Architectural heritage is a testament to human and natural development, and the process of human social development can be glimpsed through the study and exploration of heritage. However, in the long history of human social development, architectural heritage is vanishing, and protecting and restoring such heritage is a pressing issue in contemporary society. This study applies the evidence-based theory of medicine to the virtual restoration practice of architectural heritage, which focuses more on scientific data-driven research and decision-making than does traditional restoration. Combined with the practice of evidence-based medicine, the stages of digital conservation of architectural heritage for virtual restoration based on evidence-based design are investigated, forming a comprehensive knowledge system consisting of clear objectives, evidence-based research, evidence assessment, virtual restoration-guided practice, and post feedback. In addition, it is emphasized that the restoration of architectural heritage should be founded on the outcomes obtained through evidence-based practice that have been translated into evidence, in turn creating a rigorous evidence-based system with high-frequency feedback. The final illustration of the procedure is the Bagong House in Wuhan, Hubei Province, China. The examination of this practice line provides a scientific, humanistic, and practicable theoretical framework for the restoration of architectural heritage and fresh ideas for the restoration of other cultural assets, which have significant practical application value. The 50th anniversary of the signing of the Convention Concerning the Protection of the World Cultural and Natural Heritage is being observed in 2022. The World Heritage System has a special allure because it connects the shared sentiments of humanity and documents the evolution of human civilization. Nevertheless, the world in which we live is facing problems that have never been seen in the twenty-first century. The extinction of heritage is being sped up by things like the new coronavirus pandemic and the destruction of the environment . As a reEvidence-based design is a methodology that employs the concept of evidence-based medicine in the engineering industry. Such design aims to move away from the traditional design approach based on specifications, which relies on the personal experience and assumptions of the supervisor, and toward a design model that focuses on the completion of the effect and actual use and attaches importance to the accumulation and recycling of evidence to guarantee that design decisions are justifiable and traceable and to develop a more scientific and rigorous work design model . In 2000In 2008, the Center for Architectural Heritage Preservation at Texas A&M University in the United States assembled a multidisciplinary team of architects, engineers, geologists, historians, and students to collect evidence-based data for the conservation and enhancement of the A-listed French site Pointe d'Oc on the Normandy coast. This situation is a classic instance of evidence-based design, which emphasizes the identification of core problems in practice through research, the rational and rigorous search for the best evidence-based decisions, the high degree of integration between scientific research and practical application, and the significance of evaluation and feedback on the results.The virtual restoration of architectural heritage not only is a secondary way to keep history alive but also goes beyond time and space, acting as both a conversation with the past and a point of reference for the present .In 1995, the United Kingdom held a conference on "Virtual World Heritage" and presented the virtual restoration of Stonehenge, which marked the beginning of the virtual restoration of architectural heritage. Among the international cases of architectural heritage restoration, the most renowned is the world's largest virtual architectural heritage system, which took ten years to construct, in Italy's ancient capital city , Rome. TThe two categories of virtual restoration are exterior decorative restoration and structural restoration. In the case of structural restoration, when it is difficult to determine whether physical restoration will damage the structure, virtual restoration is performed in a computer environment beforehand, the force analysis of the structure to be restored is evaluated, and physical restoration is performed only after it has been determined that the restored structure is reasonable, thereby preventing secondary damage caused by humans. The emphasis on virtual repair does not imply the abandonment of actual restoration. The digital information of architectural heritage has the same precision as that of physical artifacts and can complement appropriate theoretical investigations with evidence. Virtual repair in a digital system is reversible, but actual entities cannot be restored once damaged.This article first introduces the development history of virtual restoration and the background of evidence-based design. After that, inspired by the theory and practice of evidence-based medicine, it explores the stages of realization of virtual restoration of architectural heritage digital conservation based on evidence-based design, which provides a strong theoretical research basis for digital conservation and restoration of architectural heritage. A practical route of evidence-based design in virtual restoration of architectural heritage is proposed in the methods and materials section: clearly defined objectives—evidence-based research—evidence assessment—virtual restoration guidance practice—post-feedback, as the theoretical basis of this paper. Finally, the application process is illustrated with the example of the Bagong House in Wuhan, Hubei Province, China. The framework of the article is shown in the Fig. Virtual restoration, also known as simulation restoration or digital restoration, is based on the multilevel information of architectural heritage , combined with traditional architectural conservation science and technology, and employs modern technologies such as computer graphics, image processing, web space, and virtual information to achieve the automatic restoration of building geometry, texture, and structure. The diagram in Fig. The virtual restoration of architectural heritage is a comprehensive applied technical science involving interdisciplinary and multidisciplinary synergy, with technical disciplines including chemistry, physics, environmental protection, architecture, mineralogy and petrology, computer information technology, etc., and closely related to social disciplines including museology, library science, archives, archaeology, etc. Its evolution has involved three stages: virtual archaeology, virtual heritage, and digital restoration. For more information, see Fig. The creation of virtual restoration stemmed from the foundation of archaeology, and researchers had practiced virtual archaeology and virtual heritage prior to the formation of the idea. Wilcock et al.  used comPaul Reilly did not propose the concept of "In 1998, Computer Applications and Quantitative Methods in Archaeology (CAA) hosted a conference on virtual reality in archaeology and published “Virtual Reality in Archaeology: Computer Applications