At present, “Belt and Road” (“B&R”) member states (accounting for about 61.78% of the world’s population) face different types of cancer threats to varying degrees. We analyzed the incidence and mortality and risk factors of cancer in the member countries of the “B&R” to explore the basis of health and medical cooperation between countries and provide a foundation for formulating cancer prevention and control policies for building a healthy "B&R."Data were derived from the Global Cancer Observatory and Cancer Country Profiles in 2020. Incidence and mortality were age-standardized rates (ASRs). Population attributable fractions (PAFs) was applied to measure risk factors of cancers in the “B&R” countries. The mortalitytoincidence ratio (MIR) was calculated by dividing the mortality rate by the incidence rate.A total of 26 cancers were included in the study. Lung, breast, colorectal, stomach, liver, prostate, cervical, esophageal, thyroid, and uterine cancers were the most common and highest in age-standardized mortality in the “B&R” countries. For men, Hungary had the highest cancer age-standardized incidence and mortality , followed by Latvia . In females, the highest incidence rates were estimated in Greece , and the highest mortality rate was Brunei . All countries were in the middle or high HDI range, with about half (46.88%) of countries achieving high HDI, mostly in Central and Eastern Europe (13 countries) and West Asia (10 countries). The United Arab Emirates had the highest MIR in male and female (1.59 vs 2.19). Tobacco products, infectious factors, and ultraviolet rays were the three main cancer risk factors in the “B&R” countries.The overall burden of cancer in the countries along the “B&R” remains substantial, while the corresponding cancer prevention and control policies need to be improved. Strengthening health cooperation among member countries will contribute to a joint response to the risks and challenges posed by cancer.The online version contains supplementary material available at 10.1186/s12885-022-09657-3. More than 2,000 years ago, people on the Eurasian continent explored many trade and cultural exchange routes that connected the major civilizations of Asia, Europe, and Africa, and later generations collectively referred to these routes as the "Silk Road" . During In recent years, with the development of society and the economy, the disease burden in low–human development index (HDI) and medium-HDI countries has shifted from being dominated by communicable, maternal, neonatal, and nutritional diseases (CMNNDS) to being dominated by non-communicable diseases (NCDs) and injuries . With thhttps://www.who.int/countries) [We used data from the Global Cancer Observatory (gco.iarc.fr)  and Cancuntries)  in 2020.untries) ."B&R" initiative refers to the cooperative organization of politics, economics, culture, and other related fields, and includes 66 member countries. Apart from Cyprus, the Czech Republic, Greece, Hungary, Israel, and Singapore, the remaining 60 countries are all developing countries: (1) East Asia: China, Mongolia; (2) The association of southeast Asian nations (ASEAN): Singapore, Malaysia, Indonesia, Myanmar, Thailand, Laos, Cambodia, Vietnam, Brunei, and the Philippines; (3) West Asia: Iran, Iraq, Turkey, Syria, Jordan, Lebanon, Israel, Palestine, Saudi Arabia, Yemen, Oman, United Arab Emirates, Qatar, Kuwait, Bahrain, Greece, Cyprus, and Egypt's Sinai Peninsula; (4) South Asia: India, Pakistan, Bangladesh, Afghanistan, Sri Lanka, the Maldives, Nepal, and Bhutan; (5) Central Asia: Kazakhstan, Uzbekistan, Turkmenistan, Tajikistan, and Kyrgyzstan; (6) The Commonwealth of Independent States (CIS): Russia, Ukraine, Belarus, Georgia, Azerbaijan, Armenia, and the Republic of Moldova; (7) Central and Eastern Europe (CEE): Poland, Lithuania, Estonia, Latvia, Czech Republic, Slovakia, Hungary, Slovenia, Croatia, Bosnia and Herzegovina, Montenegro, Serbia, Albania, Romania, Bulgaria, and Macedonia. The division of the “B&R” countries is based on the World Bank's division of global regions and international political and economic organizations. There is a lack of cancer-related data in Palestine and Yemen in this database. Therefore, we collected and analyzed cancer data in the other 64 member states.In this study, we used incidence, mortality, and age-standardized rates (ASRs) to analyze and compare cancer incidence and death in "B&R" countries. Incidence, generated by population-based cancer registries (PBCRs), is the number of new cases occurring in a specified period and geographic region, and conveyed either as an absolute number of cases per annum or as a rate per 100,000 people per year. Mortality, similarly, is used to measure the number of deaths per unit of time  in a population of a given size. It is usually expressed in units per 100,000 people per year. ASRs per 100,000 people-years are corrected by the direct method and the world standard population to allow for differences in the age structure of a population. The methods used to estimate the global incidence and mortality in 2020  can be found in other literature , 9. We cWe conducted a descriptive analysis and comparison of the incidence and deaths due to cancers in the “B&R” countries, as well as a visual presentation. Microsoft Excel 2019 was used for data visualization.A total of 26 cancers were included in the study. Breast, lung, colorectum, prostate, stomach, liver, cervix uteri, esophagus, thyroid, and bladder cancer ranked amongst the top 10 new cancer in 2020, and lung, colorectum, liver, stomach, breast, oesophagus, pancreas, prostate, cervix uteri, and leukaemia cancer ranked among the top 10 cancer in terms of deaths, with a total of 12,176,526 new cases and 7,054,094 deaths worldwide, respectively Table .Table 1NTable Among the top 10 cancers in East Asian countries, the total incidence and mortality of cancer in Mongolia were ASR, 158.0 per 100,000 and ASR, 128.8 per 100,000, respectively, and both were larger in females than in males. Liver cancer had the highest cancer incidence and mortality. The total cancer incidence and mortality in China were 146.3 per 100,000 and 84.4 per 100,000, respectively, and lung cancer and breast cancer had the highest cancer incidence and mortality, respectively  and Vietnam had the highest cancer mortality . The countries with the highest overall cancer incidence and mortality among males were Singapore and Laos , while for females, the country was Brunei, with an overall cancer incidence and mortality of ASR, 137.4 per 100,000 and ASR, 52.9 per 100,000, respectively. Cancers of the colorectum, lung, prostate, and liver in men, and cancers of the breast, lung, colorectum, and cervix uteri in female, continue to be the most common fatal cancers  and Turkey , with lung, prostate, bladder, and colorectal cancer being the main causes. Israel, Greece, and Cyprus had the highest cancer incidence rates of the breast, thyroid, corpus uteri, and colorectum in females. The top three countries with the highest cancer mortality were Cyprus, Egypt, and Iraq, where principal deaths of cancer were cancers of the breast, lung, colorectum, ovary, and cervix uteri; leukemia, brain, and central nervous system were all in the top five cancer death types in Iraq. See supplementary Fig. SLarge distribution differences existed in the incidence and mortality of cancers in South Asian member countries, with the total number of newly diagnosed cancer cases in Bhutan being much higher than that in other countries . Bangladesh had some of the highest cancer incidence rates in males , such as lung, prostate, and colorectal cancers. There was a high incidence of breast cancer, colorectal cancer, non-Hodgkin lymphoma, and esophageal cancers in females in Afghanistan  and the Maldives . On the contrary, deaths were more evenly distributed across countries, with the most deaths being from lung cancer and digestive system cancer in males and breast cancer and lung cancer in females. See supplementary Fig. SLung, prostate, colorectal, and stomach cancers in males in Kazakhstan and Uzbekistan had a high incidence among the Central Asian countries, while a small difference in the incidence and mortality of cancers was observed in females; cancers of the breast, cervix uteri, colorectum, corpus uteri, and stomach were the main ones , ranking the first among the types of cancer worldwide . The risIn addition, cervical cancer carries the highest burden in less developed countries and regions in the “B&R” countries , and neaInfectious agents are the key cause of cancer, particularly in low- and middle-income countries. It was estimated that in 2018, about one-eighth of the 18 million new cancer cases in the world were caused by infection . HepatitUltraviolet radiation directly or indirectly induces DNA damage, leads to mutations, triggers inflammation and immunosuppression, and finally leads to tumor growth. Photocarcinogenesis is a complex, multi-step pathway, which is triggered by the formation of dipyrimidine photoproducts and leads to the formation of mutations . Sunburn and inflammation caused by persistent DNA lesions (including dipyrimidine photoproducts and oxidative DNA lesions) play a role in promoting the process of photocarcinogenesis . The dipIn the wake of the COVID-19 pandemic, awareness of global public health has become clearer, and policy has played a crucial role in promoting global public health. By studying and comparing the incidence, mortality and risk factors of cancer in the “B&R” countries, this study identified different cancer challenges faced by different countries, proposed cancer prevention and control measures applicable to each country, and provided suggestions for health cooperation programs in “B&R” countries. However, the data sources involved in this study are extensive, and the data quality will be uneven. Readers are suggested to quote and extrapolate after reading the analysis methods and data sources of this study in detail.In summary, the challenges posed by cancer are consistent in the “B&R” member countries. Lung cancer, breast cancer, gastrointestinal cancer, prostate cancer, cervical cancer, thyroid cancer, and uterine cancer were found to be the biggest cancer burdens in the “B&R” countries, and tobacco products, infectious factors, and ultraviolet rays were the main risk factors. Moreover, the corresponding cancer prevention and control policies need to be improved. Therefore, in the context of the health "One Belt One Road" initiative, the collaboration between multiple stakeholders and the sharing of resources will play a positive role in jointly coping with the risks and challenges brought by cancer and promoting the positive development of the health and medical undertaking of all member states and the world at large.All methods were carried out in accordance with relevant guidelines and regulations.Additional File 1. Supplementary file 1 Comparison of estimated 2020 ASR (world) among East Asia countries, all ages.Additional File 2. Supplementary file 2 Comparison of estimated 2020 ASR (world) among ASEAN countries, all ages.Additional File 3. Supplementary file 3 Comparison of estimated 2020 ASR (world) among West Asia countries, all ages.Additional File 4. Supplementary file 4 Comparison of estimated 2020 ASR (world) among South Asia countries, all ages.Additional File 5. Supplementary file 5 Comparison of estimated 2020 ASR (world) among Central Asia countries, all ages.Additional File 6. Supplementary file 6 Comparison of estimated 2020 ASR (world) among CIS countries, all ages.Additional File 7. Supplementary file 7 Comparison of estimated 2020 ASR (world) among Central and eastern Europe countries, all ages.


