Web-based information systems designed to increase access to species occurrence data for use in research and natural resource decision-making have become more prevalent over the past few decades. The effectiveness of these systems depends on their usability and extent of use by their intended audiences. We conducted an online survey of academics and government professionals in the United States to compare their species occurrence data needs and their perceptions and use of web-based species occurrence information systems. Our results indicate that although views and perceptions held by academics and government professionals about the importance, usefulness, and ease of use of these information systems tend to be similar, there were differences in their use of species occurrence data and web-based species occurrence information systems. The baseline information obtained in this study will help inform future directions for improvements in species occurrence information systems. The Internet is often viewed as a medium that can facilitate access to and use of biodiversity data in research and natural resource decision-making –3. The tweb-based species occurrence information systems as databases and their data retrieval systems (including applications software and application programming interfaces) provided via websites and the Internet to discover, access, visualize, download or summarize species occurrence data. As a subset of biodiversity information systems, these systems provide access to various types of species occurrence data, such as those originating from specimens in museum natural history collections, field observations made during research studies, observations made by segments of the general public, and signals from tracking devices among others. Although recent studies have analyzed publications to identify the type of research that has been conducted using species occurrence data from web-based information systems [Species occurrence data, which are records on the occurrence (presence or absence) of an organism at a particular geographic location and time, are one of the most basic types of biodiversity data. These foundational data are used in research, management, and conservation of species . Web-bas systems –9, consiThis study focuses on identifying and comparing the species occurrence data needs and use of web-based species occurrence information systems by academics and government professionals in the United States (U.S.). Since species occurrence data can be used for diverse purposes by varied user communities , web-basOver the past 20 years, many have worked to make biodiversity data more broadly accessible via the Web –15. ThosOften, the intended audiences for web-based species occurrence information systems are scientists and natural resource professionals. Only a few studies have looked at academic users of species occurrence data and the information systems they use to obtain those data , 20. EveUnderstanding use of web-based species occurrence information systems requires learning about use of systems as well as data use practices. There is already a long tradition and large body of research about information use practices and information seeking behavior of academic scientists –28, acadLess is known about information seeking behaviors and information use practices of non-academic decision-makers and professionals in natural resource and science-related fields. But a few studies are providing some insights on information use practices of non-academic professionals in natural resource-related fields. Time constraints, insufficient searching skills, and reliance on professional networks have been found to influence the information seeking practices of natural resource professionals . Davis eIn the past two decades, studies of data use by academic researchers have focused primarily on secondary use of data (data reuse) or use of data from others for a different purpose or study from that for which the data were originally collected –40. CompStudies have found that social context, professional cultures and organizational structures have an effect on information use by professionals –45, whilUse of digital data and electronic information systems that provide scientific data have been examined in the social sciences, health sciences, and a variety of natural, earth, and physical sciences –51. In dIn this study we compared academics and government professionals in the United States on their species occurrence data needs, the sources they use for those data, and their perspectives on use of web-based species occurrence information systems as sources of species occurrence data. Level of information system use by participants was examined in terms of frequency and duration of system use, and percent of data they used that originated from those systems. This study aimed to answer the following questions:Who is using species occurrence data and web-based species occurrence information systems in their work?What type of species occurrence data do they use and how often?What sources do they use to obtain data and learn about existing web-based information systems?To what extent are they using web-based species occurrence information systems and data from those systems?What are their perceptions about web-based species occurrence information systems?What is their awareness of global and national species occurrence information systems?How likely are they to use a web-based species occurrence information system in the future?Answers to these questions allow us to identify how academic and government professionals differ or are similar in their use of web-based species occurrence information systems and the data those systems provide, and what aspects of those systems need improvement in order to be more usable.Next, we provide information about the methods used in this study, response and completion rates for our survey, and results of our research starting with a characterization of users of species occurrence data and web-based species occurrence information systems, followed by species occurrence data preferences, sources used to access species occurrence data and learn about existing information systems, use of web-based species occurrence information systems, perceptions about web-based species occurrence information systems, awareness of national and global web-based species occurrence information systems, and the likelihood of continued use of web-based species occurrence information systems.This study involved the voluntary participation of academic and government professionals. The use of human subjects in this study was conducted under a protocol reviewed and approved by the University of Florida Behavioral/NonMedical Institutional Review Board (IRB02).A questionnaire see  consistiThe questionnaire was validated via an online pilot survey of 18 colleagues, 8 from academia and 10 from non-academia, who used species occurrence data and had agreed to take the survey to provide feedback about question clarity, appropriateness, and format. The questionnaire used in this study was finalized by including revisions based on feedback received from the pilot survey.To identify academic institutions to sample, we selected universities categorized as ‘Doctoral Universities: Highest Research Activity’ in the Carnegie Classification of Institutions of Higher Education (CCIHE) . To idenTo identify potential government participants, we obtained the names of state and federal government agencies from websites listing natural resource agencies in the U.S. More detail on the types of government agencies considered relevant for this study is provided in This method identified a total of 3,154 faculty and research scientists  from academic institutions and a total of 4,250 staff from government agencies  for a total of 7,404 individuals. This large number of names with corresponding emails was gathered since sample size estimates for academics and government professionals, based on their population size  and a coInvitations to participate in an online survey were sent to 7,404 email addresses on March 2017 via the Qualtrics  softwareSome invitees emailed the principal investigator indicating they wanted to forward the survey link to colleagues. A generic link to the online survey was created and provided to those who requested it. The online survey was permanently closed on July 2017.This publication focuses on analysis and results from responses to close-ended questions of the survey only. Cleaning and processing of response records for some of the close-ended questions retained for analyses included re-categorizing some of the questions into fewer categories.Descriptive statistics, as well as cross tabulations with sector of work, were generated for each closed-ended question using SPSS . WeightsChi-square test of independence—A chi-square test of independence is a nonparametric test to determine whether two or more categorical variables are independent or are associated with each other. The test assumes random samples, independent observed data provided as counts or frequencies, mutually exclusive categorical variables with data that are nominal or ordinal, and eighty percent of expected (computed) cell frequencies should be greater than five and none should be less than one , 72. LimMann-Whitney U test—Mann-Whitney U test is a nonparametric test that compares distributions of a dependent variable for two groups to determine if they are from the same population. That test assumes random samples, the groups to be independent, continuous or ordinal data, equal group variances, and similar shape for distribution of each group if reporting the difference as medians . Test liIndependent samples t-test—A t-test for independent samples is a parametric test that compares the means of two independent groups. The t-test assumes random samples, a continuous dependent variable and an independent categorical variable, a dependent variable that is normally distributed, and equal group variances , 78. TesSpearman’s Rank-Order Correlation—The Spearman’s rank-order correlation is a nonparametric test that determines whether there is an association (correlation) between two variables. The test assumes independent observations, continuous or ordinal data, and a monotonic relationship between the variables , 81. LimAll chi-square tests, Mann-Whitney U tests, t-tests, and Spearman’s correlation analyses were evaluated for significance as two-tailed tests with an alpha of 0.05. For statistically significant chi-square tests, pairwise comparisons between academic and government participants where conducted on each class of a variable using adjusted standardized residuals as z-scores and correcting the critical value by the number of comparison tests resulting in a Bonferroni adjustment to the critical value of alpha.At the close of the survey, 1,011 of the 7,404 individuals invited to participate had responded. Most responses came from direct invitations (94%), with only a small percentage (6%) coming from the generic link to the survey. For a participant’s response to be included in the dataset that was analyzed, it had to at a minimum reach the point in the questionnaire where the participant provided a response to question Q3.3 ‘Which of the following best describes your use of species occurrence data?’ . Of recoIn analyses that follow, the number of responses is provided for each survey question. Since participants could skip questions, the number of responses varies by question.Sector of Work, 35% (n = 329) were from academia, 44% (n = 411) from state government, 20% (n = 189) from federal government, 1% (n = 11) from non-profit organizations, and less than 1% (n = 1) from a for-profit business. Non-academic participants were for the most part professionals who worked for government, but there were a few participants who had indicated working for non-profit organizations or a for-profit business. Even though we did not directly recruit participants from non-profit organizations or for-profit businesses, it is possible those participants may have collaborated or worked under contract or agreements with government agencies. The responses they provided were similar to those who were employed in government, and hence responses from those participants were grouped with those from state and federal government participants into a summarized government sector of work consisting of government professionals. The summarized sectors of work of 35% (n = 329) academics and 65% (n = 612) government professionals were used in subsequent data analyses of this study.Of the 941 survey participants who reported their Gender, there were more male than female respondents for both academia and government sectors. These percentages did not differ significantly between the two sectors of work  were more likely to be academics than from government  and within each sector . Given the high correlation, similar distributions of Age and Year of Last Degree, and slight differences in Age for the older age categories between academics and government professionals, we selected Age as the best indicator of participants’ level of experience in their field of work.Spearman’s correlation analyses show there is a strong positive correlation between Highest Level of Education attained by the majority of academic participants was a doctorate degree  being significantly different between academics and government professionals based on their z-scores with a Bonferroni correction for multiple comparisons. Survey participants who held a bachelor’s or master’s degree were almost solely from government, while the greatest percentage of participants who held doctorate degrees were from academia.The e degree . Governmducation , with thRegion of Residence) of survey participants as defined by the United States Census Bureau [South, followed by the West; the majority of government participants also resided in the South, followed by the Midwest and the West  being significantly different between academic and government participants based on Z-scores from standardized adjusted residuals with a Bonferroni correction for multiple comparisons , followed distantly by multidisciplinary or applied sciences , with the remaining working in the physical sciences, mathematics and statistics, and other disciplines. Except for mathematics and statistics , which was represented by a higher percent of government professionals than academics, the scientific research disciplines of academic and government respondents were quite similar.Most participants, whether from academia (n = 275) or government (n = 120), who indicated their Primary Area of Work as natural resource management and conservation practice, indicated they worked on species management and conservation. The remaining worked on land/water management & conservation (30%), nuisance species/invasive species control and management (8%), and other types of work (7%).Slightly more than half (55%) of government participants (n = 369) who identified their original Geographic Scope of Work of academics was primarily at national and international levels, while that of government professionals was primarily at the state level, followed distantly by a regional focus within the U.S. .The the U.S. . Chi-sqund other . These rExperience Using Species Occurrence Data (somewhat experienced in using species occurrence data. The ranked distributions and mean ranks of self-reported level of experience were not significantly different between academic and government participants (Participants were asked to self-report their level of nce Data . Most paicipants .Preferred Level of Data Processing) they preferred . The Preferred Level of Data Processing of government participants (564 participants) was more evenly distributed across categories, with the greatest preferences for original untransformed data (35%) and summarized/synthesized data (29%). Overall, there is a statistically significant relationship between Preferred Level of Data Processing and Sector of Work . Examination of z-scores of pairwise comparisons with a Bonferroni adjustment indicate that the percent frequency of respondents who selected original untransformed data, summarized/synthesized data, and analyzed/modeled data was significantly different between academic and government participants. The greatest difference and contribution to the significance of the chi-square test was from original untransformed data , followed by summarized/synthesized data , and then by analyzed/modeled data .Survey participants were asked what kind of species occurrence data  and scientific research (32%). Nearly all (88%) of the 162 government participants who selected a preference for summarized/ synthesized data worked primarily in natural resource professions. Therefore, it appears that even though there is a higher percentage of government professionals who work in scientific research that prefer original untransformed data when compared to those participants who prefer summarized/synthesized data, the greatest percentages of those government professionals who prefer original untransformed data are working in natural resource professions rather than in scientific research.The preference of government professionals for two levels of data processing might be explained by the work they do. To examine if that might be the case in this study, we identified the primary area of work of government participants who had indicated they preferred Observational Data , Specimen Data , Instrument Data , Citizen Science Data (data from citizen science programs), and Species Ranges and Distributions (species geographic ranges and distributions). These results show that the highest use by both sectors were for Observational Data and Species Ranges and Distributions. Government professionals significantly used Observational Data and Species Ranges and Distributions more than academics. And while academics significantly used more Specimen Data than government professionals, the latter used more Citizen Science Data than academics, although that use was low when compared to use of other data types  by academic participants were Citizen Science Data (56%), Specimen Data (37%), and Instrument Data (33%). For government participants, although the same types of data were used the least, the percent frequencies were reversed, with government participants not using Specimen Data (54%) the most, followed by Citizen Science Data (38%), and Instrument Data (33%). The highest percentages of responses from academic participants for any one category of frequency of use were annual use of Observational Data (22%), annual use of Specimen Data (20%), and annual (19%) and monthly (19%) use of Species Ranges and Distributions. For government participants, the highest percentages for any one category were monthly (29%) and weekly (22%) use of Species Ranges and Distributions, and weekly (25%) and monthly (24%) use of Observational Data. Comparing the frequency of use categories for each type of data between academic and government participants with Mann-Whitney U tests : Colleagues , Reports , Books, Publications , and the Web (web-based information resources and systems). The Web in this question of the survey had a broad scope and included web-based information resources such as websites and web-based search engines, in addition to web-based information systems on biodiversity and species occurrences. The results listed in Web, followed by Publications, and then Colleagues to obtain data from others, while government participants use primarily Colleagues, Reports and the Web as sources of data from others. There was a significant difference between academics and government professionals in their overall use of Colleagues and Reports as sources of data, while the slight difference in percent frequency of use of Books between academic and government participants was borderline non-significant , annually for Books (25%) and annually for Reports (24%), while for government participants, it was monthly for Reports (26%) and weekly for the Web (24%). The least used (never or less than once per year) sources of data for academic participants were Books (41%) and Reports (35%), while for government participants were Books (34%) and Publications (25%). A comparison between sectors with Mann-Whitney U tests  learned about the existence of these information systems from lleagues . To a mund Other . The onlications . Governmicipants .Use of Web-based species occurrence information systems in the last 12 months). Those who answered Yes, 76% of academic participants (n = 323) and 79% of government participants (n = 607) were asked more questions about their use of these systems.Survey respondents were asked if they had used at least one web-based species occurrence information system in the last 12 months  and weekly (24% academia vs. 27% government) use of web-based species occurrence information systems were the most common use frequencies for both sectors of work.The per year . Results Systems . Both moHours per Week Use Web-based Species Occurrence Information Systems , even though these same academics used the web for work activities (Hours per Week Use the Web for Work) more hours per week than government professionals . Although the distributions of both variables (Hours per Week Use Web-based Species Occurrence Information Systems and Hours per Week Use