The increasing concerns over emerging infectious diseases and potential pandemics led to the formation of One Health, a collaborative, multidisciplinary approach to address the risks from human–animal–ecosystem interactions. This multi-sectoral approach is specifically important in Australia, a biodiverse country with unique flora, fauna, and many infectious diseases, including leptospirosis. Leptospirosis is a relatively rare but potentially fatal zoonosis, with an attributed mortality of around 60,000 deaths per year worldwide. In recent years, sporadic cases and alarming outbreaks of leptospirosis have been notified in many states and territories of Australia, noteworthily in 2018 and 2019. The sudden outbreaks in these two years have raised a question about the possibility of a more severe menace or a potential threat to both humans and animals. Amid the fight against leptospirosis, One Health has been shown to be an excellent and ideal framework, especially in Australia, the country that has taken the lead in zoonosis control using this approach. In this review, the focus will be put on the effectiveness and ethics of One Health in leptospirosis control under the Australian setting to further advocate the implementation of this framework for many other infectious diseases. Recent decades have witnessed increasing concerns over the risk of emerging infectious diseases and potential epidemics or pandemics . The majLeptospira species [Leptospirosis, a contagious disease caused by the pathogenic  species , is a re species ,7, with  species . While m species ,10, only species . The sym species .In recent years, sporadic cases and outbreaks of leptospirosis have been reported in many regions of Australia . The larIn this battle against leptospirosis, One Health is a potential approach , showingDistribution. Globally, there are roughly one million severe cases related to leptospirosis per year, while this figure for Australian settings is much lower, with about 2400 cases and more than 100 deaths annually [annually . Notifieannually  are summannually . Within annually , which aannually .Pathology and risk factors. The leptospiral life cycle starts with shedding in the urine of the chronically infected animals, persisting in the ambient environment, acquiring a new host, and finally disseminating to the kidneys, turning them into reservoirs of pathogens [Leptospira species can enter the human body through skin cuts, abrasions, or mucous membranes in the mouth, nose, or eyes [athogens , and alsathogens . In term or eyes ,7, eithe or eyes ,19. The  or eyes . People  or eyes ,7,8, are or eyes ,7,8, avo or eyes .Diagnosis. The diagnostic process usually starts with the patient’s symptoms and laboratory tests [Leptospira. In some cases, when physicians cannot identify the exact pathogen, understanding the epidemiology and pathology of potential infectious agents can help orientate the diagnosis. Referencing to leptospirosis, as a relatively rare bacterial disease in Australia [ry tests . In compry tests ,21. Howeustralia , a largeustralia ,7,8, makustralia . Based oustralia , which eTreatment. The treatment of acute leptospirosis in humans and animals depends mostly on antibiotics and supportive measures [measures ,22. Howemeasures . This ismeasures , as resimeasures  is probameasures , to raismeasures , communimeasures , implyinmeasures , the appPrevention. In general, preventing contagious diseases requires knowledge about the sources, cycle, and pathology of infections. Unlike many other infections, leptospirosis is an endemic zoonosis [zoonosis , highly zoonosis ,7,8. Thezoonosis ,7,8. In zoonosis ,7,8, whiLeptospira species and has the potential to eradicate the pathogen from the human and animal community. However, practical and cost challenges can deter this strategy, especially in the Northern Territory of Australia [More importantly, this One Health approach might have broadened the scope of preventive measures, from defence to control and eradication . Knowleustralia . To advoFurthermore, the ambient environment where the leptospiral strains temporarily exist should also be investigated. As rodents are potential reservoirs, measures targeting these mammals’ habitats, including the removal of rubbish and food sources, are advocated ,8, partiHarm principle. This principle can relate to those deliberately trying to harm, or neglecting their responsibilities, which might inflict harm on other people [r people . In the r people , which cr people . While tr people . Howeverr people , given tr people . Howeverr people ,3, all tr people . After cr people , the OneDuty of care. The original concept of this aspect was to clarify the responsibilities of healthcare workers in the event of fatal outbreaks [Leptospira species. Measures to maintain the safety of the environment must also be carried out to mitigate the presence of the pathogen in the natural habitat, i.e., keeping livestock away from the water source in suspected areas. In regions that usually suffer from floods and leptospirosis, assistance from One Health experts to minimise the damage and consequent risks could prevent disaster after disaster. Provided that the duty of care principle aims at avoiding predictable actions that might cause harm to other people, One Health is an ideal approach, allowing us to foresee all the potential risks and the accompanying solutions.utbreaks , as thisutbreaks . Thus, tSolidarity. At the most basic level, solidarity “comprises manifestations of the willingness to carry costs to assist others with whom a person recognises sameness or similarity in at least one relevant respect” [respect” . This corespect” . In the respect” , implyinrespect”  for diffrespect” , whereasrespect” ,34, the respect” . This imHealthcare equity. In close association with solidarity, One Health has a significant potential to promote healthcare equity, specifically in low- and middle-income countries [ountries . Followiountries , governmountries . Additioountries , could bResearch ethics. One Health plays an essential role in ensuring research ethics, as it is the key to maintaining all of the above ethical aspects of this approach. The foundation of One Health is based in multiple fields, from health to the social and environmental sciences [sciences ,2, implisciences , for thesciences . As longsciences , it appesciences . By follIn conclusion, as prioritisation and resource allocation always require comprehensive considerations, including ethical principles, effectiveness, socioeconomic status, etc., a multi-sectoral approach such as that advocated by One Health is critically useful and necessary to address all of the related issues in leptospirosis control. The feasibility of One Health is mainly reflected in the context of economic, social, and political forces. Whereas One Health’s effectiveness is best expressed in the process of diagnosis–treatment–prevention, it is better to consider its necessity by analysing the underlying ethical principles. Together, both aspects can form a bigger picture about the role of the One Health approach in controlling leptospirosis as well as other infectious diseases and how to properly implement it in real settings.


Somatization and number of diseases are interrelated variables, whose association with stress-coping strategies, according to sex, has not been investigated. Therefore, the aim of this study was to investigate such association in a sample of the Mexican general population. The general population was invited to answer an electronic questionnaire via the social networks—e-mail, WhatsApp and Facebook—by the research team. A sample of 1008 adults was obtained, of which 62.2% were women, in whom we detected higher levels of negative psychological variables, somatization and number of diseases and lower levels of sleep quality. Positive moderate correlations were found between depresion, anxiety and stress with somatization, on one hand, and with the number of diseases, on the other, and negative moderate correlations were found between sleep quality and the two dependent variables. As for the coping strategies, self-blame, behavioral disengagement, denial, self-distraction and substance use were positively correlated with somatization. Of these, self-blame, substance use, and self-distraction also showed a positive correlation with number of diseases in both sexes. Negative correlations were detected for active coping and the two dependent variables in men and for religion and planning with somatization in women. In conclusion, the coping strategies showed significant correlations with somatization and number of diseases in both sexes.  Somatization, described as the “tendency to experience and communicate somatic stress and to seek medical help for it” , has beeThe number of diseases is also increased in women when compared with men ,6, whichIn a previous report, we showed that anxiety, depression and sleep quality were factors related to somatization in both sexes. Therefore, the aim of this study was to determine the association between coping strategies and both somatization and number of diseases, considering the previously associated variables of anxiety, depression and sleep quality. The study was performed in order to detect the coping strategies that are positively or negatively correlated with these two factors in each sex, which would permit the design of future preventing programs.An electronic questionnaire with sociodemographic and psychological instruments was sent via social networks, including WhatsApp, Facebook and e-mail, to the general population by the research team; this population included university students, relatives, friends, colleagues and acquaintances, many of whom re-sent the questionnaire.The study was approved by the ethics and research committee of the Health Sciences University Center of the University of Guadalajara, and the participants gave their consent to participate in the questionnaire.The socio-demographic data included sex, age, whether the participants had a romantic partner, schooling, whether they had children, whether they had a job, socioeconomic level , monthly extra money (excluding necessary expenses), daily free hours and weekly physical activity hours, the presence of 21 different diseases , thyroid diseases, migraine, skin diseases , sinusitis, kidney/bladder problems, anorexia/bulimia, hearth attack/angina pectoris, cerebral stroke, high cholesterol levels, anxiety and depression problems that require medication) and any additional disease in the last 6 months.Sleep quality was measured with item 2 (which consists of 5 items) of the OVIEDO sleep questionnaire; these 5 questions were related to sleep problems and had 5 frequency options, from never to 6–7 days in