A case-control study was conducted to explore the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation in disinfection supply centers. n = 13) and the research group . The differences in quality evaluation, disinfection qualification, quality regulation effect, supply satisfaction, job satisfaction, safety awareness, and comprehensive operation skills of nursing staff were compared, and the application value of PDCA cycle regulation combined with nursing label in nursing safety and quality regulation of disinfection supply center was comprehensively analyzed.  The medical staff in the disinfection supply center of our hospital from January 2020 to December 2020 and from January 2021 to December 2021 were included in the control group . The disinfection qualification rate of nurses in the research group was significantly higher, and the difference was statistically significant (P < 0.05). The effect of device quality supervision in the study group was significantly improved, and the difference was statistically significant (P < 0.05). The scores of various supervisions in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The safety recognition ability, risk prevention awareness, service awareness, and theory and operation scores of nurses in the study group were significantly higher than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of adverse events in the study group was lower, and the difference was statistically significant (P < 0.05). The satisfaction of the research group was significantly higher than that of the control group, and the difference was statistically significant (P < 0.05).  The quality score of nursing staff, and quality evaluation in the study group was significantly higher than that in the control group, and the difference was statistically significant ( In summary, the implementation of the PDCA cycle supervision method in the supervision of the sterile supply center in conjunction with the nursing logo is conducive to improving the quality of supervision and sterilization of all work aspects of the sterile supply center, reducing the occurrence of adverse nursing events and promoting the job satisfaction of nurses. In addition, it is conducive to standardizing the operational processes of staff, improving self-learning awareness enhancement, and improving work quality and efficiency. PDCA refers to the initials of Plan (plan), Do (implementation), Check (inspection), and Action (action), respectively, and is the scientific level followed by “total quality regulation” (TQM). Through PDCA cycle, the final aim of PDCA cycle regulation is to enhance the quality of service, product, or work step by step and optimize various work . The disThe quality of nursing regulation in the disinfection and supply center is directly relevant to the medical level of the hospital and the health of patients . If the PDCA cycle theory is a standardized and scientific cycle theory system put forward by Dai Ming, an American quality regulation expert, which can be applied to quality regulation . It has The subjects of this study were 13 nurses in the disinfection and supply center of our hospital. The routine regulation method was implemented in the department from June to December 2019, and the PDCA cycle regulation method was implemented from January to June 2020. Among the 13 nurses, 13 were female, aged from 24 to 49, with an average age of (32.64 ± 3.29) years, 1 with college degree or less, and 12 with bachelor's degree or above.The disinfection and supply center will implement the routine regulation method from January 2020 to December 2020, that is, to complete the recovery, classification, cleaning, disinfection, inspection, and storage of instruments and equipment according to the routine regulation system and process of the disinfection and supply center. The PDCA cycle regulation law will be implemented from January 2021 to December 2021, and the contents are as follows: (1) The planning stage. A PDCA cycle regulation team was set up under the leadership of the head nurse. According to the four working processes of recovery and classification, cleaning and disinfection, inspection and packaging, and storage and distribution in the disinfection supply center, all nurses were assigned into four groups, each group was led by senior nurses. Before the implementation of the PDCA cycle regulation method, the head nurse summoned the team members to analyze the problems existing in the current disinfection supply center and their causes, worked out the PDCA circulation regulation measures, and planned the regulation objectives of the disinfection supply center and the hospital infection control objectives according to the actual situation of our hospital; (2) The head nurse summarizes the regulation quality according to the relevant standards of each work flow, affirms the effective regulation methods, and continues to use them in the next cycle regulation; the ineffective regulation methods are analyzed to find out the root causes, and the improvement scheme is discussed again. Analyze the achievements and shortcomings of each cycle regulation, and make targeted strengthening and improvement measures; (3) The inspection stage. The PDCA cycle regulation team does a good job in the inspection of each training to ensure that every nurse completes the relevant training within a specified period of time, and examines the nurses regularly, and the assessment results are linked to rewards and punishments. Evaluate the quality regulation of each workflow in accordance with the regulatory objectives of the disinfection and supply center, including recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, storage and distribution regulation, and equipment maintenance regulation. Collect the feedback of each department, and evaluate the quality regulation effect of each working link according to the opinion. Do a good job in the classification of quality problems. The quality data of unqualified equipment recovery, equipment cleaning and sterilization, and equipment fault treatment are analyzed every month, and the corresponding rectification measures are put forward. Establish a sound reporting system for quality problems, including work defects or errors, damage to valuable equipment, and substandard quality of equipment handling workflow, when serious quality problems occur, they must be reported to the competent department at a higher level, analyze the quality problems, and put forward improvement measures; and (4) The head nurse organizes team members to study the relevant knowledge of PDCA cycle regulation, including regulation concepts, regulation steps and implementation measures, and conducts special training for various work processes and links. Develop work manuals according to all work processes of the disinfection and supply center, including staff operation manual, staff training manual, product maintenance manual, and pressure steam sterilizer operation manual, and record the safe operation of the equipment every day. Each group leader randomly checks all the items in 3 to 5 sterilized bags every month.The group meeting is held once a month to discuss with the group members the problems in the application of nursing signs and the methods of improvement, as well as the design of statistical signs, which are produced and distributed by the request office after filling in the application. The logo design should be eye-catching, reasonable cost, uniform specifications, practical and beautiful, and able to reflect the characteristics of the specialty, in order to improve the quality of nursing management and avoid the occurrence of nursing risks.Mainly including the concentration and method of preparation of various cleaning enzymes and disinfection solutions in the disinfection supply center, uniformly marked in white letters on a blue background and posted on special soaking buckets and corresponding instruments and equipment.The emergency plan is posted on the wall in black letters on a uniform white background so that it can be memorized and, in the event of an emergency, can be implemented immediately in accordance with the regulations to prevent errors and accidents. In addition, next to the autoclave and the cleaning and disinfection machine, the “prevent scalding” care sign is posted in a uniform style with white letters on a black background to strengthen the warning and remind staff to do a good job of self-protection.Standardize and unify the packaging of sterile items used throughout the hospital and fix rigid signs with white characters on a green background on sterile items storage baskets or shelves to facilitate storage and check distribution to improve work efficiency.According to the strict division of decontamination area, sterilization area, packaging area, and storage area of sterile articles, and unified with white letters on a green background in each area to post all kinds of routine operation procedures; at the same time, unified with white letters on a green background to post all kinds of instruments and equipment operation specification flow chart on the corresponding instruments and equipment using waterproof self-adhesive paper, so as to facilitate standardized operation.