The reliability of surface electromyography (sEMG) has not been adequately demonstrated in the equine literature and is an essential consideration as a methodology for application in clinical gait analysis. This observational study investigated within-session, intra-subject (stride-to-stride) and inter-subject reliability, and between-session reliability of normalised sEMG activity profiles, from triceps brachii (triceps), latissimus dorsi (latissimus), longissimus dorsi (longissimus), biceps femoris (biceps), superficial gluteal (gluteal) and semitendinosus muscles in n = 8 clinically non-lame horses during in-hand trot. sEMG sensors were bilaterally located on muscles to collect data during two test sessions (session 1 and 2) with a minimum 24-hour interval. Raw sEMG signals from ten trot strides per horse and session were DC-offset removed, high-pass filtered (40 Hz), full-wave rectified, and low-pass filtered (25 Hz). Signals were normalised to peak amplitude and percent stride before calculating intra- and inter-subject ensemble average sEMG profiles across strides for each muscle and session. sEMG profiles were assessed using waveform similarity statistics: the coefficient of variation (CV) to assess intra- and inter-subject reliability and the adjusted coefficient of multiple correlation (CMC) to evaluate between-session reliability. Across muscles, CV data revealed that intra-horse sEMG profiles within- and between-sessions were comparatively more reliable than inter-horse profiles. Bilateral gluteal, semitendinosus, triceps and longissimus (at T14 and L1) and right biceps showed excellent between-session reliability with group-averaged CMCs > 0.90 (range 0.90-0.97). Bilateral latissimus and left biceps showed good between-session reliability with group-averaged CMCs > 0.75 (range 0.78-0.88). sEMG profiles can reliably describe fundamental muscle activity patterns for selected equine muscles within a test session for individual horses (intra-subject). However, these profiles are more variable across horses (inter-subject) and between sessions (between-session reliability), suggesting that it is reasonable to use sEMG to objectively monitor the intra-individual activity of these muscles across multiple gait evaluation sessions at in-hand trot.

Quarantine played an important role in preventing the spread of infectious diseases between countries in the early stages of the COVID-19 outbreak. In particular, in ports, infection during transit can cause a large number of patients on board ships and can flow into the community. In this study investigated cause of the cause of transmission in ships and suggested the way of preventing secondary transmission by analyzing clinical and epidemiological characteristics of COVID-19 patients identified at Busan Port (South Korea) in 2020. During the study period, out of 19,396 ships that arrived at Busan Port, 50 ships had COVID-19 confirmed cases. Among the 50 ships, type of deep-sea fishing vessels (24 ships, 48.0%), ships weighing less than 5,000 tons (31 ships, 62.0%), and ships from Russia (41 ships, 82.0%) had the highest positivity rates. Total 283 of the 25,450 arrivals tested positive for COVID-19 (a positivity rate of 1.1%), and 270 (95.4%) were asymptomatic. Moreover, the number of COVID-19 patients increased with the duration of the waiting period between arrival and sample collection (12.7% to 37.4%), and the positivity rate was significantly higher for those working as stewards (64.3%). These results indicate secondary transmission was active on board ships and that infection among stewards importantly contributed to group outbreaks. In addition, onboard residence time after arrival significantly elevated to COVID-19 positivity rates, indicating that rapid isolation, as determined using various screening techniques, might be effective at preventing onboard transmission and subsequent community outbreaks.