and Quantitative Methods in Archaeology”, which explains the concept of virtual reality in archaeology in detail. In the 21 century, virtual archaeology has continued to develop into a distinct field .In 1995, the International Society on Virtual Systems and Multimedia conducted an international conference on virtual systems and multimedia and formally proposed the phrase "virtual heritage" to characterize architectural heritage and virtual reality, i.e., the digitalization of architectural history , 17. At The digital restoration of architectural heritage began in 2006 with the release of an article that placed greater emphasis than that in the previous two phases on the automation of architectural heritage restoration , 22. TheThe introduction of digital restoration technology into the field of heritage conservation has become a common aim among scholars from various countries, whether in paper-cut patterns , clothinEvidence-based medicine is the process of systematically discovering, evaluating, and applying well-designed results from well-designed and executed clinical studies to optimize and implement clinical decisions . AcademiEvidence-based medicine, which promotes that the practice of medicine should be based on the rigor of research methodologies and the dependability of research outcomes, is where the philosophy of evidence-based design (EBD) first emerged . In 1984"Evidence-based design" is defined as "a process in which architects collaborate with their customers to carefully and purposefully use and analyze the most trustworthy scientific evidence available to make educated decisions about design-related decisions." "Sound decisions about design-related issues result from this." In the field of medical architecture, where it has become the standard research methodology in both Europe and the United States, evidence-based design was first applied. The relationship between evidence-based design and historic building conservation was defined by Carolyn Peterson as follows in 2007, when Europe, the United States, and other developed nations formally applied evidence-based design to the conservation of historic buildings: "Historic design is the most suitable discipline in the field of architecture for the preservation, restoration, and adaptation of structures and environments." "An evidence-based design approach, which incorporates the full preservation process and directs all decision-making processes from the commencement of a project to its final details, is better suited for the preservation, restoration, and adaptive adaptation of structures and surroundings." Figure 6A damaged building is virtually restored on a computer, which then directs the actual restoration, with each step backed up by solid scientific data. Heritage is frequently viewed as an organism with "vital functions" from an ontological perspective. The "diagnosis and restoration" of its "organic" functions is conceptually and methodologically similar to the treatment of living organisms or cases, and the logic of the virtual restoration of architectural heritage has a framework that is similar to evidence-based design . Like evThe “closed-loop” control theory concept is crucial because the digital preservation of architectural history is a dynamic, ongoing developmental process. The workflow from proposal development, evidence search, virtual restoration, expert assessment of feasibility, and post restoration feedback forms a dynamic closed-loop structure in the evidence-based design practice of the virtual restoration of architectural heritage, which is in line with the core principles of heritage conservation. The concept of "feedback" is crucial to the closed-loop structure, in which some system components control themselves and monitor their objectives through negative feedback to reach a stable, balanced, and sustainable state . As indiThe creation and use of evidence procedures alternate repeatedly, and the end of one round of conservation signals the start of a new round of conservation in the ideal state of digital conservation of architectural heritage. This process is continuous and closed loop, with a post feedback mechanism that sets off a negative feedback mechanism to keep the digital conservation process stable and moving forward .The International Council on Monuments and Sites (ICOMOS) and the United Nations Educational, Scientific, and Cultural Organization (UNESCO) collaborated to create the "Guidelines on Heritage Impact Assessments for Cultural World Heritage Properties" in 2009, which formally introduced heritage impact assessments (HIAs) as a management technique in the field of heritage conservation . HIAs weAs a technical approach and managerial tool, HIAs are anticipatory and forward looking. To slow down the rate of disintegration of heritage and its surroundings and to maintain and manage heritage scientifically, many methods of improvement, restoration, and human management are implemented. By using HIAs at the initialization stage of virtual restoration, the legacy is valued, and restoration objectives are suggested as a result. The restoration team should propose restoration goals by fusing various areas of expertise, and based on these goals, key research questions that may arise in the restoration process and elicit numerous research subquestions that will serve as the foundation for the second stage of obtaining evidence to support the questions should be refined.To explore a set of guiding lessons with universal applicability, ICOMOS conducted a study and analysis of 11 case studies of the restoration and reconstruction of architectural heritage in 2019. The above authors did this in collaboration with the International Centre for the Study of the Preservation and Restoration of Cultural Property and released the "ICOMOS Seven Matrix Judging System" , as showThe next step, according to evidence-based design theory, is to find and analyze evidence to advance the protocols after the visualization of the restoration goals and protocols has been developed. The content of the evidence-based research phase can be divided into two categories: multisource data collection and data hierarchical induction.Finding trustworthy sources of data to produce an original proof is important prior to data collection. There are generally three main categories due to the variety of information sources and content involved. The information extracted from the conclusions of previous research results and verified sources, such as books, academic literature, project documentation, old photos or photocopies, that provide descriptive or documentary evidence of the target falls into two categories: the first is evidence information about the current state of existing sites, which is extracted digitally, and the second is information extracted from these sources. The third sort of evidence, which is indirect and completes the first two types, is the analysis of related cases .2,49. To expose the rules more scientifically, quantitative research aims to increase people's comprehension of the research object.Quantitative and qualitative data collection techniques are the two basic categories. Quantitative research seeks to further refine people's understanding of the subject of study to reveal the law more precisely, whereas qualitative