α value was 0.653, which was consistent with the use of this study; (4) the regulation quality before and after the implementation of PDCA cycle regulation was scored by the regulation evaluation scale made by the disinfection and supply center of our hospital, including recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, and storage and distribution regulation; and (5) to observe the occurrence of adverse events before and after the implementation of PDCA cycle regulation.The main results are as follows: (1) the job satisfaction questionnaire made by the disinfection and supply center of our hospital was adopted to evaluate the nurses' satisfaction with the regulation work. The contents of the scale included regulation quality, safety, operation proficiency, and other dimensions. The evaluation grade is assigned into very satisfactory, relatively satisfactory, acceptable, and unsatisfactory. Satisfaction = very satisfactory rate + relatively satisfactory rate; (2) to compare the differences in nursing staff's safety awareness, comprehensive operation skills, and cleaning effect before and after the implementation of nursing safety concept education. The safety awareness score form is self-made by our hospital, and is evaluated from the aspects of safety identification ability, risk prevention consciousness, and service consciousness. The full score is 10, and the higher the score, the better the safety awareness. The evaluation of comprehensive operation skills includes theoretical assessment and operation assessment, with a full score of 100. The better the score, the better the comprehensive operation skills; (3) the qualified rates of washing, sterilization, packaging, and distribution of instruments were compared, and the disinfection quality of instruments was scored and compared. Among them, the qualified rate of washing, sterilization, packaging, and distribution of instruments are evaluated according to the requirements and standards of the instructions for the use of related instruments. The quality of disinfection of instruments and the quality of nursing service were scored by the expert group of the nursing department according to the self-made scale made by our hospital. The results of the pretest indicated that the test-retest reliability coefficient was 0.977 and the internal consistency Cronbach's s). The group design t-test was adopted for the comparison and the analysis of variance was adopted for the comparison between multiple groups. Dun-net-t test was adopted for comparison with the control group. The counting data were presented in the number of cases and the percentage, χ2 test was adopted for comparison between groups, and a bilateral test was employed for all statistical tests.SPSS23.0 statistical software was adopted to process the data. The measurement data were presented as (P < 0.05). All the results are indicated in Firstly, we compared the quality evaluation of nursing staff. The quality scores of instrument disassembly, cleaning, disinfection, packaging, and environment in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the qualified situation of disinfection of nurses. The qualified rates of sterile dry cans, surgical instruments, endotracheal cannula, oxygen humidification bottles, and laryngoscope instruments in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in The quality regulation effects were compared. The qualified rate of instrument washing, sterilization, packaging, and distribution in the study group was remarkably enhanced, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the regulation scores, and the regulation score of recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, and storage and distribution regulation in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the scores of safety awareness and comprehensive operation skills. The results of safety identification, risk prevention, service, theory, and operation of nurses in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). All the results are indicated in In the control group, there were 3 complaints, 2 nursing errors, and 1 accident. The incidence of adverse events was 40.00%; there was only one nursing error in the study group, and the incidence of adverse events was 6.67%. The incidence of adverse events in the study group was lower, and the difference was statistically significant (P < 0.05). All the results are indicated in We compared the job satisfaction of nurses. In the study group, 10 were very satisfied, 2 were relatively satisfied, 1 was satisfied, and no one was dissatisfied, with a satisfaction rate of 92.31%; In the control group, 3 cases were very satisfied, 6 were more satisfied, 3 were satisfied, 1 was not satisfied, and the satisfaction was 53.84%. The satisfaction of the study group was remarkably higher, and the difference was statistically significant . The qualified rate of disinfection of sterile dry cans, surgical instruments, endotracheal cannula, oxygen humidification bottles, and laryngoscope instruments in the study group was remarkably higher, and the difference was statistically significant (P < 0.05). The qualified rates of washing, sterilization, packaging, and distribution of instruments in the study group were remarkably enhanced, and the difference was statistically significant (P < 0.05). The score of recovery and classification regulation, cleaning and disinfection regulation, inspection and packaging regulation, storage and distribution regulation in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). The nurses' safety identification ability, risk prevention consciousness, service consciousness, theoretical achievement and operation performance in the study group were remarkably higher, and the difference was statistically significant (P < 0.05). Based on the analysis of this, PDCA cycle regulation is an innovative regulation mode on the basis of conventional regulation, which promotes the development of nursing quality regulation in the disinfection supply center to a scientific and standardized direction. The PDCA cycle regulation method includes four stages: planning, implementation, inspection, and summarization. Firstly, it analyzes the problems existing in the quality regulation process of the disinfection supply center, defines the regulation objectives, and draws up regulation plans and measures, which realize the procedure and standardization of the regulation of the disinfection supply center, so as to urge every nurse in the disinfection supply center to carry out in accordance with the relevant quality regulation standards. After defining the plan and goal, the nurses completed each work in a planned and purposeful way according to the relevant requirements, which not only enhanced the nurses' regulations consciousness but also promoted their work enthusiasm and initiative. PDCA cycle can find the problems in the supervision process in time and take targeted improvement measures to ensure the continuous improvement of nursing quality in the disinfection supply center. The results indicated that compared to before implementation, the incidence of adverse events after implementation was lower, and the job satisfaction of nurses after implementation was higher, and the difference was statistically significant (P < 0.05). This indicates that the implementation of PDCA circulation regulation method in the regulation of disinfection and supply center can effectively prevent and control the occurrence of adverse events such as complaints, nursing errors and accidents, and make all nurses participate in the regulation, which greatly enhances the job satisfaction of nurses. We followed the methods of Ma et al. The same idea can be found in the study put forward by Ma et al. [It was found that the quality scores of instrument disassembly, cleaning, disinfection, packaging, and environment in the study group were remarkably higher, and the difference was statistically significant (a et al. . They haIn summary, the implementation of the PDCA cycle supervision method in the supervision of the sterile supply center in conjunction with the nursing logo is conducive to improving the quality of supervision and sterilization of all work aspects of the sterile supply center, reducing the occurrence of adverse nursing events and promoting the job satisfaction of nurses. In addition, it is conducive to standardizing the operational processes of staff, improving self-learning awareness enhancement, and improving work quality and efficiency. This study still has some shortcomings. Firstly, the quality of this study is limited due to the small sample size we included in the study. Secondly, this research is a single-center study and our findings are subject to some degree of bias. Therefore, our results may differ from those of large-scale multicenter studies from other academic institutes. This research is still clinically significant and further in-depth investigations will be carried out in the future.