the Web for Work) by sector were positively skewed and not normally distributed, their variances were homogeneous, and neither log10 (hours used + 1) transformations nor analyses with Mann-Whitney U tests yielded results that were different from those obtained with the t-tests. Therefore, academics were similar to government professionals in the number of hours per week they use web-based species occurrence information systems, with academics using web-based species occurrence information systems an average of 3.38 hours per week  and using the web an average of 19.56 hours per week , while government professionals used web-based species occurrence information systems an average of 3.90 hours per week  and the web an average of 15.66 hours per week . The median number of hours per week academics and government participants use web-based species occurrence information systems is 2.00 hours per week . Overall, use of web-based species occurrence information systems account for 17% of academics’ time and 25% of government professionals’ time per week using the web.On average, academics and government professionals did not differ in the number of Percent of Species Occurrence Data Obtained from Web-based Systems. While 40% percent of academic participants (n = 244) reported that 76–100% of their species occurrence data came from web-based species occurrence information systems, government participants (n = 473) were equally divided between those who obtained 76–100% of all the species occurrence data they used from web-based species occurrence information systems and those for whom only a small percentage (0–25%) of all their data came from those systems .As shown in 2 = 9.318, df = 1, P = 0.002, n = 696).Participants were asked if, in addition to species occurrence data, they used other types of biodiversity data from web-based information resources. A higher percent of academic  than government  participants responded they use other biodiversity data from web-based information resources , Evaluating Quality of Data Provided by Systems , and Retrieving Data in Needed Format. Equal to or more than 69% of participants in each sector reported that Finding Systems and Accessing Systems was easy , while 64% or more of participants in each sector indicated that Using Systems was an easy aspect of information system use  aspect of use of a web-based species occurrence information system  they provide, close to 50% of academic and government participants rated all easy . At the n system . UnderstFinding Systems, Accessing Systems, Using Systems, Identifying Data in Systems, Understanding Data Provided by Systems, and Retrieving Data in Needed Format. The only statistically significant difference in mean ranks between academics and government professionals is Evaluating Quality of Data Provided by Systems  and government professionals  who used web-based species occurrence information systems rated the systems as important . A Mann-Whitney U test  and government  participants viewed the web-based species occurrence information systems they use most as useful , with academics rating the usefulness of these systems higher than government professionals according to results of a Mann-Whitney U test  based on a Spearman’s correlation analysis.Participants were also asked to rate the s useful  (responsy U test . The disBiodiversity Information Serving Our Nation (BISON) (2013) [Encyclopedia of Life (EOL) (2007) [Global Biodiversity Information Facility (GBIF) (2001) [Integrated Digitized Biocollections Portal (iDigBio) (2013) [Map of Life (MOL) (2012) [NatureServe Explorer (2000) [Ocean Biogeographic Information Facility (OBIS) (2000) [PLANTS Database (1996) [VertNet (2013) [Participants were asked about their level of awareness and/or use of nine national and global web-based species occurrence information systems (the number in parentheses is the year the system was launched online): ) (2013) , Encyclo) (2007) , 89, Glo) (2001) , Integra) (2013) , Map of ) (2012) , 93, Natr (2000) , 95, Oce) (2000) , PLANTS e 1996) , 98, and6 , 98, at (2013) .Used in last 12 months by the highest percent of academic participants were GBIF (35%), then EOL (24%), the PLANTS Database (22%) and iDigBio (20%)  . The sysIF at 8% . If we cNever heard of OBIS (64%), followed by VertNet (59%), and MOL and BISON both at 57%. Government participants were most likely to Never heard of VertNet (85%), iDigBio (84%), OBIS (76%), and MOL (73%). Except for BISON, awareness and/or use of the following information systems was dependent on sector of work: EOL, GBIF, iDigBio, MOL, NatureServe Explorer, OBIS, PLANTS Database, and VertNet  of academic and 94% (n = 470) of government participants reported they are likely  to use a web-based species occurrence information system in the next 12 months , as well as for the academic sector  and government sector  separately.Spearman’s correlation analyses were conducted to examine if there is a relationship between the participants reported The results of our study indicate that perceptions about web-based species occurrence information systems are similar between academics and government professionals in the United States, but the types of data they prefer and the systems they use appear to be different. Although our findings provide insights about areas for potential improvements in web-based species occurrence information systems, there are some potential limitations in our results due to the nature of online surveys, the statistical tests used to analyze data, and our sampling strategy to recruit participants for the study.This study was based on a voluntary online survey of academics and government professionals who were invited to participate in the study. With voluntary survey instruments that are self-administered, there is the potential that non-response bias could occur if those who did not respond to our survey shared specific perspectives or experiences about web-based species occurrence information systems that were not shared by those who chose to participate in our survey. Bias could also have been introduced if those who participated in the survey overestimated or underestimated their average response to questions in the survey . AlthougWe used nonparametric tests  mostly to account for unequal sample sizes between sectors of work and skewed/non-normal distributions of variables consisting of nominal and ordinal data types. By relying on these tests, it is possible that significant differences between academics and government professionals on some variables may have been missed. Nonparametric tests tend to be less powerful than parametric tests in finding a significant difference when there is actually one, and in instances where violation of assumptions of parametric tests are not severe, parametric tests usually provide more accurate results . TherefoAdditional limitations of our study results may have resulted from sampling bias due to our methodology to recruit survey participants. Because we used websites of institutions and government agencies to look for names and emails of potential invitees to the survey, species occurrence data and information system users who were not listed in institutional websites were excluded from the potential pool of relevant participants for this study. We used this strategy however, because we felt that identifying potential invitees to our survey from institutional websites rather than from lists of academic peer-reviewed literature, one information system, or traditional scientific societies, would expand coverage to those who may not partake in those activities or be members of selective groups, since those are not traditional venues for recruiting government professionals. To limit the large number of institutions included in the CCIHE , which wThere was a greater number of both academic and government participants from the South and West regions of the U.S. than from the other regions of the country. This suggests that although the two sectors of work were comparable in participating in the survey, there were geographic differences in participation within each sector. The method of sampling and recruiting academic participants from doctoral universities with highest research activity listed in the CCIHE  may haveIn terms of demographics of our study participants, when compared to the broader academic and non-academic populations of biological science professionals in the United States , professAlthough non-academic participants were for the most part professionals who worked for government, there were a few participants who had indicated working for non-profit organizations or a for-profit business. Responses from those participants were grouped with those of government sector participants in our data analyses. The nature of work done by many non-profit organizations may be somewhat similar to the type of work done in government in relation to species management and conservation and, at least in the United States, non-profit organizations conduct work for government agencies via contracts and agreements. As these sub-sectors share some similarities, results from this study could potentially be applicable to professionals working in non-profit organizations. Additional studies of professionals in non-profit and for-profit sub-sectors will be needed to confirm what similarities may hold across non-academic sub-sectors of work.The gender distribution of academic and government participants, with a ratio of 2:3 females to males, is similar to what is found in the broad population of life sciences professionals in academia and the federal government . ParticiAcademics held primarily doctorate degrees, while government professionals held either master’s degrees or to a lesser extent bachelor’s or doctorate degrees. While participants from academia worked primarily on scientific research in the biological sciences, government participants worked primarily on natural resource professions, specifically on species management and conservation, and land/water management and conservation. Perhaps due to the different type of work they do, academics and government professionals also differed in the geographic scope of the work they conduct, with academics tending to conduct work that is national and international in scope, while government professionals conduct work primarily at state and regional levels. Academic and government participants resided in similar regions of the country.Both academics and government professionals were similar in their self-reported level of experience with use of species occurrence data, and in using species occurrence data from others in their work. The two groups differed, however, in the preferred