A total of 21 okra genotypes were evaluated for 25 morpho-agronomic traits in 2020 at Dire Dawa, Ethiopia in a randomized complete block design with three replications. Analysis of variance showed significant differences at p<0.05 level of significance for all traits. Estimates of genotypic (GCV) and phenotypic (PCV) coefficients of variation range from 9.16 to 42.3% and 9.33 to 44.16%, respectively. Heritability in a broad sense (H2) and genetic advance as a percent of the mean (GAM) ranged from 29.57 to 91.89% and 10.39 to 83.53%, respectively. Estimated variability components (GCV, PCV, H2, and GAM) were high and moderate for all traits except days to 50% emergence 9.33% of GCV and PCV, internode length 9.16% of GCV and green fruit width 29.57% of H2 that were categorized under low. The first four principal component axes (PCA1 to PCA4) accounted for 7.83 to 35.02%, which accounted 74.56% of the total variability with eigenvalues that ranged from 1.95 to 8.75. Genetic distances estimated by Euclidean distance from the 25 traits ranged from 2.33 to 12.56 with a mean of 6.83, standard deviation of 1.8, and a coefficient of variation of 26.46%. The genotypes were grouped into four distinct clusters using the Euclidean distance matrix using UPGMA. Indigenous okra genotypes collected from Ethiopia were more divergent with high genetic distances and had a higher performance for most of the traits including growth, green fruit yield, and seed yield than introduced genotypes. In conclusion, this study showed the presence of variation among genotypes for most of the traits, indicating that selection of genotypes could be effective to develop okra varieties with high green fruit and seed yield through direct selection or crossing.

OBJECTIVES Among pediatric patients with septic shock, culture-negative septic shock (CNSS) is common but there have been limited data on its clinical characteristics and prognosis. We compared the clinical characteristics and clinical outcomes between culture-positive septic shock (CPSS) and CNSS in pediatric patients. DESIGN Retrospective single-center study. SETTING Pediatric intensive care unit (PICU) of a tertiary referral hospital. PATIENTS All pediatric patients who were admitted to the PICU due to septic shock between January 2010 and November 2021, except for those with fungal or viral infections and those who expired on the day of admittance to the PICU. The primary outcome was 30-day mortality and in-hospital mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 294 patients (CPSS group, n = 185 [62.9%]; CNSS group, n = 109 [37.1%]) were included. The rates of 30-day mortality and in-hospital mortality (30-day mortality 22.7% vs 22%, in-hospital mortality 29.7% vs 25.7%) were not significantly different between the CPSS group and the CNSS group. The two groups showed comparable results in clinical outcomes such as the requirement for mechanical ventilator and renal replacement therapy, PICU stay duration, and the duration of MV and vasopressor/inotrope support. Among the CPSS group, 98 (53%) patients who were infected with multi-drug resistance (MDR) bacteria had significantly higher rates of 30-day mortality and in-hospital mortality than those infected with non-MDR bacteria. CONCLUSIONS Among pediatric patients, the CPSS group and CNSS group did not show significant differences in clinical features and mortality. Among the CPSS group, those with MDR bacteria had poorer prognosis.

BACKGROUND Women's decision-making autonomy has a potential impact on the scale-up of health care utilization. In high fertility countries, evidence regarding women's decision-making autonomy on their health care utilization and its associated factors is limited and inconclusive. Hence, it is important to investigate women decision-making autonomy on their health care utilization and associated factors in high fertility countries in sub-Saharan Africa. METHODS The data source for this study was obtained from recent Demographic and Health Surveys that were comprised of a weighted sample of 178875 reproductive age women. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios, along with the 95% confidence interval were generated to identify individual and community-level factors associated with women's autonomy in health care decision-making. A p-value less than 0.05 was declared as statistical significance. RESULTS In this study, 42% (95% CI: 41.7, 42.3) of women were able to exercise their reproductive autonomy. The highest (74.8%) and the lowest (19.74%) magnitude of women autonomy was found in Angola and Mali, respectively. In multilevel analysis; age of women 25-34 years, 35 and above (AOR = 1.34, 95% CI: 1.29, 1.39), and (AOR = 1.78, 95% CI: 1.75, 1.90), women's primary and secondary educational level (AOR = 1.25, 95% CI: 1.20, 1.31), and (AOR = 1.44, 95% CI: 1.32, 1.54), husband primary and secondary educational level (AOR = 1.24, 95% CI: 1.18, 1.29), and (AOR = 1.21, 95% CI: 1.15, 1.27), women who had work (AOR = 1.67, 95% CI: 1.59, 1.74) female household heads (AOR = 1.44, 95% CI: 1.37, 1.51), media exposure (AOR = 1.04, 95% CI: 1.09, 1.18), health insurance coverage (AOR = 1.26, 95% CI: 1.17, 1.36), urban residence (AOR = 1.14, 95% CI: 1.09, 1.19), community education (AOR = 2.43, 95% CI: 2.07, 2.85) and low community poverty level (AOR = 1.27, 95% CI: 1.08, 1.49) were predictor variables. CONCLUSION AND RECOMMENDATION Although every woman has the right to make her own health care decisions, this study showed that almost 58% of them had no role in making decisions about their health care utilization. Thus, each country Government should support women's decision making autonomy regarding their healthcare utilization through mass media and extensive behavioral education.

