biomarker studies investigated different tissue-based biomarkers using a variety of technical research methods. The selected tissue prognostic biomarkers can be divided into immunohistochemical biomarkers (68.77%) + T cells is positively correlated with survival + and CD8+) in tissue samples. Multivariate analysis showed that intraepithelial CD4+ TIL infiltration was associated with better PFS and OS, intraepithelial CD8+ TIL infiltration was only associated with better PFS. This confirms previous studies that ovarian cancer patients with high infiltration of CD4+ and CD8+ TIL have better prognosis. As a new method for the treatment of ovarian cancer, the potential value of targeted immunotherapy is an important research direction, which can be used to guide clinical practice, reduce recurrence and improve the long-term survival rate of patients.As a new type of anti-tumor effector lymphocytes with potential therapeutic value, the correlation between TIL and patient prognosis and survival has been widely concerned. Through systematic literature retrieval, we determined that TIL is a promising prognostic biomarker, and its level can be detected by immunohistochemistry. TIL can be classified by function and location in the tumor tissue, which is generally associated with better prognosis and survival, in which the presence of CD8P=0.0669) and poorer OS (P=0.0405), and increased SOD2 expression was a predictive biomarker for poor prognosis in EAOC Mitochondrial superoxide dismutase (MnSOD or SOD2) is the most important antioxidant enzyme in mitochondria, which protects cells from oxidative damage induced by reactive oxygen species (ROS) and lipid peroxidation by converting endogenous superoxide to hydrogen peroxide P<0.05). A subsequent study validated the prognostic significance of HS3ST2 methylation in patients with advanced EOC in three separate dataset of TSGH, AOCS, and TCGA, studies have confirmed that HS3ST2 inhibits the malignant phenotype of ovarian cancer by interfering with various carcinogenic ligand signals, such as IL-6, FGF2 and EGF, and patients with low HS3ST2 expression accompanied by high expression of carcinogenic cytokines or growth factors have the worst prognosis Genome-wide analysis has confirmed that epigenetic changes are common events in many cancers, cellular genomic epigenetic disorders are important causes of many diseases, including cancer and autoimmune diseases. Epigenetic changes in human malignancies mainly include DNA methylation, nucleosomal remodeling histone modification and non-coding RNA dysregulation Ovarian cancer is the most fatal gynecological malignancy with high incidence and low survival rate. By exploring the prognostic biomarkers associated with ovarian cancer recurrence and progression, independent risk factors affecting patient prognosis were identified, which laid a solid foundation for the development of novel treatment strategies and the improvement of patient treatment outcomes. This review searched the literature and database for the relevant reports on prognostic biomarkers of ovarian cancer, reviewed the classic clinical prognostic biomarkers, and focused on the recently discovered various prognostic markers. Advances in genomics, proteomics and metabolomics have provided favorable conditions for the discovery of novel prognostic biomarkers that have identified a variety of promising prognostic biomarkers, including miRNA, lncRNA and TIL, these biomarkers can affect the prognosis of patients through a variety of biological functional pathways. TCGA data sets and public databases can provide data information for large patient cohort genome studies, the application of bioinformatics modeling and high-throughput molecular analysis techniques has greatly enriched the knowledge related to biological processes such as cancer progression. The prognostic value of a variety of novel biomarkers was evaluated by integrating genomic, proteomic and metabolomic data and clinical information with a multivariate analysis model. The effectiveness of these novel prognostic biomarkers still needs to be further validated in large clinical trials. By studying the functional pathways of regulation of these molecular markers, the potential molecular mechanisms are revealed, so as to identify new therapeutic targets. This is a high-precision medical method, which may promote personalized treatment of ovarian cancer patients and improve their prognosis.Supplementary materials.Click here for additional data file.