a week . FinallyThe psychological measures included were: somatization, measured with the Patient Health Questionnaire 15 (PHQ-15), which evaluates 15 somatic symptoms with 3 frequency options for each symptom, i.e., not at all, bothered a little, bothered a lot ; stress,p value < 0.05 was considered significant.To describe the qualitative variables, we used frequencies and percentages, and for the quantitative ones, we used means and standard deviation. In order to compare the number of diseases and somatization between sexes, the Man–Whitney U test was used, considering the non-parametric distribution of the variables. Alpha Cronbach test was used to determine the reliability of each scale and sub-scale utilized. To perform comparisons between the psychological variables and sleep quality with the two dependent variables, we used the Spearman correlation test, considering the non-parametric distribution of the variables. In order to detect the distribution of the data, the Kolmogorov–Smirnov test was used. Finally, a multiple regression analysis, with the stepwise method, for both dependent variables by each sex was performed, in order to determine the variables most associated with somatization and number of diseases in men and women. All analyses were carried out with the software SPSS v. 25, and a p < 0.05).We estimate that the questionnaire was sent to about 5000 persons through the different social networks, achieving a response rate of 20%. After excluding the questionnaires submitted by underage persons (24 persons), a total of 1008 participants were included, of which 62.2% were women. The socio-demographic data of the participants are reported in The most frequent reported diseases in both sexes were anxiety, depression, skin problems, overweight, migraine and colitis/irritable colon, while the least frequent were cancer, cerebral stroke and heart attack .The Cronbach alpha test for all the instruments used was above 0.7. In the case of the sub-scales of the brief COPE, most of them had scores above 0.6, with the exception of self-distraction, behavioral disengagement, denial and acceptance, which had scores above 0.5. In the case of the sub-scale venting, the Cronbach alpha was low, i.e., 0.35; therefore, we did not use this sub-scale in order to perform correlations and comparisons. When we compared the somatization and number of diseases between sexes, women reported significantly higher somatization, number of diseases, stress, depression and anxiety than men; likewise, women reported lower sleep quality than men .In the bivariate correlations, both sexes showed significant positive moderate correlations between stress, anxiety and depression with somatization, on one hand, and with the number of diseases, on the other, with higher correlations for depression in women and for anxiety in men. In addition, sleep quality showed significant negative moderate correlations with both dependent variables .p <0.01; for women, r = 0.313, p < 0.01. The same correlation with depression was, for men, r = 0.311, p < 0.01; for women, r = 0.306, p < 0.01. The correlation with stress was, for men, r = 0.290, p < 0.01; for women, r = 0.237, p < 0.01. The correlation with sleep quality was, for men, r = −0.262, p < 0.01; for women, r = −0.328, p < 0.01. When overweight was also excluded from the number of diseases, the correlations remained similar as those found when excluding anxiety and depression problems. Somatization and number of diseases showed significant positive moderate correlations between them in both sexes: men: r = 0.545, p < 0.001, and women: r = 0.547, p < 0.001.When anxiety and depression problems were not included in the number of diseases, the correlations between the three psychological variables diminished, but were still significant for both sexes. The correlation of number of diseases with anxiety was as follow: for men, r = 0.380, In relation to coping strategies, women showed significant low positive correlations between somatization and self-blame, denial, behavioral disengagement, substance use, self-distraction and humor, and significant low negative correlations between somatization and planning and religion. For the number of diseases, women showed significant low positive correlations with self-blame, substance use, denial, behavioral disengagement, self-distraction, humor and instrumental support.Men showed significant low positive correlations between somatization and self-blame, behavioral disengagement, denial, self-distraction and substance use. For the number of diseases, men showed significant low positive correlations with self-blame, substance use and self-distraction, and significant low negative correlations with humor and active coping.p < 0.01), weekly physical activity hours , monthly extra money , whether they had children , schooling , socioeconomic level , daily free hours  and whether they worked , and a low positive correlation with smoking frequency . Sociodemographic variables also showed low but significant negative correlations with somatization and number of diseases. In women, we found negative correlations between somatization and age , weekly physical activity hours  and whether they had children .In men, we found negative correlations between somatization and monthly extra money , socioeconomic level  and weekly physical activity hours , and a low positive correlation with smoking frequency (r =0.110 p < 0.05). In men, we found low but significant negative correlations between the number of diseases and weekly physical activity hours , and a low positive correlation with age  and smoking frequency .For the number of diseases, in women, we found low but significant negative correlations with whether they had children  and anxiety. In contrast, for number of diseases, the most associated variables were sleep quality (negatively associated), anxiety and schooling .We found that somatization and number of diseases were associated and that they were also associated with the main negative psychological variables, i.e., anxiety, depression and stress. Likewise, they were negatively correlated with sleep quality, in both sexes. We also showed that typical maladaptive coping patterns were positively correlated with somatization and number of diseases (mainly self-blame) in both sexes and that active coping correlated negatively with somatization and number of diseases only in men. As previously shown, negative psychological variables, somatization and number of diseases reached higher levels in women than in men ,3,4,5. WThese differences can be explained by considering that the population studied was mainly young and could present more psychological problems and less metabolic ones. With respect to the correlation analysis, we found that the variables most associated with somatization in both sexes were anxiety, depression and stress, with moderate positive correlations, as well as sleep quality, with moderate negative correlations. The coping strategies showed lower correlations with somatization in both sexes. It is of interest that self-blame showed the highest correlations in both sexes, followed by behavioral disengagement, denial, self-distraction and substance use; these correlations indicate a possible indirect correlation between these coping strategies and somatization, considering that these strategies were positively correlated with the negative psychological variables in both sexes (data not shown) and are typically considered as maladaptive coping strategies ,22. AddiThe coping strategies negatively correlated with somatization were active coping in men, and religion and planning in women, which coincides with the fact that these strategies have been classified as adaptive ,22. HoweAs previously shown, a positive moderate correlation was found between somatization and number of diseases in both sexes . This suIn addition, self-blame and substance use were the only coping strategies positively associated (low correlation) with number of diseases in both sexes; women also showed low positive correlations with behavioral disengagement, denial and humor, while men showed low negative correlations with humor and active coping. These results confirm the correlations found for somatization, although for this variable, a decreased number of associated coping strategies and a diminishment in the strength of the associations were observed. These changes were expected, considering that disease presence is a variable related to more causes than somatization, which, in turn, is more associated with psychological variables.The multivariate analysis confirmed the results of the bivariate analysis, indicating that depression, number of diseases, sleep quality and anxiety were the variables that most explained the variability of somatization. Likewise, sleep quality and anxiety were the variables that most explained the number of diseases. These findings coincide with our previous report  where slThis study has the following limitations: the sample was predominantly young and was not randomly selected, which could decrease the representativeness of the Mexican population, restricting it to young and educated people, from a medium socioeconomic level, who have access to the internet and social networks, and not representing older people and those from lower socioeconomic levels. In addition, the cross-sectional design of the study did not permit us to demonstrate causality between the studied variables, being bilateral relationships plausible, mainly between sleep quality and somatization and number of diseases. Finally, the estimated response rate of the questionnaire was low (20%), which can represent a bias by considering that it could be answered by people who had more interest in the theme and/or who presented more emotional problems/concerns. In conclusion, somatization and number of diseases showed a higher frequency in women than in men. These variables were mainly related (positively) with the negative psychological variables of depression, anxiety and stress, as well as with sleep quality (negatively) in both sexes. Likewise, these variables showed lower but significant positive correlations with some maladaptive strategies, mainly, self-blame, in both sexes. Additionally, some of these strategies, considered as adaptive, showed negative correlations with somatization and number of diseases, being more constant in the case of men, where active coping was negatively correlated with these two variables. Humor showed different correlations in men and women, suggesting that this strategy is adaptive in men but maladaptive in women. Further studies with larger sample sizes, longitudinal designs and performed in different populations should be performed to confirm these results.


