Improved Study Design Research Articles

Mesenchymal stromal cells for bone trauma, defects, and disease: Considerations for manufacturing, clinical translation, and effective treatments

Bone is a complex tissue capable of natural repair to injury, however, the healing process is often impaired by the untoward effects of trauma, defects, and disease. Thus, therapeutic modalities, including the use of cells involved in the body's natural healing processes, are investigated to promote or complement natural bone repair. Herein, several modalities and innovative approaches for using mesenchymal stromal cells (MSCs) to treat bone trauma, defects, and diseases are discussed. Given the evidence that supports the promising potential of MSCs, we highlight important considerations for advancing the clinical use of MSCs including the standardization of procedures from the harvest to delivery to patients and realized solutions to manufacturing. A better understanding of the current approaches implemented to address the challenges of using therapeutic MSCs will help improve study designs and, ultimately, achieve effective outcomes for restoring bone health.

Cross-Sectional Associations of Lifestyle Behaviors with Depressive Symptoms in Adolescents

This study aimed to examine the associations between lifestyle behaviors and depressive symptoms in adolescents. Self-reported data from the 2019 Youth Risk Behavior Survey (YRBS) was analyzed. Depressive symptoms were set as the outcome variable. Movement variables (physical activity, muscle-strengthening exercise, physical education attendance, sports team participation, television watching, video or computer games, and sleep), eating behaviors (fruit intake, vegetable intake, milk intake, and eating breakfast or not), and substance use (alcohol use and cigarette use) were included as explanatory variables. Binary logistic regression was used to explore the associations between lifestyle behaviors and depressive symptoms after adjusting for sex, age, grade, race, and weight status. Of 13,677 participants who completed the investigation, girls were more than boys (50.3% vs. 48.6%). The proportion of participants in grades 9, 10, 11, and 12 was 26.6, 27.2, 24.3, and 20.8, respectively. Of them, the prevalence of depressive symptoms was 36.0% (weighted%: 36.7% [35.1%, 38.3%]). Among all the lifestyle behaviors included, participating in no sports teams (OR = 1.53 [1.32, 1.77]), spending more than 2 h in video or computer games (OR = 1.64 [1.40, 1.92]), sleeping less than 8 h nightly (OR = 1.79 [1.45, 2.20]), not eating breakfast (OR = 1.56 [1.37, 1.78]), alcohol use (OR = 1.74 [1.49, 2.02]), and cigarette use (OR = 1.83 [1.42, 2.37]) were associated with higher odds of depressive symptoms. To reduce depressive symptoms in adolescents, interventions can consider encouraging adolescents to engage in team sports activity, limit time for video or computer games, sleep enough, regularly eat breakfast, and avoid using alcohol and cigarette. Future studies are encouraged to verify our research findings by using a more improved study design.

Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review

Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.

Designing Field Experiments to Integrate Research on Costs

Although experimental evaluations have been labeled the “gold standard” of evidence for policy (U.S. Department of Education, 2003), evaluations without an analysis of costs are not sufficient for policymaking (Monk, 1995; Ross et al., 2007). Funding organizations now require cost-effectiveness data in most evaluations of effects. Yet, there is little guidance on how to integrate research on costs into efficacy or effectiveness evaluations. As a result, research proposals and papers are disjointed in the treatment of costs, implementation, and effects, and studies often miss opportunities to integrate what is learned from the cost component into what is learned about effectiveness. To address this issue, this paper uses common evaluation frameworks to provide guidance for integrating research on costs into the design of field experiments building on the ingredients method (Levin et al., 2018). The goal is to improve study design, resulting in more cohesive, efficient, and higher-quality evaluations.

Prognostic and Predictive Biomarkers in Head and Neck Squamous Cell Carcinoma Treated with Radiotherapy-A Systematic Review.