A continuous increase in ambient temperature caused by global warming has been considered a worldwide threat. As sessile organisms, plants have evolved sophisticated heat shock response (HSR) to respond to elevated temperatures and other abiotic stresses, thereby minimizing damage and ensuring the protection of cellular homeostasis. In particular, for perennial trees, HSR is crucial for their long life cycle and development. HSR is a cell stress response that increases the number of chaperones including heat shock proteins (HSPs) to counter the negative effects on proteins caused by heat and other stresses. There are a large number of HSPs in plants, and their expression is directly regulated by a series of heat shock transcription factors (HSFs). Therefore, understanding the detailed molecular mechanisms of woody plants in response to extreme temperature is critical for exploring how woody species will be affected by climate changes. In this review article, we summarize the latest findings of the role of HSFs and HSPs in the HSR of woody species and discuss their regulatory networks and cross talk in HSR. In addition, strategies and programs for future research studies on the functions of HSFs and HSPs in the HSR of woody species are also proposed. As one of the most harmful abiotic stresses, heat stress poses a threat to plant life by impacting plant metabolism directly  and other greenhouse gases. In addition, woody plants are the main biomass resources for biofuels. Due to the perennial and long life cycle, woody plants experience more severe and extreme abiotic stresses during their lives compared to herbaceous plants. Woody plants may have evolved more complex stress-responsive mechanisms , HSP40s, HSP60s, HSP70s, HSP90s, and HSP100s  chaperons with a molecular mass of 15–30 kDa. According to the sequence homology and subcellular localization, sHSPs are classified into 11 different classes. Class I–VI sHSPs are localized in the nucleus or cytoplasm, and the rest five classes of sHSPs are localized in mitochondria, chloroplasts, peroxisomes, or ER      , yeast, and Arabidopsis , and inducing the expression of heat-responsive (HR) genes , responds to high temperature, salt, and drought stresses and has a certain effect on the adaptability of introduction and domestication  cytoplasmic class III sHSP gene (PmHSP17.9) improves the thermotolerance of transgenic Arabidopsis by enhancing superoxide dismutase (SOD) activity  sHSP gene JrsHSP17.3 in leaves enhances tolerance to cold, heat, and salt stresses by scavenging the accumulation of ROS and by accumulating osmotic adjustment substances  from C. sinensis could be highly induced by heat and cold stresses. Overexpression of these small CsHSPs confers heat and cold tolerances in transgenic Pichia pastoris (P. pastoris) and Arabidopsis -dependent and ABA-independent signaling pathways and other stress signaling pathways -localized sHSP, sHSP22, is involved in ABA and auxin signaling crosstalk ] increases the heat sensitivity, which is manifested in the higher accumulation of ROS and lower membrane stability in silenced plants , hydrogen peroxide (H2O2), and putrescine    ] ]  ]  BpHSFA4 gene in leaves improves the salt stress tolerance by increasing the ability to scavenge ROS, thereby reducing cell damage or cell death and enhancing birch resistance    motif is commonly found in the promoters of HSF target genes  and HSFA2 (PtHSF-A2), which is consistent with their protein–protein interactions in Arabidopsis and tomato (Meiri et al., Plants possess a complex HSR regulatory network consisting of multiple HSF and HSP genes during HSR in woody plants is still lacking. On the one hand, the transcriptional regulation or interaction between HSF and HSP in woody plants is unclear. Zhang et al. (P. trichocarpa natural variant populations to successfully identify the upstream regulatory transcription factor WRKY that controls the expression of the HCT2 gene. This strategy provides a new method to identify the transcriptional regulatory relationship between genes. Therefore, the public gene expression database of woody plants can be used to preliminarily examine whether there is a potential regulatory or interaction relationship between HSFs and HSPs in these species. In addition, the continuous maturity of ChIP-Seq, CUT&Tag-Seq, and other technologies have effectively improved the ability to analyze the interaction between protein and DNA. The recently developed reverse-ChIP technology (Wen et al., HSF or HSP genes obtained from woody species in the model plant Arabidopsis or yeast. Therefore, fast and efficient gene function validation systems are urgently needed. The protoplast transient expression system (Zhang et al., With ongoing greenhouse gas emissions, the ambient temperature is expected to rise over time. Woody plants have evolved more complex stress response mechanisms to cope with changing environments than herbaceous plants to guarantee a longer lifespan (Anderegg et al., g et al.  used theJZ conceived the study. JZ, FT, and X-LH drafted the manuscript. TY, XY, J-GC, and M-ZL revised the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.