research uses induction and deduction, analysis and synthesis, abstraction and generalization, etc., to process the data obtained for the processing of thoughtWu et al.  classifiLiterature research: The current body of literature is methodically compiled and examined for identification.Document collection and analysis: Contrary to the "external information" of extant research, document collection and analysis take place primarily in internal information systems, like libraries and design institutes, and consist primarily of plans, drawings, construction technical documents, maintenance records, and changes to the project under study.Site exploration and measurement: In contrast to the "external information" of extant research, document collection and analysis mostly occur in internal information systems like libraries and design institutes. Plans, drawings, construction technical documents, maintenance records, and changes to the project being studied are the most common types of documents collected and analyzed.Questionnaire: A mixed questionnaire with both closed- and open-ended questions can be used to collect data for evidence-based research. After the questionnaire is compiled, it is given out in person, over the phone, by email, by mail, or in interviews.On-site interviews: The questionnaire's disadvantage is that it is entirely written and cannot be modified or expanded randomly. To acquire a more comprehensive and in-depth understanding of the data, they must be combined with on-site interviews.Behavioral observation: By observing the pertinent phenomena at architectural heritage sites and the behavior patterns of the pertinent users, it is a good complement to questionnaires and on-site interviews to gather useful information. Table Table By fusing the traits of various data sources with the precise target identification of the restoration program, various types of data should be extracted as evidence for data hierarchy summarization. Portus Theodosiacus introduced the "concept of multiscale evidence" in 2018  and usedData-based decision-making, or making restoration decisions based on solid scientific evidence, is the fundamental concept behind evidence-based restoration. After data collection and evidence summarization of the object to be restored in the second phase, the restoration team uses critical thinking to evaluate the source level, authenticity, significance, relevance, and other aspects of the collected evidence. This is done to ensure that the evidence is of high quality and relevant to the research problem to make the "best decision" for virtual restoration.A four-dimensional matrix is created in the virtual restoration's evidence assessment section, and its basic components include the restoration hierarchy of heritage in the X dimension , the quantity of evidence in the Y dimension, the completeness of evidence in the Z dimension, and the expert judgment of evidence in the C dimension. Using the information composite and synergy of the multidimensional matrix to achieve the reliability of restoration evidence in a comprehensive assessment, the reliability index of virtual restoration evidence is set forth as in Eq. . This diE, Reliability index of virtual restoration evidence (Evidence). L, Hierarchy of evidence for building restoration (Level). G, the pyramidal grade (Grade) to which the evidence of architectural restoration belongs. Q, the quantity of evidence (Quantity) for building restoration. I, Evidentiary integrity of architectural restoration (Integrity). e, The index of expert judgments of the evidence (expert).Because the evidence comes from multiple sources, it cannot be evaluated in a single hierarchical manner at the source. As a result, the "evidence pyramid" was developed, and the average of the two was used as the hierarchical X dimension of the repair evidence. This study proposes the modification of the "evidence pyramid," which was first introduced by SUNY Downstate Medical Center  in 2001, to assess evidence in "evidence-based medicine." Based on this, this study suggests an "evidence pyramid" that is modified for "evidence-based repair" and incorporated into the reliability index of evidence, as shown in Fig. Today, the precision of machines allows for the accurate assessment of evidence but not flexibility, which is why an index that requires human judgment—expert assessment of evidence—in the four-dimensional U dimension matrix of evidence assessment was introduced. Architectural heritage has hidden sentimental value.A crucial part of "evidence-based restoration" is "virtual restoration," which simulates the restoration of a building's past using evaluated data to determine whether and to what extent the objectives of the first phase can be accomplished. If the results support restoration goals, then the restoration moves on to the second phase of data-based research, where the evidence is adjusted and analyzed until the virtual restoration goals are met. If the computerized response to the research questions is accurate and the goals are met, then the virtual restoration plan is valid, and the restoration moves to physical restoration.The two types of virtual restoration are ornamental restoration and structural repair. The outsides of historically significant buildings are frequently restored using semantic automated restoration based on deep learning, while external virtual restoration is frequently handled using image processing technology. Wang et al.  performeIt is crucial to restore the structural integrity of historic buildings. If structural heritage is not properly restored in terms of appearance, then it will lose its original flavor and value and look inappropriate, while improper structural restoration will cause such heritage to vanish. Because wood structural damage mechanisms are more complex, it is reasonable to integrate multidisciplinary, clear repair ground research problems, the development of a correct and reasonable repair strategy, technical solutions and engineering systems, and virtue engineering. Cracks, bending, rolling, tenon pulling, and other forms of structural damage are common in wooden structures; traditional structural repair and reinforcement rely on the craftsperson's experience and judgment –58. The The notion of "post repair feedback," which is taken from the idea of "feedback" in control theory, is proposed in this work based on the use of evidence-based design theory in the virtual restoration of architectural heritage. Post occupancy evaluation (POE) is the process of gathering information on a building's spatial performance, physical performance, and user perceptions after it has been completed to provide designers, managers, and users with suggestions and better architectural standards , 63. FeeThe evaluation of the restoration impact of the heritage body and the discovery and restoration of the additional social and cultural values of the heritage are the two primary divisions of post restoration feedback material. The core component is the restoration of the heritage ontology, and as shown in Table The evaluation of the effect of the restoration of the heritage body is a technical field, and the long-term monitoring of the heritage body can be monitored in real time by means of the placement of sensors . The metThe restoration process