In the present paper, we will explore how artificial intelligence (AI) and big data analytics (BDA) can help address clinical public and global health needs in the Global South, leveraging and capitalizing on our experience with the “Africa-Canada Artificial Intelligence and Data Innovation Consortium” (ACADIC) Project in the Global South, and focusing on the ethical and regulatory challenges we had to face. “Clinical public health” can be defined as an interdisciplinary field, at the intersection of clinical medicine and public health, whilst “clinical global health” is the practice of clinical public health with a special focus on health issue management in resource-limited settings and contexts, including the Global South. As such, clinical public and global health represent vital approaches, instrumental in (i) applying a community/population perspective to clinical practice as well as a clinical lens to community/population health, (ii) identifying health needs both at the individual and community/population levels, (iii) systematically addressing the determinants of health, including the social and structural ones, (iv) reaching the goals of population’s health and well-being, especially of socially vulnerable, underserved communities, (v) better coordinating and integrating the delivery of healthcare provisions, (vi) strengthening health promotion, health protection, and health equity, and (vii) closing gender inequality and other (ethnic and socio-economic) disparities and gaps. Clinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society, for which AI and BDA can help unlock new options and perspectives. In the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks, including ageing, multimorbidity, chronic disease accumulation, and climate change. In the present paper, we will explore how new technological and digital tools can help address clinical public and global health needs in the Global South ,2, leverACADIC is a newly formed interdisciplinary consortium that brings together a unique multidisciplinary team consisting of clinical public and global health experts, physicists, software engineers, data scientists, biostatisticians, epidemiologists, mathematicians, and biomathematical modelers, from 19 research centers and institutions/organizations, based in several African countries, such as South Africa, Nigeria, Cameroon, Rwanda, Namibia, Botswana, Zimbabwe, Mozambique, and Eswatini, as well as from Canada. The present “communication” paper was designed as a narrative literature review followed by a qualitative report of our experience with the ACADIC Project in the Global South, aimed at overviewing the main challenges of contemporary medicine with a “Global South” lens to inform the execution of future initiatives in the Global South.Concerning the first part (narrative literature review), we searched PubMed/MEDLINE, a major electronic scholarly database, which represents the most important and commonly utilized biomedical repository. We looked for the following keywords: “Global South”, “public health”, “global health”, “clinical public health”, “clinical global health”, “artificial intelligence”, “big data”, “big data analytics”, “Internet of Things”, “disruptive technologies”, “innovative technologies”, “digital tools”, “ethical issues”, “ethical challenges”, “regulatory issues”, and “regulatory challenges”.Concerning the second part , we carried out a thematic analysis (TA)  of the rTo ensure the procedure is adequately carried out, the team initially familiarizes itself with the reports, then, the texts are re-read and coded, subsequently re-examined, re-assessed, and, if necessary, codes are reviewed, and re-analyzed. The coding procedure is assisted by frequency and co-occurrence analyses and the formulation of research questions. New themes can emerge and be identified: if these are considered thematic variations of already identified themes, they are merged and combined, otherwise, they are added to the list of themes. All qualitative analyses were conducted using ATLAS.ti qualitative analysis software . In the following sections, we will briefly overview the main challenges of contemporary medicine with a “Global South” lens.Despite the lack of consensus on their precise definitions, health and well-being are not seen anymore as just the absence of disease, illness, or impairment/infirmity/disability, in a narrowly focused way, strictly entailing physical aspects from a mere biomedical context. Health and well-being are, rather, considered as the dynamic outcomes of a complex interplay of several parameters, which encompass various domains, including physical, psychological , and social factors, among others ,5,6. Health and well-being can be investigated from various standpoints and scales, from the individual to the community/population perspectives, along what is known as the “healthcare continuum”. This includes disciplines such as clinical medicine, public and global health, each one of which consists of four major components: namely, (i) prevention by means of disease and disease outbreak monitoring/surveillance and early warning systems (EWSs)—that is to say, the effective collection, integration, interpretation, and deployment of data to enhance and support data-driven monitoring and surveillance of diseases and disease outbreaks, with a focus on systems that can help strengthen preparedness and early response, (ii) identification by means of clinical, public, and global health laboratory innovation—that is to say, an integrated laboratory and facility network, which is equipped with state-of-art infrastructure to provide all primary and specialist diagnostic services needed for disease and disease outbreak care, treatment, and prevention, (iii) individual and community/population health risk management by means of an integrated framework for disease and disease outbreak risk reduction and mitigation, and, finally, (iv) evidence-informed, data-driven decision-making processes ,8,9,10 tWithin the healthcare continuum, given the interrelatedness of the different domains, new specialties are arising. “Clinical public health” can be defined as an emerging, cutting-edge, multi-, cross-, and inter-disciplinary field , at the Furthermore, in the last decades, an innovative discipline called “clinical global health” ,18 has eAs such, clinical public and global health represent vital approaches, absolutely instrumental in (i) applying a community/population perspective to clinical practice as well as a clinical lens to community/population health , (ii) idClinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society  Table 2Table 2. In the last decades, health systems worldwide have been facing different, unprecedented challenges, such as the increase in the burden of disease (either communicable or non-communicable), especially in developing countries , mostly The novel Coronavirus (COVID-19) pandemic is just the latest in a series of global disease outbreaks caused by emerging (or re-emerging) infectious diseases (ERIDs), including the H1N1 influenza virus pandemic, the Severe Acute Respiratory Syndrome (SARS), and the West African Ebola epidemics , among oThese outbreaks and, in particular, the still ongoing COVID-19 pandemic have significantly challenged (i) the capacity and ability of healthcare workers to absorb unforeseen health system shocks and external events , (ii) toHealth policies responded with a profound restructuring and reorganization of health systems and medical services to better protect healthcare personnel itself and patients . HoweverTraditional approaches that inform risk assessment and management strategies as well as risk reduction and mitigation efforts aimed at addressing the complex  effects of diseases, disease outbreaks, and other public and global public health emergencies assume approximately linear relationships that link from a well-defined source to a single endpoint, and heavily rely on historical data, time series, and observations. Moreover, they are merely reactive, rather than proactive , and focThese approaches have proven to be inadequate for dealing with the challenges presented by the systemic nature of risk and vulnerability, namely, the “multifaceted interconnectedness of disease outbreaks, poorly understood breadth of population exposure, and profound nuance and detail of vulnerability” . These dAs a consequence, the global community has failed to sufficiently and proactively identify, and respond to secondary impacts that intensify as “globally networked hyper-risks”  generateLearning and adaptation in the short-term response to a disease or an epidemic/pandemic can be enhanced by identifying the capacities and integrating the acute needs of the most vulnerable. Moreover, long-term transformation must incorporate new approaches to disease, pandemic and epidemic prevention, preparedness, management, response, and recovery, to address the systemic nature of risks . Some stMoreover, diseases and disease outbreaks, especially COVID-19, have underlined the need for timely, accurate, and reliable data, to better inform public health decision-making in an evidence-based fashion. As such, data science has played a key role in the response to the still ongoing COVID-19 pandemic, driving measures and shaping interventions to mitigate its burden . An incrBasically, a “fundamental redesign” and a “knowledge and paradigm shift in thinking”  with newBy definition, “One Health” and “planetary health”/“clinical planetary health” approaches require a system science approach  ,65,69 anSince ERID-related challenges, as well as other challenges, including economic-financial, geopolitical, environmental, technological, societal, and health “network hyper-risks” , are gloAI and BDA techniques have developed rapidly over the last 10 years . New tecThe advances in AI , includiIn the last years, scholars have discussed the hypes and hopes of AI- and BDA-based tools and techniques at the individual and community/population levels, in the arena of clinical public and global health, where they can serve as tools to assist public and global health policies and decision-making processes in an informed, evidence-based, data-driven fashion . ConversAs stated by Scoones et al. , currentAI and BDA can help face healthcare needs and challenges, being the catalyst for a profound transformation in the healthcare arena  and helpAs such, AI and BDA can affect all four facets of clinical medicine, and public and global health, profoundly reshaping them. AI and BDA can, indeed, (i) help predict communicable/non-communicable disease risk and prognosis, either at the individual and community/population levels , (ii) can enhance and strengthen laboratory functioning and capacity, in terms of identification of innovative biomarkers and precision diagnostics  and infectious sample processing , (iii) predict treatment outcomes  and monitor and forecast the effectiveness of the package of public and global health interventions implemented , and (iv) predict healthcare utilization (evidence-informed decision-making) . DiffereIn the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks , includiAll these challenges are highly interconnected. The latter, for instance, is expected, indeed, to profoundly disrupt human health, affecting respiratory and cardiovascular systems, as well as causing injuries and premature deaths  and incrSocioeconomic inequalities and risks can exacerbate the effects of climate change itself, whereby sea-level rise and extreme weather events such as flash flooding and storm surges cause widespread devastation to coastal and inland communities across the globe. As urban areas expand, more people living and working near forested areas are likewise affected by greater exposure to disease vectors and longer average wildfire seasons, with catastrophic results .AI- and BDA-based algorithms can help (i) identify climate-change tipping points by means of EWSs, (ii) strengthen the ability to detect such changes, (iii) devise mitigation responses and strategies, and (iv) guide and shape locally-informed policies. In conclusion, the novel use of AI and BDA is anticipated to uncover new links between climate, climate-related disaster exposure, and the burden of disease  , helpingThe Global South is a grouping of countries and territories, from South America, Africa, and Asia, that are highly heterogeneous in terms of socioeconomic, cultural, and political characteristics, even though they share (i) obstacles and barriers to access to community and public healthcare services, (ii) the burden of disease generated by communicable disorders, (iii) food and (iv) job insecurity, and (v) the lack of state-of-art resources and infrastructure, necessary for their growth and development . As such, the Global South differs from the concept of the “Hemispheric South”, which is a geographical one. The former is, instead, a meta-category or a broad umbrella term that comprises a vast array of decolonized nations, south of the old colonial centers of power. The health needs of the populations dwelling in the Global South are generally overlooked in the scholarly literature and are not prioritized in the political agenda . As previously mentioned, AI and BDA can help pave the way for new opportunities both in the field of preventive and clinical medicine, advancing the design and implementation of personalized treatment and management, as well as precise clinical public and global health interventions. However, despite an accumulating body of evidence, only a few countries from the Global North are leading and shaping research and knowledge in the field, with findings that, as such, may not be generalizable and applicable/directly translatable to the Global South. To be really and truly meaningful, equitable, and impactful, there is an urgent need for socially and ethically responsible, inclusive, and collaborative/participatory AI and BDA, that can drive and support innovation in the Global South, in terms of research, training of qualified personnel, high-quality curated and integrated, diverse and representative, locally relevant and informed databases, algorithms, platforms, and infrastructure.“Responsible” AI and BDA can be defined as an array of innovative and emerging practices of intentionally devising, developing, implementing, and utilizing AI and BDA, to protect the public good and to empower the populations, especially vulnerable, at-risk communities, with a positive impact on society. Responsible AI and BDA are characterized by fairness, inclusiveness, transparency, accountability, explainability, human-centeredness, privacy, and security. “Explainable, trustworthy, responsible AI and BDA for social good”  can reduThese risks generated by some AI- and BDA-based technologies require a global governance infrastructure and a set of clear regulatory frameworks aimed at identifying high-risk AI and BDA applications, setting conformity assessments as well as requirements and obligations for AI- and BDA-based system developers, vendors, and users.However, while the Global North is leading the debate on how to build, regulate, and make an “explainable, trustworthy, responsible use of AI and BDA for social good” , the GloAs previously mentioned, in the present paper, we will explore how AI and BDA can be exploited to address clinical public and global health needs in the Global South, based on our experience with the ACADIC Project in the Global South, focusing on the ethical and regulatory challenges we had to face, and leveraging the framework previously introduced , Table 3ACADIC has been devising and deploying AI- and BDA-based techniques to better understand the impacts of clinical public and global health interventions implemented during the COVID-19 pandemic in the Global South ,90,91,92In South Africa, for example, ACADIC has been piloting the use of AI- and BDA-based modeling ,95,96 toThis has required accounting for country-specific differences in socio-demographic, epidemiological, and clinical variables, including rates of comorbidities. As such, ACADIC has been re-weighting the models initially developed for South Africa ,90. ACADMoreover, in terms of “explainable, trustworthy, responsible AI and BDA for social good” , ACADIC ACADIC is also devising models that can assist clinical public and global health policy- and decision-makers develop optimal COVID-19 testing policies and mass vaccination strategies  as well Through the ACADIC project in the Global South, we have learned various lessons that will inform the execution of future programs and initiatives in the field of clinical public health and AI in the Global South. These lessons point to :Partnering with CLOs and community healthcare workers helped us to acquire some of the data from communities and populations that do not visit the healthcare system. In our partnership with community health workers, we had them visit households in certain communities to collect data for us. Some of the CLOs that we partnered with already have networks set up in some of these communities and this made it very easy for us to acquire some of the “hard to get” data. For a meaningful change in the health of people in communities, it is important for solutions to be developed and scaled from the bottom up, as modeling and data collection must be community-focused, -owned, and -co-led . In most of the countries in the Global South, without “buy-in” from the government, it is difficult to influence policies or implement research results. For policy-driven research in the Global South, this is essential. Buy-in from the decision- and policymakers gave us access to data and the ability to influence the collection of data. Thanks to the fact that we had a seat at the table where decisions were made, we were able to influence data gathering in most of the countries and had it disaggregated/stratified by ethnicity, gender, sexuality, socio-economic class, geographic location, and Indigeneity to better understand how COVID-19 is disproportionately affecting socially vulnerable people. It enabled us to influence government communication strategies to address misinformation about the prevention and treatment of COVID-19.It is essential to put together a team with different expertise. The diverse expertise in our team enabled us to merge new data sources from science, technology, social, and cultural systems, in relation to opportunities and risks, centering local needs and knowledge while learning from all partners’ experiences. Being engaged with communities gave us the ability to adjust swiftly to changing circumstances.For impactful research work in the Global South, it is important to create a network and have each team uniquely assemble its own strategy for meeting the program’s objectives and provide an opportunity for teams to learn from each other and an opportunity for knowledge transfer between the teams. In addition, the teams should be encouraged to draw on their own set of experiences, community partners, local context, constraints, and possibilities. By sharing their processes and results, the groups will draw out larger-scale comparisons, synergies, and conclusions in relation to the overall goal(s). It is important to provide an opportunity for them to ‘learn by doing and ‘in the community.’ Research that leads to meaningful change is new in most LMICs in the Global South given the history of colonialism and being “forced by circumstances” to rely on the formal colonial masters up to date for most of the innovations. Thus, it is necessary to hold each other’s hands and provide mutual support. The moment researchers become frustrated with research in most countries, if there is no one to provide them with the necessary support to keep going, they will give up. Learning from each other through weekly meetings, workshops, webinars, town hall meetings, etc., is very essential. We learned from other groups within the ACADIC consortium by having weekly meetings and regular workshops. The transnational partnership’s value-added for all partners in ACADIC is grounded in our sharing across contexts and specific situations regarding effective digital data generation, management, dissemination, and ways to address equity priorities for risk minimization by amplifying the voices and agency of marginalized and highly impacted communities.It is imperative to harness data from all available sources including unconventional sources to make up for the gaps that exist in data. We have used unconventional datasets that include, household visits by community health workers, voice scripts, chatbots, Twitter, Google searches, community-level Reddit, WhatsApp, Facebook, etc., to inform health needs about COVID-19 ,89,91. IWe developed a framework that takes into account regulatory and ethical aspects , as well as community and societal needs. We extensively searched the literature (either scholarly/peer-reviewed)  and we iScience granting councils and local funding agencies in the Global South suffer from several, interrelated shortcomings and challenges, including a lack of adequate capacity, coordination, and implementation of research funding policies. Local policy frameworks and enabling structures should be developed and/or strengthened to better support the local communities of scholars and researchers. Moreover, public-private sector partnerships should be incentivized.AI- and BDA-based modeling has attracted increasing interest from policy and decision-makers across countries in the Global South, including Africa. AI- and BDA-based modeling can, indeed, help them shape their local, regional, and national Strategic Plans in an informed, evidence-based, and data-driven fashion, tracking their progress and monitoring their effectiveness. However, there still exists a significant knowledge power imbalance between a few countries leading in AI- and BDA-based modeling and the rest of the world. As such, the AI modeling ecosystem and the research and development (R&D) landscape across the countries in the Global South should be strengthened, in terms of adequate qualified personnel of researchers and innovators, as well as infrastructure and algorithms/tools. In the present paper, we explored how AI and BDA can help address clinical public and global health needs in the Global South, leveraging and capitalizing on our experience with the ACADIC Project in the Global South, and focusing on the ethical and regulatory challenges we had to face.Whilst clinical public health is at the intersection of clinical medicine and public health, clinical global health is the practice of clinical public health in the Global South. As such, clinical public and global health represent vital approaches, instrumental in combining a community/population perspective with clinical practice, identifying health needs, systematically addressing the determinants of health, better coordinating and integrating the delivery of healthcare provisions, reaching the goals of population’s health and well-being, strengthening health promotion, health protection, and health equity, and closing disparities and gaps. Clinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society, for which AI and BDA can help unlock new options and perspectives. In the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks, including aging, multimorbidity, chronic disease accumulation, and climate change.Based on the existing literature and our experience, we identified the following lessons (i) strengthening local research and healthcare capacity in the Global South, (ii) strengthening local epidemic/pandemic management planning, including the establishment and development of networks with simulator users in the Global South, (iii) a need for locally informed models in the Global South, (iv) a need for flexible modeling frameworks to respond rapidly to future emergencies in the Global South, (v) limitations and shortcomings of modeling should be communicated clearly and consistently to end users in the Global South, (vi) systematically monitoring the use and implementation of models in the process of decision-making in the Global South, (vii) a need for strengthening AI- and Big Data-related funding in the Global South, and (viii) a need for strengthening AI- and BDA-modeling capacity in the Global South.This is in line with other experiences of authors from the Global South, which reaffirm that equity in health is paramount, being “the core value of health for all” , as advoAs such, carrying out health research is vital, even though, in some resource-limited areas and environments, it may be particularly complex and difficult, with a limited capacity to undertake and translate research into practice . There, Researchers and scholars from the Global South are terribly under-represented in research ,109,110,The present study has some limitations, that should be acknowledged. The literature review was narrative rather than systematic and the qualitative part of the study was preliminary. As such, further research is needed. Moreover, only a limited number of countries from the Global South could be included and the findings of the current review may not be generalizable to other realities and contexts from the Global South. Through a narrative literature review and our experience with the ACADIC project, we have learned many lessons that will inform the execution of future initiatives in the Global South. If all these lessons are properly addressed, it will be possible to carry out responsible, inclusive, and impactful AI- and BDA-based research in the healthcare sector that will provide global benefits However, our literature review is narrative and our qualitative analysis preliminary. As such, further research in the field is warranted. More in detail, future studies should conduct high-quality systematic reviews on some (sub-)topics such as clinical public and global health, as well as on digital health in the Global South. Moreover, new interactive, web-based trackers and indicators, such as the “Global Digital Health Index” (GDHI), should be developed and validated to evaluate and monitor the progress toward inclusive, equitable, responsible, and locally championed AI and digital health throughout the world, with a focus on the Global South.