Symptoms related to abnormalities in gastrointestinal tract motility and functions are very common in the general population, affecting both pediatrics and adults, from both sexes . These sThe last decade has witnessed important advances in diagnostic tools and technologies used for the improved assessment of gastrointestinal function and motility ,6. A revFurther research has focused on improving our understanding of GERD pathogenesis, in order to ameliorate our diagnostic approach . Indeed,Notably, the application of artificial intelligence (AI) to the upper GI tract is mainly in the field of endoscopy; however, AI systems application is expanding in other upper GI settings, to include GERD, eosinophilic esophagitis, and motility disorders ,20.99m Technetium-labeled egg) is considered the gold standard for gastroparesis diagnosis [As for gastric symptoms, currently, scintigraphy of a solid meal (using aiagnosis . Howeveriagnosis . In addiiagnosis .Disorders in the anorectum such as constipation and fecal incontinence are also common in the general population and cause severe impacts on life quality and productivity . High reNumerous advances in the field of neurogastroenterology and motility have been achieved in recent years, including new imaging testing, developments at the cellular and molecular levels, the evolving role of the microbiome in various functional gastrointestinal symptoms, the role of diet and traditional and complementary medicine in managing functional gastrointestinal conditions, and many other advances from the clinical and laboratory levels. We believe that this Special Issue, in the Journal of Clinical Medicine, is of paramount significance and relevance for shedding light on the recent advances in neurogastroenterology and motility disorders, from pathophysiology to management, at the clinical and laboratory levels.


Moreover, this data set needs to be associated with the patient’s clinical information. The collection and storage of biological material enable a series of studies that will allow the distinction between the healthy and pathological tissues and the genotype and associated phenotypes.Personalized medicine can be defined as a medical approach based on individualized information that allows planning and treatment considering the patient’s clinical and genetic characteristics. Despite the great advance since the creation of the Human Genome Project aimed at identifying all the genes of human beings, the transcription of the gene was found to be not solely responsible for the result of our organism’s responses. Therefore, the investigations of proteomics and metabolomics projects were also initiated, considering the transcription from deoxyribonucleic acid (DNA) to ribonucleic acid (RNA), its production of proteins and products of cellular metabolism.The biobank is an organized collection of human biological material and associated information, collected and stored for research purposes, according to regulations or pre-defined technical, ethical, and operational standards, under the institutional responsibility and management of the stored materials, with no commercial purposes. In other words, it is the democratic storage of biological materials for research on patients, guaranteed by an institution. Contrarily, the biorepository is the storage of biological material during a specific research project, under institutional responsibility and the researcher’s management.Motivations for building a biobank are related to new goals of modern medicine and multidisciplinary practice, such as personalized medicine, early diagnosis of specific diseases like cancer or genetic diseases, and response prediction to targeted therapy with the principles of pharmacogenetics. Ischemia time clearly changes gene expression. Furthermore, the method of tissue fixation can change the results of laboratory tests, resulting into false positives or negatives. Therefore, in the biobank, best practices must be strictly followed.Biobank’s biological materials are valued in terms of the digital traceability of information and presence of clear consent and assent of participants and their guardians (in case of minors), in addition to the technique of sample acquisition, storage, quality control, data collection, correlation to clinical data, data security and access.Several specimens allow storage, like organs, solid tissues, tumors, umbilical cord, feces, blood and its derivatives, urine, cerebrospinal fluid, teeth, saliva, bronchoalveolar lavage fluid, and perfusates (samples from organ perfusion). Samples must be stored based on the objective to be studied with fresh frozen tissue; since specific preparations are required for extracting DNA, RNA, mitochondria, specific proteins, among others.However, the biobank is not restricted to the acquisition and storage of biological materials. The progressive use of artificial intelligence and databases, with the possibility of intersecting the collected materials, retrospectively or prospectively, with associated donor information, pushes new frontiers of knowledge. Additionally, the participants can include their own data using the biobank’s websites or Apps, and can be notified about the usage of their information and material.One of the main biobanks in the world is the United Kingdom (UK) Biobank, managed by England. Currently, it has more than 500,000 participants. Since 2014, magnetic resonance imaging and other images are also being collected. This biobank assesses genetics, physical activities, imaging tests, biomarkers, physical measurements, cognition, and hearing, in addition to prospective questionnaires. Although this large biobank is not compatible with the representation of the general population, as it is a cohort of healthy people, evaluation of public health outcomes can be ideally performed.Franklin Delano Roosevelt, former United States President, died in 1945 after an acute myocardial infarction. He encouraged his successor Harry Truman to develop the National Heart, Lung, and Blood Institute. In 1948, Truman included the first patient in the institute from one of the main cohorts in the world: the Framingham Heart Study. This cohort allowed several publications and guided the consensus on cardiovascular risk and its prevention. This was possible because of the integration of information and storage of biological materials. This is the concept of a biobank.In 2021, 89 biobanks in Brazil had been authorized by the National Research Ethics Commission for the most diverse purposes of collecting biological materials. Based on this tool in the arsenal of translational research, worldwide and in Brazil, the Heart Institute of the Medical School of the University of São Paulo (Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo [InCor HCFMUSP]) created the Institutional Biobank, with a capacity for more than 84,000 samples, including the cardiopulmonary department, in which groups can store samples of selected lines of action, such as lung transplantation.Presently, the concept of evidence-based medicine is developing into medicine based evidence, which means, with the acquisition of new information from large databases, associated with materials collected from biobanks and the integration of artificial intelligence, either by deep learning, neural network, or other forms of algorithms. The evidence, that is, the data, will be able to better predict the treatment, target therapy, specific diagnoses, and others. Evidence-based medicine supports personalized medicine, and the biobank plays a key role in this regard. The collection of biological materials and the reproducibility of the technique in different general and specific populations will allow these studies.Specific institutions created for biobank such as the UK Biobank or well-structured educational institutions such as the InCor, with the capacity to store information and biological materials, will be able to collect and provide researchers and the population with answers that is lacking at present, especially focused on the patient’s individuality.