of heritage should be integrated as a directed case study, involving research and conservation, and become a rigorous evidence-based system containing high-frequency feedback itself . The resThe Bagong House in Wuhan, Hubei Province, China, which has rich historical value and was named one of the city's first batches of outstanding historical structures in 1993, was added to the "Preparatory List of China's World Cultural Heritage" by the State Administration of Cultural Heritage in 2019 and was added to the eighth batch of Hubei Province in 2021, serving as the case study. The Bagong House is separated into two sections called Da Bagong and Xiao Bagong by J. K. Barnoff. J. K. Barnoff and Zino Barnoff each contributed to its construction. It is an example of a high-class apartment building in Wuhan's Hankow tenement district and shows the development of Wuhan's modern architectural style as well as the city's early real estate development and business strategy. Table The Bagong House was constructed many years ago, and although it has been used for almost a century, it has undergone numerous expansions and transformations to become the building it is today. The roof of the house, as well as a few structural situations, the building layout, along with the street facade, and the original design differ from one another. The building has several structural safety issues, such as structural aging and corrosion, and there are safety dangers according to a housing inspection report. The conservation and repair project of the Bagong House is urgent and necessary due to the local alterations of the building's function, layout, and structure, the original equipment department's failure to meet the building's normal use requirements, and the damage to the building's key conservation parts and conservation projects. Part II of this study's "Evidence-based Design in Virtual Restoration of Architectural Heritage" section uses the restoration of the Bagong House as an example.Heritage value assessment and restoration objectives are the two main sections of the "Defining Objectives" section. In accordance with the Guidance on Heritage Impact Assessments for Cultural World Heritage Properties published by UNESCO and ICOMOS, the historical value, artistic value, scientific value, cultural value, and social value of the Bagong House were evaluated, the results of which are displayed in Fig. To recreate its overall historical aspect by preserving and restoring its classically inspired exterior and interior spaces as well as its distinctive embellishments.To ensure structural security through preservation and repair for future use over a longer period of time.The revitalization of cultural heritage buildings will be accomplished through a variety of newly implemented functions, and while honoring and reproducing the spirit of the place, a cultural tourism destination of international level and influence will be created in Wuhan, igniting "new life in the old city".The restoration team established the broad restoration goals as follows, using the heritage value assessment findings and the Bagong House's present state of use:Evidence was gathered from existing sites in the section on evidence collection, including direct and indirect evidence, and Fig. Existing site evidence. This section is analyzed primarily by drawing information from the Bagong House's current state, which is a mapping of the site's actual state and reflects its objective authenticity. To ensure that the photos taken can meet the needs of 3D reconstruction, information is acquired primarily through the use of airborne camera imaging systems to gather external and environmental impact data. The relevant current state information is shown in the Fig. Direct evidence. To prepare for the clarification of 1 in the target, a portion of evidence collection and collation is shown in Fig. Circumstantial evidence. Indirect evidence from cases such as the Bagong House, the nearby Holy Church Bookstore, and the out-of-town Wukang Building (formerly Normandy Apartments) is used primarily to support the third restoration objective, the adaptive use of cultural heritage buildings through newly implanted multiple functions. Before the Bagong House, both of the above sites had been restored. It is possible to instill new functions in cultural heritage buildings that can preserve the status quo of the heritage site and have a positive impact on its adaptive use, as shown in the Fig. This section assesses and analyzes the evidence gathered in the "The Bagong House's restoration phase mostly entails the installation of additional functions, structural reinforcement, and general external and interior design, according to the restoration's goals. As a result, the objective in the virtual restoration guiding practice phase is to determine the damaged exterior and interior decoration and structure through evidence-based research and evidence assessment, to design the implementation of new functionalities, and to then guide the practice. Figure Extrapolation based on exterior damage. This study uses the southwest façade of the Bagong House as an example to explain the repair plan and restoration guidelines for the façade. These plans are based on the existing site evidence and direct evidence. The former involves a comprehensive examination of the façade's design and construction. On the southwest façade of the Bagong House, there is a red brick façade on the exterior walls of the first to third floors, rubbed sand plaster façade on the exterior walls of the later addition of the lower four-story building with two low sides, and there is a late addition. The restoration goals are to restore the rubbed sand plaster footings, restore the red brick façade on the exterior walls of the first to third floors, and repair the rubbed sand plaster façade on the exterior walls. Figure The structural part of the Bagong House adopts mainly structural reinforcement for protection. Taking crack repair in concrete engineering as an example, the main process is to clean up the crack → install grouting nozzle → seal the crack → conduct a pressure gas leak test → apply grouting pressure → apply sealing treatment. The effect is shown in the Fig. Restoration experts have defined the main business mode of the Bagong House as an ecological circle integrating a cultural and creative gathering place, cultural and leisure services, and microtourism, the zoning model of which is shown in the Fig. The ontology of the Bagong House was recently restored and has not yet been formally opened to the outside world, so many spatial performance and social benefit evaluations cannot be fully collected. The overall effect on post feedback requires a certain amount of time for the ontology to operate, as short as one and a half years or even several years. Therefore, only the issues that require attention in the post restoration feedback of architectural heritage, as described in “This article investigates the theoretical and practical paths of evidence-based design in the virtual restoration of architectural heritage, combining closed-loop theory to propose the alternation of evidence creation and evidence use procedures to ensure the success of the virtual restoration of architectural heritage. The use of evidence-based design in the virtual