The smartness that underpins smart cities and societies is defined by our ability to engage with our environments, analyze them, and make decisions, all in a timely manner . We are This Special Issue’s focus is on the IoT, and it is concerned with bringing “smartness” to the IoT and other system layers using technologies such as Cloud, Fog, and Edge Computing; High-Performance Computing (HPC); Big Data; Blockchain; and/or AI. In addition to this Editorial piece, a collection of 13 articles is featured in this Special Issue, covering a range of topics, including mobility, healthcare, image analysis, permeable pavements, solid waste management, sensor node and gateway architectures, air quality monitoring, thermal anomalies and smart helmets in industrial environments, smart airports, smart districts, smart travel choices, sensor cities, artificially intelligent cities, and platform urbanism. Smartness is a multidisciplinary topic and can be defined from different perspectives. We see through the articles included in this Special Issue that smartness can be seen to have four dimensions . These dimensions are: (i) Sensors, IoT, and Data Generation; (ii) Data and Information Processing; (iii) Actuation; and (iv) Digital Systems and Infrastructure. To elaborate, we can see smartness in the way sensing is embedded in a system, the way data and information are processed, how a system interacts internally and with its environment, and whether a system is ubiquitous or limited by space (cloud-based or edge-enabled). What follows is a brief review of the articles included in this Special Issue, which highlights their contributions with respect to these four dimensions. They are grouped according to their application areas: mobility and transportation, healthcare, industrial environments, and other urban infrastructures.Transportation is the backbone of modern economies, albeit at massive human, environmental, and economic costs ,3. Lana Chia et al.  use smarAlomari et al.  introducMotivated by the fact that over a billion people are disabled worldwide, with 253 million of them being visually impaired or blind, Busaeed et al.  propose The detection of anomalies in harsh industrial environments is a challenging task. To address this, Ghazal et al.  propose Campero-Jurado et al.  discuss Janbi et al.  propose,Yigitcanlar et al.  investigFeri et al.  propose Akram et al.  propose Jo et al.  examinedThe smartness that underpins smart cities and societies is defined by our ability to engage with our environments, analyze them, and make decisions, all in a timely manner. The IoT has been the focus of this Special Issue, and its concern has been to bring “smartness” to the IoT and other system layers using emerging technologies. The articles included in this issue cover a wide range of applications, including image analysis, permeable pavements, solid waste management, air quality monitoring, thermal anomalies and smart helmets in industrial environments, smart airports, smart districts, and smart travel choices.The field of smartness is exciting, and while a lot has been achieved, the future possibilities with technologies such as Deep Learning, Edge Computing, Virtual Reality, and more are endless. There are many works that are complementary to the research presented in this Special Issue, such as deep journalism , smartiz