The quality of human settlement environment (HSE) is related to people’s well-being. Since the implementation of the Western Development Strategy and the Grain to Green Program, the HSE in northern Shaanxi has undergone a major transformation. In order to explore the evolution pattern and seek a coordinated development strategy for all systems in the whole region, this paper, from the perspective of “production–living–ecological”, evaluates the HSE niche breadth of northern Shaanxi based on the ecological niche theory, analyzes its spatial differentiation characteristics, and identifies the development barrier factors, with the help of ArcGIS spatial analysis tools and the barrier degree model. It is found that: from 2000 to 2020, (1) the niche breadth of HSE in northern Shaanxi is high in the north and low in the south, showing obvious spatial unevenness; (2) the development of transportation promotes the improvement of HSE, but also intensifies the spatial unevenness, and the uncoordinated development rate of transportation and production and living systems has seriously restricted the further development of HSE; (3) the niche breadth of the ecosystem for each county is much lower than that of the production and living systems, and the ecological environment becomes the short board of the improvement of HSE in northern Shaanxi. Based on the patterns and problems found in the study, this paper proposes a strategy to improve the HSE of northern Shaanxi by prioritizing the balanced development of production, living systems, and transportation, strictly implementing the concept of ecological priority, dynamically adjusting the hierarchy of policies, vigorously optimizing the industrial layout, and focusing on the joint improvement of the human settlement environment in the whole region. This study expands the theories and evaluation methods of HSE to a certain extent, and the results have guiding values for promoting the sustainable development of HSE in northern Shaanxi and even the whole Loess Plateau region. Human settlement environment (HSE) is the place where human beings live together, the surface space of the earth closely related to human survival activities, the base on which human beings live in nature, and the main place where human beings use and transform nature . Faced wIn order to achieve the common goal of HSE research, scholars often take the evaluation of livability as the entry point of the research. The object of the evaluation of HSE livability is divided into subjective object , which iIn terms of methods for evaluating HSE, linear weighting and hierarchical synthesis are the current mainstream methods . For exaAlthough scholars have produced rich results in the field of HSE, most of the existing studies have focused on developed areas ,33,34 orIn summary, in order to explore the HSE evolution pattern in less developed regions and seek strategies for the coordinated development of each system, this paper takes northern Shaanxi as an example, based on HSE theory, PLE theory, and ecological niche theory, and uses the niche breadth model, hot spot analysis, spatial auto-correlation, and the barrier degree model to assess the niche of HSE, analyze its spatial differentiation characteristics and the trade-off relationship within the PLE system, and identify the barrier factors for HSE enhancement in the hope of proposing targeted HSE optimization strategies. The introduction of ecological niche theory and the perspective of production–living–ecological are the main innovations of this paper, which expands the relevant theories and evaluation methods of HSE to a certain extent. The results provide some guidance in achieving sustainable development of HSE in a typical region such as northern Shaanxi.4 km2 and includes 2 prefecture-level cities, Yulin and Yan’an, with 21 counties and 4 municipal districts under its jurisdiction  Land use data are taken from the Resource and Environmental Science and Data Center of the Chinese Academy of Sciences (https://www.resdc.cn (accessed on 5 October 2022)). (3) DEM were downloaded from 91 Guardian software, with an accuracy of 30 m × 30 m. (4) PM 2.5 data (0.01° × 0.01°) were obtained from Washington University in St. Louis (https://sites.wustl.edu/acag/datasets/surface-pm2-5/#V5.GL.02 (accessed on 8 August 2022)).Considering that the Grain to Green Program and the Western Development Strategy, implemented in 1999 and 2000, respectively, might have a greater impact on the HES in northern Shaanxi, and taking into account the availability of data, this paper takes 2000 as the starting year and 2020 as the cut-off year of the study. At the same time, to facilitate comparative research, this paper selects 2010 as the time point, which divides the research period into two decades. The data are obtained as follows. (1) Indicator data are calculated from the statistical data of Based on the analysis of the connotation of HSE and PLE, summarizing the previous achievements and combining with the situation of the study area, this paper constructs a three-dimensional evaluation index system of production–living–ecological for evaluating HSE ecological niche. The production environment is the foundation of socio-economic development and the key to the enhancement of human well-being. It is concerned with food security as well as the efficiency, intensity, and trends of development, and can be characterized by the scale, efficiency, level, concentration of development, and trends of agricultural production and non-agricultural production . The livIn summary, a total of 16 indicators were selected in this paper to evaluate the HSE ecological niche in northern Shaanxi . The resAccording to ecological niche theory, the niche breadth indicates the degree of resource utilization of a species . For thii, j = 1, 2, 3, …, n; iN is the niche breadth of county i; iS and iP are the state and trend of county i, respectively; jS and jP are the state and trend of county j, respectively; iA and jA are the dimensional conversion coefficients; jS + jPjA is called the absolute niche.Drawing on the niche trend model , this paGi* index of Hot Spot Analysis in Spatial Statistics Tools in ArcGIS was used to perform the cold and hot spot local correlation analysis of the niche breadth of HSE. The formula is as follows:ijW denotes the spatial weight; E mainly detects the dependence of the spatial distribution pattern of things and phenomena, determines the diffusion, polarization, or randomness of the spatial distribution, and is used to reveal the mechanism of interaction between the property values of the research object . The bivjP is the barrier degree of the single indicator to HSE enhancement; jZ is the standardized value of the single indicator; m = 16; jV is the barrier degree of the criterion layer to HSE enhancement.The barrier degree model is a mathematical statistical method to effectively determine the key factors that hinder the development of things, and it is now widely used in the study of impact factors in various disciplines. With reference to the existing research , the barThe spatial differentiation pattern, temporal evolution process, and regional characteristics of the production–living–ecological niche breadth of HSE in 25 counties in northern Shaanxi from 2000 to 2020 are obvious . The detProduction environment: During the study period, the