level of processing of the species occurrence data they use. Academics by far preferred original untransformed data, while government professionals showed preference for both original untransformed and summarized/synthesized data. The result that government professionals seem to have two preferred levels of data processing when obtaining data to use is not explained by the work they do, since the greatest percentages of those in government who prefer original untransformed data are working in natural resource professions rather than in scientific research. This result that government professionals prefer raw and summarized data supports the findings by Davis et al.  that govAcademics and government professionals use observational data and species ranges and distributions the most, with over 85% from each sector using those types of data. While academics use observational data and species ranges and distributions every 3 months, government professionals use these types of data on a monthly basis. The need for observational data by academic researchers has recently been documented across disciplines , and ourThere may be various reasons why these sectors do not use these types of data in their work. Government professionals may not use specimen data perhaps due to a lack of exposure to natural history collections and specimens in their education and training, unavailability of specimen data or a presentation that does not meet their needs, or simply they do not have a need for this type of data. For citizen science data, some of the most successful citizen science programs have been conducted by non-profit organizations or government agencies to serve as outreach, educational and participatory engagement tools in addition to data collection . TherefoThe most used sources of species occurrence data for academics and government professionals are colleagues and the web, with our definition of web including websites, search engines, web-based species occurrence information systems, and other web-based biodiversity resources. Both sectors use the web monthly to every 3 months, while colleagues are used as a source of data on average every 6 months by academics and every 3 months by government professionals, in addition to use of publications about every 6 months by academics and use of reports every 3 months by government professionals. Use of publications by academic scientists as a primary source of data has been well documented for various disciplines , 36, 66,The slightly greater use of the web by academics in our study to obtain data for use when compared to their use of publications, might be a result of our narrower focus on species occurrence data when compared to previous studies that focused on seeking practices for broader types of information. Species occurrence data are collected and/or generated in both academic and non-academic settings, and therefore, can be found in sources outside of publications. Some of the greatest volume of species occurrence data are observational data gathered by government programs and citizen science programs for certain taxonomic groups of species , 108, whOf those participants who used web-based species occurrence information systems, both academics and government professionals learned about web-based species occurrence information systems from colleagues, and none of the other sources seemed as effective in conveying information about the existence of these systems to potential users. After colleagues, web search engines were a very distant second source used by participants to learn about the existence of web-based species occurrence information systems. It appears that use of web search engines by academics to find data or data repositories yields mixed results . TherefoOn average, both academics and government professionals use web-based species occurrence information systems on a monthly basis, and they tend to use them for about 2–4 hours per week. A greater percentage of the data used by academics came from web-based information systems when compared to government professionals, with more than 50% of the species occurrence data used by over half of academic participants coming from those systems. Academics also use more than government professionals other types of biodiversity data from web-based information resources.Perceptions about various aspects of information system use appear to be similar for academics and government professionals. The aspects most participants found easy when using species occurrence information systems were finding systems, accessing a system, and using a system. The aspect that participants found most difficult when using information systems was evaluating quality of data provided by a system, especially for academics. These results show that, both academics and government professionals tend to have more difficulty with aspects related to the data (content) provided by web-based species occurrence information systems rather than with the technology or electronic systems themselves.Our finding that academics had more difficulty with data quality evaluation than government professionals was unexpected. In disciplines like biomedicine, data users from different specialties use different proxies for assessing data quality, and definitions of what constituted quality in data varied by the user . TherefoStudies of academic researchers on how they develop trust in data indicate that users utilize several of the following lines of evidence to assess data trustworthiness: competence of the data producer, expert recommendations from colleagues (including peer review), own experience with data, intrinsic quality of the data, data documentation and management, and data repository (intermediary) reputation , 112. SoIncreased emphasis should be placed on research and activities that seek to understand how to better convey quality, context, social aspects  and intricacies of the data that are provided by these systems to users. Although the biodiversity informatics community has made progress in providing metadata and visualizations about data in many of these information systems, it appears these efforts are not sufficient in helping users understand, evaluate, and use those data. Gregory et al.  provide Even though participants in this study indicated that on average finding information systems that provide species occurrence data was easy, a large percentage of participants were not aware of the existence of many of the national and global web-based species occurrence information systems listed in the survey. Moreover, academics and government professionals tend to use different systems and differed in their awareness about the existence of specific systems. Systems that were usually known to academics were the systems unknown to government professionals and vice versa. The most used systems overall by academics were GBIF and EOL, while for government professionals were NatureServe Explorer and the PLANTS Database. Based on our results, it appears that current outreach activities conducted for most species occurrence information systems have failed to reach a large proportion of these professionals. Although our study did not collect data on why some of these web-based species occurrence information systems were known or used more than others, our results may suggest areas of potential focus. For example, when comparing percent frequencies of use of each system by sector, academics appeared to use most those systems originally developed by academic communities (GBIF) or natural history museums (EOL), while government professionals appeared to use more those systems developed by non-profit organizations (NatureServe Explorer) or government agencies (PLANTS Database). Our findings indicate that professionals learned about the existence of information systems primarily from colleagues. Since information from colleagues conveys not only the existence of a resource, but often aspects related to evaluation and trust in the information system from the user’s own community of practice, it is likely that they would gravitate towards information systems that are developed within their own professional communities, since data and information seeking appear to be social processes. Additional research is needed to examine whether information seeking behavior of academic and government professionals, system longevity, or certain preferred system characteristics may have contributed to greater awareness and use of some of these systems by professionals who use species occurrence data.In our study, the vast majority of academics and government professionals who used web-based species occurrence information systems indicated they were likely to use one of these systems within a 1-year timeframe. Intention to use an information system has often been considered as a predictor of use of closed information systems and may serve as a proxy for examining adoption and continued use of open-access information systems depending on the type of predictor used , 60. TheAcademics working primarily in scientific research at institutions of high research activity and government professionals working on natural resources at government agencies tend to have similar views, perceptions, and preferences in terms of ease of use of various system aspects, the importance and usefulness of these systems for the work they do, the types of data they are looking for, and the sources they like to use to obtain species occurrence data and learn about new information systems. But even though these sectors are similar in many respects, they differ in significant ways with regards to the level of processing they prefer the data to be presented or provided to them, how much of the data they use come from information systems, and what types of systems they prefer to use. Therefore, when assessing how usable a system is and delivering species occurrence data via web-based species occurrence information systems to academics and government professionals, information system developers should take into consideration the sectors’ differences in preferred level of data processing and how they obtain data, and consider providing different views of their species occurrence data to each sector based on identified preferences. On first inspection, the content (data) aspects of information system use emerge from the perspective of users as the most difficult elements in their current use of web-based species occurrence information systems. It would therefore be useful to apply a socio-technical framework  to examiS1 Appendix(PDF)Click here for additional data file.S2 Appendix(PDF)Click here for additional data file.S3 Appendix(PDF)Click here for additional data file.