restoration of architectural heritage is being investigated. A scientific, humanistic, and workable theoretical foundation for the restoration of architectural heritage is provided by the combination of evidence-based design and virtual restoration. Such work also offers new ideas that can be used as references for the restoration of other cultural heritage sites, which has significant application value and practical significance.Authors’ contributions: Journal standard instruction requires the statement "All authors read and approved the final manuscript." in the “Authors’ contributions” section. This was inserted at the end of the paragraph of the said section. Please check if appropriate.Thank you very much for the reminder and have added "All authors read and approved the final manuscript." to the "Authors' contributions" section.Transparency of evidence in evidence-based research. However, any approach to preserving and restoring architectural legacy must adhere to the concept of authenticity, and the virtual restoration of architectural history is fraught with uncertainty. The authors of this study suggest virtual restoration based on evidence-based theory, which is essentially a continuous human decision-making process and inherently introduces some degree of unreliability and uncertainty . The decNew developments in the evidence and outcomes of architectural heritage restoration are not static, and the majority of the evidence data gathered in the evidence-based research component is of an immediate nature because it is derived from the study of particular issues and occurrences over a predetermined period of time. However, the applicability and quality of the evidence may vary when new concerns and the external decision-making environment develop. The evidence database needs to be updated on a regular basis to guarantee the variety of kinds of evidence and the relevance of the evidence content. The greatest benefit of the closed-loop theory introduced in this study is that it allows new evidence to emerge, and post feedback is an important method of evidence updating. As most architectural heritage has a history of thousands of years, the process of evidence-based research is inevitably challenged by a large amount of missing evidence. Only by regularly updating the evidence can scientific practice be led, and updating the evidence is a key factor in encouraging evidence-based design in the restoration of architectural heritage.The relationship between technology and culture. According to Martin Heidegger, "Technology is not by its nature technology" . TechnolAlthough this topic has been examined in the context of empirical cases, this study constructs a theoretical exploration of the practical route of evidence-based design in the virtual restoration of architectural heritage in the context of the information age. Several theoretical issues derived from the following need to be further studied.


The primary aim of the study was to determine levels of literacy in both oral health and orthodontics in an adult population. The secondary study aim was to investigate differences in literacy between males and females.Participants included individuals 18 years or older seeking dental treatment at the East Carolina University (ECU) School of Dental Medicine. To determine levels of oral health literacy (OHL) and orthodontic literacy (OrthoL), validated instruments were administered, including the Rapid Estimate of Adult Literacy in Medicine and Dentistry, the Oral Health Literacy Instrument and its separate scales, and a questionnaire on orthodontic literacy. Summary statistics were computed, and statistical significance was set at 0.05.One hundred seventy-two individuals participated in the study and had a mean age of 55.03 (range:18–88). Greater than 70% of the sampled population exhibited inadequate or marginal oral health knowledge. Additionally, greater than 70% of the sample possessed no more than an 8th grade reading level, with regard to basic medical and dental terms. Higher education was weakly associated with higher OrthoL and OHL. Higher age was also weakly associated with lower OrthoL and OHL. Males on average exhibited significantly higher OHL (p < .05) but there were no OrthoL differences between males and females. Dental visit frequency was not associated with OrthoL or OHL.Low levels of OrthoL and OHL were observed in the study. While males demonstrated a higher level of OHL than females, neither age nor the occurrence of dental appointments significantly influenced levels of literacy. Both medicine and dentistry have become increasingly aware that health literacy plays or may play an important role in patient outcomes –3. Oral Studies also show that physicians overestimate their patients’ health literacy levels and are unable to determine at-risk patients for low health literacy , 9. It hAdditionally, general oral health and orthodontic literacy, are highly impactful to clinical practice. Understanding where a practice’s patient pool is in terms of baseline levels of orthodontic and oral health literacy may be critical not only for patient compliance, but also in terms of providing access to care where it currently does not exist. There is evidence indicating a practitioner’s focus on increasing patient health literacy will increase patient trust in the practitioner, referrals to the practice, and augment the practice’s ability to educate patients about treatment . This adth most urban county in North Carolina and we anticipate the obtained results would be consistent with other similar places throughout the United States. The secondary study aim was to investigate differences in literacy between males and females within the sampled population, since previous research has reported differences between males and females [Thus, our primary aim was to determine levels of literacy in both orthodontics and oral health in an adult population in an area that has been described as underserved . The den females .This study was reviewed and approved by the East Carolina University (ECU) & Medical Center Institutional Review Board (IRB#14000398). The established inclusion criteria included adults (18 years or older), seeking treatment at the ECU School of Dental Medicine, who did not have a cognitive, visual, or hearing impairment. Eligible individuals needed to have at least a limited understanding of English and be able to verbally communicate. To our knowledge, no one in our study spoke English as a second language. Those excluded from the study included children and any adult that had a self-reported cognitive, visual, or hearing impairment, or who had no understanding of English. After providing written consent, participants were given a short screening form to ascertain basic demographic data. One hundred and seventy-two individuals participated in the study. They were also asked to complete multiple validated instruments, including the Oral Health Literacy Instrument (OHLI) and its separate scales  , the RapThe OHLI knowledge scale (17 questions) required participants to identify an oral structure, treatment device, or home care oral hygiene product that matches a label on a picture. The comprehension scale (29 questions) required the participants to read a passage that included a missing word and fill in the