Background: Radiotherapy is a mainstay in head and neck squamous cell carcinoma (HNSCC) treatment but is mostly applied without stratification by molecular diagnostics. Development of reliable biomarkers may have the potential to improve radiotherapy (RT) efficacy and reduce toxicity. We conducted a systematic review to summarize the field of biomarkers in HNSCC treated by RT. Methods: Pubmed and EMBASE were searched independently by two researchers following pre-defined inclusion and exclusion criteria. Z curves were generated to investigate publication bias. OncoKB was used for identification of druggable targets. Results: 134 manuscripts remained for data extraction. 12% of tumors were AJCC/UICC stage I-II and 82% were stage III-IV. The most common biomarkers were proteins (39%), DNA (14%) and mRNA (9%). Limiting analysis to prospective data and statistically significant results, we found three potentially druggable targets: ERCC2, PTCH1 and EGFR. Regarding data quality, AJCC/UICC stage was missing in 32% of manuscripts. 73% of studies were retrospective and only 7% were based on prospective randomized trials. Z-curves indicated the presence of publication bias. Conclusion: An abundance of potential biomarkers in HNSCC is available but data quality is limited by retrospective collection, lack of validation and publication bias. Improved study design and reporting quality might accelerate successful development of personalized treatments in HNSCC.

Cellular Therapeutics for Chronic Wound Healing: Future for Regenerative Medicine.

Chronic wounds are associated with significant morbidity and mortality, which demand long-term effective treatment and represent a tremendous financial strain on the global healthcare systems. Regenerative medicines using stem cells have recently become apparent as a promising approach and are an active zone of investigation. They hold the potential to differentiate into specific types of cells and thus possess self-renewable, regenerative, and immune-modulatory effects. Furthermore, with the rise of technology, various cell therapies and cell types such as Bone Marrow and Adipose-derived Mesenchymal Cell (ADMSC), Endothelial Progenitor Cells (EPCs), Embryonic Stem Cells (ESCs), Mesenchymal Stem Cell (MSCs), and Pluripotent Stem Cells (PSCs) are studied for their therapeutic impact on reparative processes and tissue regeneration. Cell therapy has proven to have substantial control over enhancing the quality and rate of skin regeneration and wound restoration. The literature review brings to light the mechanics of wound healing, abnormalities resulting in chronic wounds, and the obstacles wound care researchers face, thus exploring the multitude of opportunities for potential improvement. Also, the review is focused on providing particulars on the possible cell-derived therapeutic choices and their associated challenges in healing, in the context of clinical trials, as solutions to these challenges will provide fresh and better future opportunities for improved study design and therefore yield a substantial amount of data for the development of more specialized treatments.

Comparative modelling of inspiratory airflow and micron particle deposition patterns in monkey and human nasal airways

Laboratory animals have historically performed a vital function in evaluating health effects of human exposure to ambient particulate matter (PM). Due to the complexity of particle-laden flows and airway interactions that involve multiple species, in-depth knowledge of airflow and particle transport in both the non-human primate surrogates and human airways is still lacking. To advance the understanding in this field, this paper presents a numerical study that investigated the airflow and particle deposition characteristics of inhaled PMs in monkey and human nasal airways. Anatomically accurate macaca fuscata monkey and human nasal cavity models were reconstructed from CT images, micron particles with diameters less than 10 μm were included to conduct in silico exposure studies. Resultant particle deposition patterns were quantified by deposition enhancement factor (DEF) and deposition intensity (DI) along the airways to provide profound understanding of the similarities and differences in particle inhalation exposure characteristics across species. Anatomy comparison showed that the convoluted nasal passage of the monkey airway possessed higher level of complexity in terms of the surface-area-to-volume ratio compared to the two human nasal models, which could lead to higher evaluated nasal exposure to airborne particulate matter. Similar airflow patterns were observed from streamlines and wall shear stress distributions in all three nasal cavities of two species, with bulk air concentrated mainly in the middle and inferior meatuses in the nasal chambers. Despite the evidenced inter-subject deposition variations presented in all considered nasal cavity models, strong and similar micron particle deposition preferences with comparable DEF and DI levels were observed along the floor region of middle and inferior meatuses for both species. The methods and research findings presented in this work represent critical, initial steps towards establishing high-fidelity qualitative and quantitative linkages between the two species that enable more effective laboratory data extrapolations, improve study design, and facilitate validations of in vitro techniques currently being developed as part of international efforts to reduce or replace the use of animals in toxicity assessments for aerosol exposures.