Volatile organic compounds (VOCs) are a group of aromatic or chlorinated organic chemicals commonly found in manufactured products that have high vapor pressure, and thus vaporize readily at room temperature. While airshed VOCs are well studied and have provided insights into public health issues, we suggest that belowground VOCs and the related vapor intrusion process could be equally or even more relevant to public health. The persistence, movement, remediation, and human health implications of subsurface VOCs in urban landscapes remain relatively understudied despite evidence of widespread contamination. This review explores the state of the science of subsurface movement and remediation of VOCs through groundwater and soils, the linkages between these poorly understood contaminant exposure pathways and health outcomes based on research in various animal models, and describes the role of these contaminants in human health, focusing on birth outcomes, notably low birth weight and preterm birth. Finally, this review provides recommendations for future research to address knowledge gaps that are essential for not only tackling health disparities and environmental injustice in post-industrial cities, but also protecting and preserving critical freshwater resources. Post-industrial urban centers such as Detroit, Michigan (MI), a home of early industrialists including Ford and Dodge , are facDetroit has had its share of economic challenges in recent years and is still recovering from the largest municipal bankruptcy filing in U.S. history in 2013. New efforts aimed at urban renewal and revitalization are juxtaposed with a vast landscape of aging urban infrastructure that threatens the quality and safety of the existing built environment. In recognition of the tremendous infrastructure problems throughout MI, the recent American Society of Civil Engineers Infrastructure Report Card (2018)  assignedVOCs are a group of aromatic or chlorinated organic chemicals that have high vapor pressure, and thus vaporize readily at room temperature. They originate from diverse manufactured products such as building materials, paints, cleaning agents, furnishings, adhesives, combustion materials, floor, and wall coverings. People are exposed to volatile contaminants through dermal contact, inhalation, and ingestion. Prevalence of VOCs in the airshed overlying urban landscapes has been well studied and are especially problematic ,9, negatWhile information about airshed VOCs may provide insights into some public health issues, most people in the U.S. spend at least 90% of their time indoors ; thus, wVOCs, especially chlorinated solvents, can persist belowground in soils and shallow aquifers for decades ,32,33 anVOCs are a part of everyday life and the sources of indoor VOCs can be largely dependent on the activities of people inhabiting the building. For example, homes with attached garages and basements can influence indoor air quality by storing VOC-emitting products such as automobiles, paints, and solvents ,49. GiveThere is an urgent and unmet need in the city of Detroit to understand and remediate the consequences of VOC environmental exposure on humans. In this review, we explore the state of the science of subsurface movement and remediation of VOCs, and the linkages between these little-understood contaminant exposure pathways and health consequences based on research in various animal models and in adverse birth outcomes in humans, notably low birth weight and PTB. We seek to better understand how volatile and semi-volatile organic compounds from urban brownfield sites may contaminate the subsurface beneath the built environment and through a combination of liquid and vapor transport, expose and negatively impact humans. Thus, we aim to uncover significant knowledge gaps that limit our ability to explain the complex source-migration-exposure-outcome scenario of VOCs in urban settings, tackle health disparities and environmental injustice in post-industrial cities, and protect and preserve critical freshwater resources.Groundwater provides a conduit for chemical movement through urban systems. Volatile chemicals, such as VOCs, can move from groundwater into the unsaturated zone, or vadose zone, as soil vapor. Soil vapor causes a vapor intrusion concern when volatile chemicals in contaminated soil or groundwater migrate through the subsurface soils and/or preferential pathways and impact the indoor air quality of buildings . In thisShallow groundwater has a high risk of contamination from surface spills and buried waste due to the relatively short vertical distance to the water table and small hydraulic retention time ,64,65. AThough water is a critical resource in urban areas and groundwater accounts for between 22 and 42% of total water balance into the Great Lakes (with precipitation and surface water runoff accounting for the remainder) , urban gTo increase the resiliency and sustainability of urban centers, anthropogenic changes to urban hydrology need consideration . One wayThe city of Detroit resides in a glacial depositional environment and on the historic glacial Lake Maumee depositional zone. This depositional environment is characteristic of large sediment layers, including large clay layers from the glacial lake period. The clay composition of subsurface sediments provides conditions for the formation of shallow groundwater ,91,92,93Urban sewer lines represent another exposure pathway for VOC vapor intrusion into buildings ,100,101.The lack of groundwater data, continuing growth of urban areas, and pollution of urban groundwater create a potential threat to the long-term health and viability of the Great Lakes hydrologic system , pointinRemediation of VOC contamination can be generalized to three basic components for this review: (1) identifying the human exposure pathways, (2) identifying the geographic extent of contamination, and (3) minimizing the threat to human health by mitigating the exposure pathways. Possible human exposure pathways for VOCs related to brownfield sites are: (1) inhalation of indoor air impacted by vapor intrusion and (2) ingestion, dermal contact, and inhalation while showering with contaminated groundwater . A remedwsat) and the air-water partitioning coefficient (awK or H) of the contaminant [In general, the highest concentrations of free-floating product and dissolved concentrations are found at a contaminant source . The dissolved concentration and volatilization potential are a function of the aqueous solubility  to risk. Acceptable risk from environmental chemical exposure is defined by EPA as an additional risk of mortality of 1 in 1,000,000. Remediation projects cannot proceed without an identified funding source, and litigation is often required to secure funds for remediation projects. In 1980, the U.S. Congress passed the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) which created a tax on the petroleum and chemical industries to provide a financial means for conducting large-scale remediation projects on sites that “endanger public health or the environment” . The fraA remediation project typically begins in earnest with a Phase I Environmental Site Assessment (ESA) to investigate for a recognized environmental condition (REC). A Phase I ESA may be triggered due to real estate transactions, land use change applications, property owner concern, or when a regulatory agency has suspicion of contamination . The purIf an REC is identified in Phase I, a Phase II ESA is commenced  and requA suitable remediation strategy that reduces exposure to acceptable risk levels is developed based on site-specific conditions, clean-up criteria, costs, and the type of contaminated media . Because surface water is the main drinking