production niche breadth of each county is basically stable, showing the spatial distribution characteristics of high in the north and low in the south. Specifically, from 2000 to 2010, Fugue, Shenmu, Luochuan, and Yuyang had much higher niche breadth values than the other counties, while all other counties had similar values. From 2010 to 2020, although the value of Fugu decreased significantly, from the highest to the fourth highest, Fugu, Shenmu, Luochuan, and Yuyang still had values above all other counties. Over the 20 years, the production niche breadth increased slightly in all the counties of Yulin City, except for Fugu County. However, in Yan’an City, only Baota District and Yanchuan County saw a slight increase, while the rest of the counties saw a decrease in production niche breadth to varying degrees.Living environment: Unlike the production environment, the living niche breadth in northern Shaanxi varied more markedly in space during the study period. From 2000 to 2010, the living niche breadth in the study area shows a circle-like spatial distribution. Baota District is the center of the circle, and the value of its living niche breadth is much higher than that of other counties; in the middle of the circle are the counties immediately adjacent to Baota District, and their values are at the lowest level of the study area; the counties in the north and south ends of the study area are at the outermost part of the circle, and the values of these counties are in the middle for the study area. From 2010 to 2020, the values of living niche breadth in northern Shaanxi change significantly in spatial distribution, which can be summarized as high in the north and low in the south. Specifically, the value of Baota District slightly decreased, and the values of its surrounding counties remained at the lowest level in the study area; the high value of living niche breadth shifted from Baota District to Yuyang, Shenmu, and Fugu, which are located in the northernmost part of the study area.Ecological environment: The ecological niche breadth in northern Shaanxi was much lower than that of production and living environment during 2000–2020, and the change in its value is also small, but the change of spatial characteristics is obvious. From 2000 to 2010, the highest values were found in Shenmu, followed by Ansai; the low-value areas were mainly concentrated in the eastern part of the study area; Luochuan and Huanglong, located in the south, and Wuqi, located in the west, also had low values; the rest of the counties were at medium or high levels. From 2010 to 2020, Yuyang, Shenmu, and Fugu, located in the northern region, and Fuxian and Ganquan, located in the southern region, had the highest values; the values in the western part of the study area decreased significantly, and the eastern part remained as a low-value concentration area.The comprehensive evaluation results show that from 2000 to 2020, the niche breadth of HSE in northern Shaanxi has a small temporal variation, but the spatial variation in the north–south direction is obvious, and the overall distribution is high in the north and low in the south. In the north of the study area, Yuyang, Shenmu, and Fugu have the highest values, and in the south, Baota has the highest value, while the peripheral counties in Baota have the lowest level of niche breadth in the study area.The hot spot analysis  helps toZ-test (p = 0.05) as the criterion. With the help of the LISA distribution map, the spatial interaction of two adjacent functions in the region can be better expressed [To deeply explore the spatial trade-offs among production, living, and ecological, the bivariate local autocorrelations of niche breadth within the PLE system from 2000–2010 and 2010–2020 were analyzed with the help of GeoDa 1.20, using a 5000 m grid as the base unit and xpressed .The trade-off relationship within the PLE system is spatiotemporally heterogeneous . SpecifiOverall, from 2000 to 2020, the HH synergistic area of P-L system, P-E system, and L-E system expanded in the three northern counties of the study area or shifted to this range; LL synergy extended from the east and west sides of the study area to the central part; HL trade-off, LH trade-off, and LL synergistic were interspersed in the southern region.The barrier degree of each factor to HSE enhancement in northern Shaanxi was calculated with the help of the barrier degree model, and the top three factors for each county were listed .Statistics found that (1) from 2000 to 2010, the main barrier factors for HSE enhancement in 19 counties were transportation land density (TLD), total ecosystem services value (TESV), and the number of industrial enterprises above the scale (NIEAS). Except for Baota District, the factor with the highest barrier degree in each unit was TLD. In addition to the three factors mentioned above, the ratio of social security spending to GDP (RSS) had a large impact on the enhancement in Baota, Huangling, Yuyang, Shenmu, Fugu, and Jingbian. (2) From 2010 to 2020, TLD was still the most dominant barrier factor in most counties. The main barrier factors in Baota District changed significantly, from TESV, NIEAS, and RSS to TLD, TESV, and RSS. The three northern counties also changed significantly, with the primary factor changing to RSS, and grain yield per unit area (GYPU) and annual precipitation (AP) becoming important barrier factors.Overall, HSE enhancement in most counties in northern Shaanxi continued to be constrained by transportation and ecosystem services, and only a few counties saw changes in the major barrier factors over the 20-year period. In comparison with the results of the niche breadth measurement and the PLE spatial trade-off analysis, significant changes were still observed in Shenmu, Fugu, and Yuyang in the northern part of the study area, and in Baota in the southern part.Based on the results of the barrier degree measurement, the barrier degree map of the PLE system of northern Shaanxi HSE enhancement was drawn .From 2000 to 2010, the HSE niche of more than half of the counties in northern Shaanxi was mainly constrained by the development level of living environment, and the barrier degrees produced for Shenmu, Huangling, and Luochuan were all greater than 0.45. The main barriers for Baota and Suide were production environment, with barrier degrees of about 0.50 and 0.40, respectively. Nine counties, including Yanchuan, Fuxian, Huanglong, and Hengshan, were constrained by both production and living environments, and the barrier degrees of both systems were above 0.35. The ecological environment had stronger constraints on Fugu, Luochuan, Zichang, and Baota.From 2000 to 2020, the barrier degree of the PLE system to HSE in northern Shaanxi changed to some extent, but living environment constraint or L-P double constraint was the main pattern. The production environment produced serious constraints only in a few areas. Ecological, P-E, and P-L-E constraint patterns did not appear.With the help of the niche breadth model and hot spot analysis, we found that the spatial distribution of HSE niche breadth in northern Shaanxi is characterized by being high in the north and low in the south. The values of Yuyang, Shenmu, and Fugu are the highest in the northern region, and the values of Baota are the highest in the southern region. The low-value areas