Anxiety is an ambiguous term, meaning an emotional state, a clinical symptom, a disorder, or a group of disorders. Anxiety is a normal feeling that arises when a person believes he is in danger from a threat or unidentified danger, ensuing with a state of alertness, arousal, and exploratory attention. Its distinction from neighbouring concepts, such as anguish, fear, worry, anxiety, panic, or uneasiness, is valuable but controversial.Review and synthesize various contributions from phenomenology and philosophy to the understanding of what it is like to experience generalized anxiety.Selective review of the most prominent literature regarding anxiety psychopathology, namely that of Jaspers, Heidegger, López-Ibor, Sims, Berrios, Femi Oyebode, Pio Abreu, James Aho, Picazo Zappino and Gerrit Glas.Jaspers described free-float anxiety as common and painful, floating and detached, as a feeling of misunderstood genesis, imposing despite the inapparent object, driving an inescapable need to provide some content to it, but also susceptible to insight by those who experience it. It can take a vitalized or primarily psychic form. Anxiety is closely related to the limits of the human being and to (hopelessness). For Heidegger, angst is the expression of authentic existence. López-Ibor considered anxiety and anguish nuances of the same experience, in both of which there is fear of the dissolution of the unity and continuity of the self (anguish). When what exists is not a fear, but only a threat, anxiety arises.Phenomenologically informed psychopathology is relevant for clinicians. Complementing neurosciences, each answers questions that the other cannot.No significant relationships.


The International Association for the Study of Pain (IASP) has defined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage, which also comprises a subjective component . Pain isRegarding chronic pain, it entails a serious health burden, and a high comorbidity with other disorders such as anxiety, depression, insomnia, and cognitive impairments ,9,10,11.The principal chronic pain disorders include headache, migraine, and local and generalized musculoskeletal diseases. The last may be further divided into those with inflammatory , mechanical , or unknown origin . These dFibromyalgia, chronic tension-type headache, migraine, and the temporomandibular disorder are some examples of chronic pain disorders without a clear physiological cause. In all of these disorders, the pain intensity is found not to be proportional to the reported injury ,23,24,25The intervention of chronic pain should be considered from a biopsychosocial perspective. As pointed out before, chronic pain is a condition characterized by physiological and biological correlates, in turn modulated by emotions (including negative beliefs) ,33,34,35In general, to contribute to the effectiveness of chronic pain treatment, patients must be informed of the characteristics of the treatment. Thus, they are capable of committing to the treatment and can achieve better results . It is cIn sum, the chronic pain field requires continuous research in order to improve its prevention, diagnosis, and treatment. Considering the worldwide incidence, and prevalence of chronic pain in developing countries , scienti