Introduction: Neuromuscular diseases comprise a heterogeneous group of genetic syndromes that lead to progressive muscle weakness, resulting in functional limitation. There is a gap in the literature regarding the communication of the diagnosis of such diseases, compromising the autonomy of patients and families, besides causing stress on the assistant physician. Objectives: Developing a guide to reduce communication barriers in the diagnosis of neuromuscular diseases. Methodology: Systematic review, after searching the descriptors (“Muscular Diseases” OR “Neuromuscular Diseases”) AND (“Truth Disclosure” OR “Bad news communication” OR “Breaking bad News”) in the Pubmed, Bireme, and Scopus websites, and these results were analyzed through narrative textual synthesis. Results: 16 articles were submitted to the final analysis, giving rise to seven steps to support the communication process. These are Empathy, Message, Prognosis, Reception, Time, Individualization, and Autonomy. Discussion and conclusion: The empathic transmission of the message and the prognosis must accommodate the feelings of the interlocutors with different information needs. In this way, communication planning optimizes the time and individualizes each context, respecting the autonomy of those involved. EMPATIA reflects the bioethical and interdisciplinary analysis of the literature and comes to fill the gap related to the communication of bad news in neuromuscular diseases. Neuromuscular diseases comprise a heterogeneous group of genetic syndromes, with variable phenotypes and genotypes that affect the peripheral nervous system. These are rare diseases, which, in general, present progressive functional limitation secondary to muscle weakness, and may lead to the inability to sit, walk, perform manual activities, speak, swallow, and breathe, besides systemic complications secondary to possible damage to the heart muscle, bronchoaspiration, and respiratory infection, for example, besides musculoskeletal deformities, and death ,2,3.The care of patients with disabilities must be based on the ethical principles of beneficence, non-maleficence, autonomy, and justice, from the moment of communicating the diagnosis to end-of-life decision-making ,5. ThereImproving communication skills strengthens the physician–patient/family bond, motivation and adherence to treatment, the feeling of security and hope, in addition to favoring shared decision-making, avoiding inappropriate expectations ,13,14,15Given the above, the existence of a guide to assist in the communication of the diagnosis of neuromuscular diseases is essential to reduce stress and communication barriers between students, physicians in training, and experts, favoring the ethics of individual/family-centered care.A systematic review was performed by searching for articles on the Pubmed, Bireme, and Scopus websites until May 2022. The descriptors used in Pubmed were ((Muscular Disorders) OR (Neuromuscular Disease)) AND ((Bad news communication) OR (Truth Disclosure) OR (Breaking bad news)), in Bireme and Scopus were (“Muscular Diseases” OR “Neuromuscular Diseases”) AND (“Truth Disclosure” OR “Bad news communication” OR “Breaking bad News”). There was no restriction regarding the year of publication, and the filters used were studies in humans and English. The flowchart displaying the article selection is shown in Initially, a pre-selection of articles was conducted by the first author, followed by a final selection after analysis and discussion with the other authors, considering the interdisciplinarity inherent to the theme. After the stages of initial selection and final approval, the analysis of the articles began, independently reviewed, avoiding any ambiguity. Articles were not excluded based on the quality of the research presented, because of the small number of studies selected, and there was no superiority or need to exclude the experiences described.The articles were carefully analyzed and individually interpreted through the following questions: 1. What factors have positively impacted the communication of the diagnosis of a neuromuscular disease? 2. Which communication barriers were described during the communication of this diagnosis? Except for some cases of basic numerical analysis of percentages, the data used for our research questions were qualitatively analyzed, after a synthesis of correlated results, and grouped through narrative textual synthesis, constituting a communication guide . ResultsThis guide was prepared after a neurologist with expertise in neuromuscular diseases, a specialist in medical law and bioethics, and a researcher specialized in palliative care and bioethics analyzed the results. Suggestions and critical remarks were sent by email to the first author, who conducted the final review and evaluation.The following communication protocols for breaking bad news were used as a basis: SPIKES, the Six-Step Protocol for Delivering Bad News , EFNS guSixteen articles were included for the final analysis after the selection of the systematic review. Five (31.2%) of them describe the perspective of people diagnosed with Amyotrophic Lateral Sclerosis (ALS), two (12.5%) report the experiences of family caregivers of people diagnosed with ALS, two (12.5%) of family caregivers of people with Duchenne muscular dystrophy (DMD), one (6.25%) of family caregivers of people with spinal muscular atrophy (SMA), three (18.75%) are mixed studies involving affected people and their caregivers , two (12.5%) involve neurologists, and one (6.25%) resident physicians. One article obtained during the search in the references approaches the perspective of communication of the diagnosis between family members and people with genetic diseases, linked to the X chromosome, which, despite not directly addressing neuromuscular diseases, was selected for the final analysis because of the similarity related to rarity, genetic origin, functional impairment, absence of curative treatment, and need for continued rehabilitation . The artThe selected studies describe experiences from the United States of America, Canada, Europe, Australia, and Brazil . SamplesThe analysis of the results gave rise to the EMPATIA Communication Guide, subdivided into seven steps to support the transmission of the diagnosis of neuromuscular diseases, they are Empathy, Message, Prognosis, Acknowledgment, Time, Individualization, and Autonomy .Empathy is the essence of this communication guide. Despite being considered a basic skill , severalThere must be medical preparation before the consultation so that breaking bad news does not result in a communication barrier ,25,29 duProfessionals must keep in mind that empathically communicating the truth does not harm the quality of life of their patients, and may also improve their vitality ,33, reduThe diagnosis must be informed in person, whenever possible ,16,17,20Attention must be given to the feeling of privacy regarding the physical environment, the number of professionals and students during the breaking of bad news, and the opportunity for patients to get dressed, if they have been recently examined ,16,20,31As tables or desks may be perceived as a communication obstacle, professionals must sit close to the patients, preferably side by side and at the same level, and look at them with care, indicating interest and allowing active listening ,16,20. TThe diagnosis must not be omitted. The “conspiracy of silence” or “pious lie” is a way of “sparing” the patient; or the distortion of information by, for example, using generalized terms such as “diseases of the nervous system” and “damage of motor nerves” instead of the actual name of the disease ,16,29,35The message must be communicated clearly and up to date, with accessible vocabulary, an appropriate tone of voice, uses of examples, metaphors, but also simple drawings or images. Sentimentality, ambiguity, understatement, medical jargon, and impersonal expressions must be avoided ,26,27,28Physicians must also listen to the patients and make sure that the message transmitted was understood and, if there are any doubts, show patience, interest, and availability for further clarification ,25,28,30Written referrals to rehabilitation services and other medical specialties, such as geneticists for genetic counseling, pulmonologists, orthopedists, among others, are recommended. Interdisciplinarity is essential for having a positive impact on the communication process, therapeutic planning, and the establishment of clinical and rehabilitation goals, improving functional independence, preventing complications, in addition to functioning as a support network, avoiding inappropriate conduct, financial expenses, and waste of time ,29,30,31Delivering a summary or providing materials related to the subject addressed in the consultation  is essential; professionals must also provide information on support groups, associations, labor rights, assistance benefits for people with disabilities, and reliable research sources ,27,29,30Physicians must maintain proper communication at each stage of evolution. Every conversation has to involve individualized support in the short, medium, and long term ; therefoBreaking news for patients in childhood age:The needs of the doctor/child/legal guardian trinomial must be individualized, with guidance to parents and family members who must have their doubts clarified to feel prepared to talk about the diagnosis in the different stages of maturity of their children ,22,23,31“Keeping the child away from information” should be avoided as, for example, a “family secret”, since this attitude generates tension in the family environment, in