The objective is to identify the risk factors for necrotizing enterocolitis (NEC) in neonates by a meta-analysis, and to provide a reference for the prevention of NEC.The databases, including Chinese Biomedical Literature Datebase, China National Knowledge Infrastructure, Wanfang database, and Weipu Periodical database, PubMed, Web of Science, Embase, Cochrane Library, were searched for studies on the risk factors for NEC in neonates. The meta-analysis was carried out with the aid of Stata software.A total of 52 studies were included, with 48 case-control studies and 4 cohort studies. There were 166,580 neonates in total, with 33,522 neonates in the case group and 133,058 neonates in the control group. The meta-analysis showed that gestational diabetes , premature rupture of membranes , low birth weight , small for gestational age , septicemia , blood transfusion , congenital heart disease , respiratory distress syndrome , premature birth , pneumonia  were risk factors for NEC in neonates. Breastfeeding , take probiotics , prenatal use of glucocorticoids , Hyperbilirubinemia  were protective factors for NEC in neonates.Gestational diabetes, premature rupture of membranes, low birth weight, small for gestational age, septicemia, blood transfusion, congenital heart disease, respiratory distress syndrome, premature birth, and pneumonia may increase the risk of NEC in neonates. Breastfeeding, taking probiotics, prenatal use of glucocorticoids, and Hyperbilirubinemia may reduce the risk of NEC in neonates. Necrotizing enterocolitis (NEC) in neonates is a severe muti-factorial disease characterized by intestinal necrosis in the ileum, jejunum, and colon. It is one of the leading causes of morbidity and mortality in preterm infants , with whChina National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Journal Database, Chinese Biomedical Literature Database, PubMed, Web of Science, Embase and Cochrane Library were searched to systematically collect published studies on risk factors of NEC in neonates. The search strategy of combining keywords and subject terms was adopted. The Chinese search terms were “newborn”, “necrotizing enterocolitis”, “risk factors”, “case-control study”, “cohort study”, etc. English search words “Enterocolitis, Necrotizing”, “Infant, Newborn”, “relative risk”, “cohort”, etc., supplemented by manual search and literature tracing.Inclusion criteria: 1. The diagnosis of NEC is clear; 2. The study type was a case-control study or cohort study; 3. The subjects were neonates (<28 days); 4. The original data is available. The OR (odds ratio) value and 95% confidence interval (CI) are provided, or the OR value and 95% CI can be calculated from the data.Exclusion criteria: 1. Conference summary, comments and review articles; 2. Unable to extract effective outcome indicators from the literature; 3. The experimental design is not rigorous ; 4. Unable to get a full text; 5. The sample size is too small.Two researchers strictly followed the inclusion and exclusion criteria to independently conduct literature screening, quality evaluation, data extraction, and discuss possible differences to reach an agreement. The final results were confirmed by more senior researchers. The Newcastle-Ottawa Scale (NOS)  was used2 statistic were used to evaluate the heterogeneity, and the test level was set as 0.1. If the heterogeneity test results were P > 0.1 and I2 < 50%, the pooled effect size OR and 95% CI were calculated using the fixed effects model. Otherwise, the random effect model is used to calculate; Sensitivity analysis uses different models to analyze the same data. Egger's or Begg's test was used to evaluate publication bias, and Stata12.0 was used for statistical analysis.The Q test and IA total of 5,728 relevant articles were obtained through preliminary screening, and 3,931 articles remained after being re-selected by Endnote software. Ulteriorly, 3,475 articles were excluded after reading the title and abstract, and 117 articles remained for further evaluation. Finally, after reading the full text, 52 articles were included according to the inclusion and exclusion criteria, as shown in According to the risk factors involved in the included literature, gestational diabetes, premature rupture of membranes, cesarean section, low birth weight, small for gestational age, sepsis, blood transfusion, congenital heart disease, respiratory distress syndrome, mechanical ventilation, breast feeding, probiotics, preterm delivery, pneumonia, prenatal use of glucocorticoids, hyperbilirubinemia, ect., were selected for analysis. Heterogeneity test results showed that there was heterogeneity among the studies of diabetes in pregnancy, premature rupture of membranes, cesarean section, small for gestational age, sepsis, blood transfusion, congenital heart disease, respiratory distress syndrome, mechanical ventilation, breast-feeding, probiotics, preterm delivery, pneumonia and hyperbilirubinemia, and the random effect model was used to combine the effect amount. In contrast, there is no heterogeneity in other related factors, and the fixed effect model is used to combine the effects. The meta-analysis results demonstrates that: Cesarean section and mechanical ventilation were not statistically significant with NEC in neonates. Gestational diabetes mellitus, premature rupture of membranes, low birth weight, small for gestational age, sepsis, blood transfusion, congenital heart disease, respiratory distress syndrome, premature birth and pneumonia were risk factors for NEC in neonates. Breastfeeding, probiotics, prenatal glucocorticoid use, and hyperbilirubinemia were protective factors for NEC in neonates, as shown in P < 0.05), as shown in For the screened risk factors, the fixed effect and random effect models were used to recalculate the combined effect size. The calculation results of these two models were basically consistent, indicating that the results of this study were basically reliable. However, the results of premature rupture of membranes are not robust enough and should be treated with caution. The results of Egger's or Begg's test suggest that the results of sepsis, probiotics, and pneumonia are biased  Due to the immature intestinal function and slow intestinal peristalsis of low birth weight infants, food residues are easy to be detained and fermented, providing a good environment for bacterial growth, leading to a large number of bacterial proliferation; (2) The intestinal microbiota of low birth weight infants is very immature, and direct contact with pathogenic microorganisms will cause inflammation related to mucosal damage, leading to NEC .This meta-analysis showed that small for gestational age (SGA) was a risk factor for NEC. SGA infants have a high probability of NEC, neonatal asphyxia, brain injury and respiratory distress syndrome . One stuThis meta-analysis showed that septicemia, congenital heart disease, respiratory distress syndrome, and pneumonia were risk factors for NEC. In severe infection, the body is in a state of inflammation activation, producing a variety of inflammatory transmitters. These substances directly or indirectly cause damage to the intestinal mucosa, and then participate in the occurrence and development of NEC , 63. MeaThis meta-analysis showed that blood transfusion was a risk factor for NEC. The possible pathogenesis of NEC is as follows: the inflammatory mediators such as TNF-α, IL-6, and PAF produced during the processing of whole blood and the storage of red blood cells, and the residual white blood cells, free hemoglobin, red cell membrane fragments, etc. promote the occurrence of NEC. The pathological changes of red blood cells occurred during storage, including decreased erythrocyte deformability, increased oxygen affinity ability and decreased nitric oxide resulting in the loss of vasodilator activity, etc., resulting in the failure to improve intestinal microcirculation perfusion flow after blood transfusion; NEC may be caused by anemia .This meta-analysis showed that preterm birth was a risk factor for NEC. Due to the unsound development of the enteric nervous system and poor regularity of small intestinal peristalsis, premature infants are prone to excessive bacterial growth and gas after food fermentation, and are prone to NEC .This meta-analysis showed that breastfeeding, probiotics, prenatal glucocorticoid use, and hyperbilirubinemia were protective factors for NEC. Breast milk is known as the most natural and safe natural food for infants and young children, containing nutrients and antibodies necessary for the development of organized organs, especially beneficial antibodies, which can help maintain the immune function of newborns, inhibit the inflammatory reaction, and speed up the repair of the damaged intestinal mucosa . CompareThis study has some limitations: First, sensitivity analysis found that the results of premature rupture of membranes were not robust enough. Therefore, the relationship between premature rupture of membranes and NEC in neonates needs further study. Secondly, there exist differences in sample size, case selection, and definition of exposure factors among the studies, which may lead to heterogeneity among the studies and have a certain impact on the results. Finally, only Chinese and English literature ware included in the included study, and literature published in other languages could not be analyzed, which may result in language bias.We conducted a meta-analysis to evaluate the risk factors of NEC. This meta-analysis showed that gestational diabetes mellitus, premature rupture of membranes, low birth weight, small for gestational age, sepsis, blood transfusion, congenital heart disease, respiratory distress syndrome, premature birth, and pneumonia maght increase the risk of NEC in neonates. Therefore, perinatal health care should be strengthened to reduce the incidence of neonatal complications, so as to prevent the occurrence of NEC in neonates.


For decades, the concept of “disease-modifying” treatment has been used profusely in several neurodegenerative diseases including Parkinson's disease (PD). This concept has been employed sometimes as an accomplished goal, and many more as a wishful thinking objective. In addition, the related concept of neuroprotective therapy has been widely used and a quick search on Medline shows a steady increase in the number of papers on this issue over time.As Morant et al.  pointed Perhaps it is time to ponder over these two related concepts: disease modifying and neuroprotective therapies, at least in relation to PD. First, it is important to have (more or less) clear definitions, and then, we can discuss whether we have or we may have (or not) disease modifying and neuroprotective therapy for PD.To begin with, the definition of “disease-modifying” treatment varies both within and between neurodegenerative disorders, and terminology in current regulatory guidelines also lacks consistency . CummingHere it must be pointed out that, in theory, any disease-modifying treatment may have symptomatic effect as well, possibly masking the modifications produced in the disease. Recently, Vijiaratnam et al.  reviewedTo date, no disease-modifying drugs has been found, although some promising candidates are still in the pipeline including exenatide and gene therapy .And still, probably, a real disease-modifying treatment for PD already exists and has been used for decades: Physical exercise. As Eric Ahlskog already suggested a decade ago, “often overlooked (…) is the potential benefit of sustained vigorous exercise on PD progression” .In this short review, we collect and summarize, the most relevant data of physical exercise as a symptomatic and preventive measure, and its potential for disease modifying therapy for patients with PD.de novo PD patients. They found statistical differences in Unified Parkinson's Disease Rating Scale (UPSRS) motor score in the high-intensity group compared with the usual care group. Another interesting study was carried out by van der Kolk et al.  –34, suffIf physical exercise is symptomatically effective, probably prevents neurodegenerative diseases, and has potential neuroprotective mechanisms, why is it not universally used?This conundrum may be explained by several factors. There are barriers to exercise , 38, as In summary, although physical exercise is inexpensive, its use as a treatment requires a complete change of strategy. Exercise training would be considered the first antiparkinsonian measure, even before (or at least at the same time) than drug therapy is added , 38, 39.Finally, physical exercise would be a practical and inexpensive approach for those patients at risk for PD (such as LRKK2 carriers).PG conception and design, interpretation of data, drafting the submitted material, and critical review. RL and JM drafting the submitted material and critical review. All authors contributed to the article and approved the submitted version.PG received research support from Allergan and UCB, personal compensation as a consultant/scientific advisory board from Italfarmaco, Britannia, Bial, and Zambon and speaking honoraria from Italfarmaco, Zambon, Allergan, and Abbvie. JM has received honoraria as a speaker from AbbVie, Allergan, Bial, Krka, Merz, Ipsen, Italfarmaco, Medtronic, TEVA, and Zambon; travel grants from AbbVie, Allergan, Bial, Italfarmaco, TEVA, Merz, Krka and Zambón; research grants from AbbVie, Allergan, Merz, Italfarmaco, and Zambon; and participated in advisory boards of AbbVie, Allergan, Bial, Merz, Italfarmaco, Lundbeck, Orion, UCB, and Zambon. RL has received honoraria for lecturing and advisory board from AbbVie, Lundbeck, UCB, and Italfarmaco and research grants from the European Commission and Instituto de Salud Carlos III.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Instead of ‘Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa’ it should be ‘Surgeons for Little Lives, Department of Paediatric Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa’.In the published article, Elghobashy A, Scribante J, Perrie H, Nel D. Anaesthetists’ knowledge of airborne infections S Afr J Infect Dis. 2022;37(1):a351. The publisher apologises for this error. The correction does not change the study’s findings of significance or overall interpretation of the study’s results or the scientific conclusions of the article in any way.