water source for most Great Lakes cities, and large treatment works and distribution systems are common, the main exposure pathways of interest for an urban risk-based remediation strategy are: (1) direct exposure  from a contaminated site, and (2) possible vapor intrusion into buildings adjacent to the contaminated property. In this case, source zone remediation would reduce direct exposure, whereas site remediation would limit exposure to building occupants.The three main source zone remediation approaches are: (1) isolation, (2) extraction, and (3) transformation . IsolatiTransformation remediation techniques provide methods for converting VOCs into smaller metabolites with the goal of complete mineralization. These techniques include chemical oxidation/reduction, thermal treatments, and various bioremediation strategies. Several mitigation techniques are often used in VOC remediation projects. Mitigation techniques eliminate or minimize the exposure pathway without eliminating the source from the environment. Increased building ventilation, sub-slab depressurization systems (SSDS), and sorbent-based air purifiers are notable techniques ,132.The selection of appropriate remedial technology depends on the nature of the contaminant. Non-halogenated or hydrocarbon VOCs are relatively biodegradable and can be treated through bioreactors, bioattenuation, biostimulation, and other related techniques. The Federal Remediation Technologies Roundtable (FRTR) evaluated 64 different potential remediation technologies for VOCs and noted widely used remediation strategies based on media are excavation (soil), pump and treat via carbon adsorption or air stripping (water), and soil vapor extraction (pore gas) . Once a Although sometimes criticized, the infant mortality rate has long been recognized as an important marker of a country’s health . Low birA small but growing number of studies have examined the associations between various VOCs and birth outcomes. However, results have been conflicting. In North Carolina, PCE exposure was estimated by residential proximity to PCE contamination; women with the highest PCE exposure (odds ratio (OR) = 1.3, 95% CI = 1.0–1.6) or women with a duration of PCE exposure of 11–20 weeks  were more likely to deliver a PTB infant ,144. In There is a growing body of evidence linking the mixture benzene, toluene, ethylbenzene and toluene (BTEX) or its individual components with adverse birth outcomes. In a study of pregnant women in the Infancia y Medio Ambiente (INMA) cohort in Spain, estimated exposure to benzene was calculated based on the mother’s residential address using ambient collection and land use regression. INMA women with estimated exposure to benzene levels >2.7 μg/m in the air across pregnancy had increased risk of PTB  compared to women with lower benzene exposure levels . Higher Most of these studies, however, are limited by reliance on estimated exposure and thus are subject to bias due to potential exposure misclassification. Such misclassification may have contributed to the conflicting results reported for PCE and TCE and birth outcomes, but there is also a need to consider underlying social factors that clearly influence both exposure to environmental contaminants and pregnancy outcomes. There is a notable lack of data on how poverty, stress, racism, inadequate housing, and other social factors influence both susceptibility to adverse environmental exposures and their subsequent influence on birth outcomes ,151. FutAs PTB and other adverse birth outcomes are multifactorial pathological events, elucidating the role of VOC exposures in epidemiological studies alone is challenging. Animal models are useful tools to help establish a causative link between VOC exposure and adverse reproductive and developmental outcomes due to more stringent control over additional environmental stressors and genetic variability. Toxicologists utilize animal models in which dose-response relationships can be more easily manipulated and controlled compared to human epidemiological studies to informing mechanisms of toxicity and intervention strategies. Data from both non-mammalian and mammalian models further supports a link between VOCs and reproductive and development health.Pimephales promelas) and African sharptooth catfish (Clarias gariepinus) in a dose-dependent manner [Oryzias latipes) related to neurological, cardiovascular, and/or ocular development, as well as distortion of the embryonic axis [Danio rerio) after PCE and TCE exposure, respectively [Drosophila melanogaster) larvae exposed to benzene, toluene, or ethylbenzene throughout development showed a dose-dependent delay in emergence from the pupa and decrease in overall emergence that were associated with significant increases in expression of common stress genes  and generation of reactive oxygen species [The reproductive and early developmental effects of VOC exposure have been explored in a variety of non-mammalian models. Benzene or toluene exposure negatively affects embryonic growth in fathead minnows , but some evidence related to other VOCs such as TCE also exists in mammalian systems . In chroRodent models have also been utilized to identify mammalian toxicokinetics, dynamics, and metabolism of benzene and related VOCs during pregnancy. Pregnant women mostly share the same distribution processes as other non-pregnant adults, but pregnancy-related weight gain, differential perfusion of tissues and fat, and the formation of the placenta as a new tissue compartment may modulate the kinetics and distribution of BTEX chemicals . By usinEmerging data now implicates benzene, toluene, ethylbenzene, xylene, and related VOC exposures during pregnancy on disruptions to the fetal immune system. The use of animal models is useful to link VOC exposure with disruptions of the fetal immune system, but mechanistic studies using well-established rodent models are currently lacking and require more attention. In one such example, however, pregnant mice were injected with benzene  from day 12.5 through 19.5 of gestation . The resBelowground VOCs and the related vapor intrusion process are understudied despite evidence that these contaminants are widespread beyond Superfund and brownfield sites, as well as epidemiologic and animal model studies suggesting significant adverse birth outcomes and early life health consequences following exposure to VOCs that are commonly found indoors. The COVID-19 pandemic has served to further add relevance and urgency due to increased time spent indoors. In order to better understand volatile and semi-volatile organic compounds, specifically in urban environments, future research must: (1) focus on groundwater data and integrated modeling that accounts for the high degree of anthropogenic hydraulic and hydrologic modifications affecting subsurface VOC movement; (2) identify VOC remediation techniques and technologies that produce predictable and reproducible results; (3) examine personal and biological levels of VOCs and VOC mixtures throughout pregnancy, underlying social factors that influence exposure, and subsequent health outcomes; and (4) develop and utilize animal models to elucidate a link between environmentally-relevant VOC exposure and reproductive and early developmental effects, as well as mechanisms of toxicity, with the goal of informing and driving epidemiologic studies and developing human intervention strategies and therapies. Addressing these knowledge gaps will require robust transdisciplinary collaboration and is essential for not only tackling health disparities and environmental injustice in post-industrial cities such as Detroit, but also protecting and preserving critical freshwater resources within the Great Lakes basin.