There are substantial differences in work organization between residential and commercial construction sectors. This paper examined differences in work factors between construction sectors and examined the association between sector and health behaviors, health outcomes, and work outcomes. We surveyed 929 male construction apprentices  and found that residential apprentices reported fewer workplace safety policies, higher frequency of heavy lifting, and greater likelihood of reporting musculoskeletal pain compared to apprentices in commercial work. Residential apprentices reported higher job strain, lower supervisor support, more lost workdays due to pain or injury, and lower productivity related to health than commercial apprentices. Multivariate Poisson regression models controlling for multiple work factors showed that residential construction work, high job strain, heavy lifting, low coworker support, and low supervisor support were each independently associated with one or more work or health outcomes. These findings suggest that interventions should seek to improve coworker and supervisory supportive behaviors, decrease job strain, and reduce organizational stressors, such as mandatory overtime work. Our study shows disparities in health and safety between construction sectors and highlights the need for interventions tailored to the residential sector. Work organization has been associated with poor health outcomes in several industries. How the work is coordinated and controlled to accomplish the goals of the company may create physical and psychosocial burdens on the workforce. Common factors that lead to poor health include rotating or long shift work, seasonal jobs, mandatory overtime, and jobs with low autonomy ,2. TheseConstruction is among the most hazardous industries, with high rates of worker fatalities and non-fatal injuries. In addition to these well-known rates of work injury, many construction workers suffer or experience chronic diseases, are more likely to receive medical care for musculoskeletal conditions, and have a greater prevalence of functional health problems that limit work when compared to other working populations ,12,13. CWork organization and environment differs greatly between commercial and residential construction. Residential construction is typically characterized by fewer safety resources; smaller employers with less formal organization and project oversight; frequently changing work environment, higher turnover of workers on projects; fewer safety regulations; less training; and small, often scattered, crews with less knowledgeable leaders ,16,21. TWe based this study on a conceptual model of Total Worker Health used in our prior study among apprentice carpenters . Our conApprentices attending training classes offered by two union apprenticeship programs in Missouri (Carpentry and Floor Laying) at any time between 15 February and 14 June 2017 were invited to complete a survey on health and work. Each apprentice received a survey packet containing the study description and invitation to complete the survey, and the survey at the beginning of the school day, and were provided time to complete the survey. Participants provided informed consent by completing the survey and returning it to a research technician who was located at the school. Participants were compensated $15 for survey completion and were only allowed to complete the survey once. The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of University of Iowa (protocol code 201611819 and approved on 23 January 2017)The survey contained 78 items addressing four major domains that have previously shown associations between work and health: work organization and environment, health behaviors, health outcomes, and work outcomes. Many studies have shown negative work-related health consequences from organizational and environmental factors such as unhealthy physical work environment and low autonomy and poor managerial support . There at-tests, chi square tests, and Wilcoxon rank sum tests . We conducted univariate and multivariate Poisson regression with robust sandwich estimators to determine the relative risk of each independent variable to one or more outcomes [We calculated the strain ratio from reported job demands and decision latitude on the Job Content Questionnaire (JCQ) , and theoutcomes . We seleoutcomes ,30,37.n = 929). There was no meaningful difference in age , years in trade , or apprentice training term (59.3% beyond first year of training) between residential and commercial workers. Those working in residential construction were more likely (p < 0.05) to be white (90.4% vs. 85.5%), less likely to be obese (15.7% vs. 23.3%), and less likely to be eligible for union benefits based on hours worked (79.1% vs. 84.7%) than those working in commercial construction. A total of 408 apprentices (44%) were currently or most recently employed on residential construction projects, and 56% on commercial construction.We distributed 1070 surveys to construction apprentices; 963 were completed and returned (response rate = 90%). As only 3.5% of respondents were women, we limited our analyses to male workers . There were no differences in requirements for hard hats and safety glasses. Commercial workers more often reported access to water at the worksite and access to seasonal warming or cooling. There was no reported difference in employer policies on drug and alcohol testing; however, hearing tests were more likely to be required in commercial construction (data not shown). Residential workers were more likely to report frequent heavy lifting at work.Examination of psychosocial factors and job demands found that residential apprentices reported higher levels of job strain, related to their higher reported job demands and lower reported job skill discretion (job control) on the Job Content Questionnaire (JCQ). JCQ scores for social support from supervisors and coworkers were also lower in residential construction, as were scores on scales for supervisory support for safety and for coworker safety ,37. ResiRegarding workplace supports for individual health behaviors, workplace restrictions on smoking were less common on residential projects. Workers in residential construction also reported lower availability of sunscreen, hand sanitizer or a place to wash hands, access to food for purchase, a place to refrigerate or store food, or a designated eating area (data not shown).Residential workers reported using alcohol more days per month and binge drinking (five or more drinks on one occasion) more frequently than commercial workers. Residential workers were slightly more likely to report current smoking, though not e-cigarette use.Health outcomes were poorer among residential apprentices when compared to commercial. Residential workers were more likely to report pain or