are clustered in the periphery of Baota District. The reasons for the formation of this feature are complex and varied, and we will discuss it from the perspective of the PLE environment.Agricultural production and industrial economy are direct manifestations of the production environment, and it may be possible to find some reasons for the formation of spatial differentiation of HSE in terms of their changes, i.e., in terms of changes in the production environment itself. In the industrial economy, as economic powerhouses in western China, the energy and chemical industries in Shenmu and Fugu have been ranked among the top in the country in terms of production capacity and output efficiency. The economic benefits from industrial production have laid a solid foundation for HSE enhancement in the northern part of the study area. With regard to agricultural production, taking Yulin City as an example, relevant studies  show thaThe living environment is also closely related to the spatial characteristics of HSE in northern Shaanxi. Transportation is an important grasp of economic development , and likSince the implementation of the GGP, the ecological environment in northern Shaanxi has been significantly improved , and theProduction, living, and ecological environment are not separate. There are intertwined situations between them . For exaFrom the perspective of barrier factors, transportation, ecosystem services, number of large-scale industrial enterprises, and social security expenditures were the main barrier factors for HSE enhancement in most counties in northern Shaanxi from 2000 to 2020. The positive response of economic development to the improvement of transportation level directly drives the enhancement of the HSE’s production and living environment. Since the Western Development Strategy, the rapid development of transportation in northern Shaanxi has contributed to the formation of the HSE niche spatial pattern. However, the contribution of transportation is slightly insufficient compared with the dominant indicators such as industrial output, food production, and economic density. The difference in the development rate of transportation and other factors might be the reason for this result. The amount of ecosystem services, as another important barrier factor, constrains the HSE niche enhancement in various ways. On the one hand, the fragility of the ecological background in northern Shaanxi was the main shortcoming of HSE enhancement. Although it improved over the 20 years, the service capacity and service volume of the improved ecosystem remained at a relatively low level. On the other hand, in order to adapt to the rapid economic development, ecological land has been continuously squeezed by urban and rural construction land, and some of the ecological benefits brought by the Grain to Green Program have been offset. A related study  showed tIn terms of the barrier degree of P-L-E environment, there are mainly two patterns of single living environment barrier and living-production dual barrier for the enhancement of HSE in northern Shaanxi. Combining the barrier degrees at the indicator level, it can be concluded that the constraints arising from the production environment are caused by the decrease in the number of large-scale industrial enterprises, and the constraints of the living environment are mainly caused by the ratio of social security expenditures to GDP and transportation factors. Influenced by transportation factors, the constraint of living environment on HSE enhancement in northern Shaanxi becomes more prominent after excluding the number of large-scale industrial enterprises and the ratio of social security expenditure to GDP. In addition, it is worth noting that the measurement results show that the ecological environment has not produced significant constraints. This is due, on the one hand, to the trade-off between the ecological environment and the living and production environment, and on the other hand, to the fact that the niche breadth of the ecological environment has been at an extremely low level, even producing differences in order of magnitude compared with the production and living environment. Because of this, for northern Shaanxi, the ecological environment is an important shortcoming for HSE enhancement. From the above discussion, it is easy to find that the results of the barrier model are generally in line with the reality of the study area, but the limitations of the method lead to the barrier of some factors being only reflected in the “value”. In other words, with socio-economic development, some of the factors are no longer significant barriers to HSE improvement, but they still seem to have some influence from the model’s arithmetic results. Therefore, future studies should not only carefully consider whether the selected indicators or impact factors can be adapted to socio-economic development, but also closely integrate the situation of the study area when analyzing the results to remove unreasonable factors. This will provide a more scientific basis for the proposed strategy.In summary, differences in economic base, resource endowment, and policies have caused spatial unevenness in the PLE niche breadth for HSE in northern Shaanxi. Different development rates of transportation and economy have further exacerbated this unevenness, and even made the transportation level an important barrier factor for HSE enhancement. The fragile native ecological environment and the dramatic expansion of urban and rural construction land have led to the contribution of the Grain to Green Program to HSE becoming limited. In addition, the trade-offs within the PLE system have made it challenging to improve HSE overall. Due to the dynamic and complex nature of the HSE system, when carrying out enhancement optimization, we should distinguish the main and secondary issues, prioritize the main issues while taking into account the shortcomings, and dynamically coordinate multiple secondary issues in the optimization process. For northern Shaanxi, the mismatch in development speed between transportation and production and living environment is the main factor that restricts HSE enhancement, which should be adjusted as a priority. The fragility of the ecological environment has been an inherent shortcoming of the region, and the concept of ecological priority should be consistently implemented. For example, land should be used as intensively as possible when enhancing the production and living environment in order to avoid large encroachments on ecological land and to maximize the ecological benefits brought by various measures. In addition, the imbalance should be broken by optimizing policies and industrial layout and other means to drive the development of low-value areas for HSE niche breadth, thus realizing HSE enhancement in the whole area of northern Shaanxi.Based on niche theory and PLE theory, this paper evaluated the HSE niche of each county in northern Shaanxi from a macro perspective with the help of the niche breadth model, ArcGIS hot spot analysis tool, and barrier degree model, analyzed its spatial distribution characteristics and the barrier factors for enhancement, and put forward development suggestions from the perspective of breaking through the constraints. The main conclusions are as follows.From 2000 to 2020, the overall spatial