addition to upset, frustrated, and anxious children and adolescents, with a continuous feeling of mistrust. The principle of truth, besides being an ethical stance, positively impacts the communication of the diagnosis . DiscussPhysicians must listen to children, encourage them to ask questions, and share their feelings . Open, hIn this context, attention is needed towards “those forgotten to be informed”, such as siblings of patients who, anguished, isolated, and silent, endure a family history of genetic and neurodegenerative disease , carryinAnother relevant recommendation is for professionals not to anticipate prognosis or determine a lifespan. Prognostic information should be individualized and realistic, understanding information needs and clarity ,9,16,30,Honesty about progression and acknowledging the severity of the disease, maintaining “realistic hope” through communication about neuroprotective  and disePhysicians must teach, guide, and clarify doubts continuously at each stage of evolution, so that patients feel prepared in case of complications and safe to make therapeutic and palliative decisions, reducing the feeling of fear and anxiety ,25,28,36Being sensitive to spiritual needs demonstrating compassion are also essential traits for health professionals. Even in the face of a bad prognosis, these behaviors may be sources of comfort, peace, hope, and belonging. When the medical team does not feel able to talk about spirituality or has divergent thoughts from the patient, spiritual counseling may help to reflect on faith, beliefs, and values ,40. StudAnother essential indispensable step is acknowledging fear, insecurity, pain, anger, denial, anxiety, outburst, revolt, sadness, or silence . After cProfessionals must take care of their emotional health and acknowledge it. Their emotional reaction is an important communication barrier ,25,28; tPlanning the step by step of this communication guide to adjust the time and reduce situations that show that the time is limited, such as interruptions and staring at the clock, is essential ,29. The Physicians must also individualize the process, adapting this guide to the context related to the emotional, social, cultural, intellectual, financial, and religious issues of those involved and the information needs, centered on the patient and their family caregivers ,25,28. EJudgment must be avoided and be replaced by guidance and support throughout the course of the disease ,22. Not Adapting the service environment is also recommended, organizing tables and chairs, accessibility, noise reduction, and privacy, in addition to the training and guidance of a care team that involves all the staff, from the doorman to professionals who perform general services and secretaries, to facilitate accessibility and have empathic postures and conducts that value equity. The involvement of other health professionals in the integrated and continuous treatment is essential, besides the administration of the appointment schedule according to Step 2.8, and 2.9.The desired consequence of the EMPATIA guide is respect for the autonomy of those involved. Efficient communication favors consent and conscious and voluntary decision-making by patients or their legal guardians . ProfessThis systematic review has demonstrated that empathic communication of the diagnosis and prognosis of a neuromuscular disease requires availability and management of time for individualized technical clarification according to the particularities of the patients and their caregivers. After the necessary information is given, there must be acknowledgment and guidance on which paths to follow in order to respect the autonomy of those involved.In this way, the EMPATIA guide reflects the bioethical analysis of the literature related to breaking bad news about neuromuscular diseases, based on internationally supported protocols and a transparent and objective systematic review, discussed in an interdisciplinary manner. This guide fills the gap related to the communication of the diagnosis and the need for technical training of neurologists ,26,27,29The authors intend to analyze the impact of EMPATIA on several aspects, such as the communication of the diagnosis of neuromuscular diseases, the physician–patient relationship, the stress related to the doctor during this moment ,12,26,27The limitations of this guide comprise the lack of research related to the communication process of the diagnosis for most neuromuscular diseases and the absence of this type of investigation in several continents, which may require cross-cultural adaptations or specific adjustments regarding some neuromuscular diseases.


Artocarpus lakoocha is a synonym for Artocarpus lacucha and is a plant that can be found in Indonesia. This medicinal plant has been used to treat many diseases. (1) Objective: This article discusses the scientific investigations carried out on A. lacucha, namely the plant’s chemical content, pharmacological activity, and active compounds. (2) Methods: The design of this study was based on an article that was a review of previous research. A search for relevant publications over the past ten years (2012–2022) using data from Pubmed, Proquest, Ebsco, ScienceDirect, and Google Scholar resulted in the discovery of 369 articles. (3) Results: Fifty relevant articles investigate A. lacucha’s substances and their applications in the health field. The presence of secondary metabolites and bioactive compounds has been reported, which is evidence that A. lacucha possesses antidiarrheal, immunostimulant, anticholesterol, and hepatoprotective agents. (4) Conclusions: Mobe (A. lacucha) is a plant native to North Sumatra, Indonesia. This plant is efficacious as an antioxidant, antibacterial, antidiarrheal, anti-inflammatory, analgesic, antinociceptive, schistosomicidal, hepatoprotective, neuroprotective, cytotoxic, antiglycation, and anticholesterol, and can also be used for anti-aging and wound healing. In addition to its various benefits, it turns out that this plant also has many active compounds that are useful to the health sector, especially the pharmaceutical field.Studies have shown that approximately two-thirds of the plant species in the world have some medicinal value.  In Indonesia, where there are many different ethnic groups, plants are used as medicines in increasingly different ways . The numAntidotes made from plants have been used for thousands of years. Our ancestors used them and passed them down from generation to generation until they finally made it into the pharmaceutical world and were recognized by science . Many peA. lacucha is a species of Artocarpus from the Moraceae family , antibacterial, antimalarial, antituberculosis, antiplasmodial, antiatherosclerotic, antifungal, antidiarrheal, antidiabetic, wound healing, anti-inflammatory, and anticancer and also contain active compounds such as artocarpin, oxyresveratrol, phenols, and flavonoids . Ad. AdA. laA. lacucha plants contain several active compounds, which have been discussed in this article. One of them is oxyresveratrol, which has anti-aging activity associated with its high phenol content, free radical scavenging activity, and antiglycation activity [activity ). Oxyresactivity ,78,79.A. lacucha fruit has antibacterial, antihelmintic, and cholesterol-lowering properties  agent in Alzheimer’s disease [Based on the results of the literature study, it can be stated that the operties . People nd drugs ,13. The nd drugs . They alnd drugs . Other i disease ,83,84.


In the published article, the author names were incorrectly written as Na Z, Kevin F, Yoshiki M, Corentin S, Malgorzata K, Robert N and Vitalie F. The correct author names are Zhou N, Forton K, Motoji Y, Schoubeau C, Klass M, Naeije R and Faoro V.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Antibodies are key reagents in diagnostics, therapeutics, and experimental biology, capable of detecting numerous targets. The immunization of animals  with antigens mixed with an adjuvant and the induction of antibodies is a well-established process. This procedure for the generation of monoclonal antibodies was originally described by Köhler and Milstein, and is well-known and has been thoroughly tested ,2,3,4,5.The choice of suitable peptides is crucial for the generation of a good peptide antibody. The peptides used are typically 10–20 amino acids long and can be designed to represent many different targets, e.g., post-translational modifications, terminal ends, areas of high conservation, turns, loops, α-helices, etc. ,5. BasedIn addition to peptide antibodies obtained by the immunization of animals, they can be produced using mammalian expression systems, which facilitate native antibody folding and post-translational modifications . This ap2LC2) linked via disulfide bonds, although some antibodies are occasionally prone to dimerization, or even oligomerization, as recently described by Mieczkowski et al. [Antibodies are typically expressed in a basic format with two HCs and two LCs  antibodies should be characterized in terms of reactivity, specificity, and cross-reactivity, e.g., by titration assays and competition studies, where the relevant target is used as an inhibitor ,3,5. MorPeptide antibodies are used for research and diagnostics in many different immunoassays, e.g., immunohistochemistry, immunocytochemistry, immunoblotting, immunoprecipitation, and sandwich assays ,11,15,24The seven articles featured in this Special Issue, addressing the design, production, characterization, and use of (peptide) antibodies, are of considerable interest to scientists investigating approaches related to this topic.