discomfort in the past year in all body parts assessed: hands, neck, lower back, and knees. Residential workers were also more likely to have seen a physician in the past year for musculoskeletal pain (25.6% versus 19.3%) and more likely to have received a prescription pain medication. These workers also reported poorer mental health and physical health than commercial workers on the SF-8 scales, and they more often reported fatigue and low levels of energy.As shown in Prior to regression analysis, we removed the hearing protection policy due to its high correlation with glove requirement policy, and supervisor and coworker support for safety due to high correlations with supervisor and coworker support on the JCQ scale. In univariate Poisson regression models , residenOur study found high rates of unhealthy behaviors and evidence of poor health and work outcomes among apprentice construction workers as a whole. There were large differences in health behaviors and outcomes between young workers in the residential and the commercial construction sectors, and large differences in the availability of some workplace organizational and environmental supports for health between sectors. Safety practices and injury rates have been found to be worse in residential construction, particularly in small residential contractors, than in commercial construction ,21,22. OOur study found few demographic differences between apprentice carpenters working residential or commercial construction. The smaller proportion of residential workers who were eligible for union benefits (based on hours worked) may reflect the more seasonal and cyclical nature of the residential home building environment; however, we did not see differences in reported job stability and job security between the two sectors.The finding of a higher rate of work-related injuries and lost days among residential construction has been reported in previous studies ,39. In oUnique findings from this study include the increased likelihood of residential workers to report lower work productivity due to health, and lower work ability with respect to the physical demands of work, though not reduced work ability related to mental demands of work. These findings may reflect both the higher prevalence of musculoskeletal pain and the higher workplace physical demands reported by residential workers and are supported by national data showing higher rates of overexertion injuries among workers in the residential sector . The higThe high prevalence of musculoskeletal disorders (MSDs), particularly among residential workers, is an example of how the absence of effective workplace policies, programs, and practices affect construction worker health and well-being. The physically demanding nature of the work, including manual materials handling, awkward and static postures, vibration, and strenuous physical exertions, helps explain why MSDs account for the majority of all injuries resulting in days away from work . ComplaiMore frequent alcohol use, including more frequent binge drinking, was reported by residential construction workers. Higher rates of alcohol use among construction workers than the general population have been previously reported ,18; howeConsistent with other studies, differences in workplace safety policies and supports were apparent between the two sectors, with commercial employers being more likely to require use of personal protective equipment and to require surveillance examinations (hearing and respiratory testing), as well as to provide water and seasonal warmth or cooling. Our study found several differences in psychosocial factors and job demands between commercial and residential workers. Residential apprentices reported lower scores for supervisor and coworker safety; these and other measures of safety climate have been linked to workplace safety practices and also to greater fatigue ,23, whicDifferences in safety practices between commercial and residential construction have long been recognized. Safety training practices, the quality of safety programs, and use of protective equipment for common hazards have been noted to be lower in residential than commercial construction ,21. In aOur study had a number of limitations. The cross-sectional design with self-report of both work conditions and health and work outcomes should engender caution in making any causal attributions. Annual follow-up of this worker group is continuing and will allow for future longitudinal analyses. Our classification of workers in residential or commercial construction is based on self-report of the current or most recently held job. Since some workers move between residential and commercial projects, the actual differences in outcomes and exposures may in reality be larger than those found in this study. Our study was limited to union apprentice workers in one construction trade in one metropolitan area; results may have been different in different trades or locations. Results may also differ in a non-unionized workforce, as well as with general construction workers whose behaviors and health outcomes may change with age and experience.Our study findings show disparities in health and safety between the residential and commercial construction sectors and highlight the need for interventions to target the high rates of poor work and health outcomes seen in both sectors. The differences between the sectors is due in part to the nature of the work, with smaller crews, less oversight, short-term projects, and less formal work conditions common to residential work. As a whole, the construction apprentice workforce is characterized by low wages, job insecurity, and contract work/temporary employment, issues faced by a growing number of industries due to changes in work organization . The cha


This systematic review, guided by the ReAble-definition, (1) provides an overview of reablement interventions and their effect on Activities of Daily Living (ADL), and (2) identifies common features of effective interventions. A systematic search was conducted from 2002 to 2020, identifying nineteen studies from eight countries with a total of 6,534 participants. Ten studies  revealed improvements in ADL functioning. Three common intervention features were identified within effective interventions: use of multidisciplinary teams; a protocoled or standardized assessment; and using multiple components such as ADL-training, education and exercise programs. This review emphasizes that future studies should provide a more consistent and detailed reporting on the intervention and its components. Furthermore, a uniform approach regarding components, follow-up times and outcome measures can contribute to the comparison of reablement interventions and better determine their effectiveness, independent of the healthcare system or country in which it is used.