Standards of care offer doctors and patients the confidence that an established quality, evidence-based, care is provided, and represent a tool for optimal responding to the population’s needs. It is expected that they will increasingly express a multimodal relationship with gynecologic laparoscopy. Laparoscopy is, now, a standard procedure in operative gynecology, standards are embedded in many laparoscopic procedures, standardization of the skills/competency assessment has been progressively developed, and the proof of competency in laparoscopy may become a standard of care. A continuous development of surgical education includes standard equipment , standardized training, testing (and performance) assessment, educational process and outcome monitoring/evaluation, patients’ care, and protection, etc. Standards of care and training have a reciprocally sustaining relationship, as training is an essential component of standards of care while care is provided at higher standards after a structured training and as credentialing/certification reunites the two. It is envisaged that through development and implementation, the European wide standards of care in laparoscopic surgery  would lead to effective delivery of better clinical services and provide excellent training and education. Standards of Care offer doctors and patients the confidence that an established quality of the service is provided. The Royal College of Obstetricians and Gynaecologists have described service standards as “standards of clinical care which the college would expect units and hospitals to adopt in relation to the quality of patient services, training opportunities and participation in national data gathering of relevance to clinical accountability and effectiveness” [iveness” .Evidence-based care is a solid and helpful concept, with influences not limited to the specialists’ activities, but also to the nurses’ ones, and is still debated at present .Laparoscopy has shown in the last decades a steep evolution, including indications, procedures, increased patient comfort, advanced appropriate surgical skills, tools, and, beyond all this, a difference in the medical care paradigm. The changed dimension of the incision, or in the number of incisions (toward a single one) or, even, to the natural orifice surgery , depict Standards are the criteria we can use to analyze quality. It is the institution’s responsibility to develop and to monitor standards, as a prerequisite in the process of pursuing higher quality. A diversity of standards responds to different needs, views, and organizations. Accreditation, ethics, client rights, billing, and professional/criminal records are only some examples.Standards in laparoscopy may include criteria related to the equipment, facilities, surgical procedures, surgeons’ credentials/expertise, etc.Standards of Care not only ensure that patients receive the best available care, but they are also a tool for better responding to the population’s needs. It is not possible, these days, to conceive such a system without including quality standards.The application of standards should aim to obtain the expected outcome and to minimize risks for the population. Working with patients in the process of developing and implementing them would be a good option to obtain their partnership. Seeking beneficiary feedback and linkage to other existing programs represent another strategy in ensuring acceptance, support, and social integration.As a procedure—but also as a philosophy—laparoscopy is the gold standard of care worldwide in the treatment of many abdominal pathologies such as appendicitis, cholecystitis ,5,6, or Standards of care and gynecologic laparoscopy have a multimodal relationship.First, laparoscopy is, now, a standard procedure in operative gynecology [1. necology . It becanecology , endometnecology ), ovarianecology , or tubanecology . More renecology , hysterenecology  or myomenecology .Laparoscopic urogynecology, in particular, showed relevant evolution and adaptation, especially after the FDA warning, allowing meshes to be used only for pelvic organ prolapse (POP) . LaparosGynecologic oncology is another field where laparoscopy became the reference, and recommended, procedure. Endometrial cancer and pelvic lymphadenectomy represent such cases; cervical and ovarian cancer, and robotic-assisted surgery are areas with continuous assessment and development ,22. CervRecent developments were reported. Laparoscopic minilaparoscopy, with shortened hospital stay and better esthetical outcomes [outcomes ,32, provoutcomes  or hysteoutcomes ,35,36 whoutcomes . Single-outcomes  and was outcomes , hystereoutcomes ,41,42—inoutcomes ,44—or cooutcomes . Furtheroutcomes . Vaginaloutcomes , and prooutcomes , hystereoutcomes ,48,49,50outcomes . Laparosoutcomes , were proutcomes ,54,55,56Another recent, unfortunate development, which profoundly influenced the laparoscopic surgery, was (and still is) the COVID-19 pandemic. Presently, “there is no consensus on limiting or restricting laparoscopic or robotic surgery” —an asserSecond, standards are embedded in, now, a great number of laparoscopic procedures. In general surgery, a good recent example is represented by the laparoscopic right hemicolectomy [2. olectomy . In gyneolectomy . These polectomy , or haveolectomy  or robotolectomy  hysterecolectomy . Standarolectomy  and was olectomy ,69 or ceolectomy  cancer. olectomy .In urogynecology a search for better, easier, procedures, with better postoperative outcome, drove physicians to standardize modification of well-established procedures—such as the Burch colposuspension —or to fiThe COVID-19 pandemic imposed specific recommendations/standards related to the perioperative management for gynecologic laparoscopy, such as preoperative screening and testing, with subsequent preprocedure quarantine, online follow-up, and psychological support ,59,60. EStandardization is also visible in the sterilization or disinfection equipment, facilities, and related procedures (and training) . This isStandards of the laparoscopic procedures’ documentation are essential for both assessment of care quality and for research .Third, standardization of the skills/competency assessment has been progressively developed. A structured assessment of laparoscopic assistant skills (SALAS) was developed to assess camera navigation and was validated for laparoscopic cholecystectomies [https://www.flsprogram.org, accessed on 13 February 2022). Developments on FLS were evaluated as a proficiency-standard in advanced laparoscopic surgery [3. ectomies . The samectomies . The objectomies . The Gloectomies —measuresectomies . Fundameectomies   is considered, by some, as the standard for skills assessment . An ObjeFinally, the proof of competency in laparoscopy may become a standard of care [4.  of care . Without of care . The Int of care . Standar of care  and for  of care —but, app of care . These s of care . Under t of care  is manag of care .In Europe, such accreditation standards were implemented by the European Society for Human Reproduction and Embryology (ESHRE) in 1997, and are comprised of four levels of expertise . A jointESGE, in collaboration with the European Academy of Gynecological Surgery (EAGS), has also developed training models, structured training programs  and a ceA French version of GOALS proved to measure trainers’ progress . The SocAs it could be easily deducted, skill standards and surgical competency express the outcome of training.Training involves standards as an essential constituent. Educational requirements vary according to the level of training and to the category of personnel. These standards may be more flexible or rigorous, depending on the needs of the trainees, and the level of the curriculum. Education and assessment instruments should be adapted to training/practice in as many institutions as possible, to obtain standardization and broad application [lication . GeneralTraining in gynecologic laparoscopy follows the same, general, pattern, and expresses, at the same time, noticeable particularities.Different surveys reported an increased interest in a standardized curriculum in gynecologic laparoscopy ,121, incStandardized training and education in this field was developed in many regions/countries of the world [he world ,125,126.he world . Specifihe world ,129, virhe world , advancehe world ,134,135,he world ,119,136.he world ,138, moshe world , a standhe world ,139 or phe world , as wellhe world ,140,141.he world , visio-she world , or sutuhe world ,142. Thehe world . Some auhe world ,143.One of the most comprehensive standardizations of endoscopic surgical training is offered by ESGE , as presented previously. Its face and construct validity were reported . GESEA iTraining was significantly influenced by recent available evidence, by medical policies, or by the context. After the LACC trial , fewer LStandard equipment may bring value for research and development. An eloquent illustration is the box trainer. Reports on its use, as a standard component of the study, addressed various aspects, as the training on an open box [open box , elaboraopen box , new camopen box , value oopen box , translaopen box , as wellopen box ,155, VR open box ,157, or open box .Standardized testing and assessment, validated rating scales, and procedure-specific checklists, are of utmost importance in developing and conducting training programs [programs ,158,159.programs . The preprograms  and traiprograms ,161. Simprograms ,162,163,programs , or as aprograms . Scoringprograms . Computeprograms .Performance standards can be set by different approaches: laparoscopic experts considered as reference, contrasting groups method or Angoff method [f method ,168. Thef method .The educational outcome represents, evidently, the result of the above-mentioned education. As a meta-analysis, though, its standardization was embedded in the previously mentioned structured training, equipment, testing, performances benchmarks, and credentialing. Acquisition of a required knowledge level [ge level , and stage level ,167, havge level ,125. Thige level , VR [130ge level ,119 surgge level  and, eveThe educational process assessment is essential, in validation with the curriculum [rriculum ,126 or erriculum . Relatedrriculum , while arriculum . Resultsrriculum . Anotherrriculum . Relativrriculum , while arriculum .It seems that there is a need for more research in this field .Patients’ care and protection represents not only a training standard, but also, now, an ethical criterion. It was supported, in recent years, by the introduction/validation of simulation-based training, and, even more, by normalizing it as a necessary stage in a structured education, before OR surgical training [training ,169. Laptraining .Monitoring is the process through which one verifies if standards are met [ are met . Standar are met .Organizations use various methods for monitoring: process supervision, supervisory visits, provider surveys, trainees’ assessments and feedback, educational planning, case management, program reviews, etc. . The EurStandards of care and training have a reciprocally sustaining relationship.(a) Training is an essential component of standards of care, to support highly complex training programs.One of the fundamental concerns of EBCOG relates to issues around inequity concerning health service provision across Europe and its impact on the quality of training for our future generation of “doctors in training” to sustain high quality services in Europe. This is especially important as “European integration allows free movement of persons, services, capital and goods” . TherefoA supplementary benefit for the patients is that the training program and resources are founded on evidence-based practice and on solid ethical principles.(b) Care is provided at higher standards after a structured training.As stated previously in this text, the most important outcome of training is safe and good surgical performance. Another important goal is the avoidance of—or finding solutions for—difficult situations . The conStandardized surgical skills assessment could be useful for residents and not necessarily for gynecologic surgeons in practice . DiffereSimulation-based training gained a lot of interest, in recent decades, even if box training tasks do not have the variability, complexity and environment of the real OR (advanced) surgery [ surgery . We depiBesides increasing (basic and advanced) psychomotor laparoscopic skills in a dry lab , laparosThose results were obtained when related to different simulation training tools. Box training was already mentioned. VR-based training was reported to help transfer/increase skills in gynecologic laparoscopic surgery in trainees/gynecologists with minimal surgical experience ,190,191.As a supplementary benefit, a structured training could enhance the quality of the OR performance by standardizing the respective procedure—as it was reported for the total laparoscopic hysterectomy .No matter the simulation tool, many authors support the idea that, compared to conventional clinical training, simulation-based training is superior, in terms of OR surgical proficiency, for both basic ,194,195 However, surgical competence could depreciate over time when based exclusively on simulation training . AnotherThe best of the worlds resides in combining standardized, structured theoretical, simulation-based and live-surgery/OR training, as suggested by a recent systematic review .(c) Credentialing/certification, mentioned previously, reunites the two directions of the standards of care–training relationship. One of the results is that certification and licensing  are closely related to training requirements [irements . Specialirements . Such a irements . The misirements —or theirirements . There iirements . A very irements . There airements .In the end, the most important accomplishment of training is both for patients and for providers: the certifying and continuously ensuring the fitness to practice.It is envisaged that by implementation, the European wide standards of care, in close harmonization with the personalized medicine, would ultimately lead to effective delivery of not only clinical services but indeed provide excellent (standardized) training in these units.