Older adults living in rural communities often encounter health disparities related to chronic conditions and access to care. In an effort to address these disparities, a community-based program focused on health promotion and education was implemented with community dwelling, rural, African American older adults. We partnered with a local church to provide education regarding health promotion, chronic disease self-management, and support for senior group members (n=32). Program materials were accessed online in order to facilitate sustainability and potential program expansion. Key findings from a qualitative content analysis indicated the majority of participants reported improved engagement in chronic disease management and health promotion activities , incorporating health behaviors to prevent the development of co-morbid conditions, and increased client-provider communication. Implications for further research will be discussed and key elements of program implementation such as a continued partnership will be explored.


Diseases of the respiratory system are a leading cause of morbidity, mortality and disability worldwide. The lungs are constantly exposed to a myriad of noxious agents present in ambient air, such as particles, chemicals and infectious organisms. At least 2 billion people are exposed globally to the toxic smoke produced by combustion of biomass fuel, inefficiently burned in poorly ventilated indoor stoves or fireplaces used for cooking or warming. One billion people inhale polluted outdoor air, and another billion are exposed primarily or secondarily to tobacco smoke. As a consequence, respiratory disease is a major cause of morbidity, disability and death worldwide primarily affecting individuals of low socioeconomic status, who are exposed to crowding, environmental exposures and poor living conditions. Annals of Global Health provides comprehensive information about the prevalence, pathophysiology, risk factors and impact of these conditions and suggests possible public health and policy interventions to improve patients’ outcomes.Globally, 4 million people die prematurely from chronic respiratory disease. The Forum of the International Respiratory Society identified five major lung problems, the “big five,” which include chronic obstructive pulmonary disease (COPD), asthma, acute lower respiratory tract infections, tuberculosis and lung cancer. These conditions are responsible for most of the global burden of lung disease. The present issue of Multidisciplinary experts from multiple areas of the globe offer their perspectives on the burden of smoking and the negative impact of tobacco on lung health as well as the role of anti-smoking legislation and anti-tobacco campaigns. Two of the principal investigators of the Proyecto Latino-Americano de Investigación en Obstrucción Pulmonar (PLATINO) study, the largest population-based survey conducted in Latin America, review the prevalence of COPD, screening strategies, risk factors, the role of hypoxemia, treatment strategies, outcomes and costs of this condition in developing countries. On the same topic, an original study reports on the economic impact of severe COPD exacerbations in a high burden region in North India. A different group of researchers from India explore the relationship between quality of life and respiratory health status among iron workers. The issue also includes a comprehensive review of the international status of interstitial lung disease with a special emphasis in its relationship with air pollution and occupational exposures. Two articles review the epidemiology and management of asthma in pediatric and adult populations, a major pulmonary condition across the globe. Tuberculosis is another highly prevalent infectious lung disease that is reviewed in this issue. Finally, a paper on the global epidemiology of lung cancer is included with special attention to risk factors such as environmental exposures, indexes of lung cancer risk and the impact of early diagnosis via screening. We hope this selected collection of papers provides a comprehensive review of the global burden of lung pathology and highlights potential strategies for improving the outcomes of patients with respiratory diseases worldwide.


The World Health Organization declared on March 11, 2020, that the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has escalated from epidemic into pandemic. As the initial outbreak area, China has taken multiple active measures to deal with the epidemic. Updated versions of diagnosis and treatment guideline for novel coronavirus (COVID-19) patients have been issued, and traditional Chinese herbal medicine has been recommended as a treatment. The objective of this study will be to summarize the recommendations in current clinical practice guidelines about the use of traditional Chinese herbal medicine for COVID-19 patients. We will also evaluate and report on the methodological and reporting quality of these guidelines.In this systematic review, we will search for guidelines, expert consensuses, and policy documents published since December 2019 in electronic databases  and on websites of governments or organizations , Scottish Intercollegiate Guidelines Network [SIGN], and WHO). Eligible documents will be independently selected, and relevant data will be independently extracted by two reviewers. We will also independently evaluate the methodological quality and reporting quality of the included guidelines, using the Appraisal of Guidelines for REsearch & Evaluation (AGREE) II tool and Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement, respectively. Any discrepancies will be discussed and resolved through discussion among the reviewers. We will use the extracted information to summarize their recommendations for traditional Chinese herbal formulae and Chinese patent medicine for COVID-19 patients and to summarize the strength and quality of these recommendations with reference to the results of AGREE II and RIGHT tools.This review will summarize the recommendations in current clinical practice guidelines and provide insight into the implementation strategies for traditional Chinese herbal medicine in COVID-19 patients.CRD42020179205PROSPERO  Novel coronavirus COVID-19) pneumonia, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in Wuhan, China, in late December 2019 9 pneumon, 4. WithAs the initial outbreak area, China has taken multiple active measures to deal with COVID-19. The National Health Commission of China established the first version of Diagnosis and Treatment Guideline of Pneumonia Caused by Novel Coronavirus on January 16, 2020. This contained the etiology of COVID-19, clinical characteristics of patients, diagnosis, and treatments of this disease. As more information became available, updated versions of this diagnosis and treatment guideline were issued. Since the third version of National COVID-19 Diagnosis and Treatment Guideline, traditional Chinese herbal medicine has been recommended as a treatment for COVID-19, based on different stages and syndrome differentiations of disease [Traditional Chinese herbal medicine has played an important role in thousand-of-years’ combat between Chinese doctors and pandemic and endemic diseases. During the outbreak of severe acute respiratory syndrome (SARS) coronavirus in the late 2002 in Guangdong, China, traditional Chinese herbal medicine showed beneficial effects such as relief of symptoms, decrease of mortality, and control of infection in patients with SARS –13. WithAlong with the guideline issued by the National Health Commission of China, provinces, cities, and autonomous regions have also released clinical practice guidelines recommending traditional Chinese herbal medicine. The syndrome differentiations, treating principles, and recommended formulae may differ across these guidelines because of the different characteristics of their respective regions and population. Other reviews have been published which consider the treatment of COVID-19 patients with traditional Chinese herbal medicine and the guidelines for treating children with COVID-19 with herbal medicine , 18. TheThis systematic review is registered in the Prospective Register of Systematic Review (PROSPERO) database CRD42020179205). This protocol is reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) statement   published by any advising body or healthcare organization since December 2019, which provide information on the use of traditional Chinese herbal medicine therapy for COVID-19 patients.Recommendations for patients diagnosed with COVID-19 pneumonia and the associated SARS-CoV-2 virus as confirmed by clinical tests . There will be no restrictions with respect to age, gender, or