Evaluation of motor vehicle crashes between scooter riders and car drivers after diagnosis of type 2 diabetes in Taiwan

BackgroundDespite the plausibility that diabetes may increase the risk of motor vehicle crashes (MVCs) due to various diabetes related complications and co-morbidity, findings from epidemiological studies on the relationship between diabetes and MVCs remained inclusive mainly due to heterogeneity in the study design and failure to complete consideration of potential confounders. This study re-visited this putative association with an improved study design. MethodThis study employed a controlled before–after study design and included 1,264,280 people aged 18–75 years with T2D newly diagnosed from 2009–2014 and an equal number of age-, sex-, and time-matched controls. The rate ratios (RRs) of vehicle type–specific incidence rates of MVCs in the 1 and 2 years before and after diabetes diagnosis (or the matched dates) were compared between the individuals with type 2 diabetes (T2D) and their matched controls. ResultsThe rate of MVCs increased slightly among people with T2D over 1 and 2 years following diabetes diagnosis, with RRs of 1.04 (95% confidence interval [CI]=1.02–1.07) and 1.11 (95% CI=1.09–1.13), respectively. These RRs were comparable to those obtained for controls (1.06 and 1.12, respectively). By contrast, the RRs of scooter crashes were significantly higher in the T2D group than in the control group during the 1 year (1.28 vs. 1.08, p < 0.001) and 2 years (1.32 vs. 1.08, p < 0.001) following diabetes diagnosis. Conclusion: T2D diagnosis was associated with a moderate but significant increase in the risk of MVCs among scooter drivers, but not among car drivers.

Couple-Based Behavioral HIV Interventions by the Social Intervention Group: Progress, Gaps, and Future Directions

Purpose: This paper reports a review of couple-based behavioral HIV interventions conducted by the Social Intervention Group (SIG); and addresses gaps, future directions, and implications for couple-based HIV interventions. Method: We performed a literature review for SIG research on intervention and prevention studies involving couples/partners. Results: We identified nine couple-based interventions. Outcomes included reduced sexual and substance use-related risk behaviors and improved use of anti-retroviral treatment. We conducted these studies in diverse venues, including needle/syringe exchange programs, primary care clinics, and criminal justice settings. Conclusions: The findings of this review provide strong evidence for the efficacy of couple-based HIV interventions in reducing sexual HIV risks and linkage to HIV and substance-use treatment. SIG has advanced couple-based HIV intervention research science by improving study design, intervention core components, conceptual models, and implementation strategies; which have informed scientific directions and transformed couple-based HIV prevention research.

Methodological Considerations for Investigating Iron Status and Regulation in Exercise and Sport Science Studies.

Iron deficiency is a common health issue in active and athlete populations. Accordingly, research into iron status, regulation, absorption, and iron deficiency treatment strategies is increasing at a rapid rate. However, despite the increase in the quantity of research, various methodological issues need to be addressed as we progress our knowledge in this area. The purpose of this review is to highlight specific considerations for conducting iron-related research in active and athlete populations. First, we discuss the methodological importance of assessment and interpretation of iron status, with reference to blood collection protocols, participant screening procedures, and biomarker selection. Next, we consider numerous variables that should be accounted for in the design of iron-related research studies, such as the iron regulatory hormone hepcidin and its interaction with exercise, in addition to an examination of female physiology and its impact on iron metabolism. Subsequently, we explore dietary iron and nutrient interactions that impact iron regulation and absorption, with recommendations made for optimal methodological control. Consideration is then given to key features of long-term study designs, such as the monitoring of training load, oral iron supplementation, dietary analysis, and general lifestyle factors. Finally, we conclude our recommendations with an exploration of stable iron isotope tracers as a methodology to measure iron absorption. Ultimately, it is our intention that this review can be used as a guide to improve study design, biomarker analysis, and reporting of findings, to maximize the quality of future research outputs in iron-related research focused on active and athlete populations.