BACKGROUND Intensive care units are directly associated with the competency level of nurses and are units where ethical problems are frequently experienced. This research aims to determine the relationship between intensive care nurses' ethical attitudes and holistic competence levels. METHODS This study was conducted as a cross-sectional design using self-report questionnaires distributed to 131 intensive care nurses in Turkey. The data of the study were collected with the "Nurses Information Form," "Holistic Nursing Competence Scale" and "Ethical Attitude Scale for Nursing Care". RESULTS The total mean score of the Holistic Nursing Competence of the nurses was 6.89±0.95. Holistic Nursing Competence level was significantly lower for those who had experienced less than one year in the profession, and it was higher for those who worked in the emergency intensive care unit and the nurses whose clinics had 21 and above nurses. The total mean score of the nurses' ethics attitude toward nursing care was 59.36±29.09. Ethical Attitude for Nursing Care was significantly lower for those who had a master's degree, and the nurses whose clinics had 21 and above nurses scored higher. There was a weak and negative correlation between the nurses' Holistic Nursing Competence Scale and the total mean score of the Ethical Attitude Scale for Nursing Care. The ethical attitude was predicted in 13.2% of the Holistic Nursing Competence of nurses. CONCLUSIONS It was concluded that nurses' holistic competence levels were high, their ethical attitudes were negative, and there was a weak negative correlation between their holistic competence levels and their ethical attitudes toward care.

The COVID-19 pandemic has led to substantial lifestyle changes worldwide, contributing to heightened psychological stressors such as depression and anxiety. The demands of parental care have also intensified, increasing the risk of caregiver burnout and potential child maltreatment. This study aimed to evaluate the efficacy and feasibility of implementing distance laughter therapy for mothers caring for young children during the pandemic, with a focus on mitigating depression, anxiety, and parental stress. Utilizing a pilot randomized controlled design, 22 participants were divided into two groups-experimental and control groups-and underwent four virtual sessions over two weeks. The experimental group engaged in distance laughter therapy, a technique designed to stimulate self-induced laughter, while the control group viewed a 50-minute entertainment TV show. Both groups experienced a significant decrease in depression and anxiety; however, only the experimental group experienced a significant reduction in parental stress. Nonetheless, the differences in outcomes between the groups were not statistically significant. Participants who engaged in distance laughter therapy reported positive changes across physical, emotional, social, self-perception, and stress-coping domains in exit interviews. Therefore, laughter therapy has an additional benefit of reducing parental stress, which may be particularly useful for mothers primarily responsible for childcare during the pandemic. Future research should investigate the effects of laughter on broader populations and settings and quantify the actual amount of laughter generated.

BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.

OBJECTIVE To gain better understanding of osteoarthritis (OA) heterogeneity and its predictors for distinguishing OA phenotypes. This could provide the opportunity to tailor prevention and treatment strategies and thus improve care. DESIGN Ten year follow-up data from CHECK (1002 early-OA subjects with first general practitioner visit for complaints ≤6 months before inclusion) was used. Data were collected on WOMAC (pain, function, stiffness), quantitative radiographic tibiofemoral (TF) OA characteristics, and semi-quantitative radiographic patellofemoral (PF) OA characteristics. Using functional data analysis, distinctive sets of trajectories were identified for WOMAC, TF and PF characteristics, based on model fit and clinical interpretation. The probabilities of knee membership to each trajectory were used in hierarchical cluster analyses to derive knee OA phenotypes. The number and composition of potential phenotypes was selected again based on model fit (silhouette score) and clinical interpretation. RESULTS Five trajectories representing different constant levels or changing WOMAC scores were identified. For TF and PF OA, eight and six trajectories respectively were identified based on (changes in) joint space narrowing, osteophytes and sclerosis. Combining the probabilities of knees belonging to these different trajectories resulted in six clusters ('phenotypes') of knees with different degrees of functional (WOMAC) and radiographic (PF) parameters; TF parameters were found not to significantly contribute to clustering. Including baseline characteristics as well resulted in eight clusters of knees, dominated by sex, menopausal status and WOMAC scores, with only limited contribution of PF features. CONCLUSIONS Several stable and progressive trajectories of OA symptoms and radiographic features were identified, resulting in phenotypes with relatively independent symptomatic and radiographic features. Sex and menopausal status may be especially important when phenotyping knee OA patients, while radiographic features contributed less. Possible phenotypes were identified that, after validation, could aid personalized treatments and patients selection.