blank from four options. The numeracy scale (5 prescription questions) presented various prescription labels with questions that the participant must accurately describe or calculate. An example of this would be: How many times can you refill this medication? The total OHLI scale involved a combination of these three components. The REALMD-20 is a list of 20 medical and dental terms that the participant must read and pronounce aloud. The questionnaire relating to orthodontic literacy (OrthoL) is a series of 12 basic orthodontic questions the participants respond to, either choosing a given option or filling in the blank. All OHLI scales and the REALMD-20 constituted the OHL scales for this study. The OrthoL questionnaire was the only instrument utilized to investigate patient literacy regarding orthodontics.Descriptive statistics were computed for OHL and OrthoL scales. The association of gender with OHL and OrthoL scales was evaluated using a Kruskal-Wallis test. The associations of age, education, and dental visit frequency with the OHL and OrthoL scales were evaluated using Spearman correlation coefficients. Neither race nor ethnicity was collected from the patients and these parameters were not included in the statistical analysis. Multiple-variable linear regression analyses were used to examine the effects of the factors simultaneously on the OHL and OrthoL scales. The associations among the literacy scales were evaluated using Pearson correlation coefficients. The study was designed a priori to have at least 80% power to detect an OHLI difference of 5 between males and females, assuming at least 64 subjects in each gender, a 5% significance level, and standard deviation of 10.The analyses first explored each of the demographic variables against the literacy scales. These are represented in Tables Tables As expected, high correlations were observed for OHLI comprehension and OHLI numeracy with OHLI total. Moderate correlations were observed among the other OHL and OrthoL scales.One of the most critical findings of this study was that regular adult dental visits were not related to higher levels of either OHL or OrthoL Tables , 6 and 7th grade reading level with regard to basic medical and dental terms provides evidence of significant barriers to optimal OrthoL and OHL. This is consistent with research evaluating “patient and parent understanding of the child’s orthodontic treatment in a dental school population,” where it was determined that “the vocabulary levels of the children and their parents were low; parents’ vocabulary and educational levels were correlated with their comprehension” [The fact that the majority of this sample exhibited either inadequate or marginal oral health knowledge and no more than an 8hension” .Our study showed males and females differed significantly on two distinct measures of OHL (OHLI and REALMD-20). In contrast, there were no differences between males and females regarding OrthoL. These mixed results are consistent with the contrasting results found in other research investigating the relationship between health literacy and gender. In a review conducted by Aldin et al. it was observed that some studies have indicated that “women typically have slightly better health literacy than men,” while others do not find “significant differences between the genders” . LikewisSpecialists may not be surprised that OrthoL appeared to be substantially low in this sample. Previous research indicated that participants poorly answered questions about risks for decay, oral hygiene, and retention . LikewisFurthermore, those involved in the current study did not understand the need to continue seeing a general dentist during orthodontic therapy. Likewise, participants did not exhibit understanding as to the consequences of not brushing well and maintaining good oral hygiene habits during orthodontic therapy. For example, there was no concept that negative consequences such as developing white spot lesions  or develMoreover, the sample did not exhibit a knowledge of typical treatment time, which is consistent with recent studies within a University clinical setting in Lagos, Nigeria, examining patient and parent expectations , and oneOrthodontic literacy as conceptualized in this study is the ability to obtain and understand orthodontic information in order to make reasonable or informed orthodontic care decisions. Why should this matter to orthodontists? First, improving patient outcomes or improving patients’ understanding of orthodontic conditions through increased orthodontic literacy empowers and provides patients with a higher standard of care. Second, it is likely that those who spend time to increase literacy are more trusted and receive more referrals than those who do not. For instance, a doctor that designates someone on his or her team to educate patients in order to increase their OHL or OrthoL, over a one-year period, is capable of increasing patients’ trust by 2.5 fold . AdditioThe development of educational programs  focusing on these findings, will play a critical role in addressing patient oral health and orthodontic illiteracy. We expect that programs will be developed that create a foundation for protocols within the dental and specialty curriculum, providing a clearer path for patients to become more literate in orthodontics and oral health. We also anticipate that these findings and eventual protocols will be highly relevant to practitioners.The authors acknowledge that the current study contained a few limitations. First, the conducted study only included data from a single site. However, we anticipate the obtained data would be consistent with other similar samples throughout the United States. Additionally, we did not collect information on the participants’ race or ethnicity. Based on the literature, it is possible that some of our results could be different when compared to individuals with different backgrounds. Additionally, there were several participants with missing responses for some literacy scales. Participants with missing responses were excluded from analyses of that scale. However, this was unlikely to affect the conclusions of the study because the lowest completion rate was 92% for OrthoL and 97% or higher for all other scales. We also noted that the power analysis  was based on a standard deviation of 10 but some of the measurements had standard deviations that exceeded this threshold. However, we recruited nearly three times the number of required subjects, so we are confident that this did not negatively impact the study findings.Further studies are needed to assess how OHL and OrthoL relate to orthodontic status and oral health outcomes. Additionally, similar studies that investigate the impact of race and ethnicity on OrthoL are warranted.An important finding of this study is that regular dental visits do not lead to higher oral health literacy or orthodontic literacy. Additionally, female oral health literacy was found to be significantly lower than males, specifically in the area of numeracy. Both male and female orthodontic literacy is also substantially inadequate and orthodontic literacy is generally deficient in this sample. Finally, orthodontic literacy was lower than a measure of total oral health literacy.S1 Dataset(XLSX)Click here for additional data file.