characteristics of HSE niche breadth in northern Shaanxi showed a pattern of high in the north and low in the south, and the niche breadth value of ecological environment was much lower than that of production and living environment. The rapid development of the energy industry, which has brought about substantial economic growth, was the main reason for the increase in the HSE niche. The differences in resource endowment and economic base, as well as the strategic layout of the government, etc., have led to an uneven level of industrial development among the regions, resulting in the spatial unevenness of the HSE niche in northern Shaanxi, i.e., the production environment has dominated the formation of the spatial characteristics of the HSE niche in northern Shaanxi.The hot spots of HSE niche breadth in northern Shaanxi mainly concentrated in Shenmu, Fugu, and Yuyang, which are located in the northern part of the study area, and the cold spots mainly concentrated in the periphery of Baota District. From 2000 to 2020, the HH synergies of P-L, P-E, and L-E also mainly clustered in the three northern counties, while the LL synergies showed an overall extension from the eastern and western parts of the study area to the central part. In the southern part, the spatial trade-offs of the PLE system were intricate and complex, with HL trade-offs, LH trade-offs, and LL synergies interspersed.The development of transportation has driven the enhancement of HSE in northern Shaanxi, but it has also exacerbated the spatially uneven characteristics of the niche. At the same time, the difference in the development rate of transportation and production and living environment is an important reason to restrict the enhancement of HSE niche in northern Shaanxi, and the ecological environment is an inherent shortcoming of the enhancement.Finally, based on the results of this paper and the actual situation in northern Shaanxi, we propose a strategy to improve HSE by prioritizing the balanced development of production, living systems, and transportation, strictly implementing the concept of ecological priority, dynamically adjusting the hierarchy of policies, vigorously optimizing the industrial layout, and focusing on the joint improvement of the human settlement environment in the whole region.


Sleep problems severely affect the quality of life in the elderly and have gradually gained attention among scholars. As a major hot spot of current research, sleep in older adults is highly exploratory and of great significance for human health.Therefore, in this study, the current state of the art of sleep research in older adults was analyzed through the visual mapping function of CiteSpace software. Using this software, we analyzed popular research questions and directions and revealed the development trends and research frontiers of this field.In this paper, we searched the Web of Science database for sleep-related studies focusing on older adults and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by using CiteSpace software.Sleep has published the majority of the articles on sleep in older adults and has the highest citation frequency. The Journal of the American Geriatrics Society has the highest impact factor and CiteScore among the top 10 journals in terms of the number of published articles. The United States has the highest number of publications and most of the leading institutions in this field are located in the United States, with the University of California, Los Angeles, and the University of Pittsburgh having the highest number of publications. Dzierzewski JM is the most published author and has played an important role in guiding the development of this field. Research in this area is focused on insomnia, sleep quality, depression, and sleep duration.Our results revealed that the number of publications concerning sleep in older adults has gradually increased; after 2017, this field underwent rapid development. The journal The rapid development of sleep research in older adults, which shows a yearly growth trend, indicates that this field is receiving increasing attention from researchers. Insomnia in older adults is the most concerning problem in this field. At the same time, future research should continue to focus on the impact of sleep disorders on older adults to improve sleep and quality of life in older adults. The aging population experiences age-related symptoms, such as slowed metabolism, decreased resistance, and decreased physiological functions, and may even develop age spots and memory loss . With thSleep disorders (SDs) are symptoms of abnormal amounts of sleep, abnormal behaviors during sleep, and disruptions of the circadian rhythm  , 9. SDs Good and sufficient sleep is beneficial to the recovery process from physical diseases, and it is necessary for undertaking daily activities. Furthermore, it can improve the quality of life in older adults , reduce Research on sleep in older adults has gradually increased in recent years. Since elderly sleep is influenced by many aspects, such as sex, sleep habits, physical and mental disorders, and medications, a considerable number of studies exist in this area, and their findings are complicated. Scientific knowledge mapping is a popular research method in the fields of scientometrics and visual analysis, which reveals the development patterns and research hot spots of related fields through visualization . With thThe data used in this paper were obtained from the Web of Science (WOS) database from 1 January 2000 to 1 August 2022. The search was conducted using author keywords (AK) in the form [AK= (older adults) or AK= (older people)] and AK= (sleep). A total of 475 documents were retrieved, after which the items were refined by document type (article) and excluded by types of publication ; thus, 65 items were excluded. The items were manually filtered by excluding reviews, meta, case reports, books, letters, comments, and meetings, through which 13 items were excluded. A total of 397 items were included in this study . The entIn this study, CiteSpace 6.1.R2 software was used to map scientific knowledge, and co-occurrence and clustering analyses were performed on high-frequency terms, research institutions, and countries. Finally, 397 papers were included in the study, and the trend maps of publication volume, authorship, institutional cooperation, geographical distribution, and keyword mapping were drawn to highlight key nodes and research hots pots, thus visualizing the field of sleep research in older adults. Each of these plots represents cutting-edge hot spots and trends in scientific research and can be selectively analyzed based on a particular aspect of the problem . In addiAfter searching and screening, a total of 397 publications were found in the WOS database between 2000 and 2022. It can be seen in Sleep ranks first, with 23 articles, and is also first in terms of citation frequency (508). Ranking second and third are the Journal of Clinical Sleep Medicine and Sleep Medicine, with 22 and 19 articles, respectively. The Journal of the American Geriatrics Society ranks fourth in terms of the number of published articles. This journal ranks first in both impact factor (7.538) and CiteScore (8.8). Overall, 5 of the top 10 journals in terms of the number of published articles are from the United States. This is followed