Authenticity and traceability are essential for modern food and medicine inspection, and reliable techniques are important for the trade of halal foods, which reach more than 20 percent of the world market. A sensitive and accurate porcine detection method is required to develop a conformity assessment system that includes laboratory testing for porcine-free certification. This study proposes a procedure that could be incorporated into the development of a standardized control and protocol for real-time PCR (qPCR) methods and their traceability using droplet digital PCR (ddPCR). The design used a recombinant pUC57 plasmid as an amplification target to carry the 97 bp fragment of the porcine ATCB gene. The absolute quantification and linearity assessment showed high precision with R2 values of 0.9971 and 0.9998 for qPCR and ddPCR, respectively. In general, both methods showed comparable results in terms of linearity and detection limit. However, both limit of detection assessments showed high sensitivity, although ddPCR showed a slightly higher sensitivity than that of qPCR, especially at low DNA concentrations. Multiple-sample and inter-participatory testing evaluations revealed a high sensitivity, broad applicability, and robustness of the qPCR method. Therefore, we conclude that based on a recombinant plasmid analysis with a low quantity (less than five copy number), the digital PCR method produced more reliable results. These results could provide scientific information for regulatory authorities, especially those in Indonesia, to consider the development and formulation of a well-established qPCR protocol for porcine detection using expected DNA concentrations.

Biofilms are formed by microorganisms and their products on the surface of materials such as medical devices. Biofilm formation protects microorganisms from antimicrobial agents. Bacteria and fungi often form dual-species biofilms on the surfaces of medical devices in clinical settings. An experimental system to evaluate in vivo biofilm formation by the pathogenic fungus Candida albicans was established using silkworms inserted with polyurethane fiber (PF), a catheter material. In the present study, we established an in vivo experimental system using silkworms to evaluate the antimicrobial tolerance of Escherichia coli in single- and dual-species biofilms formed on the surface of the PF. The injection of E. coli into the PF-inserted silkworms led to the formation of a biofilm by E. coli on the surface of the PF. E. coli in the biofilm exhibited tolerance to meropenem (MEPM). Furthermore, when E. coli and C. albicans were co-inoculated into the PF-inserted silkworms, a dual-species biofilm formed on the surface of the PF. E. coli in the dual-species biofilm with C. albicans was more tolerant to MEPM than E. coli in the single-species biofilm. These findings suggest the usefulness of an in vivo experimental system using PF-inserted silkworms to investigate the mechanisms of MEPM tolerance in E. coli in single- and dual-species biofilms.

BACKGROUND Most adults in the UK experience at least one viral respiratory tract infection (RTI) per year. Individuals with comorbidities and those with recurrent RTIs are at higher risk of infections. This can lead to more severe illness, worse quality of life and more days off work. There is promising evidence that using common nasal sprays or improving immune function through increasing physical activity and managing stress, may reduce the incidence and severity of RTIs. METHODS AND DESIGN Immune Defence is an open, parallel group, randomised controlled trial. Up to 15000 adults from UK general practices, with a comorbidity or risk factor for infection and/or recurrent infections (3 or more infections per year) will be randomly allocated to i) a gel-based nasal spray designed to inhibit viral respiratory infections; ii) a saline nasal spray, iii) a digital intervention promoting physical activity and stress management, or iv) usual care with brief advice for managing infections, for 12 months. Participants will complete monthly questionnaires online. The primary outcome is the total number of days of illness due to RTIs over 6 months. Key secondary outcomes include: days with symptoms moderately bad or worse; days where work/normal activities were impaired; incidence of RTI; incidence of COVID-19; health service contacts; antibiotic usage; beliefs about antibiotics; intention to consult; number of days of illness in total due to respiratory tract infections over 12 months. Economic evaluation from an NHS perspective will compare the interventions, expressed as incremental cost effectiveness ratios. A nested mixed methods process evaluation will examine uptake and engagement with the interventions and trial procedures. TRIAL STATUS Recruitment commenced in December 2020 and the last participant is expected to complete the trial in April 2024. DISCUSSION Common nasal sprays and digital interventions to promote physical activity and stress management are low cost, accessible interventions applicable to primary care. If effective, they have the potential to reduce the individual and societal impact of RTIs. TRIAL REGISTRATION Prospectively registered with ISRCTN registry (17936080) on 30/10/2020. SPONSOR This RCT is sponsored by University of Southampton. The sponsors had no role in the study design, decision to publish, or preparation of the manuscript.