Rheumatism covers a wide range of diseases with complex clinical manifestations and places a tremendous burden on humans. For many years, our understanding of rheumatism was seriously hindered by technology constraints. However, the increasing application and rapid advancement of sequencing technology in the past decades have enabled us to study rheumatism with greater accuracy and in more depth. Sequencing technology has made huge contributions to the field and is now an indispensable component and powerful tool in the study of rheumatism.Articles on sequencing and rheumatism, published from 1 January 2000 to 25 April 2022, were retrieved from the Web of Science™  database. Bibliometrix, the open-source tool, was used for the analysis of publication years, countries, authors, sources, citations, keywords, and co-words.The 1,374 articles retrieved came from 62 countries and 350 institutions, with a general increase in article numbers during the last 22 years. The leading countries in terms of publication numbers and active cooperation with other countries were the USA and China. The most prolific authors and most popular documents were identified to establish the historiography of the field. Popular and emerging research topics were assessed by keywords and co-occurrence analysis. Immunological and pathological process in rheumatism, classification, risks and susceptibility, and biomarkers for diagnosis were among the hottest themes for research.Sequencing technology has been widely applied in the study of rheumatism and propells research in the area of discovering novel biomarkers, related gene patterns and physiopathology. We suggest that further efforts be made to advance the study of genetic patterns related to rheumatic susceptibility, pathogenesis, classification and disease activity, and novel biomarkers. AlthougRheumatism encompasses a wide range of diseases . AccordiSequencing technology, that is, the technology that detects the sequence pattern of biomacromolecules in the central dogma of molecular biology. covers DNA sequencing to RNA sequencing to protein sequencing and provides us with insights into the relationship between genotypes and phenotypes . It laidThe progress made in sequencing technologies has been echoed in the recently improved understanding of rheumatism. The advancement and widened application of sequencing technology and bioinformatics has helped us to take a deeper look into rheumatic diseases on their molecular and cellular levels, and has become an indispensable research tool for its great contributions to the classification, pathogenesis, diagnosis, and treatment of rheumatic diseases. GWASs could be used to explore associations between genetic variants and phenotypes . The incBibliometrics takes the global document characteristics and literature landscape as its research object and utilizes methods that include statistics and mathematics to explore the quantitative relationships, changing laws, and distribution patterns of document information, thereafter the characteristics, structures, and laws of technology and science are analyzed. , which c22.1The Web of Science™ , the most trusted global database, and the strongest search engine, was used for publication retrieval on 25 April 2022. The retrieval strategy was as follows: (((TS=rheumatology) OR (TS=rheumatic disease) OR (TS=rheumatism)) AND ((TI=transcriptomic) OR (TI=proteome) OR (TI=proteomics) OR (TI=metabolomics) OR (TI=bioinformatics) OR (TI=metagenomics) OR (TI=metatranscriptomics) OR (TI=omics) OR (TI=microarray) OR (TI=sequence) OR (TI=RNA-seq) OR (TI=sequencing) OR (TI=ATAC-seq) OR (TI=single cell sequencing) OR (TI=single cell sequence) OR (TI=single cell RNA sequencing) OR (TI=single cell RNA sequence) OR (TI=expression profile) OR (TI=bioinformatic*) OR (TI=high throughput))). We retrieved a total of 1,374 articles published from 1 January 2000 to 25 April 2022 in the Web of Science Core Collection. Reviews and monographs were excluded as publication types, and articles, meeting abstracts, proceedings papers, editorial material, letters, and corrections were retained (2.2www.r-project.org) for quantitative research in scientometrics. Bibliometrix can support the workflow for bibliometric analysis and can be easily upgraded and integrated with other R packages  , an open-source tool developed by Massimo Aria and Corrado Cuccurullo using statistical computing and R language  . Other tanalysis . VOSviewanalysis , was als33.1Since the year 2000, publications in rheumatism sequencing have shown an overall tendency of growth. From 2000 to 2004, few articles were published in this area. In 2005, the number of publications increased in line with the development of proteomics and maturation of microarrays. After 2009, with the emergence of single-cell sequencing, publication numbers rapidly increased, with more effort dedicated to the field using this technology. The data retrieval date (April 25) may account for the steep decline in 2022 Figure 13.2A total of 1,374 articles were retrieved, from 62 countries, led by the USA and China, which accounted for 334 publications and 300 publications, respectively, creating a huge production gap between these two countries and the rest of the world. Ranked by accumulated publication frequency, the USA came first, with 1,592 publications, and China second, with 982 publications , Brigham and Women’s Hospital (n = 41), the Karolinska Institute (n = 34), Leiden University (n = 34), and the University of California, San Diego (n = 34), four of which are in the USA. Shanxi Medical University, the affiliation of the most prolific author, Li, and the University of Minnesota, the affiliation of the third most prolific author, Baechler, also made the top 20. These results are in line with the accumulated production figures for countries noted above, indicating that the USA is in the vanguard of the field.The source of authors’ inspiration, and the incubator for their discoveries, is their institution. Thus, it is of great importance to identify the prolific institutions. 3.3Annals of the Rheumatic Diseases, and Arthritis & Rheumatism were the top three, all with publications numbers surpassing 140, accounting for the majority of the relevant articles , Annals of the Rheumatic Diseases (H = 17), and Arthritis & Rheumatology (H = 16), making them valuable sources for research related to rheumatism and sequencing  are words or phrases that are calculated by special algorithms that do not appear in the title of the article but appear in the titles of the article’s references. Article keywords, in contrast, are supplied by the article authors themselves. The KeyWords Plus analysis  had achieved the important milestone of completion of a working draft sequence, ushered in the post-genomics era, which placed more stress on the study of functional genomics, specifically the dynamic genome, and its products such as RNA, proteins, and metabolites . In lineIn this bibliometric analysis, we examined 1,374 articles published from 2000 to 2022 (April 25) on sequencing technology and rheumatism.The number of annual publications, to a certain extent, can reflect the level of researchers’ interest in the field. The number of articles on rheumatism and sequencing started to increase significantly after 2000 and has continued to exhibit an overall increase, despite a few ups and downs. In the year 2005, the number of publications saw its first peak, with most publications focusing on proteomics and gene expression profiling. The same theme lasted for years, until the technique of single-cell RNA sequencingbecame mature and was widely deployed, as a result of which it became the most popular research topic in rheumatism and sequencing. Sequencing in rheumatism regained its popularity in 2009, and the number of articles published increased to nearly 100 per year. In 2017, the publication number received another boost, and in 2021 reaching a record high of 152 publications.Among the 62 countries that dedicated efforts to this field, the USA ranked first, in terms of both the total number of documents and total number of MCPs, and was the home to a large proportion of most relevant affiliations, such as Stanford University, the University of California, San Francisco, and so on. China came in second in total publication numbers, but had the highest