IgA nephropathy (IgAN) typically is a slowly progressing disease, with 10% to 60% of patients developing chronic kidney failure within 10 years.In round 1, most statements (19 [95%]) met the criteria for high consensus, including those regarding pathophysiology, diagnosis, and treatment of early stage and rapidly progressive IgAN . ParticiP = 0.044). For round 2, statement #28 was split into 2 statements . Further analyses by country can be found in P = 0.045). In round 2, the difference in agreement between academic and nonacademic nephrologists for both statements #28A and #28B was no longer statistically significant . It is possible that academic nephrologists may assess the long-term risk-benefit profile of corticosteroids more conservatively than their nonacademic colleagues.Further analyses explored differences in agreement levels among participants practicing in different geographic locations  and S2. The DEFINE: Physicians Delphi survey on IgAN identified high consensus overall after just 1 round of the survey. This finding suggests that nephrologists in North America and Europe have similar opinions on IgAN management and that these opinions are largely consistent with the KDIGO guideline. The statement with the lowest level of agreement  was statement #28, which described corticosteroid use in adults. Corticosteroids for managing IgAN is a controversial topic, considering recent results from studies including the STOP-IGAN and TESTING trials.The high level of agreement found for the pathophysiology and treatment goal statements ; #3.6Most statements in this survey aligned with the 2021 KDIGO guideline for glomerular diseases.The high levels of agreement found in this study may be driven by the fact that treatment options for IgAN are limited, with no alternatives to consider. However, the treatment landscape of IgAN may change, as many studies are currently investigating potential therapies for this disease.Limitations of this study include that it was conducted in English and did not involve nephrologists from Asia or South America. Furthermore, there was a limited number of female participants and pediatric nephrologists in this survey  and S5. In summary, the lowest levels of agreement were observed on corticosteroid use in adult patients who receive optimized supportive therapy but still have elevated proteinuria. Although overall agreement was high regarding this topic, some nephrologists, particularly in Europe, disagreed with the use of corticosteroids in this setting. This suggests that further research on the risk-benefit profile of corticosteroids and new therapies in IgAN are needed. Overall, the DEFINE: Physicians study found high levels of consensus regarding the pathophysiology, diagnosis, management, and monitoring of IgAN among nephrologists from North America and Europe and that, in general, their opinions align with the latest KDIGO guideline for statements evaluated herein.JF is employed by Rheinisch-Westfälische Technische Hochschule University of Aachen; has consultancy agreements with Amgen, Bayer, Calliditas, Novo Nordisk, Omeros, Travere Therapeutics, Inc., Vifor, and Visterra; has received honoraria from Amgen, Astellas, Bayer, Calliditas, Novo Nordisk, Omeros, Travere Therapeutics, Inc., Vifor, and Visterra; is a scientific advisor for Calliditas, Omeros, and Travere Therapeutics, Inc.; and is on the speakers bureau for Amgen and Vifor. JB has received research grants from Argenx, Calliditas, Chinook Therapeutics, Galapagos, GSK, Novartis, Travere Therapeutics, Inc., and Vera Therapeutics; and serves as a medical/scientific advisor to Alnylam Pharmaceuticals, Argenx, Astellas, Biocryst, Calliditas, Chinook Therapeutics, Dimerix, Galapagos, GlaxoSmithKline, Novartis, Omeros, Travere Therapeutics, Inc., UCB, Vera Therapeutics, and Visterra. RC has consultancy agreements with Amgen, Argenx, Calliditas, Novartis, Ostuka, Reata, Recordati, and Travere Therapeutics, Inc., and has an agreement with UpToDate. RL has received research funding from Calliditas, Chinook, National Institutes of Health, Novartis, Travere Therapeutics, Inc., Pfizer, Vera, Omeros, and Visterra; and is an advisor for Alexion, Calliditas, Chemocentryx, Chinook, Novartis Omeros, Pfizer, Reatta, Travere Therapeutics, Inc., and Visterra. JR has received research grants from Travere Therapeutics, Inc.; is on a steering committee for Travere Therapeutics, Inc.; and has consulting/advisory board roles with Angion Biomedica and Travere Therapeutics, Inc. HNR has received consulting fees from Calliditas, Chinook, Novartis, and Travere Therapeutics, Inc.; has received honoraria from Novartis; is an advisor for Novartis and Travere Therapeutics, Inc.; has served as national coordinating investigator for trials by Calliditas and Chinook; has served as an investigator for GN clinical trials by Alnylam, Calliditas, Chemocentryx, Omeros, and Pfizer; and is director of the Glomerulonephritis Fellowship funded by the Louise Fast Foundation. BR has received consulting fees from Calliditas, Novartis, Omeros, and Travere Therapeutics, Inc. DTS has consultancy agreements with BioPorto and Travere Therapeutics, Inc. MV is on advisory boards for Apellis, Novartis, Roche, and Travere Therapeutics, Inc.; receives consulting fees from Alexion; and has participated in studies sponsored by Bayer, Novartis, Chemocentrix, and Chinook. This does not influence the content of the present study. CP is employed by ApotheCom, which received funding support from Travere Therapeutics, Inc. for the DEFINE: Physicians study. VT has served as principal investigator and steering committee member for clinical studies in focal segmental glomerulosclerosis supported by Travere Therapeutics, Inc., and has consultancy agreements with AstraZeneca, Boehringer Ingelheim, Calliditas, Novartis, Omeros, and Travere Therapeutics, Inc.


In the published article, there was an error in affiliation 1. Instead of “State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China”, it should be “Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China”.In the published article, there was an error in affiliation 2. Instead of “Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China”, it should be “State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China”.In the published article, there was an error regarding the affiliation for Ruiying Han. As well as having affiliation 2, they should also have Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.In the published article, there was an error. There was a mistake in the time range of the searched literature in Abstract.Methods, 1. This sentence previously stated:A correction has been made to Abstract, “We systematically searched databases including Medline, Embase, and Web of Science for studies up to March 2022 with no start date limited.”The corrected sentence appears below:“We systematically searched databases including Medline, Embase, and Web of Science for studies from January 2000 to March 2022.”The authors apologize for these errors 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.


Life.Hypoxia is a current research topic in biology, physiology, and medicine. The effects of hypoxia and the adaptive and maladaptive responses to the hypoxic stress are extensively explored in the domains of altitude, exercise, pulmonary and cardiovascular medicine, inflammation, immunity, cancer, and metabolic diseases. However, the molecular machinery that regulates the activity of certain genes in response to hypoxia is still not explored. This Special Issue “Cellular and Functional Response to Hypoxia” presents 14 papers dealing with all aspects of responses to hypoxia, at the molecular, cellular, and integrative levels ,3. First


There is an error in affiliation 5 for author Verena Loidl. The correct affiliation is: Institute for Medical Information Processing, Biometry, and Epidemiology—IBE, LMU Munich, Munich, Germany.


Instead of “Department of Pharmacology and Pharmacotherapy, University of Debrecen, Debrecen, Hungary”, it should be “Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary”.In the published article, there was an error in 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.