ethnicity.We will include recommendations for Chinese herbal medicine including Chinese medicinal formulae and Chinese patent medicine regardless of their forms . See Additional file We will exclude old versions of guidelines or consensus statement published by a single advising body or healthcare organization.We will search for guidelines, expert consensuses and policy documents published since December 2019 in the following electronic databases: PubMed, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang database (Wanfang Data). In addition, we will search other sources of guidelines including the following: The National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), and WHO. We will use search strategies that combine terms relating to novel coronavirus, traditional Chinese medicine, and guideline. The search strategy for PubMed is described in Additional file We will upload search results into the EndNote X9 reference management software. Duplicated references will be filtered and removed. Two independent reviewers (YXL and DLZ) will screen titles and abstracts to identify potentially eligible documents, which will be retrieved in full text for final review. Any disagreements will be discussed and arbitrated by a third reviewer (YGZ).We will design a data extraction form based on characteristics of included guidelines and consensuses. In order to achieve a consistency (at least 80%) in extracted items, we will pilot test the data extraction form with data extractors using a sample of eligible documents. Results of this pilot extraction will be discussed among review authors and extractors before finalizing it. Data extraction will be conducted independently by two reviewers (JL and YZ) and will include the following data: (1) characteristics of guidelines: name, type, source, and date; (2) stage of disease; (3) syndrome differentiation; (4) treatment principle; (5) recommended formula; and (6) recommended Chinese patent medicine etc. Disagreements will be resolved by discussion among the review team.We will evaluate the methodological quality and reporting quality of the included guidelines using the Appraisal of Guidelines for REsearch & Evaluation (AGREE) II tool –22 and RWith the information extracted from the included guidelines, we will summarize the recommendations made for traditional Chinese herbal formulae and Chinese patent medicine for COVID-19 patients. The recommendations of prescriptions for different stages and syndrome differentiations of COVID-19 will also be summarized. We will present the evidence in narrative format and tables with descriptive statistics . The assessments from the use of the AGREE II and RIGHT tools will be presented in tables with reporting rate of each item and the overall reporting rate. These findings will be discussed in light of the strength and quality of these recommendations with reference to the results of AGREE II and RIGHT tools.This systematic review will comprehensively congregate information from and appraise the quality of guideline recommendations for traditional Chinese herbal medicine for COVID-19 patients. Other reviews have either examined the application of traditional Chinese herbal medicine for COVID-19 patients or investigated current management for COVID-19 patients. Examples of other studies include Ho and colleagues’ work on the case definition, clinical classifications, and relevant treatments of COVID-19 patients, in accordance to recommendations of the 7th edition of the National COVID-19 Diagnostic and Treatment Guideline of China . In addiGiven the many guidelines and consensuses that are now being regularly updated to advise clinical practices on the use of traditional Chinese herbal medicine for COVID-19 patients, this review will provide an important overall summary of their recommendations and provide insight into relevant implementation strategies.There may be some limitations in our retrieving and reviewing of the evidence: (1) we will only search Chinese and English databases, so we may miss guidelines published in other languages; (2) COVID-19 is a very urgent public health issue requiring rapid responses, which means that the production of associated guidelines might not follow the standards for the development of guidelines in more usual times. Some other considerations are that according to traditional Chinese medicine, Chinese herbs should be prescribed based on different constitutions of the population and the environment, and we will classify the data and discuss the results based on the theory. If changes are needed for this protocol, we will update our PROSPERO entry as necessary. We intend to publish this review in a peer-reviewed journal.Additional file 1. PRISMA-P 2015 Checklist.Additional file 2. Definition and examples of Chinese herbal medicine.Additional file 3. Search Strategy for PubMed.


The stomach and intestine are important organs for food digestion, nutrient absorption, immune protection and hormone production. Gastrointestinal diseases such as cancer and ulcer are big threats to human health. Appropriate disease models are in sore need for mechanistic understanding and drug discovery. Organoids are three-dimensional in vitro cultured structures derived from tissues and pluripotent stem cells with multiple types of cells and mimicking in vivo tissues in major aspects. They have a great potential in regenerative medicine and personalized medicine. Here, we review the major signaling pathways regulating gastrointestinal epithelial homeostasis, summarize different methods to generate human gastrointestinal organoids and highlight their applications in biological research and medical practice. The human digestive system is comprised of the mouth, esophagus and gastrointestinal (GI) tract, plus the accessory organs that aid in digestion , Hippo and BMP have been shown to control the homeostasis of the intestinal epithelium. Wnt signaling has been demonstrated to be essential in maintaining stem cells and driving proliferation of stem and progenitor cells 2). The fVarious protocols have been reported for human GI organoid derivation and culture , including embryonic stem (ES) cells and induced pluripotent stem (iPS) cells, have the capacity of giving rise to all cell types, and are easily manipulated by gene-editing, they have been widely used for investigation of human development and pathogenesis. However, their cell type homogeneity limits their applications. Since organoids can more accurately reflect the multicellular interactions in physiological and pathological conditions, PSC-derived organoids then become great models for understanding of human organogenesis and pathogenesis Clevers, .Studies of embryonic development in model organisms have made successful efforts to direct the differentiation of PSCs into specific tissue cell types in vitro. By mimicking development processes, tissue-specific organoids can be induced Fig. . The majGeneration of GI organoids from PSCs provides a way to generate multicellular 3D structures mimicking native human tissues. In particular, using various established methods, iPS cells can be handily obtained from different types of cells from normal or pathological tissues  gene and causes malfunctions in multiple organs including the GI tract  are an ideal system for anti-cancer drug screening with two apparent advantages: 1) preservation of the most characteristics of the cancer of origin; 2) the feasibility and economy to maintain and amplify them in a large scale  scaffold similar to the crypt or crypt-villus structure (Wang et al., Furthermore, 2D monolayer culture may also serve as a substitution for 3D GI organoids. Due to rapid cell death and stem cell loss, monolayer culture of GI epithelial cells was not successful until recently. With a thin extracellular matrix-based coating, several simple and economical 2D monolayer culture systems have been established (reviewed in (Liu and Chen, Moreover, various growth factors are supplemented in the culture medium to maintain organoid growth. The complex nature and high cost limit their application on a large scale. Recently, we have established a growth factor-free culture system of murine intestinal organoids with two small molecules (Li et al., As current culture medium is mainly designed for the expansion of the epithelial cells, a considerable challenge for cancer organoid culture is the overgrowth of the normal cells (Weeber et al., Despite existing challenges, the research of human GI organoids still holds a promising future. GI organoids and organoids resembling other tissues can be assembled into assembloids with complex structures, which can shed new light on tissue or organ interactions (Marton and Pasca,