The STAGED-PKD 2-Stage Adaptive Study With a Patient Enrichment Strategy and Treatment Effect Modeling for Improved Study Design Efficiency in Patients With ADPKD

Rationale & ObjectiveVenglustat, a glucosylceramide synthase inhibitor, inhibits cyst growth and reduces kidney failure in mouse models of autosomal dominant polycystic kidney disease (ADPKD). STAGED-PKD aims to determine the safety and efficacy of venglustat and was designed using patient enrichment for progression to end-stage kidney disease and modeling from prior ADPKD trials.Study DesignSTAGED-PKD is a 2-stage, international, double-blind, randomized, placebo-controlled trial in adults with ADPKD (Mayo Class 1C-1E) and estimated glomerular filtration rate (eGFR) 45-<90 mL/min/1.73 m2 at risk of rapidly progressive disease. Enrichment for rapidly progressing patients was identified based on retrospective analysis of total kidney volume (TKV) and eGFR slope from the combined Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease and HALT Progression of Polycystic Kidney Disease A studies.Setting & ParticipantsTarget enrollment in stages 1 and 2 was 240 and 320 patients, respectively.InterventionsStage 1 randomizes patients 1:1:1 to venglustat 8 mg or 15 mg once daily or placebo. Stage 2 randomizes patients 1:1 to placebo or venglustat, with the preferred dose based on stage 1 safety data.OutcomesPrimary endpoints are TKV growth rate over 18 months in stage 1 and eGFR slope over 24 months in stage 2. Secondary endpoints include: annualized rate of change in eGFR from baseline to 18 months (stage 1); annualized rate of change in TKV based on magnetic resonance imaging from baseline to 18 months (stage 2); and safety, tolerability, pain, and fatigue (stages 1 and 2).LimitationsIf stage 1 is unsuccessful, patients enrolled in the trial may develop drug-related adverse events that can have long-lasting effects.ConclusionsModeling allows the design and powering of a 2-stage combined study to assess venglustat’s impact on TKV growth and eGFR slope. Stage 1 TKV assessment via a nested approach allows early evaluation of efficacy and increased efficiency of the trial design by reducing patient numbers and trial duration.FundingThis study was funded by Sanofi.Trial registrationSTAGED-PKD has been registered at ClinicalTrials.gov with study number NCT03523728.

Risk Stratification in Noninvasive Respiratory Support Failure: A Narrative Review

The use of noninvasive respiratory support, including noninvasive ventilation and high-flow nasal cannula therapy, has increased over the years. Failure of noninvasive respiratory support, defined as the need for invasive mechanical ventilation, increases the mortality rate. To familiarize critical care nurses with available risk stratification assessments and identify common concepts and limitations. Few risk stratification assessments are available to identify patients at risk of failure of noninvasive respiratory support. Although many studies have analyzed risk, substantial variation in study design, definitions, terminology, and outcomes have led to a wide range of findings, making clinical application difficult. Further study is needed to broaden known assessments to general patient populations, determine diagnostic accuracy during critical periods, and analyze noninvasive ventilation and high-flow nasal cannula therapy. Risk stratification could allow for better implementation of preventive strategies and patient education. Future research opportunities include improving study design for risk stratification and implementing preventive strategies for patients requiring noninvasive respiratory support. Clinically, risk stratification can provide an opportunity to share knowledge and facilitate conversations with patients and families.

Improving the design and implementation of sediment fingerprinting studies: summary and outcomes of the TRACING 2021 Scientific School.

PurposeIdentifying best practices for sediment fingerprinting or tracing is important to allow the quantification of sediment contributions from catchment sources. Although sediment fingerprinting has been applied with reasonable success, the deployment of this method remains associated with many issues and limitations.MethodsSeminars and debates were organised during a 4-day Thematic School in October 2021 to come up with concrete suggestions to improve the design and implementation of tracing methods.ResultsFirst, we suggest a better use of geomorphological information to improve study design. Researchers are invited to scrutinise all the knowledge available on the catchment of interest, and to obtain multiple lines of evidence regarding sediment source contributions. Second, we think that scientific knowledge could be improved with local knowledge and we propose a scale of participation describing different levels of involvement of locals in research. Third, we recommend the use of state-of-the-art sediment tracing protocols to conduct sampling, deal with particle size, and examine data before modelling and accounting for the hydro-meteorological context under investigation. Fourth, we promote best practices in modelling, including the importance of running multiple models, selecting appropriate tracers, and reporting on model errors and uncertainty. Fifth, we suggest best practices to share tracing data and samples, which will increase the visibility of the fingerprinting technique in geoscience. Sixth, we suggest that a better formulation of hypotheses could improve our knowledge about erosion and sediment transport processes in a more unified way.ConclusionWith the suggested improvements, sediment fingerprinting, which is interdisciplinary in nature, could play a major role to meet the current and future challenges associated with global change.Supplementary informationThe online version contains supplementary material available at 10.1007/s11368-022-03203-1.