Background: Health organisations and stakeholders use social media for a range of functions, including engaging stakeholders in the design and quality improvement (QI) of services. Social media may help overcome some of the limitations of traditional stakeholder engagement methods. This scoping review explores the benefits, risks, barriers and enablers for using social media as a tool for stakeholder engagement in health service design and QI. Methods: The searches were conducted on 16 August 2022. Inclusion criteria were: studies of any health service stakeholders, in any health setting, where social media was used as a tool for service design or QI. Data was analysed using deductive content analysis. A committee of stakeholders provided input on research questions, data analysis and key findings. Results: 61 studies were included. Benefits included improved organisational communication and relationship building. Risks/limitations included low quality of engagement and harms to users. Limited access and familiarity with social media were frequently reported barriers. Making discussions safe and facilitating access were common enablers. Conclusion: The benefits, risks, barriers and enablers identified highlight the complexity of social media as an engagement tool for health service design and QI. Understanding these experiences may help implementers design more effective social media-based engagement activities. Social media has shaped the internet since Web 2.0 was defined in 2004 . Social Social media can also be used to facilitate the engagement consumers and other stakeholders in activities to change, design, or improve health services . BataldeStakeholder engagement in health service design and QI which includes consumers has been shown to improve patient access and outcomes ,16,17, aThe aim of this scoping review was to explore the benefits, risks, barriers and enablers for using social media as a tool for stakeholder engagement in health service design and/or QI. This study complements a previously published paper which used the same scoping review method and described a related but distinct set of findings on the features of social media platforms, models of communication, populations of people, and types of service design, QI or change activities . The keyThis scoping review was conducted using Joanna Briggs Institute (JBI) methodology . The objIt should be noted that the JBI methodology for scoping reviews was updated in 2020 however this was after the scoping review protocol was published  and enacThis review was guided by the involvement of an advisory committee of three healthcare consumers and three healthcare service providers. Members of the advisory had professional and/or lived experience in palliative care, mental health, ICU and critical care, transplantation, chronic disease, consumer engagement and representation, and health communications.The advisory committee and scoping review were part of a larger doctoral research project. Committee members were invited following purposeful sampling  from theDeciding upon the research question;Finding articles for screening;Assisting with data analysis, including making suggestions to refine and re-group codes and themes;Reviewing the manuscript; andShaping the content of the discussion section through prioritising the analysis findings based on their own experience of the health system.Advisory committee members contributed to the review by:Advisory committee member contributions to the review were made through two 90 min meetings held via video conference, and through ongoing email correspondence throughout the review and manuscript-writing process.The two members of the advisory committee who provided feedback on the manuscript, and answered the questions which informed the discussion section, are included as co-authors on the review .The eligibility criteria outlined below and the subsequent search strategy and methods for the extraction of the results were guided by the Population-Concept-Context structure . The eliUsers or potential users of a health service ; and/orHealth service providers .For inclusion in this review, participants in the included studies were:No restrictions were placed on the age or gender of study participants.Studies only involving participants from non-health service settings  were excluded from the review.Studies where social media was used as a tool within design or QI activities which were initiated by health organisations, andStudies where social media was used as a tool by stakeholders to influence or advocate for changes to the design or delivery of health services, systems or policy.The core concept to be examined in this review are the benefits, risks, barriers and enablers of using social media as a tool for health service design and QI. To capture the full range of potential uses of social media in health service design and QI, two broad study types were included. These were:A date range limitation of ‘2004–current’ was placed on the search. This date range was chosen because 2004 is considered the beginning of Web 2.0, the era in which the internet shifted from being primarily comprised of static webpages, to instead being made up of sites and applications which allowed for user-generated content creation and distribution . This shStudies where social media was used, but there was no intention or objective to design or improve health services, systems or policies were excluded from the review. This included social media being used for disease surveillance, health information dissemination, treatment, peer support, education and research without health service change, design or improvement.Studies conducted in health service or health policy settings and published in English. Studies from any geographic location, regardless of income status, were included.Studies conducted in non-healthcare settings  were excluded.Original primary research or evaluation articles (any methods) in peer reviewed academic publications, were eligible for inclusion in the review. Sources without original research, and secondary research literature, were excluded from the review.On 16 August 2022 Medline OVID, Embase OVID, PsycINFO OVID, and CINAHL EBSCO were searched. All searches were restricted by the date range of January 2004–current (16 August 2022) and published in English only. Example search strategies for Medline OVID and Embase OVID are provided in Supplementary Table S2.In addition to the searches above, the reference lists of included studies were screened for potentially eligible studies. Members of the advisory committee also submitted potentially relevant studies for inclusion.L.W. screened the titles and abstracts of retrieved studies, and the screening process was managed in EndNote. L.W. retrieved the full text of potentially eligible studies and assessed them for inclusion, using a screening template developed by L.W., N.H. and S.H. . When anThe analysis represents the scoping review step of “charting the data” which allows for both a numerical summary of the scope of the literature in terms of quantity of research  and qualComments from the advisory committee in response to the results of the data analysis also informed the content of the discussion section of this article, including how results should be presented and which elements should be emphasised.In the protocol  and the When an otherwise eligible conference abstract was identified, an additional search was conducted to determine whether a peer reviewed article from the same study had been published. When an otherwise eligible secondary research article was identified, the studies included in the review were individually screened for eligibility.After screening 5456 titles and abstracts, and 292 full text articles, 61 articles from 59 study settings were included in the scoping review. All articles were published since 2010, with 23 of the included articles (38%) published since 2020. The majority of studies (90%) were conducted in high income countries. The list of included studies and their key characteristics are shown in The benefits, risks, barriers and enablers for the use of social media as a tool for stakeholder engagement in service design and QI are presented below. Key findings of the analysis are presented in the commentary for each of the a priori themes. A summary of the themes, sub-themes and codes developed through the analysis is presented in Using social media for stakeholder engagement in health service design and QI resulted in a broad range of reported benefits. Benefits were grouped into the sub-themes of (1) improves organisational communication, (2) builds relationships, (3) higher quality information and (4) improves organisational culture and reputation.Improves the efficiency of communication. The most common benefit relating to organisational communication was that using social media as a tool within health service design and QI activities improves the efficiency of communication [nication ,87,92,95nication ,73,82,92nication ,85,86,92nication ,71,80,95nication ,55,66,71nication ,69,73,84nication ,52,68 anAdditional channel for communication. Social media provides an additional channel for communication [nication ,73,80,84nication ,58,80,84nication ,56,65,66nication ,59,73. NFacilitates collaborative relationships. Social media is beneficial for collaborative relationship building between individuals, groups or organisations [isations ,89,91,93isations ,86,89,91isations ,48,70, sisations ,77,86, aisations ,91,93.Engages new audiences. Using social media in health service design and QI also provides opportunities to develop relationships with new audiences [udiences ,86,88,91udiences ,59,73 anudiences .Improves clinical practice. The relationship-building capacity of social media was also seen to improve clinical practice [practice ,81,91,97practice ,91,97, apractice ,72,81.Improves the quality of information gathered or shared. Social media was seen to improve the quality of information gathered or shared by organisations [isations ,86,90,95isations ,69,73,85isations . In the isations ,84,90,95Facilitates high quality discussions. Social media was seen as effective for facilitating high quality discussions [cussions ,67,69,76cussions ,56, creacussions ,67,69, aFacilitates positive organisational culture change. The use of social media in QI and service design was seen to facilitate positive organisational change [l change ,82,84,92l change ,69,74,84l change ,71,81,92l change ,52, incrl change ,52,81,84The risk and limitations reported in the included studies were grouped into the sub-themes of (1) limited or ineffective engagement, (2) limited evidence of effectiveness, (3) risks of direct harm to individuals and organisations, and (4) challenges to strategic use.Underutilisation by target audiences. The most frequently reported risk or limitation theme was that social media is underutilised by target audiences of the health service or QI/design activity [activity ,90,96,97activity ,86,90,97activity ,52,65,74activity ,96,97, pactivity ,97 and sactivity  observedactivity  found thQuality of discussion or information gathered not sufficient for QI purposes. The quality of discussion or information on social media could limit its effectiveness for informing QI activities [tivities ,76,80,97tivities ,65,76,97tivities ,57, and tivities ,63,75,80Unclear evidence of the benefits compared to traditional stakeholder engagement methods was a limitation to using social media in some of the included studies [ studies ,80,84,86 studies ,55, one  studies  and one  studies . There a studies ,55,81,86Malicious, fake or negative messages and actions were recognised as a risk [s a risk ,86,90,97s a risk ,86,90,97s a risk  were exas a risk ,60,64,90s a risk .Breaches of privacy and professional behaviour. Privacy and professional behaviour breaches are a concern for all social media users engaged in service design and QI [n and QI ,74,76,84n and QI ,41,84. Sn and QI  and are Difficult to use strategically to achieve change. Social media can be difficult to use in a strategic way to achieve change [e change ,63,81,97e change ,63. AddiDifficult to evaluate. Social media engagement was seen as difficult to evaluate in five studies [ studies ,65,74,80 studies  were allBarriers to social media use in health service and system design and QI were experienced by all user types. Barriers included specific, observed, barriers which occurred during a study, and expressed concerns based on opinions or beliefs about health service use of social media that were significant enough to stop or limit social media use. The expressed concerns that act as barriers to the use of social media were wide-ranging and were most often expressed by organisations or service providers, rather than health consumers. The barriers identified in the included studies have been grouped into the sub-themes of (1) lack of access to and familiarity with social media, (2) lack of organisational processes and support, (3) concerns about how people behave online, and (4) problems with social media platforms.Lack of resources and access was the most frequently occurring barrier [ barrier ,86,96,97 barrier ,86,96,97 barrier ,58,82,97 barrier  and staf barrier .A lack of skills and confidence in using social media [lack of familiarity with using social media for health or QI purposes [al media ,74,84,97purposes ,68,72,88Issues with organisational culture and a lack of executive support were observed as barriers in some studies [ studies ,71,72,84 studies ,52,61,72 studies ,43, gove studies ,43, a la studies ,84, and  studies ,71. From studies ,52.Concerns about implementation and evaluation processes were expressed as barriers to the use of social media [al media ,52,65,73al media ,50,51,52al media ,65.Concerns about how to manage messaging, people and interactions in a public forum were reported as barriers [barriers ,68,72,97barriers ,66 or fibarriers , other ubarriers , legal abarriers , managinbarriers , and worbarriers ,52,97.Concerns about the possibility of users breaching privacy or professional codes of behaviour were expressed as barriers to using social media for health service design and QI activities [tivities ,74,91,97Unwillingness to share personal information online can act as a barrier to consumers using social media for health service design and QI activities [tivities ,89,91,97Rapid changes in the social media environment meant organisations struggled to maintain a presence across all relevant platforms [latforms ,89.Poor usability of platforms, particularly purpose-built platforms [latforms  or platflatforms , were alThe enablers of social media use in health service or system design and QI were grouped into the sub-themes of (1) facilitating access and use for all stakeholders, (2) making discussions safe, (3) providing high quality content and user incentives, (4) supportive organisational systems and culture, and (5) building a social media community.Making use of social media easier for target audiences. Making social media easier to use enables its use in health service design and QI activities [tivities ,92,96,97tivities ,69,73,81tivities ,66,77,87tivities ,86 also Organisational systems, processes, resourcing and partnership. Organisations can enable the use of social media through creating systems, processes, plans and roles related to social media use [edia use ,87,93,97edia use ,74,97, aedia use ,81,82,87edia use ,52, and edia use ,73 and sedia use ,43,73,82Providing multiple ways to engage. Social media being only part of a suite of engagement strategies was an enabler [ enabler ,80,85,88 enabler ,69,73.Facilitating access to social media. Making access to social media easier enabled its use [ its use ,73,77,93 its use ,73. Advo its use ,73, or eMaking discussions safe. Safe discussions for all participants was a commonly reported enabler [ enabler ,84,91,93 enabler ,72,73,84 enabler ,65,69,93 enabler ,69. Ther enabler ,69,71,91Delivering engaging, trustworthy and targeted content. Quality content, tailored to social media platform formats and communication styles, is a way to enable and encourage use of social media for health service design and QI [n and QI ,86,88,94Users gaining benefits from participation. All user types were more likely to use social media if they could see benefit from their participation [cipation ,73,81,82cipation ,41,81, scipation ,81,82, acipation , seeing cipation ,81,82, acipation ,73,81,82Fostering connections between users within a social media community. Connections between users enabled the use of social media [al media ,88,89,93al media ,68,88,89al media ,40,72,82al media ,82,93. DOrganisations promoting their use of social media. Promotion is a way to build a social media community for health service design and QI activities [tivities ,51,52,65The findings of this review present a comprehensive summary of the scope of existing research into the risks, benefits, barriers and enablers of social media use experienced by stakeholders involved in, or trying to advocate for, the design and improvement of health services, systems and policy.Benefits of social media use in health service and system design and QI included improvements in organisational communication, culture and reputation, and improvements in relationships and the resulting quality of information from the social media process. The most frequently reported enablers were approaches which made access and use easier and discussions safer. Common negative experiences of use related to the risks of limited engagement and a lack of evidence around social media. In terms of barriers, a lack of access to, and familiarity with, social media, and a lack of organisational support were reported most frequently.In general, the benefits, risks, barriers and enablers of social media use described in the current literature were similar across user groups, which indicates that solutions to overcome reported risks and barriers are likely to benefit all users. However, further study into the experiences of marginalised population groups is warranted and might reveal different experiences that are not currently known.Advisory committee members determined the most relevant and important findings from the analysis, based on their experience of stakeholder engagement in health service design and QI and their knowledge around the issues related to social media-based engagement faced by health services and their stakeholders. These findings are emphasised and discussed in detail in the sections below.Social media may assist in helping health services engage new audiences in the process of QI ,86,88,91The risk of negative, false or malicious messaging was highlighted as an important finding, even though this risk was only mentioned in thirteen studies ,86,90,97The advisory committee felt that the strategies of monitoring ,72,73,84Whatever the reason for the potential under-reporting of monitoring, moderation and group rules, the fact that our advisory committee highlighted the importance of these strategies indicates that they may be a key area for future research, in order to better understand the impacts of monitoring and moderation practices on stakeholder engagement in health service and system design and QI.Social media can have positive impacts on trust and the quality of relationships between consumers and their providers or health organisations. The potential for social media use to make organisations more transparent ,69,74,84However, the findings of the review also demonstrate that this experience of improved relationships is not universal. Some of the included studies identify risks of negative experiences for users through social media messaging or online behaviour ,86,90,97There was some discrepancy between consumers wanting some ability to maintain privacy and anonymity in social media spaces ,91, and This is the first scoping review to our knowledge to explore risks, benefits, barriers and enablers for using social media as a tool within health service design and QI activities. Much of the existing literature which examines social media use in health either discusses theoretical models of use in service design or QI activities ,107,108,The findings of this review challenges previous theoretical literature on the use of social media in health service design and QI. Much of the theoretical literature views social media as a way to overcome some of the limitations or barriers of traditional face-to-face models of consumer engagement ,24,25,26Additionally, the findings of the review reinforce what is known around the use of social media in health more broadly, such as the benefits of improved data gathering and sharing, improved relationships and support, and concerns about privacy, usability and misinformation, which are already reported in research on social media-based health peer support and health service delivery activities ,7,8.Few included studies reported monitoring and moderation as an enabler. It may be under-reported because moderation is simply seen as usual business by the organisations and groups that manage social media, and so the use of moderators was not explicitly stated. Given that moderation has the potential to mitigate some of the risks and barriers of social media use , but may also create or reinforce power structures in online spaces which can affect the quality of engagement , more atThere were mixed findings on some key issues. For example, some studies found social media use improved the richness and authenticity of the information gathered for QI and service design organisations ,86,90,95The objectives and inclusion criteria for this review meant that the views, opinions and experiences of people who are not current social media users, but who are involved (or who could be involved) in health service design or QI through other engagement methods, were most likely not captured in the included studies. By not including this group, key experiences may have been missed, particularly ones relevant to increasing social media uptake by non- or infrequent-user groups, or understanding experiences that may lead to stakeholders not engaging through social media at all. Additionally, the included studies largely reported on the process of social media-based engagement methods, rather than outcomes of social media-based engagement, or comparisons between social media engagement methods and more typical engagement methods. This means that the findings of the included studies may reflect some pro-social media bias, as they were conducted in organisations or with stakeholders who had already decided to use social media as an engagement tool.This review had some methodological limitations. The review protocol was published and reviews guided by an earlier version of the JBI Reviewer’s Manual  using a Finally, using a deductive content analysis method with a priori themes as a coding framework, may have led us to overlooking opportunities to expand or refute existing theories . To miniThis review adds to the growing empirical literature on the use of social media for consumer engagement in health service design and QI, as well as potentially for broader engagement purposes. Health services and stakeholders involved in design or QI activities could use the findings to inform their planning. For example, the findings relating to benefits may provide support for social media as an engagement approach, while the enablers give practical strategies for implementing social media as a stakeholder engagement tool. The risks/limitations and barriers findings may help planners understand where they need to provide support to help people engage or may meet resistance to social media engagement approaches.This review has uncovered a number of potential areas for future research. The highly dynamic nature of social media makes it likely that new issues and experiences around the use of social media as an engagement tool in health service design and QI will emerge in the future. Future research could examine innovations in social media-based engagement and how new risks and barriers to use could be overcome. In particular, the increase in health services being provided digitally and/or remotely during the COVID-19 pandemic  may leadWhile studies in this review described benefits around involving new people in engagement activities ,86,88,91This review has also identified potential under-reporting of monitoring and moderation as an enabler for stakeholder engagement through social media. Further research into the role and impacts of monitoring and moderation of health-related social media spaces may lead to a better understanding of the role social media moderators play in facilitating stakeholder engagement in health service design and QI.This scoping review examined the risks, benefits, barriers and enablers when using social media as a tool to engage a range of stakeholders in health service design or QI activities. The benefits, risks, barriers and enablers described in the included studies highlighted the complex experiences of individuals and health service engaging in service design or improvement through social media. Social media may improve organisational communication and help individuals build relationships which can enhance health service design and QI activities, but can also expose health services and individuals to reputational risks, trolling, harassment and breaches in privacy. These risks can be managed through strategies such as monitoring and moderation of social media spaces and establishing organisational policies and processes around social media. However, without executive support and good communication between implementing teams, concerns about these risks can become barriers to using social media as stakeholder engagement tool, particularly in health services with an existing culture of risk aversion. In addition to these potential barriers caused by organizational culture, health services using social media in their suite of engagement strategies need to consider whether there are any accessibility and usability barriers in any of their stakeholder groups, including access to internet, access to computers and other devices, and the usability or accessibility of social media platforms.Having a good understanding of the complexity of using social media as a stakeholder engagement tool in the design and improvement of health services may assist planners and implementers to be more aware of, and more able to overcome, some of the known barriers, risks and limitations. It is also important for implementers to understand that there may be experiences that are not yet captured, due to the dynamic social media environment and lack of data on the experience of marginalised groups.