number of SCPs. Countries also worked together to conquer obstacles, with the USA having the strongest cooperative bonds with China, European countries, and Korea. Switzerland had the highest MCP ratio, indicating that most of its publications resulted from collaboration with other countries. In terms of the most relevant authors, Li from Shanxi Medical University and Liu from the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were at the top, with 16 and 15 related articles published in total, respectively, and they are still very active today. Baechler of the University of Minnesota and Gregerson of the Feinstein Institutes for Medical Research reached their peak publishing activity in 2005, and their output has since gradually declined. Several connections can be found between the most relevant authors and affiliations. For instance, Shanxi Medical University, which ranked 12th on the most relevant affiliations, is the institution where Li, the most prolific author, works. This indicates that the most relevant authors also played prominent roles in the establishment of great teams and research environments in this field.Arthritis & Rheumatology, Annals of the Rheumatic Diseases, and Arthritis and Rheumatism were the three most relevant sources, among which the first two presented an increase in 2013. Although PLOS ONE had only an impact factor of 3.752 in 2022, it published 36 relevant articles and had an h-index of 19, so its influence on the subject should not be ignored.Streptococcus pyogenes”  and transcription factor 7 (TCF7), novel SLE susceptibility genes, were uncovered by GWASs and expression quantitative trait loci (eQTL) analysis  and diseases, to estimate the possible risks or susceptibility. For instance, using large-scale GWASs, researchers identified the significant genetic variants connected with rheumatoid arthritis susceptibility . Nicotinanalysis . All wor4.2.2Cluster 2 was colored in red, and consisted of the terms “expression”, “identification”, “gene”, “protein”, “cartilage”, and “articular-cartilage”, concentrating on the molecular basis of rheumatism. More and more relevant molecules, whether genes or proteins, have been found, using sequencing technologies such as microarray, to play a pivotal role in rheumatic disorders. Take SLE as an example: the etiology of SLE is multifactorial, involving genes, epigenetic factors, and autoantibodies . Utilizi4.2.3COL6A3) and actin gamma 1 (ACTG1)] as key components of OA , identified the focal adhesions pathway and two marker genes [i.e., collagen type VI alpha 3 chain  and refined our classification standards for SLE . Ambigui4.2.5SAA4), gelsolin (GSN), and vitamin D-binding protein (VDPR) as RA biomarkers, which has value for not only the diagnosis but also the prevention and treatment of rheumatic diseases  classification criteria  for RA’sdiseases . He ZR ediseases . Similardiseases . The disAlthough keywords were separated into five clusters, cross-links between clusters still existed. Exploring the genetic expression pattern could also contribute to an understanding of an individual’s susceptibility to rheumatic diseases, as well as their disease classification status. Discovering novel biomarkers could also lead to the further explication of the pathological or physiological progress involved in rheumatism. Thus, it is of great importance to bear in mind the close relationship between these key themes. In addition, of the various diseases that rheumatism covers, it is apparent that RA, SLE, and OA are the hottest spots for research, with solid foundations and great clinical significance. All in all, sequencing technology was introduced to rheumatism studies to find solutions for unsolved problems, but it is now altering and even leading groundbreaking studies in rheumatism.Nevertheless, limitations in our study still exist. Our study included only articles published from 2000 to 2022, which might have led to the oversight of both early important studies and the latest updates.5In this bibliometric study, we reviewed the progress made in the last 22 years in sequencing and rheumatology, and identified the hotspots and frontiers for future investigation. Evidently, sequencing technology has invigorated the study of rheumatism. From the standpoint of pathogenesis, genomic sequencing has equipped us with knowledge of the pathogens involved, and identified possible genetic backgrounds and molecules involved in the pathogenesis of rheumatism. From the standpoint of clinical value, genomic sequencing has identified possible markers for diagnosis, supplemented evidence for defining stages and classifications, and spotted potential targets for therapy. Among those contributions, employing sequencing technology to study the pathogenesis and classifications of rheumatism would be a wonderful direction for future studies to take. Discovering novel biomarkers for diagnosis and uncovering genetic patterns related to disease susceptibility are also promising orientations. We hope that, with this bibliometric study, we can provide a reference for researchers to better grasp the trends and key points of the study of rheumatism.The original contributions presented in the study are included in the article/Conception/design: RH, JT, SW, YLiu, MZ, MJ, HQ, WQ, YLu, YiY, BL, YuY, PY, JH, WZ, JL, MG, YZ, XG, SX, XL, and ZH. Collection and/or assembly of data: RH, JT, SW, YLiu, MZ, MJ, HQ, WQ, YLu, YY, BL, YY, PY, JH, WZ, JL, MG, YZ, XG, SX, XL, and ZH. Data analysis and interpretation: RH, JT, SW, YLiu, MZ, MJ, HQ, WQ, YLu, YiY, BL, YuY, PY, JH, WZ, JL, MG, YZ, XG, SX, XL, and ZH. Manuscript writing: RH, JT, SW, YLiu, MZ, MJ, HQ, WQ, YLu, YiY, BL, YuY, PY, JH, WZ, JL, MG, YZ, XG, SX, XL, and ZH. Final approval of manuscript: RH, JT, SW, YLiu, MZ, MJ, HQ, WQ, YLu, YiY, BL, YuY, PY, JH, WZ, JL, MG, YZ, XG, SX, XL, and ZH. All authors contributed to the article and approved the submitted version.


In the published article, there was a misprint in affiliations. Instead of “Department of Neurosurgery, Asan Medical Center, Seoul, South Korea” it should be “Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea”. Additionally, instead of “Department of Radiology, Asan Medical Center, Seoul, South Korea” it should be “Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea”.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


In this article Gunter Bombaerts was incorrectly linked to 'Delft University of Technology, Jafalaan 5, 2628BX Delft, The Netherlands', due to an incomplete correction. He should have been linked to 'Eindhoven University of Technology, VITO, Eindhoven, The Netherlands', as he was in the original manuscript.The original article has been corrected.


In the midst of a global pandemic with a rising death toll, the children´s mental health can be easily overlooked in the country’s response. But this overlook would have devastating consequences for years to come.The objective of this research is to compare children’s physical and mental development before, during and after the situation of social isolation caused by the pandemic of COVID-19.The parents/guardians of 100 children aged between 0 and 5 years and 11 months old were asked to answer questions based on the ASQ-3 (Ages and Stages Questionnaire III), containing questions related to Communication, Gross Motor, Fine Motor, Problem Solving, and Personal-Social and ASQ- SE  addressing issues of self-regulation, compliance, social-communication, adaptive functioning, autonomy, and affect. In addition, behavioral issues related to children’s mental health will be included, such as: aggressiveness, insomnia, lack of appetite, apathy, sadness, tiredness, lack of interest, hyperactivity, manias, tantrum, morning among others. Child development data will be collected before and during quarantine / isolation and later, in a second stage, after the end of social isolation.The data will be analyzed in order to characterize child behavior before, during and after the period of social isolation, correlating the different areas of child development, especially mental health.As argued, socially isolated children are at increased risk of health problems in adulthood. Furthermore, studies on social isolation have demonstrated that a lack of social relationships negatively impacts the development of the brain’s structure.No significant relationships.


Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement.This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers.A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout.Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences . An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts.Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes. Earltechnology fatigue [Findings from VDT studies of occupational hygiene  and ophthalmologic dimensions appear to be quite pertinent to video, EHR, and psychosocial work commonly associated with  fatigue ,10,76. J fatigue , and com fatigue ,78.Displays and workflow interventions have been successful in many respects. A 15-minute work period with microbreaks  and physThere are overlaps and differences between burnout and prolonged fatigue . Fatigueindividual level may involve the following: (1) changing work patterns, (2) developing coping skills, (3) obtaining social support, (4) using relaxation strategies, (5) promoting good health and fitness, and (6) developing a better self-understanding. At the workplace or organizational level, this may mean the following: (1) redesigning job tasks, (2) improving recognition of notable work by both teams and individuals, and (3) developing more fair and equitable policies.Conceptualization of fatigue and burnout may also be organized according to engagement and job stress ,25,83. EA shift to a culture of well-being with technology use requires the evaluation, implementation, and monitoring of individual, workplace, workflow, and institutional strategies  and IT, use of lean methods and emphasis on interprofessional education efforts with technology team-based care from the Institute of Healthcare Improvement and Agency for Healthcare Research and Quality . More spHealth care provider well-being and health appear to be related to the technological integration of video, EHR, and mobile health over time . This fiStudies related to the implementation and evaluation of technology are increasingly sophisticated and provide a starting place despite varying widely in duration, approaches, methods, and quality of measures. The 12 studies that met all the inclusion criteria for technology, health care, and fatigue studied the behavioral, emotional, cognitive, and physical impact of workflow at individual, hospital, and system or organizational levels  8,13,1414,45-53.burnout is undergoing change, with a shift toward the recognition of burnout as an occupational phenomenon rather than solely as an individual medical disease  per the World Health Organization [Beneficial changes in workplace culture, focus on well-being, and prevention of burnout from other fields are beginning to be used in health care ,49,86, bnization . Thus, dwrap-around support for providers, not just patients, may be needed, as suggested by the Quadruple Aim. In the business culture of successful companies, such as Cirque du Soleil, L’Oreal Paris, and Nintendo, the tetrad foci of research, production, marketing, and finance have been expanded to a pentad by integrating technology rather than appending it [To begin to address challenges in health care related to fatigue and burnout, including those associated with technology, a substantial collaborative effort is needed from health system leadership, organizational researchers, IT and IS specialists, and potentially the government ,3,28,29,nding it ,38,88. Anding it  based onnding it .therapeutic, enjoyable and easy to provide, and promotes their well-being and performance as individuals, team members, and leaders. In time, continuous data collection and analytics could support clinical decision-making for patient quality, workforce satisfaction, and system outcomes, creating an organizational culture of well-being, compassion in care, and prevention of fatigue and burnout in all employees, including providers [A structural and functional redesign of systems would emphasize evaluation, effectiveness, implementation, and application of process improvement ,60,85,89roviders ,3,90. Huroviders ,85.workplace at the individual, clinic, hospital, and system or organizational levels may need better definitions. Sixth, the review does not cover all potentially relevant well-being, burnout, and stress dimensions of the workplace, nor does it cover research on the physical environment, occupational health, or mobile, virtual or telework workflows. Seventh, broader input for consensus across organizations could have been helpful, and a qualitative, small group interview approach with experts using a semistructured guide could have discovered more information.This scoping review has some limitations. First, there were fewer findings than we expected using our inclusion and exclusion criteria, despite a broad scope, to find the relationships between health care, fatigue, and synchronous  and asynchronous  technologies. Second, only 1 author reviewed the titles and abstracts. Third, the entire search was described but not saved and consolidated as an appendix for reviewers; reresearch findings of the 2 main databases were included as an appendix for reviewers. Although the terms, databases, and dates are a guide to other researchers, this omission does not enable others to simulate the approach. Fourth, given the small sample sizes, heterogeneous methods, and variable study duration, the team was unable to apply a systematic quality evaluation system or draw conclusions using a quantitative meta-analysis. Cross-sectional studies of associations with multiple factors in applied rather than controlled settings have limitations. Fifth, the stratification of behavioral, cognitive, emotional, and physical domains of impact, although heuristically helpful, could have been operationalized more rigorously. Similarly, Health care delivery and systems are increasingly incorporating technology but need to evaluate its impact in accordance with the Quadruple Aim to support providers. Approaches with causal questions and longitudinal implementation research could benefit from a multilevel approach with objective measures for clinical and human factors, training, professional development, and administrative workflows. If done well, technology integration could further population-centered health and effectiveness of service delivery, although the redesign of financing, reimbursement, regulatory, and other changes may be necessary. Integration of health care quality outcomes with those for technology and well-being is suggested and requires institutional strategies and competencies. Otherwise, continued advances in the use of technology may inadvertently worsen provider workload burden, fatigue, and burnout.


Henrique Walter Pinotti was born in São Paulo to Italian immigrants. He began attendingthe Hospital das Clínicas of the Medical School of the University of São Paulo (FMUSP)when he was admitted to the Medical School, in 1950, participating in the ClinicalGastroenterology Service as an academic trainee under the guidance of the then head,Professor José Fernandes Pontes. He went through all sectors of the specialty, havingcontact with the pathophysiological and clinical bases of gastroenterology, deciding onsurgery on the eve of his graduation, in December 1955. Then, he was selected as asecond-year resident physician of the Department of Surgery of the Hospital, a positionheld until May 1958. During those years, he also attended the Department of PathologicalAnatomy as a volunteer.He was granted his first academic title in March 1959, when he was appointed by ProfessorAlípio Corrêa Netto, upon recommendation of Professor Arrigo Raia, Teaching Assistant ofSurgical Clinics. Later, in 1960, he was appointed FMUSP Assistant.Since then, he had the opportunity to monitor the activities and absorb the teachings ofrenowned surgeons, notable school leaders, such as Benedito Montenegro, EdmundoVasconcellos, Eurico da Silva Bastos and, especially, Alípio Corrêa Netto, from whom hereceived great encouragement for his university career, as well as from his followers,Euryclides de Jesus Zerbini and Arrigo Raia, with whom he enjoyed a close and long-termrelationship.He presented his Doctoral Dissertation at FMUSP in 1964 and became an AssociateProfessor, by public official examination, in Surgical Clinic in 1967, and thedissertations of both programs were related to Megaesophagus.In 1968, a new academic order was established: the chairs were extinguished andDepartments were created. Disciplines and departments were established; the former, infact, are specific teaching programs, and the later, the bunion of related disciplines.At that moment, the Discipline of Digestive Surgery was established at FMUSP, as well asthe respective Digestive Surgery Division at the Hospital das Clínicas, to housesurgeons specialized in this area from the former chairs.He always sought to follow the specialty in its entirety, performing activities in allareas. With the structuring of this Discipline, he assumed, from 1974 onwards, the Headof the Esophageal Surgery Service, where he promoted great development to Brazilianesophagology.In 1981, he obtained the title of Adjunct Professor of FMUSP, and in August 1982, withthe retirement of Professor Arrigo Raia, upon recommendation of the Board of theDepartment of Surgery, he held the position of Professor of the Discipline of DigestiveSurgery of FMUSP. Subsequently, on recommendation of the same Board, he was appointedTechnical Director of the Digestive Surgery Division of Hospital das Clínicas and itsservices: surgeries of esophagus, stomach, and small intestine, liver and portalhypertension, colon, rectum, and anus. In 1984, after a memorable civil servicecompetitive examination, he was appointed Full Professor of Digestive Surgery atFMUSP.A prominent event took place in 1986, with the establishment of the Department ofGastroenterology of the FMUSP, on the initiative of Professors Agostinho Bettarello andHenrique Walter Pinotti. This event was important for the national and internationalhistory of clinical and surgical Gastroenterology and also for teaching students,residents, and graduate students, as well as for conducting scientific and care-relatedresearch with the integration of surgeons, gastroenterologists, endoscopists, andnutrologists.Tratado de Cirurgia do Aparelho Digestivo, Acesso aoEsôfago Torácico por Transsecção Mediana do Diafragma, andFilosofia da Cirurgia ,,,,,,,In his memorial, the following stand out: 590 publications in national and internationaljournals; 26 awards; 46 films or videos and countless lectures at national andinternational congresses and courses; 191 book chapters and seven books, among whichstand out Curso de Atualização de Cirurgia do Aparelho Digestivo -Gastrão), the most important in Digestive Surgery in Brazil. He has alwaysbeen intensely dedicated to this course, especially during his tenure. It is alsonoteworthy, in 1974, the creation of the Continuing Course in Gastroenterology(Curso Continuado em Gastroenterologia), periodically administeredin 10 annual sessions, on Saturdays, for doctors from the State of São Paulo andBrazil.In 1973, he was founder, together with Professors Arrigo Raia, Joaquim JoséGama-Rodrigues, Marcel Cerqueira Cesar Machado, and Angelita Habr-Gama, of the DigestiveSurgery Update Course (Brazilian College of Digestive Surgery (CBCD), gatheringspecialists from all over Brazil. It was registered with the Brazilian MedicalAssociation, the Brazilian Federal Council of Medicine, and competent bodies, with thespecific determinations for obtaining the degree of specialist, in addition to therecognition of medical residency in the specialty by the National Medical ResidencyCommission (CNRM)In 1986, he created the Brazilian Archives of Digestive Surgery (ABCD) with severalsurgeons from Hospital das Clínicas and Brazil, which later became the officialscientific agency of the Brazilian College of Digestive Surgery (CBCD). This spirit ofnational union concerning the specialty also enabled, in 1988, the idealization andfoundation of the He was member of several national and international Medical Societies, notably theBrazilian Medical Association, the Brazilian Federation of Gastroenterology, theBrazilian College of Surgeons, the American College of Surgeons, the InternationalSociety of Diseases of the Esophagus, and the International Association for GastricCancer. In particular, his activities at the International Society for Diseases of theEsophagus (ISDE) are noteworthy, where he was president of the 2001 World Congress, heldin São Paulo, Brazil.He made numerous study trips inside and outside the Country. In Brazil, he participatedin congresses, courses, and medical conferences in most states, visiting its mainmedical and university centers, where he had the opportunity to learn about the problemsrelated to regional clinical pathology, medical assistance, professional issues,scientific research, and especially medical education.Doctor Honoris Causa ofthe University of Goiás (Brazil), University of Coimbra , and University ofMilan .He received numerous honors, including the title of He became Professor Emeritus at the Medical School of the University of São Paulo in2000.grupodos Zezinhos (“group of Zezinhos”), who carried out theirundergraduate research by instrumenting their surgeries and participating in clinicaldiscussions. It is also worth noting his dedication to the 71 HCFMUSP Digestive Surgeryresidents trained under his guidance and to the 26 private Service residents at HospitalNove de Julho. He actively participated in graduate studies advising 57 surgeons andseveral assistants, including the authors of this text.For those who knew and related to Prof. Pinotti, he was an authentic leader, who showedgreat dedication to undergraduate education, in particular by creating a center foreducational training in surgery for fourth-year students, the so-called We thank him on behalf of all of them, quoting his own words: “The mission for which weset ourselves has been achieved, the climax generates a state of tranquility as we haveculminated in one of the fundamental actions of the University Professor of Surgery,which is to transmit what he knows.”