INTRODUCTION Adequate peri-operative care is essential to ensuring a satisfactory outcome in cardiac surgery. In this study, we look at the impact of evidence-based protocols implemented at Stanford Hospital. METHODS This study is a single-center, retrospective analysis. Enhanced recovery after surgery (ERAS) protocols were implemented for CABG/Valve and open Aortic operations on 11/1/2017 and 6/1/2018, respectively. Propensity-score matched analysis was used to compare 30-day mortality and morbidity of patients from the pre- and post-implementation cohorts. Secondary endpoints included the following: total hospital length of stay (LOS), ICU LOS, time until extubation, and time until urinary catheter removal. RESULTS After the implementation of the ERAS protocols for CABG/Valve operations, the median post-op LOS decreased from 7.0 days to 6.1 days (p<0.001), and median ICU LOS decreased from 69.9 hours to 54.0 (p = 0.098). There was no significant decrease in 30-day mortality (4% to 3.3%, p = 0.47). However, the incidence of post-op ventilator associated pneumonia (VAP) decreased from 5.0% to 2.1% (p = 0.003) and post-op urinary tract infections (UTIs) from 8.3% to 3.6% (p<0.001). Patients who underwent open aortic procedures experienced an improvement in 30-day mortality (7% to 3.5%, p = 0.012), decrease in median ICU LOS (91.7 hours to 69.6 hours, p<0.001), and a decrease in duration of mechanical ventilation (79.3 hours to 46.3 hours, p = 0.003). There was a decrease in post-op LOS, post-op VAP, and post-op UTI, although statistical significance was not attained. CONCLUSION At Stanford Hospital, ERAS pathways have led to decreased morbidity and LOS while simultaneously improving mortality amongst our critically ill patient population.

Interruptions are a part of our everyday lives. They are inevitable in complex societies, especially when many people move from one place to another as a part of their daily routines. The main aim of this research is to understand the effects of interruptions on individuals from a psychological and crowd dynamics perspective. Two studies were conducted to investigate this issue, with each focusing on different types of interruptions and examining their psychological (emotion, motivation, arousal) and physiological (heart rate) components. Study 1 examined interruptions in a video game setting and systematically varied goal proximity (N = 61). It was hypothesized that being interrupted in the later stages of goal pursuit would create a high aroused impatience state, while interruptions in the earlier stages would produce a low aroused boredom state. However, the results showed that the hypothesized groupwise differences were not observed. Instead, interruptions created annoyance in all conditions, both psychologically and physiologically. Study 2 investigated interruptions in pedestrian crowds (N = 301) and used a basic motivational dichotomy of high and low motivation. In the experiments, crowds (80-100 participants) were asked to imagine that they were entering a concert hall consisting of a narrow bottleneck. The low motivation group reported feeling bored during the interruption, while the high motivation group reported feeling impatient. Additionally, a motivational decrease was observed for the high motivation group due to the interruption. This drop in motivation after the interruption is also reflected in the measured density (person/m2) in front of the bottleneck. Overall, both studies showed that interruption can have significant effects on individuals, including psychological and physiological impacts. The observed motivational decrease through interruption is particularly relevant for crowd management, but further investigation is needed to understand the context-specific effects of interruptions.