Background: The pregnancy and psychological status of infertile couples has always been a concern, but there is no clear evidence for the efficacy of psychotherapy for infertile couples. This study aimed to summarize the current evidence of the effects of psychotherapy on psychological and pregnancy outcomes for infertile couples.Method: We searched Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science (ISI) for articles published from 1946 to June 26, 2020. The pregnancy outcomes, psychological outcomes, and acceptability were involved in the study.Results: Overall, 29 studies with a combined total of 3,522 adult participants were included in the meta-analysis. Compared with a placebo, psychotherapy was associated with the pregnancy rate ], total psychological scales associated with infertility ], subsymptoms of psychological scores using the 28-item version of GHQ , and the integrative body–mind–spirit (BMS); total psychological scales associated with infertility using other treatments and more than a month; and anxiety using BMS had significant statistical significance. The funnel plots of all outcomes were approximately symmetrical, and no significant publication bias was found.Conclusions: The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, were applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility. As the most basic physiological activity of human beings, reproduction plays an important role in stabilizing social units and forming families. Even though fertility and childbirth are a part of life for many couples, ~9–15% of the childbearing population worldwide has infertility  guidelines. We obtained a list of eligible studies that were published in English from 1946 to June 26, 2020, using the following databases: Ovid MEDLINE, Ovid EMbase, The Cochrane Library, and Web of Science (ISI). For the search, Medical Subject Headings (MESH) terms and keywords were used, such as “infertility,” “childlessness,” “IVF,” “ICSI,” “fertility treatment,” “fertility problems,” “assisted reproduction,” “psychological intervention,” “psychosocial intervention,” “social support,” “couples therapy,” “psycho-education,” “internet-based intervention,” and “behavioral therapy.”Two reviewers (ZR and JSX) independently assessed abstracts and potentially eligible articles identified during the literature selection. Discrepancies were resolved through discussion. If necessary, a third reviewer (LD) was involved when disagreements could not be resolved.The following inclusion criteria were used: (1) patients had infertility caused by various reasons; and (2) included a psychological intervention that involved psychotherapy. Types of psychotherapy include cognitive behavioral therapy (CBT); the integrative body–mind–spirit (BMS) intervention and mindfulness provide advice, supportive treatment, and so on; (3) included a placebo control group; and (4) contained at least one of the following outcomes: pregnancy outcomes, psychological outcomes, and acceptability. The outcomes for pregnancy included pregnancy rate and failed pregnancy outcomes, which were designated as ongoing pregnancy, first-trimester miscarriage, biochemical, preclinical, and molar. Psychological outcomes were total psychological scales associated with infertility, anxiety, depression, sexual concern, relationship concern, rejection of a child-free lifestyle, need for parenthood, social concern, depression, psychosom, and social function. The four primary outcomes were pregnancy rate, total psychological scales associated with infertility, anxiety, and acceptability. The other outcomes served as secondary outcomes. In addition, we focused on studies that were randomized controlled trials (RCTs).The following exclusion criteria were used: (1) patients with polycystic ovary or premature ovarian failure, (2) there were no data available in the original research or the data could not be converted, (3) the study focused on prevention or prevention of relapse, (4) the study was a duplicate publication, and (5) the intervention group included drug treatment.Information and data were extracted by two independent authors (ZR and JSX) and proofread, and, if needed, disagreements were arbitrated by a final investigator (LM). With regard to the selection of scales for symptom relief in total psychological scales associated with infertility and anxiety, the priority scale evaluated by clinicians was a self-rated scale. We aimed to compare the difference before and after the change in value, but if those values were not available, we use the final measured value  independently assessed the quality of the included studies based on the risk of bias from Cochrane's handbook  with 95% confidence interval (CI) was used as the effect size. For continuous data, the mean difference (MD) and standardized MD (SMD) with 95% CI were used . However, 967 of those were excluded due to duplication, 4,838 studies were excluded by reading titles and abstracts based on the strict inclusion and exclusion criteria, and 68 potential studies were screened for full-text reading. Finally, 29 RCTs with 3,522 individuals were chosen in The characteristics of 3,522 adult patients from published parallel 29 RCTs  ], relationship concern ], rejection of a child-free lifestyle ], need for parenthood , and depression