Around 1,000 peer-reviewed papers were selected from 3,450 articles published during 2020–2021, and reviewed as the representative advances in tribology research worldwide. The survey highlights the development in lubrication, wear and surface engineering, biotribology, high temperature tribology, and computational tribology, providing a show window of the achievements of recent fundamental and application researches in the field of tribology.


Due to a production error, there was an error in affiliation 1. Instead of “Artificial Life Lab, Institute of Biology, University of Graz, Prague, Austria”, it should be “Artificial Life Lab, Institute of Biology, University of Graz, Graz, Austria”.The publisher apologizes for this mistake. The original version of this article has been updated.


In 2018, ~382,000 new cases of cancer  and 157,400 related deaths  were registered in France  on overall health. It is an essential and key parameter for the prevention and treatment of chronic diseases, such as cancer. PA is defined as any body movement generated by the contraction of skeletal muscle that raises energy expenditure above the resting metabolic rate and is characterized by its modality, frequency, intensity, duration, or context of practice . It is cWhile PAL has long been studied for its role in non-communicable diseases , the impvs. “SB” or “high” vs. “low” PA to describe the complexity of human movement behaviors. Indeed, we and other researchers encourage a move toward a multidimensional approach to PA characterization, and a detailed analysis of body motion and fine movement behaviors  to identify more precisely individuals at risk for future chronic disease   . Thus, pry only) , and recry only) . CommercGE, DT, and MD conceived the idea, drafted, revised, and edited the manuscript. LD, AR, QJ, and FM revised the manuscript. All authors read and approved the final version of the article.


In “Share to Seek: The Effects of Disease Complexity on Health Information–Seeking Behavior” :e21642), the authors noted two errors.In the originally published article, affiliations of the first author, Ashwag Alasmari, appeared in the following order:1,2Ashwag Alasmari1University of Maryland, Baltimore County, Baltimore, MD, United States2King Khalid University, Abha, Saudi ArabiaMoreover, the original Affiliation 2 inadvertently did not specify any department.In the corrected version, affiliations appear in the following order, and the reordered Affiliation 1 specifies the author's affiliated department:1,2Ashwag Alasmari1Computer Science Department, King Khalid University, Abha, Saudi Arabia2University of Maryland, Baltimore County, Baltimore, MD, United StatesThe correction will appear in the online version of the paper on the JMIR Publications website on September 30, 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.