Nanomaterials, which aims to publish original and review papers on new scientific and applied research and make boundless contributions to the finding and understanding of the reinforcing effects of various nanomaterials on the performance of polymer nanocomposites. This Special Issue also covers the fundamentals, characterization, and applications of fiber-reinforced polymer nanocomposites.“Fiber-Reinforced Polymer Nanocomposites” is a newly open Special Issue of Today, nanomaterials are used in several applications, including composites, packaging, electronic, electrical, structural, energy storage, automotive, filtering, and coating applications, among other  1,2,3,4,43,4,5. Nanomaterials can be classified into natural and synthetic. Nanocellulose, nano-clay, graphene and MXene, carbon nanofibers and nanotubes, silica nanoparticles, and ZnO quantum dots are common nanomaterials used in polymer nanocomposites ,9,10. MoInterestingly, research in the field of fiber-reinforced polymer nanocomposites received a lot of findings that positively contributed to many applications such as biomedical, automotive, electronics, structural materials, packaging ,17,18,19This Special Issue will cover recent advances in the three primary aspects of processing, characterization, and performance. Both synthetic and natural nanomaterials-based composites are welcome. Moreover, this issue is welcomed in several vital aspects, such as the production of nanomaterials, surface and interfacial characterization of its properties, economic feasibility, challenges, and future perspectives in the field of polymer nanocomposites; as a result, current and future literature data can be enriched.


A Corrigendum onA Coronal Landmark for Tibial Component Positioning With Anatomical Alignment in Total Knee Arthroplasty: A Radiological and Clinical Study10.3389/fsurg.2022.847987by Gong, T., Wang, R., Gong, S., Han, L., Yi, Y., Wang, Y., et al. (2022). Front. Surg. 9:847987. doi: Incorrect Affiliation**1**. Instead of “** Department of Orthopaedics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China**”, it should be “** Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China **”. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.In the published article, there was an error in affiliation The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Bacteroidetes (B), Proteobacteria (P), and diversity (D) after BS. Firmicutes (F), B, and the (F/B) ratio was inconsistent, increasing or decreasing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were conducted, compared to before surgery. There was a reduction in the relative proportion of F. Moreover, a higher proportion of Actinobacteria (A) was observed after RYGB was conducted. However, the same was not identified when SG procedures were applied. Genera abundance and bacteria predominance varied according to the surgical procedure, with limited data regarding the impact on phyla. The present study was approved by PROSPERO, under registration number CRD42020209509.Gut microbiota (GM) after bariatric surgery (BS) has been considered as a factor associated with metabolic improvements and weight loss. In this systematic review, we evaluate changes in the GM, characterized by 16S rRNA and metagenomics techniques, in obese adults who received BS. The PubMed, Scopus, Web of Science, and LILACS databases were searched. Two independent reviewers analyzed articles published in the last ten years, using Rayyan QCRI. The initial search resulted in 1275 documents, and 18 clinical trials were included after the exclusion criteria were applied. The predominance of intestinal bacteria phyla varied among studies; however, most of them reported a greater amount of  Obesity is a public health problem, and its prevalence has increased in recent decades; this is due, in part, to its multifactorial characteristics, which make it difficult to control ,2,3. It Recently, scientific evidence has proposed the contribution of the gut microbiota (GM) to metabolic alterations and obesity ,3. The GFirmicutes (F) and an increase in Bacteroidetes (B) and Proteobacteria (P) [In the face of the global obesity pandemic, bariatric surgery (BS) has been considered one of the most effective treatments for severe obesity, as well as for long-term weight reduction and maintenance. In addition, the surgical treatment has been proposed as a possible explanation in regard to the observed modifications of the GM composition after surgery ,10,11,12eria (P) ,13. For Search Strategy.A systematic literature review was conducted by two independent reviewers in November 2022, using the PubMed, Scopus, Web of Science, and LILACS databases. The languages were restricted to English, Spanish, and Portuguese. The terms used for the search consisted of “bariatrics”, “gastroplasty”, “bariatric surgery”, “gastric bypass”, “jejunoileal bypass”, “stomach stapling”, “microbiot”, “microbiome”, “gastrointestinal flora”, “gut flora”, “intestinal flora”, “gastrointestinal microflora”, and “enteric bacteria”, using the Boolean operators “AND” and “OR”.Helicobacter pylori; intervention with probiotics, prebiotics, food supplements, and herbal medicines and medications (except in case of antidiabetic drugs).Studies that evaluated the GM profile in obese adults undergoing BS were included. Exclusion criteria were as follows: articles not published in the last ten years, not within the scope of the review, and not written in English, Portuguese, or Spanish; studies carried out in animals, pregnant women, lactating women, adolescents receiving bariatric surgery, and adults with obesity not undergoing BS; experiments with fecal microbiota transplantation, which did not assess the GM profile and without analysis of F and B; chronic noncommunicable diseases, except obesity and type 2 DM, inflammatory bowel diseases, nephropathy with the presence of Two researchers (V.O.R.C. and L.C.) carried out the identification and selection of the studies. They utilized the Rayyan QCRI application/website, with the intent of documenting all inclusion and exclusion decisions, allowing peer review with impartiality and traceability, thus minimizing the risk of bias . After sOutcome Measures.The primary outcome was to verify the occurrence of alterations in the composition of the GM, analyzed by 16S rRNA and metagenomics techniques, after BS. The secondary outcome consisted of changes in anthropometric parameters, including body weight, body mass index (BMI), and the remission of obesity-related diseases, such as type 2 DM. The main aspects of interest for article selection are described in The present study was approved by the public database of protocols for systematic reviews with health outcomes PROSPERO, under registration number CRD42020209509.The applied search strategy returned a total of 1275 published articles, 8 in LILACS, 432 in PubMed, 555 in Scopus, and 280 in Web of Science, between November 2012 and November 2022, of which 518 were duplicates. After screening by title and abstract, as well as the full text when necessary, 18 studies were included in the systematic review, as shown in Relevant data from the studies included in this systematic review are summarized in The studies added to the systematic review and the results of interest are shown in Of the selected studies, 15 out of 18 (83 %) were conducted after an RYGB procedure ,28,30,31The interaction between GM and BS is complex since surgery itself results in anatomical and physiological changes in the intestine. It is a multifaceted condition, where in addition to the surgical modifications, food consumption is altered, and weight loss occurs quickly after surgery, conditions that impact the GM. On the other hand, the GM composition seems to influence the prognosis of weight loss and metabolic improvement ,10,20,32Modifications in the GM after BS have been associated with improved glucose homeostasis, weight loss, changes in food course and motility in the gastrointestinal tract, and changes in nutritional status and diet therapy after BS ,10,26. TRoseburia intestinalis, from phylum F. This increase was also described in other recent studies, regardless of the surgical procedure, associated with a beneficial effect on improved insulin sensitivity, corroborating the hypothesis that alterations in the composition of the GM after BS may be associated with remission of DM. It should be noted, however, that changes in the proportion of phylum F after BS were still heterogeneous in both surgical procedures [Murphy et al. observed a reduction in BMI and type 2 DM remission after one year of both SG and RYGB . Koffer ocedures ,23,30.In obese individuals, GM dysbiosis has been documented, especially towards a greater relative abundance of F and a reduction in B and D, with modifications regarding the quantity and variability of bacterial species. Most studies in the present review corroborated the indication that D decreased with BS. Studies that showed an increase in F, associated this modification with the higher energy and fatty acids uptake and BMI .The literature has shown that a lower F/B ratio is associated with weight loss and metabolic improvement . HoweverThe increase in P abundance, observed in different postoperative periods of RYGB and after six months of SG, may be due to greater transient oxygen exposure and changes in the gut pH as a result of BS . In miceVeillonella, from the F phylum, was higher in only four of the sixteen studies with RYGB, and the same was not observed in the SG procedure [The relative abundance of the genus rocedure ,19,21,25Veillonella. The relative abundance of this bacteria was higher after three months of BS, when compared to the preoperative period, and associated with BMI reduction. The higher proportion of Veillonella may be due to anatomical modifications on stomach size and the oral microbiota composition after surgical intervention and has been linked to the control of inflammation and body weight [In patients undergoing RYGB, a negative correlation was observed between the BMI and five genera of bacteria, including y weight .Akkermancia muciniphila, from the phylum Verrucomicrobia, has been considered to have an anti-obesity effect and enhance type 2 DM remission [emission . This baemission ,18,23,26emission ,25,26. HStreptococcus, the genus of phylum F, had greater abundance in only two of the thirteen studies with RYGB and in one of the nine studies with SG, which may show the survival and proliferation of aerotolerant bacteria [Streptococcus in patients with persistent type 2 DM one year after the surgical procedure, suggesting a positive association between the expansion of this genus of bacteria and the risk of this chronic disease [As for bacteria ,21,27. A disease .Faecalibacterium prausnitzii, despite evidence associating its abundance with reduced plasma glucose levels and increased insulin sensitivity and possible anti-inflammatory effect [y effect ,37, showy effect ,23.Akkermansia muciniphila, Escherichia coli, Bacteroides spp., and bacteria associated with the oral microbiota [In general, RYGB surgery seemed to result in a major modification of the GM composition compared to SG ,31. Thuscrobiota , as obseGM appears to stimulate the immune system and the enteric nervous system, modulating the central nervous system and possibly impacting the hypothalamic signaling of hormones related to hunger and satiety, immune regulation, intestinal motility and