using the 14-item version of Beck's Depression Inventory (BDI) ] and Center for Epidemiological Studies Depression Scale (CES-D) ]. The 21-item version of Depression, Anxiety Stress Scale (DASS-21) ], Patient Health Questionnaire-9 (PHQ-9) ], and Zung's self-administered depression scale (SDS) ] were not statistically significant in This outcome was included in 25 studies, with a total of 3,540 patients. Compared with the placebo groups, psychotherapy did not lead to more dropouts, and there was no statistically significant difference ] based on random-effects model in Based on the stratified results including only female, compared with the placebo, Based on different treatment cycles, the placebo group was significantly different from the total psychological scales associated with infertility for more than a month ]. However, the psychotherapy intervention on pregnancy rate for less than a month ] and more than a month ], total psychological scales associated with infertility for less than a month ] and more than a month ], anxiety for less than a month ] and more than a month ], and acceptability for less than a month ] and more than a month ] were not different in In subgroup analyses based on assisted fertility, the placebo group was significantly different from the pregnancy rate using assisted reproduction ]. However, the psychotherapy intervention on pregnancy rate using natural pregnancy ], total psychological scales associated with infertility using assisted reproduction ] and natural pregnancy ], anxiety using assisted reproduction ] and natural pregnancy ], and acceptability using assisted reproduction ] and natural pregnancy ] were not different in Different psychotherapies were included in the study. In terms of pregnancy rate using CBT ] and BMS ], total psychological scales associated with infertility using other treatment ] and anxiety using BMS ] had significant statistical significance. However, no psychological method was statistically significant in other results in Funnel plots of all outcomes were approximately symmetric, and no significant publication bias was found. Funnel plots were performed for acceptability presented in A total of 29 RCTs with 4,010 patients were included in this study to evaluate the efficacy of psychotherapy for infertile patients. The results show that psychotherapy was effective for patients with infertility for both the psychological  and pregnancy outcomes  and that there was no difference in tolerance between psychotherapy and placebo.In contrast to a previous meta-analysis (de Liz and Strauss, For psychological outcomes, psychotherapy was effective for treating the pain related to infertility, but no significant effect was found for the symptoms of total psychological scales associated with infertility and other psychological scales. Although these findings are consistent with previous research indicating that infertility can lead to related psychological problems (Peterson et al., The number of part of the intervention type in this study was small. The BMS intervention was supported by only two studies (Chan et al., Reviewing the previous meta-studies (Hämmerli et al., We have updated the latest and most comprehensive studies on the comparison of psychotherapy and placebo in the treatment of infertility, and we made corresponding treatment recommendations based on the results of this study. These findings provide a direction for future clinical research and information that can be used for changing guidelines. This study also has some limitations. First, the number of studies was small, and it was difficult to evaluate all current psychotherapies. Second, due to the particularity of psychological intervention, the integrity of the blind method cannot be guaranteed, which will lead to the low quality of the overall study, thus affecting the accuracy and stability of the results. Third, the correlation between studies was not high, so it was difficult to directly compare the advantages and disadvantages of psychotherapy.The study showed that psychotherapy can lead to improvements in the pregnancy rate for infertile patients, especially for patients receiving assisted fertility. In addition, it may help improve total psychological scales associated with infertility and depression. CBT and BMS play an important role in improving rate of pregnancy, and BMS is associated with reducing anxiety. Although psychological interventions had limited effects on the pregnancy outcomes of infertility, our study still recommended that psychotherapies, in particular CBT and BMS, be applied to the therapeutic regimen for infertility, especially for patients receiving assisted fertility.The original contributions presented in the study are included in the article/J-SX and RZ contributed to the study conception and design, the acquisition of data, and the drafting of the manuscript. RZ, J-SX, and DL contributed to the analysis and interpretation of the quantitative data and the drafting of the manuscript. RZ, J-SX, and Y-MC contributed to the development of critical revision of the final draft. J-SX and RZ contributed to the analysis and interpretation of the descriptive statistics and the revision of the final draft. All authors have read and approved the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.