Access to basic sanitation is a human right and a critical environmental determinant of health. In this paper, we detail the development of three tools to investigate sanitation justice: (1) our public restroom spatial database, (2) our field assessment tool, and (3) survey of restroom access experiences. We document our process to collect these data in a consistent, health equity-driven framework. Together, these tools comprise a suite of methods for the examination of public restrooms from the macro- to the micro-level, and highlight key opportunities to promote health and well-being among restroom-reliant populations (e.g., people experiencing homelessness) by advancing sanitation justice in the built environment. With an illustrative case study, we demonstrate how methods triangulation, using the tools in concert, can provide a comprehensive assessment of basic sanitation access in a given region-San Diego, CA. We also detail how each tool can also be used separately to assess key sanitation justice and health equity questions that may be of interest to researchers, public health practitioners, policymakers, and advocates, including: (1) where do public restrooms exist (mapping)?; (2) how accessible are public restroom facilities, and what health-supportive features do they have (field assessment)?; and (3) what are the experiences of people most reliant on the available public restroom facilities (survey)? The results of our case study demonstrate that these adaptable tools can be used to provide meaningful data on and a holistic picture of public restroom quantity, quality, accessibility, and the experiences of public restroom users in a given region.

PURPOSE The aim of this study was to investigate the association between methionine (MET) metabolism and endocrine function of the pituitary gland in patients with suprasellar region tumor. MATERIALS AND METHODS Twenty patients with intracranial germinoma were included in this study. Initial staging and all surveillance MET PET/CT scans and comparable serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), and thyroid stimulating hormone (TSH) were analyzed. The patients were divided into two groups according to tumor location, with tumors in the suprasellar region (condition) or not (control). MET uptake of the pituitary gland (i.e., SUVR [standardized uptake value ratio]) and levels of FSH, LH, TSH were compared in the condition and control groups and in the before and after treatment phases of each group. RESULTS The SUVR in the control group was like that found in normal pituitary glands in previous studies, whereas the SUVR of the untreated condition group was high and that of treated condition group was low with significance compared to the control group. Serum levels of pituitary hormones in before and after treatment condition groups were significantly lower than those in the control group. The FSH and LH levels of curatively treated patients in the control group were positively correlated with SUVR with respective ß values of 3.71 and 0.98 (p < .001). The TSH level of the treated condition group was negatively correlated with SUVR (ß = -1.02, p < .001). CONCLUSION This study is the first known investigation to examine the association between MET metabolism and endocrine function of the pituitary gland, and it confirmed that MET metabolism reflects endocrine function. A future study validating the result of correlation analysis is warranted.

In recent years, China's sub-healthy and aging populations have increased dramatically, giving rise to a series of health and wellness needs. People prefer health and wellness tourism activities instead of sightseeing tourism activities because of the increasing emphasis on safety and experience. Health and wellness tourism resources are a prerequisite for the development of health and wellness tourism. To critically reflect on China's official tourism resource evaluation criteria, expert consultation was carried out by applying the Delphi method, and index weights were determined using the analytic hierarchy process. Through three rounds of expert consultation, a value evaluation system for health and wellness tourism resources was established and improved in three aspects: construction of an index system, selection of evaluation subjects, and grade discourse description, thus enhancing the feasibility and application value of the evaluation system. The system developed in this study not only enables a reflection on China's official tourism resource evaluation criteria, but also presents a new approach in the value evaluation research of health and wellness tourism resources.