There are challenges to delivering high quality primary care within prison settings and well-recognised gaps between evidence and practice. There is a growing body of literature evaluating interventions to implement evidence-based practice in the general population, yet the extent and rigour of such evaluations in incarcerated populations are unknown. We therefore conducted a scoping literature review to identify and describe evaluations of implementation interventions in the prison setting.We searched EMBASE, MEDLINE, CINAHL Plus, Scopus, and grey literature up to August 2021, supplemented by hand searching. Search terms included prisons, evidence-based practice, and implementation science with relevant synonyms. Two reviewers independently selected studies for inclusion. Data extraction included study populations, study design, outcomes, and author conclusions. We took a narrative approach to data synthesis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for scoping reviews.Fifteen studies reported in 17 papers comprised one randomised controlled trial, one controlled interrupted time series analysis and 13 uncontrolled before and after studies. Eight studies took place in the US and four in the UK. Ten studies evaluated combined (multifaceted) interventions, typically including education for staff or patients. Interventions most commonly targeted communicable diseases, mental health and screening uptake. Thirteen studies reported adherence to processes of care, mainly testing, prescribing and referrals. Fourteen studies concluded that interventions had positive impacts.There is a paucity of high-quality evidence to inform strategies to implement evidence-based health care in prisons, and an over-reliance on weak evaluation designs which may over-estimate effectiveness. Whilst most evaluations have focused on recognised priorities for the incarcerated population, relatively little attention has been paid to long-term conditions core to primary care delivery. Initiatives to close the gaps between evidence and practice in prison primary care need a stronger evidence base.The online version contains supplementary material available at 10.1186/s40352-022-00200-x. The global incarcerated population has grown by a quarter over in the past two decades, to 11 million in 2021  on health care delivery and outcomes in the general population  as these fell outside the scope of recognised implementation strategies . During the screening process, two authors were contacted via email to request final studies from published study protocols with one response received  then searched Medline, EMBASE, CINAHL, Scopus, and Web of Science for grey literature, searching up to August 2021  and abstracts (JB and JBl). We included all titles and abstracts screened in by any reviewer. Two reviewers (JB and JBl) independently screened full texts, resolving disagreements by discussion or reference to a third author (RF). Consistent with scoping review methodology, we did not exclude papers on the basis of poor methodology as we aimed to describe and summarise currently available evidence   Checklist. This file contains details of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist (Tricco et al., Additional file 2. Search Strategy. This file contains details of the complete search strategy performed.


Recommendations addressing screening for scoliosis differ substantially. Systematically developed guidelines are confronted by consensus and opinion-based statements. This paper elaborates on the issue of the standards of development and reporting of current guidelines and recommendation statements, as well as on the methodological quality of the corresponding evidence syntheses. The SORT classification and the AMSTAR 2 tool were used for those purposes, respectively. Publications included in the analysis differed substantially in terms of their methodological quality. Based on the SORT and AMSTAR 2 scores, the 2018 US PSTF recommendation statement and systematic review on screening for scoliosis are trustworthy and high-quality sources of evidence and aid for decision making. The recommendation statement on insufficient evidence to formulate any recommendations is, paradoxically, very informative. Significantly, updated opinion-based position statements supporting screening for scoliosis acknowledged the importance of research evidence as a basis for recommendation formulation and are more cautious and balanced than formerly. Expert opinions, not built on properly presented analyses of evidence, are at odds with evidence-based practice. Nonetheless, contemporary principles of screening programs, especially those addressing people’s values and preferences, and the possible harms of screening, remain underrepresented in both research and recommendations addressing screening for scoliosis. Adolescent idiopathic scoliosis, AIS, is a health condition that affects 1–3% of the general population . PotentiSchool screening for scoliosis applies to millions of schoolchildren globally ,8,13,14,One important, and long debated issue is the X-ray exposure and related long-held view of carcinogenic risks from X-rays. Current 2021) UK National Screening Committee, UK NSC, recommendations against screening for scoliosis include potential overdetection, waste of resources, and unnecessary X-ray exposure, as reasons for not meeting the criterion of “a simple, safe, precise and validated screening test”, needed to justify a screening program 21 UK Nat no studiGuidelines and recommendations not only remain discrepant or contradictory but were developed according to various standards and procedures ,24,25,26The study addresses the trustworthiness of current recommendations and position statements addressing screening for scoliosis in terms of their methodological quality and standards of development. Strengths of recommendations and methodological quality of the underlying evidence reviews were assessed.Consequently, the paper updates earlier research synthesis studies, conducted in 2011  and 2013This report also provides a methodological enhancement of another analysis , focusedThis study was informed by the PRISMA 2020 guideline for reporting systematic reviews, specifically as regards guidance for conducting and reporting updated reviews . NeverthThe analysis comprised two stages. Firstly, the current recommendations on screening for scoliosis were examined in terms of their standards of development. For that purpose, their content was analyzed according to the Institute of Medicine criteria for guideline development and reporting  28]. Th. Th28]. All current  recommendations and position statements, regarding screening for scoliosis, were included in the initial analysis. Both opinion-based and evidence-based documents were