Psidium cattleianum), cambuí (Myrciaria floribunda), gabiroba (Campomanesia xanthocarpa), jabuticaba (Plinia cauliflora), and jambolan (Syzygium cumini). Scientific studies were gathered and selected in Google Scholar, Scielo, and Science Direct indexed databases, out of which 14 were about araçá, 7 concerned cambuí, 4 were about gabiroba, 29 were related to jabuticaba, and 33 concerned jambolan, when we observed the pre-established inclusion criteria. Results showed that the anthocyanins, such as cyanidin, petunidin, malvidin, and delphinidin, were the mostly identified class of flavonoids in plants of the Myrtaceae family, mainly relating to the purple/reddish color of the evaluated fruits. Other compounds, such as catechin, epicatechin, quercetin, and rutin were also identified in different constituent fractions, such as leaves, peel, pulp, seeds, and in developed products, such as jams, desserts, wines, teas, and other beverages. It is also worth noting the positive health effects verified in these studies, such as anti-inflammatory qualities for jambolan, antidiabetic qualities for gabiroba, antioxidant qualities for araçá, and cardioprotective actions for jabuticaba, which are related to the presence of these phytochemicals. Therefore, it is possible to point out that flavonoids are important compounds in the chemical constitution of the studied plants of the Myrtaceae family, with promising potential in the development of new products by the food, chemical, and pharmaceutical industries due to their bioactive properties.This integrative review aims to identify the main flavonoids present in some species of the Myrtaceae family. Studies published between 2016 and 2022 were selected, specifically those which were fully available and written in Portuguese, English, or Spanish, and which were related to the fruits araçá ( Eucalyptus spp.), used in the production of wood and flavoring agents [Psidium cattleianum Sabine) [Myrciaria floribunda (H. West ex Willd.) O. Berg) [Campomanesia xanthocarpa (Mart.) O. Berg) [Syzygium cumini (L.) Skeels) [Plinia cauliflora (Mart.) Kausel) [Myrtaceae is a family comprising 121 genera and 5800 plant species, occurring mainly in tropical and subtropical regions of the world, being a predominant group in the Brazilian Atlantic Forest [ Sabine) , cambuizO. Berg) , gabirob Skeels) , and jab Kausel) , studiedVarious species of the Myrtaceae family, when processed, provide important products, such as essential oils, dyes, and food products, and can be also employed in traditional medicine ,9,10,11.The range of utilities provided by these plants may be related to the presence of phytochemicals, such as flavonoids, which are the main compounds of interest in this study. These compounds help in the prevention of various chronic non-communicable diseases, such as cardiovascular pathologies, oxidative stress, certain types of cancers, atherosclerosis, diabetes, Alzheimer’s disease, cataracts, and other respiratory disorders, and are concentrated in different parts of the plant . FlavonoPsidium, Myrciaria, Campomanesia, Plinia, and Syzygium stand out for their phytochemical composition with a multitude of bioactive compounds, characterized by the production of flavonoids, water-soluble and condensed tannins, saponins, mono- and sesquiterpenes, and triterpenoids, among others [In this context, fruit trees of the genera g others .Psidium originates from tropical and subtropical America, which has great biological and economic importance in Brazil. This group includes several species of trees and shrubs, with emphasis on the guava tree (Psidium guajava L.) and araçá tree (P. cattleianum), plants geographically distributed in several regions of Brazil [The genus f Brazil .Popularly, the fruits of the araçá tree are known as araçá, yellow araçá, red araçá, araçá-de-comer, araçá-da-praia, araçá-de-coroa, and araçá-do-mato. Despite the distinction of names, varieties and color, the fruits are characterized by having an ovoid shape, translucent pulp, and a kernel full of seeds, which can vary from approximately 22 to 250 units  16,17,1,117,18.Araçá has high agro-food potential due to its chemical composition. Among the compounds found in this fruit, organic acids, carotenoids, and flavonoids stand out . In termFood technology allows the incorporation of araçá into a multitude of products in order to make it available on the market, and it is found in the form of sweets, jams, and flour, benefiting producers and adding economic value to certain communities . In scieMyrciaria, the cambuí tree is a medium-sized tree (with a height of 6–14 m) and a rounded crown, distributed throughout the northeast and north of South and Central America. Its fruits are characterized by being shiny, fleshy, and juicy elliptical berries, which can have a diverse color, ranging from orange to dark purple . Additionally, they are fruits that have antioxidant compounds in their constitution, especially carotenoids and flavonoids [Cambuí presents a succulent pulp, a sweet and astringent flavor, and is characterized by having high concentrations of sugars and excellent levels of vitamin C , with a varied, dense crown and a smooth reddish-yellow stem . Its fruJabuticaba has high mineral concentrations, such as iron, copper, and manganese, as well as vitamin C; however, it stands out in the research scenario for its significant concentration of phenolic compounds, mainly anthocyanins, which are concentrated mainly in its peel, which is usually discarded and sees little use industrially .According to Batista et al. , consumpPsidium cattleianum, Myrciaria floribunda, Campomanesia xanthocarpa, Plinia cauliflora, and Syzygium cumini.Considering the large number of species of the Myrtaceae family and their importance, it is evident that there is still much to be studied, especially in relation to their chemical constituents. Therefore, the objective of this study was to carry out an integrative review identifying the main flavonoids present in Through the search strategies, 2516 scientific works were identified in the aforementioned databases, with the selection process shown in Out of these studies, 2358 were excluded by the previous analysis of the title and abstract since they did not answer the guiding question or were found to be duplicated in different research bases. After a complete reading of 158 works, 87 articles published between 2016 and 2022 were selected to compose this integrative review, with an emphasis on the phytochemical characterization of vegetables, beneficial effects on human health, and product development with the maintenance of bioactive compounds.n = 11), in 2021 , in 2020 , in 2019 , in 2018 , in 2017 , and in 2016 .As shown in Bioactive compounds or phytochemicals are substances derived from the secondary metabolism of plants, with beneficial properties for human health . FlavonoFor the identification and/or quantification of these bioactive constituents in the different extracts evaluated, the following methods were employed: spectrophotometry , LC-DAD-Catechin and quercetin were the prominent flavonoids in the evaluation of the leaves of the five species studied in this work, and these compounds were identified by Balyan and Sarkar  and BalyO-glucoside), quercitrin (quercetin-3-O--L-rhamnoside), and rutin (quercetin-3-O-rutinoside). All of these compounds are found in extracts of cambuí and gabiroba leaves [Quercetin is an aglycone, which can be found in the glycosylated form bound to different sugars; some examples are isoquercitrin , apigenin (flavone), taxifolin (flavanone), and isorhamnetin 3-O-glucoside (flavonol) were other flavonoids identified in the extracts of the studied fruits, both whole, dried, or lyophilized. Pulps, commonly used in product development, were characterized by Garcia et al. [Plantagoside (flavanone), hesperetin 7-a et al.  when evaa et al.  when stua et al.  when anaa et al.  when stuDiets rich in industrialized, refined products, high in sugar, fat, and lacking in vegetables are one of the main risk factors for the populations’ health, since they are associated with delicate health conditions, favoring cardiovascular diseases, diabetes, stroke, obesity, and certain types of cancers, among others . As suchInsulin resistance (IR) may be a risk factor for the development of cardiovascular disease and steatosis, which is associated with abdominal obesity, type 2 diabetes, and other syndromes. This pathology may contribute to increased oxidative stress and damage to cell membranes and other functional components, such as proteins and lipids .Due to these issues, Cardoso et al.  evaluateP. guajava and P. cattleianum leaf extracts and their nano-liposomes in improving paracetamol-induced hepatotoxicity in rats.In addition to the properties of araçá, Vinholes et al.  concludeRegginato et al.  evaluateThe antigenotoxic potential of jabuticaba peel extracts was investigated in the work by Marques et al.  as inhibP. cauliflora extracts induced a cardiorenal protective response, preventing hemodynamic, functional, and remodeling changes. Paula et al. [Hydroalcoholic extracts of jabuticaba peels were also evaluated in the work by Romão et al. . The auta et al.  investigAnthocyanin-rich fractions extracted from jambolan were evaluated in work by Chamnansilpa et al. . The resS. cumini fruit extracts employing HPLC.Anti-inflammatory and antinociceptive properties were demonstrated by Qamar et al.  and QamaThe same flavonoid compound may be present in different parts of the plant, as is the case of myricetin, identified in the jambolan fruit in work by Soorya et al.  and in iBaldissera et al.  evaluateFruit production is one of the most prominent activities in the Brazilian market, especially when considering the development of new products resulting from the processing of these raw materials , as BrazFruit growing activity can generate a multiplier effect, with the possibility of moving the economy and promoting the development of stagnant places with few viable resources . Fruit pLinked to these conditions and aiming at the production of sensorially accepted foods with added nutritional value, scientific research promotes the development of juices, purees, jams, ice creams and/or other dairy desserts, and fermented, protein, or isotonic drinks, aiming at the addition of natural ingredients and, consequently, the incorporation of bioactive compounds, such as flavonoids ,110,111.Preparation of juices was proposed in the work of Rybka et al.  when usiAnthocyanins were also present in cambuí juice, being quantified (311.7 mg) and expressed in mg of malvidin-3-glucoside per 100 mL of product . In jabuIce cream and dairy desserts are products much appreciated by the population, mainly due to their sensory and nutritional characteristics, since they appeal to a diverse audience and because of the presence in their formula of several nutrients, such as proteins, carbohydrates, lipids, calcium, phosphorus, and other minerals ,123.Considering this fact, Böger et al.  quantifiAccording to Neves et al. , alcoholFrozen fruit purees are products widely used in the preparation of other foods, due to their nutritional and functional characteristics, since they are rich in phenolic compounds, especially flavonoids . StafussTea, in general, is one of the most consumed beverages in the world, being a rich source of flavonoids, mainly due to the use of different parts of the plant in the product development, whether including leaves, stems, rhizomes or fruits . Sari etCambuí and jabuticaba processing by-products were used by Rybka et al.  and RodrThis integrative review consists of a study based on the collection and analysis of scientific works related to the theme “Flavonoids in plants of the Myrtaceae family”, elaborated from the reading of online journals. The study presented the following steps: (1) formulation of the guiding question; (2) definition of search methods; (3) selection of scientific works; (4) analysis and evaluation of the studies included in the review; (5) presentation of the synthesis of the knowledge produced and published.A guiding question was proposed while conducting this study, namely “What are the main flavonoids found in certain plants of the Myrtaceae family?”. Data collection took place during the months of February and May 2022 in the following databases: Science Direct, Google Scholar, and Scielo. Basic descriptors used in the research process were as follows: Flavonoid AND Myrtaceae, in addition to specific terms for each plant species, as shown in P. cattleianum), Cambuí (M. floribunda), Gabiroba (C. xanthocarpa), Jabuticaba (P. cauliflora), and Jambolan (S. cumini).The following inclusion criteria were defined: studies published in the databases, in the period between 2016 to 2022, presented in full text, in English, Portuguese, or Spanish, and whose title and/or abstract referred to the topic of flavonoids in plants of the Myrtaceae family, such as Araçá .It was, therefore, possible to observe the importance of plants in the Myrtaceae family in terms of their phytochemical composition in relation to flavonoids, positive health effects, and the possibilities for their use in product development. A more significant number of scientific works associated with jambolan and jabuticaba were selected, with in vivo and in vitro experiments demonstrating these raw materials’ bioactive potential. This way, an association was possible with specific health benefits, such as antioxidant, cardioprotective, antidiabetic, and anti-inflammatory activities.The preservation of flavonoids in jams, juices, wines, and other foods can also be observed, with anthocyanins being the predominant chemical class. Additionally, the integrative review employment as a methodology for this study proved relevant for achieving the objective. It guides the research practice and encompasses several scientific works on a subject.