The biogenesis of ribosomes requires tightly controlled transcription and processing of pre-rRNA which comprises ribosomal RNAs forming the core of large and small ribosomal subunits. Early steps of the pre-rRNA processing and assembly of the ribosomal subunits require a large set of proteins that perform folding and nucleolytic cleavage of pre-rRNAs in the nucleoli. Structure and functions of proteins involved in the pre-rRNA processing have been extensively studied in the budding yeast S. cerevisiae. Functional characterization of their human homologues is complicated by the complexity of mammalian ribosomes and increased number of protein factors involved in the ribosomal biogenesis. Homologues of human nucleolar protein SURF6 from yeast and mouse, Rrp14 and Surf6, respectively, had been shown to be involved in the early steps of pre-rRNA processing. Rrp14 works as RNA chaperone in complex with proteins Ssf1 and Rrp15. Human SURF6 knockdown and overexpression were used to clarify a role of SURF6 in the early steps of pre-rRNA processing in human cell lines HeLa and HTC116. By analyzing the abundance of the rRNA precursors in cells with decreased level or overexpression of SURF6, we demonstrated that human SURF6 is involved in the maturation of rRNAs from both small and large ribosomal subunits. Changes in the SURF6 level caused by knockdown or overexpression of the protein do not result in the death of HeLa cells in contrast to murine embryonic fibroblasts, but significantly alter the distribution of cells among the phases of the cell cycle. SURF6 knockdown in both p53 sufficient and p53 deficient HCT116 human cancer cells results in elongation of G0/G1 and shortening of G2/M phase. This surprising result suggests p53 independence of SURF6 effects on the cell cycle and possible multiple functions of SURF6. Our data point to the shift from pathway 1 to pathway 2 of the rRNA biogenesis caused by the SURF6 knockdown and its likely association with p53 pathway.

Optimizing the spatial layout of high-quality tourist attractions is of great significance in the sustainable development of the tourism industry. This work employs the ArcGIS spatial analysis tool to study the form, equality, and density of the spatial distribution of the 892 3A+ tourist attractions (high-quality tourist attractions hereafter) in Shandong Province, China. It also examines the factors influencing the spatial distribution of tourist attractions from the perspectives of geographic features and landscapes, culture and heritage, socioeconomic development, and transportation. We therefore find the following: 1) High-quality tourist attractions in Shandong Province have obvious clustering in spatial distribution with the high-density areas mainly concentrated in Qingdao, Jining, Jinan, Tai'an and other cities. Influenced by resource endowment and economic development, the two major geographical areas in Central Shandong and Jiaodong Peninsula have the most concentrated distribution of high-quality tourist attractions. 2) The distribution of high-quality tourist attractions shows a southwest‒northeast clustering direction; Qingdao is a high-high clustering area, and Heze is a low-high clustering area with low uniformity of spatial distribution and obvious spatial divergence. 3) Tourist attractions show an obvious "N" type high-density distribution belt and nuclear density distribution across the three existing agglomeration centers in the Jining-Tai'an intersection, Binzhou-Dongying intersection, and Qingdao Jiaozhou Bay coast. 4) Topography, climate conditions, history and culture are intrinsic factors affecting the spatial distribution of tourist attractions, while socioeconomic and transportation conditions are external requirements for the development thereof; collectively, they constrain the spatial distribution of high-quality tourist attractions.

Physical literacy is a multidimensional construct that has been defined and interpreted in various ways, one of the most common being "the motivation, confidence, physical competence, knowledge and understanding to maintain physical activity throughout the life course". Although its improvement can positively affect many behavioral, psychological, social, and physical variables, debate remains over an appropriate method of collecting empirical physical literacy data. This systematic review sought to identify and critically evaluate all primary studies (published and unpublished, regardless of design or language) that assessed physical literacy in adults or have proposed measurement criteria. Relevant studies were identified by searching four databases (Pubmed, SportDiscus, APA PsycINFO, Web of Science), scanning reference lists of included articles, and manual cross-referencing of bibliographies cited in prior reviews. The final search was concluded on July 15, 2022. Thirty-one studies, published from 2016 to 2022, were analyzed. We found seven instruments measuring physical literacy in adults, of which six were questionnaires. The Perceived Physical Literacy Instrument was the first developed for adults and the most adopted. The included studies approached physical literacy definition in two ways: by pre-defining domains and assessing them discretely (through pre-validated or self-constructed instruments) and by defining domains as sub-scales after factorial analyses. We found a fair use of objective and subjective measures to assess different domains. The wide use of instruments developed for other purposes in combined assessments suggests the need for further instrument development and the potential oversimplification of the holistic concept, which may not result in a better understanding of physical literacy. Quality and usability characteristics of measurements were generally insufficiently reported. This lack of data makes it impossible to compare and make robust conclusions. We could not identify if any of the existing physical literacy assessments for adults is appropriate for large-scale/epidemiological studies.