FACTORS ASSOCIATED WITH RESPONSE TO EXERCISE INTERVENTIONS IN ADULTS WITH SYMPTOMATIC KNEE OSTEOARTHRITIS - AN INDIVIDUAL PATIENT DATA NETWORK META-ANALYSIS

Purpose: Several modalities of structured exercise program, such as physical therapy, aerobic exercise, lower-limb strengthening exercises, and mind-body interventions including Tai Chi and yoga are recommended as core therapy for knee osteoarthritis. However, heterogeneity in treatment response is poorly understood. Identification of factors associated with response to exercise regimen would inform improved study design and interpretation of future research.

Lessons Learned About Designing and Conducting Studies From HRI Experts.

The field of human-robot interaction (HRI) research is multidisciplinary and requires researchers to understand diverse fields including computer science, engineering, informatics, philosophy, psychology, and more disciplines. However, it is hard to be an expert in everything. To help HRI researchers develop methodological skills, especially in areas that are relatively new to them, we conducted a virtual workshop, Workshop Your Study Design (WYSD), at the 2021 International Conference on HRI. In this workshop, we grouped participants with mentors, who are experts in areas like real-world studies, empirical lab studies, questionnaire design, interview, participatory design, and statistics. During and after the workshop, participants discussed their proposed study methods, obtained feedback, and improved their work accordingly. In this paper, we present 1) Workshop attendees’ feedback about the workshop and 2) Lessons that the participants learned during their discussions with mentors. Participants’ responses about the workshop were positive, and future scholars who wish to run such a workshop can consider implementing their suggestions. The main contribution of this paper is the lessons learned section, where the workshop participants contributed to forming this section based on what participants discovered during the workshop. We organize lessons learned into themes of 1) Improving study design for HRI, 2) How to work with participants - especially children -, 3) Making the most of the study and robot’s limitations, and 4) How to collaborate well across fields as they were the areas of the papers submitted to the workshop. These themes include practical tips and guidelines to assist researchers to learn about fields of HRI research with which they have limited experience. We include specific examples, and researchers can adapt the tips and guidelines to their own areas to avoid some common mistakes and pitfalls in their research.

An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study

BackgroundKnee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis.MethodsThis 9-week single-arm feasibility study recruited participants aged 40–85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval.ResultsForty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m−2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection.ConclusionThis study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis.Trial registrationACTRN12620000229976 prospectively on 25/2/2020.

Challenges and potential strategies utilizing external data for efficacy evaluation in small-sized clinical trials

ABSTRACT In clinical trials for diseases with very small patient populations, trial investigators may encounter recruitment difficulties. It can be challenging to conduct clinical trials with enough power to detect a treatment effect, and randomization may not be feasible due to timeline, budget, and ethical concerns. To bring breakthrough therapies to the market quickly, it is important to come up with efficient approaches to utilizing individual patient data through improved study design and sound statistical methods. Emerging topics in this area include the use of Bayesian approaches to flexibly incorporate prior information into the current clinical trials, the use of historical controls to efficiently conduct trials that will reduce the number of subjects recruited and ease ethical considerations, and the use of innovative study designs, such as a platform design, to improve the efficiency and speed of the medical therapy development progress. In this paper, we describe three scenarios which highlight some of the challenges encountered in small-sized clinical trial development and provide potential statistical approaches to overcome the aforementioned challenges.