secretion, and intestinal mucosal homeostasis. This mechanism of interaction between the GM, the immune system, and the neuroendocrine system has been associated with intestinal permeability, inflammatory state, changes in feeding behavior, and bacterial survival and growth , which cHelicobacter pylori or urinary tract infection, for example), the use of antibiotics in the perioperative phase and supplements, complications after BS, withdrawal of participants during the research, and the use of different surgical procedures and procedures for DNA extraction for analysis of the GM composition [The heterogeneity of data on the impact of BS on the GM, is partly due to the small sample sizes, the lack of information and/or control of dietary intake and gastric pouch size after surgery, studies with only one sex or no information regarding the sex of the study population, and the lack of information on the presence of diseases associated with obesity ,22,25,30position ,17,31. FThe long-term impact of BS on the GM is not yet known, particularly in terms of postoperative follow-up greater than one year, with most studies having up to six months ,28,29,31Actinobacteria (A), P, and D was observed in most studies with no consistency regarding the F/B ratio. After SG, there was an increase in the proportion of B, P, and diversity, with no reports on A or consensus on the F/B ratio. In both surgical procedures, there were reports of a decreased proportion of F. For specific bacteria genera, the literature available is not necessarily the same as for phyla. The magnitude of the modifications on the abundance of bacteria is also unknown.Obesity surgical treatment, such as BS, has a positive impact on lipid and glucose metabolism, remission of type 2 DM, and weight loss and also results in GM changes. In patients undergoing RYGB, an increase in B, The results are controversial, differ according to the surgical procedure, and may change depending on the postoperative period studied; thus, it is not possible to state whether changes in the GM would be permanent. Additionally, the literature available cannot discriminate between whether the GM changes are due to the BS itself  and not to the diet and lifestyle modifications that also occur after surgery, for example. For now, it is not prudent to state the magnitude of the influence of changes to the GM, as a contributing factor for weight loss promotion and metabolic improvement after BS.


In “Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration” :e36405), one error was noted.In the originally published paper, Affiliation 6 for author Andrea Gaggioli appeared as follows:Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, ItalyIn the corrected version of the paper, Affiliation 6 has been revised as follows:IRCCS, Istituto Auxologico Italiano, Milan, ItalyThe correction will appear in the online version of the paper on the JMIR Publications website on September 14, 2022, together with the publication of this correction notice. Because this was made after submission to PubMed, PubMed Central, and other full-text repositories, the corrected article has also been resubmitted to those repositories.


The identification of the factors underlying the willingness or lack thereof to respond to public health emergencies is paramount to informing more capable health services. The interest in this topic appears renewed with each surge of threat, either referring to natural disasters, man-made violence, or epidemic and pandemics. However, there is no systematic approach to the research patterns and related main findings concerning individual and contextual determinants. The present article contributes to this theme through a systematic literature review of a sample of 150 articles published in the last 30 years on the subject of willingness and preparedness of health professionals to deal with public health threats. Our findings show that the research is mainly phenomena and contextual driven, responding to whichever emergency threat is more salient in a given period. Geographically, research on this topic is led by USA and China, mostly solely, while European countries invest in collaborations that are more international. Universities, including health institutes and schools, and researchers at hospitals conduct most of the research on the topic. The main research areas are medicine, psychology, and psychiatry. Pandemics, including COVID-19, influenza, and natural disasters, are the phenomena gauging more attention as opposed to terrorism events and biological accidents. The specific role of health professionals within the institution, their belief in ethical duties, preparation training, and concerns regarding infection of self and family are the main variables influencing the willingness and ability to report to work in public health emergencies. The worldwide impact of the COVID-19 pandemic fostered the debate and research on a number of issues that required urgent understanding to face the challenges ahead and mitigate the negative impact of the circumstances. These included, among many others, the effects of public health communication, the citizens’ attitudinal and behavioral dispositions to engage and act in accordance with the governmental measures, the general view and compliance with vaccination programs, teleworking provisions, and related issues concerning work-personal life balance and gendered expectations ) OR (disaster[Title/Abstract])) OR ) OR (COVID-19[Title/Abstract])) AND (willing to work[Title/Abstract])) OR (report to work[Title/Abstract]).No time period was applied, and only publications in English and Portuguese languages were retained, with the exclusion of French and German articles for which we did not have the required language skills to analyze. In addition, errata and letters were excluded.Following these criteria, 206 publications were identified, 131 in the SCOPUS database and 75 in PUBMED, with 37 duplicates that were excluded, resulting in 169 publications. A second reading to determine the eligibility of the publications by titles, keywords and abstracts was made by two independent reviewers, and 18 publications were excluded due to focusing on tangential aspects of the topic under analysis. The final number of publications was 151  selected from the two databases (SCOPUS and PubMed) were saved in bibtex and converted in R in bibliometrix, allowing the analysis of the bibliographic patterns of each publication. More specifically, it characterizes the geographic dissemination of this research as also the authors and institutions that may be specialized in the subject or its specific dimensions, answering to our first goal. A manual and software-based content analysis was conducted. First, the theoretical models, samples, and phenomena were identified manually to answer our second goal. In a second phase, a lexicographic analysis, hierarchical descending cluster analysis, and post-hoc correspondence analysis were conducted using the textual analysis software Iramuteq version 0.6. This software provides the users with different text analyses, either simple ones, such as the basic lexicography , or multivariate ones, such as hierarchical descending analysis, herein used. The hierarchical descending cluster analysis is an iteration method that results in a hierarchy of clusters. The corpus was separated into 150 texts corresponding to the number of abstracts to be analyzed. Nouns and verbs were considered for analysis, as they were suitable to reflect emergent themes and theoretical and methodological aspects. The hierarchical descending cluster analysis retained 512 text segments and 2854 elementary context units (ECUs) from the total of (99.45%). The ECUs are text units within which IRAMUTEQ calculates the frequency of word co-occurrences. The aim of this analysis was to determine the more frequent themes of the research of public health emergencies and interrelated notions, thus meeting our third goal. The vocabulary distribution is presented in a comprehensive and clear way with graphical representations derived from the lexicographic analysis . The maiThe publications related to our search words, including pandemic, disasters, public health emergency, COVID-19, and willingness, as shown in The author with more publications is from the USA and publishes in health sciences, albeit with only three articles ; Table 1As shown in The number of articles’ citations is a suitable indicator of how widespread and disseminated the research is. The analysis was performed using Plum x Metrics, which allows us to see the usage and reads, captures, dissemination in social media, and mentions .The more cited articles focus on capacity needs for health care systems, factors that determine the ability and willingness to contribute during catastrophic events, and those that determine the lack thereof. A common topic among the more cited is ethical professionals’ duty in emergencies that may affect them visa vis the fear of contracting or transmitting to their families the infectious disease at hand. Interestingly, the one more disseminated in social media focuses precisely on perceived barriers to ability and barriers to willingness, concluding that there is an overlapping between both. The need to stimulate both abilities and willingness of health professionals  should cThe publication venues are very fragmented, with one journal comprising seven articles, the other three journals encompassing six, five, and four articles, respectively, and the remaining with three or fewer articles published in diversified journals. The more common is specific to disaster research , followed by generalist journals on public health . Reinforcing the scarce publications per author, the wide dispersion of publication venues, with few journals publishing more than three articles on this subject, is also suggestive of the lack of a centralized corpus of research or specialized venue encompassing all the different emergency manifestations and valences. The more frequent disciplinary field is medicine .n = 94) together with other educational institutions, namely health institutes (n = 4) and health schools (n = 6), followed by hospitals (n = 13) and specific medical departments (n = 10).The authors’ affiliations are mostly linked to universities  and the pandemic influenza of 2009 and 2010.As shown in The articles researching willingness and preparedness of health professionals during the COVID-19 pandemic correspond to a wide array of geographical contexts, given the worldwide reach of this threat: Palestine , AustralThirty-five other studies refer to other pandemics, particularly influenza virus-based that required special care in health units. These also include several geographical contexts: United States ,109,110,As for natural disasters, ranging from higher to lesser impactful ones, they were conducted mainly in places where these disasters are more common, including Israel , Canada Articles researching the coping of health professionals and the required measures in case of future attacks in the face of terrorist attacks are circumscribed to the U.S. ,118.The main instruments used to collect data were questionnaires, interviews, and, to a lesser extent, focus groups. The questionnaire is employed more often e.g., ,99,114) ,114 99,1Regarding the data analysis patterns, besides descriptive statistics, the more commonly employed are linear and multiple regression analyses. In , the