N = 51) were charted, and a qualitative content analysis was conducted. Five themes were formed which provided insights into how both physical and social environmental qualities combined provide for maximum play value in outdoor play experiences. These multifaceted play experiences included the desire for fun, challenge, and intense play, the wish to self-direct play, and the value of playing alone as well as with known people and animals. Fundamentally, children wished for playgrounds to be children’s places that were welcoming, safe, and aesthetically pleasing. The results are discussed in respect to social, physical, and atmospheric environmental affordances and the adult’s role in playground provision. This scoping review represents the valuable insights of children regardless of abilities and informs about how to maximise outdoor play experiences for all children.For children, playgrounds are important environments. However, children’s perspectives are often not acknowledged in playground provision, design, and evaluation. This scoping review aimed to summarize the users’ (children with and without disabilities) perspectives on environmental qualities that enhance their play experiences in community playgrounds. Published peer-reviewed studies were systematically searched in seven databases from disciplines of architecture, education, health, and social sciences; 2905 studies were screened, and the last search was performed in January 2023. Included studies ( Play is a fundamental right of children that is essential for health, well-being, and development, as stated in article 31 of the United Nations Convention on the Rights of the Child (UNCRC)   experiences to gain insight into what environmental qualities maximize the play experience in public playgrounds for all children.A three-step search strategy was undertaken. First, an initial search helped identify relevant articles and other key search terms. Second, a test search in one database with an initial search string was performed. In this phase, information specialists from the University College Cork library were consulted to validate the search string and strategy. Third, the systematic search using the revised search string was conducted in August 2021; a follow-up-search was performed January 2023. See The systematic search of peer-reviewed studies was conducted in seven databases  relevant to the disciplines of health, education, social sciences, and architecture, which allowed a broad range of literature for different professional audiences to be included. No limitations were set for publication year. The executed search string see  was builThe two-step review process involved scanning titles, abstracts, and full texts. All citations were transferred into the online review software COVIDENCE . DuplicaAs recommended by Levac et al. , two phaThe second phase included a convergent synthesis design using the same content analysis on qualitative, quantitative, and mixed-method studies . The quaThe findings where charted and summarized by the first author (T.M.). First, the scope of the included studies is summarised. In the second part, themes from the qualitative content analysis are presented. In approaching this review from a children’s perspective, including children with and without disabilities, the findings only elaborate on a specific population when findings were only found for that specific population.The searches revealed a total of 6095 references, which was reduced to 3190 after duplicates were removed. Articles were reduced in two rounds of title and abstract scans first to 503 studies and, after refinement of the inclusion criteria, to 104 studies. Full text reviews identified 49 studies meeting the inclusion criteria see . Two addn = 25), Australia and New Zealand (n = 11), followed by Asia (n = 8) and North America (n = 7). No studies from Africa or South America met the inclusion criteria (See A detailed description of the included papers can be found in eria See .n = 16), Education (n = 15), Occupational Therapy (n = 6), Psychology (n = 4), Exercise, Sport and Nutrition Sciences (n = 4), Human Geography (n = 3), Occupational Science (n = 1), Public Health (n = 1), and Practitioner Researcher (n = 1). Interdisciplinary contributions to the topic came from Architecture and Landscape Architecture (n = 30) methods, followed by quantitative (n = 13) and mixed methods (n = 8). Most studies used multiple data collection methods (see n = 23), focus groups (n = 10), walk-along talks (n = 10), and observational methods referred to as systematic (n = 11) and unsystematic (n = 9).Most papers employed qualitative , suburban (n = 6), rural (n = 6), and mixed (n = 2) areas. Location was missing in ten studies, and in two studies a reported location was not relevant to the study aims. Playgrounds were located in community areas such as playgrounds in parks or specific playground spaces (n = 27), schools (n = 16), or both public and school playgrounds (n = 3). Two of the papers looked at adventure playgrounds [In total, 212 playgrounds were represented. The locations of playgrounds were reported in urban  male, 35.3% (n = 1299) female, and 29.8% (n = 1095) unreported sex. Six observational studies provided observation counts but not participant numbers [The total participant sample included  numbers ,95,101,  numbers . The stuOnly ten studies included children with disabilities, representing a sample of 125 participants . Of these, four studies focused on children with disabilities only ,68,102, Fifteen studies also included other participants along with our population of interest, for example, parents and other family members, teachers, playground maintenance staff, play workers, or health professionals ,99,102. Five themes were identified that provide insight into the interconnection between play experiences and the environments that enhance outdoor play see . These fdiverse intense and novel play experiences, which related to engagement in intensified movements and intensified sensory experiences  finding suitable challenges, (2) using the environment flexibly, and (3) having moments to unfold their own play. This theme synthesises evidence of what the physical and social environment provided for children, especially in the context of having permission to self-direct their own play.suitable challenges in their playgrounds [Children reported the importance of having ygrounds ,78,84,88ygrounds  and needygrounds ,84. Thisygrounds ,61,63 thygrounds ,94,102. ygrounds ,77,102. ygrounds ,68. In sygrounds . This maygrounds .Using the environment flexibly meant exploiting any possible way to engage with play equipment and other built structures beyond their intended use [nded use ,92,101. nded use ,71,79,80nded use ,59,65 ornded use ,67,88, bnded use ,59, jumpnded use , or hangnded use . Other cnded use ,65,67. Anded use ,71,89 ornded use ,78,84,92nded use , and anynded use ,75,76. Bnded use ,63,75; tUnfolding own play was linked to social and physical environmental qualities. This was accomplished by having uninterrupted moments to unfold own play afforded by the physical and social environment. The physical environment meant having a suitable space and objects affording children to engage in their unfolding play. The social environment meant adults (and other people) granting permission for children’s own play. Across studies, children or children’s groups provided examples of their unfolding play in correspondence to their particular physical and social environment [ironment ,76,81,88ironment ,70, fly-ironment , jumpingironment , needle-ironment , or raceironment . Sometimironment ,78,91,94ironment , being-aironment , the-floironment , being-dThis subtheme describes the evidence showing that children value and seek opportunities to engage with a diversity of people and animals while also wanting to play by themselves, especially when playing away from adults offers treasured play experiences. Playing with children was a key component described as enhancing children’s play experiences. Examples included swinging together with one particular friend [r friend ,78, rollr friend , climbinr friend , crashinr friend ,64, or hr friend ,67,68. Cr friend ,84,88,91r friend ,91,101. r friend . Similarr friend . The phyr friend ,60,67,68r friend ,79,84,95r friend ,64,82, or friend ,72,92,96Playing with adults occurred in the presence of supportive adults who knew how and when or when not to intercede with children’s play. This was perceived in three ways. First, adults were actively involved in the same play together with the children [Adults who accompanied children influenced their play ,67,88. Pchildren ,64,84,88children  or playichildren ,68,71. Schildren . This wachildren ,73. The children . Third, children ,61,67,88children ,67,68,84Being away from adults and other children was about the experience of not being seen and showed a connection with the theme of choices and self-directed play. Children referred to being away from adults more frequently than they did being away from other children. Being away from adults was associated with privacy, having secrets, and breaking the rules. This was possible in places in the natural and built environment that afforded privacy and seclusion, such as small spaces [l spaces ,76,81,96l spaces ,76,78,94l spaces ,64,75,76l spaces ,64,67,75l spaces ,75,81, al spaces ,64,81. Il spaces , such asl spaces ,76,84, fl spaces ,84, diggl spaces , wanderil spaces ,64,75 lil spaces , or entel spaces ,67,76,84Both physical and social environmental qualities influenced children’s feelings of connection with their playgrounds. Belonging to their playground was experienced by (1) being familiar with the playground, (2) feeling welcome and safe, and (3) enjoying playground aesthetics.Feeling connected with the playground had relational qualities, including knowing the playgrounds located in the home community [ommunity ,58,61,66ommunity ,70,78, aommunity ,72,73,78ommunity ,74,77,81ommunity ,66,79. Hommunity ,55,61,68ommunity ,81,96.feel welcome and safe in playgrounds, especially children with disabilities who wanted a welcoming atmosphere created by accessible and usable playground design that afforded play with others [Children wanted to h others ,61,67,68h others ,102. Welh others ,68,72. Rh others ,80, peoph others , caring h others ,64,80, oh others . Similarh others ,80 or whh others . Whetherh others  or gave h others . Howeverh others ,83,85. perceptions of aesthetics