The Association between Physical Education and Mental Health Indicators in Adolescents: A Cross-Sectional Study

Objective: To explore the associations between physical education attendance and mental health indicators. Methods: Using data from the Global Student Health Survey, the frequency of physical education attendance, suicidality-related indicators, loneliness, bullying, and anxiety were all assessed using a standardized self-reported questionnaire. Multivariable logistic regression was used to estimate the association between physical education attendance and mental health-related indicators. Results: The study included 276,169 participants from 71 countries (47.3% males, aged 11–18 years old). After controlling for sex, age, food insecurity, close friends, physical activity, sedentary time, others’ help, and parents’ understanding, physical education attendance was not signifi- cantly associated with suicidal attempts, suicidal ideation, and anxiety. However, compared with no physical education attendance, individuals attending physical education for 1, 2, as well as 5 or more days had significantly reduced odds/ratios of suicide; only 2 days of physical education attendance was associated with a lower odds ratio for suffering from loneliness. Even 1 day of physical education was associated with not being bullied by others. Conclusion: This study suggests that physical education attendance may not have an effective role in reducing mental health illnesses in children and adolescents. Future studies are encouraged to corroborate or negate our research discoveries by using better and further improved study designs.

Specific Types of Screen-Based Sedentary Time and Depressive Symptoms in Adolescents

Purpose: Screen-based sedentary behavior (SSB) has been identified as risk factor for mental disorders in most of adolescents. However, there is little literature pertaining to the specific kinds of SSB and its connections with depressive symptoms in most of adolescents. In the present study, we are going to find out the connections between specific types of SSB and depressive symptoms in Chinese adolescents. Methods: A cross-sectional data based on 996 study participants of middle school students in Guangdong Province. SSB was evaluated by distributing the questionnaire of Health Behavior in School-aged Children, while depressive symptoms were evaluated using Chinese version of Children’s Depressive symptoms Inventory (CDI). SSB was categorized into TV/movie time, video games time and other electronic devices-based time (e.g., mobile phone, computer use). Generalized linear models was used to explore the connections between specific kinds of SSB and depressive symptoms. Results: After controlling for variables of sex, ethnicity, grade, residence, siblings, perceived family affluence, father educational level, mother educational background, body mass index (BMI), physical exercise, duration of sleep, other electronic devices-based time was positively correlated with depressive symptoms in Chinese adolescents (B = 0.557%, 95%CI: 0.187–0.926, p = 0.003). This significant connection was also found in girls (B = 0.728%, 95%CI: 0.230–1.225, p = 0.004) instead of boys (p > 0.05). The other types of SSB were not significantly in relation to depressive symptoms in adolescents regardless of sex. Conclusion: This study suggested that it might be effective in reducing or preventing depressive symptoms through limiting electronic devices-based time, like computer use or mobile phone use time. This strategy would be particularly useful in girls. Future studies should negate or replicate the research results by introducing more improved study design, which is beneficial to better understand the connections between SSB and depressive symptoms as well as then design more efficient interventions in adolescents.

Understanding the dynamics of physiological changes, protein expression, and PFAS in wildlife.

Per- and polyfluoroalkyl substances (PFAS) accumulation and elimination in both wildlife and humans is largely attributed to PFAS interactions with proteins, including but not limited to organic anion transporters (OATs), fatty acid binding proteins (FABPs), and serum proteins such as albumin. In wildlife, changes in the biotic and abiotic environment (e.g. salinity, temperature, reproductive stage, and health status) often lead to dynamic and responsive physiological changes that alter the prevalence and location of many proteins, including PFAS-related proteins. Therefore, we hypothesize that if key PFAS-related proteins are impacted as a result of environmentally induced as well as biologically programmed physiological changes (e.g. reproduction), then PFAS that associate with those proteins will also be impacted. Changes in tissue distribution across tissues of PFAS due to these dynamics may have implications for wildlife studies where these chemicals are measured in biological matrices (e.g., serum, feathers, eggs). For example, failure to account for factors contributing to PFAS variability in a tissue may result in exposure misclassification as measured concentrations may not reflect average exposure levels. The goal of this review is to share general information with the PFAS research community on what biotic and abiotic changes might be important to consider when designing and interpreting a biomonitoring or an ecotoxicity based wildlife study. This review will also draw on parallels from the epidemiological discipline to improve study design in wildlife research. Overall, understanding these connections between biotic and abiotic environments, dynamic protein levels, PFAS levels measured in wildlife, and epidemiology serves to strengthen study design and study interpretation and thus strengthen conclusions derived from wildlife studies for years to come.