goaThe studies researching socio-demographic factors indicate that older health professionals show less willingness to work in emergency contexts, as do women and health professionals with more family responsibilities, especially small children and, also, pets to take care of e.g., ,80,142).,142.80,1Socio-demographic features and the type of emergency are thus fundamental variables impacting the willingness to report to work in public health emergencies. The radiological and nuclear incidents are the hazards associated with less willingness to report to work ,146 alsoIndividual features of healthcare professionals, including fear, lack of confidence, and uncertainty about safety, are the more systematic variables predicting the willingness to report to work in several types of public health emergencies . Other iOn a supra level, tackling the same need to mitigate the uncertainty brought by a public health crisis is the need for awareness from health professionals to know the steps of the emergency protocol or plan, and tailored changes in the workplace to accommodate pandemic challenges e.g., ,149,150),150149,1The hierarchical descending cluster analysis divided the corpus into 5 clusters distributed as shown in p < 0.01), casualty , radiological , mass , incident , earthquake , nuclear , radiation , terrorist , personnel , management , chemical , victim , biological , guideline , family , terrorism , train , disaster , nonterrorism , smallpox , radioactive , oncology , accident , educational , bomb , preparedness , confidence , need , emergency , safety .Cluster 1, labeled “High profile Health hazards”, accounts for 24.68% of our sample and focuses on a wide variety of public health risks and threats caused by natural events or man-made situations. The literature associated with this cluster emphasizes the need for strategic preparedness and readiness of healthcare workers and systems to resiliently deal with these dangerous hazards. It includes the following expressions: event , health , public , worker , local , avian , response , ability , pandemic , department , workforce , universal healthcare , U.K. , surge , ethical , state , system , potential , catastrophic , ill , emergency , global , absenteeism , capacity , unit , ethic , facility , duty , government , behavior , plan  flu , employee , numb , clinician , h1n1 , threat .Cluster 2, named “Outbreaks impact on public healthcare system and workforce” (21.56% of our sample), focuses on other diseases that require emergence responses from the healthcare system and workers, namely influenza and H1n1 (avian flu). The articles associated with this cluster  emphasize more healthcare public policy provisions alongside specific challenges faced by the healthcare workforce, such as absenteeism. It includes the words influenza , logistic , datum , leadership , questionnaire  female  woman , peritraumatic , distress , stress , exhaustion , domestic , proportion , disorder , support , collaboration , anxiety , status , intervention , emotional , social , scale , interview , mental .Cluster 3, named “Psychological impacts of emergency work”, accounts for 21.56% of the articles and includes more information on specific statistical analysis and instruments of data collection, but, more importantly, analyzes the psychological consequences of working in emergency situations. These include an allusion to emotional and socially demanding situations for mental health emergencies, including distress, stress, anxiety, peritrauma, and exhaustion, felt particularly by female participants. The concepts more associated with this cluster are regression , stressors , doctor , volunteer , respiratory , medical , coronavirus , education , choice , career , medicine , conclusion , infection , disease , specialty , military , cause , infectious , Chinese , burden , anxiety (χ² = 14.69 p < 0.01), syndrome , parent , symptom , educate , satisfaction , depression , decrease , psychological , efficacy , , COVID , cope , stress , fear , expose , worry , emerge science , depressive , exposure , frontline , mental , male , train period .Cluster 4, named “COVID-19 and medical doctors coping”, includes articles closer to those of cluster 1 also revolving around COVID-19, albeit with a broader range of issues and specific healthcare professions. It accounts for 13.51% of the articles. The emphasis is on students of medicine and medical doctors coping with pandemic COVID-19 stressors in situ and the application of educational and scientific-based approaches to deal with the new challenging outbreak. While Cluster 1 emphasized the burden on nurses, this cluster explores more in depth the psychological impact on doctors. The stronger words associated are student , nurse , China , professional (χ² = 21.59 p < 0.01), work , challenge , influence , perspective , willingness , decision , quality , outbreak , frontline , evidence , natural , provider , disease , care , crisis , patient , condition , demand , motivation , commitment , Australian , problem , policy , organizational , Japan , pressure , affect  and healthcare . In order to better grasp the contextual meaning of the concepts pertaining to this cluster, we have consulted the typical text segments in which some of the most frequent words appear (using as ranking score the sum of χ² = of marked forms in segment).Cluster 5, named “COVID-19 Outbreak and health providers motivation and commitment”, accounts for 18.7% of the sample, including literature already focused on the pandemic COVID-19, emphasizing notions of urgency and challenging demands and conditions. Although nurses are the specific health professionals more associated with this cluster, more generic mentions of professionals, providers, and organizational contexts are made. Moreover, the focus on health providers considers their motivation, commitment, and willingness, especially those on the frontline. The main geographical contexts are China, Japan, and Australia. The specific words more associated with this cluster are COVID  are alongside the specific hierarchical role, the schedule required, and the quality of preparation training. Belief in duty and belief in protecting their family are at the different symbolic and values-based poles of this dilemma. The individual aptitude for working and thriving in an emergency context depends on the individual risk perception and underlying factors, the family support in engaging in that activity, and the required perceived skills to fight the emergence. Naturally, different provisions are required depending on health emergencies, and the response outlining must consider the aptitudes and willingness of health professionals as well as the available resources in the institution . SpecifiThe mindset, as profusely emphasized during times of crises, should be to capacitate health professionals with the best resources possible, including specific training, psychological accompaniment during and after the exposure to the acute or long-standing event, awareness-raising regarding their role and duties, a clear, comprehensive attitude of support to mitigate the feelings of concern or fear regarding one’s or family health. To know the factors and apply contingency measures is halfway through more capable and willing health professionals to deal with threatening situations with the least impact possible on their health in its aftermath.


Silicon carbide nanotubes (SiCNTs) have generated significant research interest due to their potential use in the fabrication of electronic and optoelectronic nanodevices and biosensors. The exceptional chemical, electrical and thermal properties of SiCNTs are beneficial for their application in high-temperature and harsh-environments. In view of the limited thermal stability of carbon nanotubes, they can be replaced by silicon carbide nanotubes in reinforced composites, developed for operations at high temperatures. However, fundamentally theoretical studies of the mechanical properties of the silicon carbide nanotubes are at an early stage and their results are still insufficient for designing and exploiting appropriate nanodevices based on SiCNTs and reinforced composites. In this context, the present study deals with the determination of Young’s and shear moduli of non-chiral single-walled silicon carbide nanotubes, using a three-dimensional finite element model. For nearly two decades, non-carbon nanotubes (N-CNTs) have been the focus of interest for the National Aeronautics and Space Administration (NASA) due to their use in hazardous environments . SiliconSiCNTs were synthesized for the first time by Sun et al. , who conThe reinforcement of composites for machinery parts by CNTs significantly improved their performance and helped to reduce the weight of its components. Nevertheless, this may not meet the requirements for numerous applications, such as high-temperature and high-power electronics, systems with improved thermal conductivity and nanodevices operating at high temperatures and in harsh environments. SiCNTs with optimum thermal properties, high conductivity and promising prospects for mass production can be suitable candidates to replace the CNTs. However, the silicon atom, Si, has a larger atomic radius, lower electronegativity and weaker bonds, which leads to properties of SiCNTs that are different from those of CNTs . RegardiOn atomistic approaches, in the work by Baumeier et al. , the surWith regard to the CM approach, where the whole nanotube is replaced by a single continuum structure, Mercan and Civalek  analyzedIn contrast to CM, the NCM/MSM approach considers the bonds between Si and C atoms as elastic beams, making use of the connection between the nanotube molecular structure and solid mechanics. Genoese et al.  evaluateThe goal of this study is to assess the Young’s and shear moduli of non-chiral single-walled silicon carbide nanotubes (SWSiCNTs) with chiral indices and diameters in a broad range, making use of the NCM/MSM approach, which employs beam elements. So far, the NCM/MSM approach is the most commonly indicated for effective and fast computational simulation of the N-CNTs mechanical response. To this end, a three-dimensional numerical model was used, which allowed the determination of bending, tensile and torsional rigidities, and, afterwards, the calculation of the elastic moduli of SWSiCNTs.hC, and the chiral angle, θ, given by the following expressions, respectively:As shown in The SiC sheet can be rolled up into a cylinder in different ways, varying the chiral angle, θ, from 0° to 30° see, , formingc, and the diameter, NTs are characterized by the nanotube circumference, L0.177 nm , 0.179 n0.177 nm  and 0.180.177 nm .bAb, bending, EbIb, and torsional, GbJb, rigidities of beam elements, constituting the equivalent continuum structure, and the bond stretching, kr, bond bending, kθ, and torsional resistance, kτ, force constants, which describe the molecular structure:l is the beam length.The nanoscale continuum modelling/molecular structural mechanics approach was used, which substitutes the Si–C bonds of SWSiCNTs by equivalent beam elements. Li and Chou  establisl, and the bond length, Thus, Equation (5) is the basis for the analysis of the elastic behaviour of SWSiCNTs, using the link between the continuum and molecular mechanics, which together with the assumption of equivalence between the beam length, FE model .