and beauty in the built and natural environment. Children wanted to play on appealing playgrounds. Playgrounds were unattractive and ugly when they were dirty; smelled bad; were littered with glass, needles, cigarette butts, duck and dog excrement; had graffiti; or were noisy and overcrowded [The connection to playgrounds was strengthened by children’s rcrowded ,78,84,92rcrowded ,78,82,89rcrowded ,67,80,84rcrowded ,75,76,89rcrowded ,84,85. Trcrowded ,94. Naturcrowded ,78,84, ircrowded ,64,78,81rcrowded ,64,91 anrcrowded ,88,94. Arcrowded ,70,75,76rcrowded ,81. experience of fun was the overarching and core experience in outdoor play. Children actively sought more fun in play. Fun evolved while playing but was also anticipated when children engaged in play and was sometimes described as a prerequisite for play [The for play ,61,84. Cfor play . The expFor the physical environment, this was interwoven with providing intense play opportunities ,57,59,84The social environment included having people and animals available to play with ,55,61,81Fun was contrasted to the boredom experienced when the playground did not provide a sufficient diversity of play opportunities in the built and natural environment ,70,79,84children’s place. These findings point to the importance of acknowledging children’s perspective’s, regardless of ability, in playground provision, design, and evaluation.This scoping review aimed to summarize the experiences of children with and without disabilities, and to gain insight into environmental qualities that maximize play experiences for all children on community playgrounds. There were two key findings. First, this review showed that the combined qualities of the physical and social environment afforded play experiences that children preferred and desired when engaging in outdoor play. This interconnection was sometimes linked to certain environmental qualities relating only to the physical environment or only to the social environment, but more commonly related to both the social and physical environment combined. Second, the review revealed children were knowledgeable about their community playgrounds and environmental qualities that contributed to enhancing their outdoor play experiences. These play experiences were multifaceted and included having opportunities for fun and intense motor and sensory play, engaging in suitable challenges, making choices, and having moments to unfold their own play. Children valued a spectrum of play, from playing alone, to playing in small to big groups of peers and friends, and playing with adults and animals. Children also desired safe, welcoming, and aesthetically pleasing playgrounds where they felt they belonged as they knew other users and the playground. In other words, community playgrounds with the best play value become a children’s places that went beyond simply being a place to play.This review presented rich and varied information about how children utilised physical and social environmental affordances available to them. Environmental affordances have been successfully used in outdoor play research to understand how children perceive and use their environments for outdoor play ,103,104.The findings of the review confirmed a persuading agency of the physical environment on affordances that children perceive and actualize in outdoor play. Persuading agency refers to the power the environment has to entice children to play. In this review, the understanding of affordances was broadened, as children did not only perceive action possibilities ,103,104 Intersections between the physical and social environmental qualities were found to contribute to the overall atmospheric and more tacit atmospheric affordances of playgrounds. Children elaborated on these atmospheric affordances in their experiences of feeling safe and welcomed and their perception of aesthetics. A physical environment that is aesthetic, colourful, clean, and contained both built and natural play opportunities contributes to an environment that is appealing to children. Loebach and Gilliland  found thIn this review, social affordances were not only related to those with whom children played, such as children, adults, or animals. Children, regardless of ability, emphasised their relationship to significant play partners such as children and adults they knew, such as friends from school and the proximate neighbourhood, known people from the community, and known peers with similar abilities and interest, or of the same sex. This concept of knowing others also transcended to the physical space, as if the playground was a friend as well. Children wanted to feel connected to their playground through positive play experiences either alone or with known people who were associated with the playground. These findings indicate that playgrounds have the potential to be spaces for social inclusion ,29. SuppFurther social affordances in this review were related to social rules and practices such as having permission to use built environments flexibly, having uninterrupted moments to unfold own play, and having opportunities to play away from adults and solely with peers. Both children with and without disabilities valued opportunities to self-direct their play an expressed the wish for less adult interference and surveillance. However, such opportunities were identified differently by children with and without disabilities and depended on different physical and social environmental qualities in combination. For children with disabilities, adult permission needs to be discussed, since these children frequently reported needing adult assistance due to inaccessible and unusable physical environments ,102,112.The review findings provide synthesized evidence of children’s perspectives on the outdoor play experiences they value and prefer in community playgrounds, helping to identify environmental qualities that provide for such experiences. Aligning with other studies ,30,33,72The findings need to be interpreted with the following considerations. First, parents’ and caregivers’ perspectives were not included. These would provide an additional viewpoint for understanding children’s play experiences. Future research might investigate both the perspectives of parents and children to provide insight into how these differ. Second, the included studies encompassed community and school playgrounds as the units of analysis. This inclusion criterion was set because, for some countries, school playgrounds are open to the public during non-school-hours. In this review, most studies of school playgrounds did not specifically state if a school playground was open to the public or not. However, some included study data were collected during school times. Third, a methodological quality assessment might strengthen the interpretation of the study findings. However, a methodological quality assessment was omitted due to the interdisciplinary scope of the research and the variety of methodologies and methods used. A scoping review was considered a suitable methodology in the interdisciplinary area of playground research, and the inclusion of publications from a diversity of disciplines strengthened the findings. This review was able to link play experiences to environmental qualities by synthesizing findings from peer-reviewed articles using qualitative, quantitative, and mixed methods. The most useful information regarding children’s perspectives was collected through multiple methods, including verbal accounts  and observations. Most of the studies relied on qualitative methodologies. This highlights the need for instruments to allow investigations into children’s perspectives in a more systematic way and consider the conjunction between children’s experiences and environments. Future research should investigate environmental qualities such as those found in this scoping review to elicit potential affordances for play experiences available to children with and without disabilities. A further gap in research was identified in the representation of perspectives in research. Only ten studies included children with disabilities; of these, only six studies included children with and without disabilities in combination. If playgrounds are places for inclusion, research and practice need to take a more diverse perspectives into consideration in playground provision, design, and evaluation.This scoping review aimed to synthesise play experiences of children with and without disabilities and gain insight into what environmental qualities contribute most to enhancing play experiences in community playgrounds. Gaps in research were identified in the limited number of papers that included both children with and without disabilities, in the lack of research about how community playgrounds can provide more access to nature for all children, regardless of ability, and the need for instruments that investigate the connection between children’s experiences and environments. The main findings of this scoping review were as follows. First, the available evidence allows an understanding of how the combined social and physical environmental qualities of playgrounds enhance outdoor play experiences by providing a diversity of experiences. Multifaceted play experiences were reported with the desire for fun, challenging, and intense play; the wish for self-directed play; opportunities to play alone and with known social partners; and a desire for welcoming, safe, and aesthetically pleasing playgrounds. Second, regardless of ability, children were knowledgeable about the play value of their community playgrounds, and therefore, their perspectives need to be more closely considered. Playground provision, design, and evaluation needs to move beyond merely providing dedicated spaces for play and consider instead, provisions for potential outdoor play experiences that allow playgrounds to become children’s places. This means that children’s preferences and what children want to experience in playgrounds need to be at the heart of playground provision, design, and evaluation.


This popular annual session will provide cutting-edge information on what the 117th Congress has and has not accomplished to date, and what may be left for the lame duck session to address. Speakers will discuss key issues such as Social Security, Medicare, Medicaid, Older Americans Act, Build Back Better Act, social isolation, serious illness care, and funding. Predictions for the 118th Congress may be provided.