by the United Kingdom, with 4 of the top 10 journals.The included literature was organized and ranked according to the number of published articles, resulting in the top 10 journals in terms of the number of articles . The resEffects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. This article has 146 citations and is authored by King AC. The article was published in 2008. Among the top 10 cited articles, 4 articles were published in 2010 in Sleep Medicine, Sleep, Psychoneuroendocrinology, and Journal of Medicinal Food. Most of the highly cited articles were published in American journals, namely Journals of Gerontology Series A-Biological Sciences and Medical Sciences, Sleep, American Journal of Geriatric Psychiatry, and Medical Clinics of North.The top 10 most frequently cited articles are listed in As seen from The number and size of the nodes in the author collaboration network map show the frequency of co-occurrence, and the number of connected lines indicates the collaborative network between authors, as well as its strength . There aThe visual analysis of sleep in older adults was performed using CiteSpace software , and theIn order to better understand the research hot spots in the field of sleep in older adults, a keyword clustering map was drawn by running the CiteSpace visualization software . The sciTo better visualize the research dynamics of sleep research in older adults, a keyword time-zone mapping was developed to show the evolution of research hot spots from 2003 to 2022 . High-frWith aging-related physiological changes, the sleep schedule of the elderly also changes, with shorter nighttime sleep, more frequent daytime sleep, and reduced sleep duration. The underlying causes for these problems include physical diseases, mental problems, environment, and living conditions. Through the bibliometric analysis of research on elderly sleep with CiteSpace, the current situation and development trend of the elderly sleep research were identified in terms of authors, institutions, journals, countries, and keywords.The trends in sleep research on older adults are reflected by the number of published papers in recent years. Sleep ranks first in terms of the number of articles. This indicates that the journal has a high academic advantage and influence in the study of sleep in older adults. The main research directions of Sleep are behavioral sciences, clinical neurology, neurosciences, and psychiatry. The top three journals are all in the field of clinical neurology. The Journal of the American Geriatrics Society focuses on geriatrics gerontology. The journal is ranked first in both impact factor and CiteScore, indicating the high quality of academic papers published in the journal. Other journals in the field of geriatrics include BMC Geriatrics, Geriatrics Nursing, International Psychogeriatrics, International Journal of Geriatric Psychiatry, and Clinical Gerontologist.Effects of moderate-intensity exercise on polysomnographic and subjective sleep quality in older adults with mild to moderate sleep complaints. The article focused on the effects of exercise interventions on sleep in older adults. It revealed that moderate-intensity exercise improved sleep quality in older adults with mild-to-moderate sleep complaints (Highly cited research is an essential source of scientific knowledge in any field of study, as it indicates the level of research and trends of development in that field and is the scientific basis for exploring the frontiers of research and hot spots . The citmplaints .The country–region distribution map is a much better depiction of the scientific research differences and distribution in sleep research in each country. Far more papers are published in the United States than in other countries. This indicates that the United States has the highest level of research and influence in the field of sleep research. University of California, Los Angeles, and the University of Pittsburgh rank first in terms of the number of published papers, indicating their outstanding contributions to this field. The University of California, Los Angeles is the cradle of scientific research and high-tech industry professionals in the United States. It invests a considerable amount of human and material resources into research every year. The mapping of institutional collaboration shows that several US research institutions have active collaborative networks with other institutions and that more opportunities exist for academic exchange and learning. Various institutions learn from each other and contribute to the continued development of related research.Author collaboration mapping provides a clear view of the research status of individual scholars in a research area and the collaboration among them . It provKeywords are high-level summaries of the topic of a paper and reflect the research direction and value of the article. Analysis of keywords in the related literature of a certain field helps explore the research hotspots and development trends in that field . KeywordSome studies have shown that approximately half of older adults suffer from SDs, which is closely related to physical health status . The durThis bibliometric analysis of studies involving elderly sleep was conducted with the help of CiteSpace software, using visual mapping to more graphically reveal the trends and patterns in this field, which in turn led to a series of new findings and interpretations. This paper focused on the number of publications, journals, authors, institutions, countries, and keywords, aiming at a macro analysis of the field, so some important detailed parts were not reflected in the study. CiteSpace software was developed based on the Web of Science Core Collection and, therefore, generally relies on this database for analysis. Thus, our choice of databases was limited. Additionally, we limited the search period to January 2000–August 2022, and those articles published after this period were not included.This bibliometric study focused on sleep quality in older adults, providing detailed information on the relevant literature from a global perspective through visualization with CiteSpace. We found that the number of studies in the field of elderly sleep has increased year by year, especially after 2017, with a sharp increase in the number of publications, indicating that this research area has excellent growth potential. Pioneering research on elderly sleep originates from the United States. The research institutions involved in this area are mainly universities. Research hot spots revolve around insomnia, sleep quality, depression, sleep duration, etc. Research topics include sleep quality, cognitive impairment, obstructive sleep apnea, etc. To summarize, this study predicts future research trends in elderly sleep through visual analysis and can provide valuable insight to help understand the research frontiers and hot spots in this field. At the same time, sleep research in older adults is highly exploratory and deserves further development.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.HL contributed to conceptualization, design, and supervision. HJ and WH collected data from the database. FL and ZD analyzed the data. HL and FL wrote the original draft. HL made critical revisions of the manuscript. All authors have read and agreed to the published version of the manuscript.