Instead of “Division of Psychopharmacology, Department of Pharmacy, The Third People’s Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China”, it should be “Division of Psychopharmacology, Department of Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China”. In the published article, there was an error in affiliation 3. Instead of “Department of Pathology, The Third People’s Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China”, it should be “Department of Pathology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China”.In the original article, there was an error in affiliation 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.


International Journal of Molecular Sciences, provides up-to-date information about the effects of a range of toxicants on the reproduction and development of many animal species, including humans. As so often is the case, the results from toxicant exposures to animal species can serve as sentinels for human toxicant exposures. Furthermore, reproductive systems, as well as developing embryos and fetuses, display greater risk from exposure to most toxicants, from pharmaceuticals to environmental contaminants. Developing new alternative models, including in vivo, in vitro, or in silico models, is critical to increasing our understanding of how toxicants affect reproduction and development. Not only is modeling critical, but it also is essential to be able to carry out research at all levels of scientific inquiry—from molecules to integrated systems of organisms.Toxicology is an incredibly complex and diverse area of biomedical science that includes numerous areas of specialization. The overarching goals for investigators working in all areas of toxicology are to identify and define the exposures to potential toxicants, assess the risks, and mitigate the impacts. This Special Issue, Reproductive and Developmental Toxicology 2.0, in the Drosophila melanogaster [Caenorhabditis elegans [Currently, there are ten articles published in this Special Issue, providing a broad sampling of this vital and vibrant area of toxicology research. Several themes emerge when looking at the articles included in this Special Issue. First, there is a distinct emphasis on developmental toxicology, which indicates its importance in the broader area of toxicology. In the past, the assessment of developmental toxicity has utilized animal studies, primary mammals, the vast majority being rodents. However, new, more advanced, high-throughput modeling systems are rapidly being developed. As evidence of this shift in research focus, six of the ten articles report on studies that utilize non-mammalian testing systems, including nogaster ,2, sea unogaster , choroidnogaster , zebrafinogaster , Caenorh elegans . Regulat elegans , albeit  elegans  and embr elegans , resulti elegans ,4,5,9, a elegans , and PAH elegans . Environ elegans , which i elegans . Underst


This Research Topic introduces selected articles on sport studies, mainly focused on methodological, interventional, and neuroscientific perspectives, that provide the basis for the title of the current volume. All of these topics are represented herein and we believe that our readers will value this balanced framework.With the aim of providing a panoramic view of the 27 articles that form this Research Topic, and properly assessing the contributions made, we present a transversal perspective from the following criteria:Tristán et al.; Valenzuela et al.; Vergara-Torres et al.), the achievement goal theory , mental toughness , the self-efficacy theory , ecological momentary assessment , and mixed methods (Izquierdo and Anguera).1. Conceptual: Although most of the 27 articles are “original research,” with only one wholly fitting into the conceptual category, it is beyond any doubt that numerous articles contained herein highlight the conceptual implications of their research. This Research Topic includes some reference works focused on the self-determination theory, including the mini-theory of basic psychological needs , some have a psychometric special interest , some are observational , some are experimental/quasi-experimental , and others apply a combination of the preceding ones, using multimethod studies that employ, for instance, observational and selective methodology .2. Methodological: For this criterion, a variety of procedural orientations are differentiated in the empirical studies contained herein. Some of the studies use selective procedures . The majority of the instruments used consisted of questionnaires , scales , inventories , and even tests , although ad hoc instruments have been built for observational studies . Additionally, some studies used structural and functional magnetic resonance images .Among empirical studies, especially in those that use observational methodology, there is a clear interest in mixed methods, which have acquired so much relevance in recent years due to an eagerness to integrate qualitative and quantitative approaches. In some articles, the mixed method perspective is adopted, either in an explicit or implicit way , AMOS , AQUAD , GSEQ5 , GRETNA , HOISAN , LINCE PLUS , SPSS , and THEME . In particular, we highlight the new software “Function Estimation”, contained in the MENPAS platform and described by Pastrana-Brincones et al..Moreover, the different types of software used in the studies featured in this Research Topic can be of interest to readers. Such software includes programs such as ALCESTE , cluster analysis , polar coordinates analysis , analysis of structural equations , factorial analysis , linear regression analysis , logistic regression analysis , sequential delay analysis , ANCOVA , ANOVA , T-Patterns detection , MANOVA , and temporal series . In the observational studies data, quality control was applied before the data analysis, using either consensual concordance , the kappa coefficient , or generalizability theory .A diverse range of data analyses are featured in this Research Topic, including content analysis  and PSIXPORT  apps.3. Technological: we would like to highlight a Brief Research Report describing the development of the B alert , athletes , basketball , quality of life , team coordination , elite sports , aerobic exercises , coaches and training , fatigue , fitness , soccer , sports injuries , taekwondo , and motor skills/task . Additionally, some reviews compile up-to-date knowledge on perceptual aspects of sports training , hypnosis (Li and Li), and the translation and validation of questionnaires .4. Scope of application: All the articles published in this Research Topic belong in the area of sport psychology, although many of them focus on specific subjects, such as physical activity (In short, with our best wishes, 27 articles that will help to expand the knowledge of our readers are presented in this Research Topic.Articles featured in this Research Topic offer a wide spectrum of theoretical and methodological contributions, and as editors, we would like to express our satisfaction with the materialization of these works and their transfer to the scientific community.The articles that make up this Research Topic already have a high number of “views” according to inner metrics. All articles were published between 2021 and 2022. Of the 30 articles that were initially submitted, 27 were accepted, resulting in an acceptance percentage of 90%.AH-M coordinated the editorial work. MTA, JC, and VM-S contributed to the process. MTA wrote the article for this editorial letter. JC, AH-M, and VM-S reviewed the final version. All authors contributed to the article and approved the submitted version.