® . To transform the program database files, provided by the Nanotube Modeler© software, to a format suitable to be used in the commercial ABAQUS® code, the home programme InterfaceNanotubes.NM was used [The FE models of the SiC nanotubes use the coordinates of the Si and C atoms to create the nodes and the appropriate connections between the nodes to generate the beam elements. The respective meshes were constructed using the Nanotube Modeler© software , which produces program database files. These files contain the atom positions and interatomic connections, which serve as input to FE’s commercial code, ABAQUSwas used . Table 2®. Therefore, in the respective conventional tests, the transverse force, Ft, the axial tensile force, Fa, and the torsional moment, T, were applied to one edge of the NT, while the other edge is constrained. To carry out the torsion test, the loaded nodes were prevented from moving in the radial direction.The mechanical behaviour of SWSiCNTs under numerical bending, tensile and torsion tests was studied with to the FE code ABAQUSa, the transverse displacement, ut, and the twist angle, φ, are obtained from the FE analysis of the tensile, bending and torsion tests, respectively. Consequently, the tensile, EA, bending, EI, and torsional, GJ, rigidities of the SWSiCNTs can be determined as follows, respectively:n is the NT’s length.The axial displacement, uAs for the single-walled carbon ,27, boroKnowing the EA and EI rigidities and using Equations (9) and (10), the diameter Subsequently, replacing the mean diameter, As in the case of most N-CNTs , there in, several authors have chosen to report the values of the surface Young’s  and (14), requires reliable knowledge of the value of tThe viability of Equations (15) and (16), to be used to evaluate the The tensile, EA, bending, EI, and torsional, GJ, rigidities of non-chiral SWSiCNTs, from (SWCNTs) ,27, the (SWCNTs) , and the(SWCNTs) , for non[Dn see, b, and thAs previously established by the authors for the SWCNTs ,27, SWBNIt is worth noting that the linear function presented by Equation (19) and the cubic functions expressed by Equations (20) and (21) can be comprehended based on the quasi linear relationship of the cross-sectional area, A (Equation (9)), and the cubic relationships between the moment of inertia, I (Equation (10)), and the polar moment of inertia, J (Equation (11)) with the nanotube diameter, respectively.To investigate the accuracy of the aforementioned analytical expressions for the evaluation of the three rigidities, Substituting, in Equations (15)–(18), the tensile, EA, bending, EI, and torsional, GJ, rigidities by the respective expressions (19)–(21), and knowing the parameters As a result, Equations (22)–(25) allow the assessment of the SWSiCNTs elastic moduli without resorting to numerical simulation.First, the results of the non-chiral SWSiCNTs Young’s modulus, calculated with Equations (13) and (22), for three different values of the NT wall thickness, ter see, . It shouThe results related to the effect of the nanotube wall thickness, It can be concluded that the Young’s modulus, E, decreases when the wall thickness, u et al. , the val nm see, a. Thus, As there is no reported accurate value of o 0.6 nm a,b. For ess see, a,b. FromThe results presented in The surface Young’s modulus, 24) see, a. The la8 TPa·nm  which arr et al. , using ar et al. , who empr et al.  and Jianr et al.  are at ar et al. , calculaEquation  in the prk of Le  and Jianrk of Le . Despiterk of Le  and Jianrk of Le  sharing rk of Le  reportedrk of Le , most liThe discrepancy of the In this section, the results of the shear modulus, G, and the surface shear modulus, e et al. .n = 0.34, 0.39, 0.45 nm.The shear modulus, G, of the non-chiral SWSiCNTs increases for NT diameters, Similar to the case of the surface of the Young’s modulus, the non-chiral SWSiCNTs surface of the shear modulus, The  nm see, a,b. ThusThe As can be seen from The average value to which the surface of the shear modulus of the non-chiral SWSiCNTs converges is approximately 36% lower than that evaluated for the SWCNTs. This should be taken into account in the design and construction of NTs-based devices and systems, where SiCNTs are considered a replacement for CNTs. Regarding the e et al. . Reasonae et al.  reportedses see, . Howevere et al. , which ue et al.  assumed The Young’s and shear moduli of non-chiral SWSiCNTs were assessed using numerical simulation, based on the NCM/MSM approach. The main achievements of the present study are presented in the following paragraphs.Equations establishing the relationship between each of the three rigidities—tensile, bending and torsional—and the NT diameter were obtained. The fitting parameters of Equations (19)–(21), which permit the assessment of the rigidities of the SiC nanotubes—regardless of the symmetry group: zigzag or armchair—were calculated. In this way, the previously established method for calculating the three rigidities without resourcing to numerical simulation, is extended to silicon carbide NTs.The evolutions of the Young’s modulus with the nanotube wall thickness were used to make assumptions regarding the realistic value of The accuracy of Equations (17) and (18), for the evaluation of the surface of the Young’s and shear moduli, respectively, was demonstrated. In our view, these equations are suitable to calculate the surface of the Young’s and shear moduli of the N-CNTs, for which there is no appropriate value of the NT wall thickness reported in the literature.The results obtained contribute considerably to a benchmark in the evaluation of the elastic constants of the silicon carbide nanotubes by theoretical methods.


Magnetic Functional Materials: Synthesis, Characterization and Application is a new open Special Issue of Materials, which aims to publish original and review papers on new scientific and applied research, and make great contributions to the finding and understanding of magnetic functional materials and related synthesis, fundamentals, characterization, and applications.The early magnetic materials were mainly silicon steel and ferrite. Since the 1960s, a series of high-performance magnetic functional materials such as amorphous soft magnets, nanocrystalline soft magnets and rare-earth permanent magnets have appeared one after another [In the contemporary information society, energy, information, and materials are the important foundation of production, life, and high technology. Magnetic functional materials are widely used in energy, information, and materials science and technology. There are many kinds of magnetic functional materials, and their progress is rapid. Magnetic functional materials have attracted a great deal of attention regarding their applications. Magnetic behaviors are widespread in a variety of materials, such as metals, ceramics, organics, and emerging 2D materials. Applications of magnetic materials include memories, sensors, magnetic refrigeration, drug delivery, electrochemistry, environmental protection, energy storage, and more.Magnetic Functional Materials: Synthesis, Characterization and Application includes, but is not limited to, the following: permanent magnets; magnetic functional materials; magnetism in correlated electron systems; memories and sensors devices; magnetic refrigeration; environmental protection; and devices based on magnetic materials.The research interest of the section


Instead of “Department of Pharmacy Practice,” it should be “Department of Clinical Pharmacy.”In the published article, there was an error in affiliation Ohoud S. Almalki was mistakenly not credited as a contributing author in the original Author Contributions. The Author Contributions Statement previously stated:OSA and OAA: conceptualization and project administration. OAA: methodology, software, data curation, formal analysis, and funding acquisition. OSA and MA: validation and writing—original draft preparation. OSA, OMA, and MA: investigation. YA, OMA, and OAA: writing—review and editing. OMA, MA, and YA: visualization. OSA, YA, and OAA: supervision. All authors have read and agreed to the published version of the manuscript.The corrected Author Contributions Statement appears below.OSA and OAA: conceptualization and project administration. OAA: methodology, software, data curation, formal analysis, and funding acquisition. OSA and MA: validation and writing—original draft preparation. OSA, OMA, and MA: investigation. YA, OMA, and OAA: writing—review and editing. OMA, MA, and YA: visualization. OSA, YA, and OAA: supervision. All authors have read and agreed to the published version of the manuscript.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The American Journal of Gastroenterology published a series of reviews by a Rome Foundation Working Group on the emerging role of food in the pathogenesis, illness experience, and treatment of what were then referred to as Functional Gastrointestinal Disorders (FGIDs)  . At the  (FGIDs) –9.Over the ensuing 9 years, our thinking about FGIDs has expanded and evolved. We have an enhanced understanding of the complexity of the pathophysiology of these conditions. Reflecting this, the Rome Foundation has proposed a change in the label applied to FGIDs, which for many had become a 4-letter word. The new label, Disorders of Gut-Brain Interaction (DGBI), retains a 4-letter abbreviation but one that is intended to be more descriptive and less negatively charged for patients and providers .One of the most important advances in our understanding of DGBI involves the interaction between the gut luminal microenvironment and the host . Among tAJG manuscript series published in 2013, we posited, “food is complex.” These words ring even more true in 2022 (In the introduction to the  in 2022 . It is pAJG for enabling the dissemination of the work of this Rome Foundation Working Group. We also extend our heartfelt gratitude to the authors for their hard work and dedication to this project. We hope that in the menu of offerings, you find information that suits your fancy. Bon Appetit!We thank the editors of Guarantor of the article: William D. Chey, MD.Specific author contributions: All authors participated in the conception, preparation of the first draft, critical revision of subsequent drafts, and approval of the final article.Financial support: None to report.Potential competing interests: W.D.C. is a consultant for AbbVie, Allakos, Alnylam, Ardelyx, Arena, Bayer, Biomerica, Ironwood, Nestle, QOL Medical, Salix/Valeant, Takeda, Urovant Sciences, and Vibrant; has received grant and/or research study funding from Biomerica, Commonwealth Diagnostics International, QOL Medical, and Salix; has stock options in GI on Demand, Modify Health; serves on the Rome Board of Directors; and is a member of the Board of Trustees of the American College of Gastroenterology and Board of Directors of the International Foundation for Gastrointestinal Disorders. J.T. is a consultant for Adare, Alfa Wassermann, Arena, Bayer, Christian Hansen, Clasado, Danone, Devintec, Falk, Grünenthal, Ironwood, Janssen, Kiowa Kirin, Menarini, Mylan, Neurogastrx, Neutec, Novartis, Nutricia, Ricordati Shionogi, Takeda, Truvion, Tsumura, Zealand, and Zeria pharmaceuticals; has received research support from Biohit, Shire, Sofar, and Takeda; and has served on the speaker bureau for Abbott, Allergan, AstraZeneca, Janssen, Kyowa Kirin, Menarini, Mylan, Novartis, Shire, Takeda, Wellspect, and Zeria and is President of the Rome Foundation.