eligible. New or updated publications were eligible if they were not included in the preceding appraisals ,26. ThusA review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods  may or may not be used to analyse and summarise the results of the included studies” [systematic review” to “evidence synthesis” [The starting point to define the types and forms of review studies was the classical characteristics of systematic review (such as that in the glossary of terms from the Epistemonikos database: “studies” ). Nonethstudies” ,46,47, anthesis”  were incReview reports prepared for the development of guidelines (either commissioned or conducted by the guideline development group) were included. External systematic reviews, referred to in the analysed guidelines, but not prepared in the process of their development, were not included in the analysis of methodological quality with AMSTAR 2, but were only considered in the assessments of strengths of recommendations with SORT.Similar articles” and “Cited by” navigation tools were used for further browsing. For other bibliographic databases, corresponding search terms and limits were used. Additionally, the reference lists of papers included for full-text analysis as well as websites of institutions that have released the included documents, were checked for information on updates, discontinuations, or withdrawals. The PRISMA 2020 [PubMed and pre-appraised sources—NICE Evidence, TRIP, PEDro, and REHAB+ databases, as well as G-I-N and INAHTA guideline registries, were searched between 5 and 8 February 2022 for new or updated pertinent publications, published since January 2014 . As thiSMA 2020  flow diasystematically developed statements aimed at helping people make clinical, policy-related and system-related decisions” [Clinical practice guidelines are “cisions” . In the cisions”  , experts may be the only or main source of evidence ,39,40. Trthiness ,40.People’s views, preferences, and circumstances, as well as person-centeredness, are contemporarily acknowledged and promoted in health policies, including concepts and principles of screening ,10,11,13Expert opinions were appreciated in the Scoliosis Research Society, SRS, International Task Force’s recommendation formulation process, prepared through a methodological study, as of particular importance for considering perceived harms in the absence of available research evidence on this critical issue . CorrespSystematic reviews are at the top of the classical pyramid hierarchy of evidence, whilst narrative reviews are at the bottom ,30. Theya scholarly summary along with interpretation and critique, which can be conducted using a number of distinctive methodologies, differing from the classic methodology of systematic review, but not unsystematic  [evidence-informed rather than evidence-based [Thus, systematic and narrative reviews serve different purposes and should be viewed as complementary. While conventional systematic reviews address narrowly focused  questions, and their key contribution is summarising data, narrative reviews provide interpretation and critique, and their key contribution is to deepen understanding. In that sense, a narrative review is  ad hoc) . Narratice-based ,46,60,61Not only the issues of expert evidence ,40, contscreening for disease to the prediction of poor health, from early disease detection to preventive service, and from asymptomatic subjects to otherwise healthy individuals, have been formulated [Screening principles, and also terminology, have evolved, and crucial proposals, such as shifting from rmulated ,10,11. Armulated ,26,54 tormulated .against” screening for scoliosis  [no recommendation” due to “insufficient evidence to assess the balance of benefits and harms of screening” [The US PSTF have changed their recommendation from “6, 2004) ,26 to “ncoliosis 96, 2004 reening” , while treening” ,25, and reening”  (Table 3insufficient evidence”) in terms of recommendation formulation of whether to screen or not to screen for scoliosis. The decisions are, however, left to decision-makers—patients and clinicians [The “I” recommendation is addressing the body of evidence  when evidence is sparse or doubtful (insufficient), recommendations need to be issued; otherwise, guideline panels miss an opportunity to support clinicians and patients  (2) condesearch” , as the The US PSTF “I” recommendations on important health topics are annually reported to the US Congress. Adolescent health topics, including mental and behavioural health, were reported in 2020 . The nee“sufficiently important to merit a separate entry” [The Oxford Centre for Evidence-Based Medicine, OCEBM, levels of evidence classification, with questions referring to early detection (screening) tests (added in the revised version of the classification as e entry” ), gives not only further, and methodologically rigorous research, but also more people-centred research is warranted.Additionally, considering contemporary standards of person-centred care ,20,40,53Based on the presented updating analyses, it is clear that the lack of an adequate evidence base remains a crucial problem in recommendation formulation of whether to screen or not to screen adolescents for scoliosis.The US PSTF has issued high-quality guidance , and theNonetheless, the key issues are that recommendations remain contradictory, that an evidence base to formulate trustworthy statements remains lacking, and that the contemporary principles of screening programs, especially those addressing people’s values and preferences, and the possible harms of screening, are still underrepresented in research and recommendations.All screening programmes do harm; some do good as well.” [“s well.”


The purpose of this study is to discover the main themes and categories of the research studies regarding digital literacy. To serve this purpose, the databases of WoS/Clarivate Analytics, Proquest Central, Emerald Management Journals, Jstor Business College Collections and Scopus/Elsevier were searched with four keyword-combinations and final forty-three articles were included in the dataset. The researchers applied a systematic literature review method to the dataset. The preliminary findings demonstrated that there is a growing prevalence of digital literacy articles starting from the year 2013. The dominant research methodology of the reviewed articles is qualitative. The four major themes revealed from the qualitative content analysis are: digital literacy, digital competencies, digital skills and digital thinking. Under each theme, the categories and their frequencies are analysed. Recommendations for further research and for real life implementations are generated. The extant literature on digital literacy, skills and competencies is rich in definitions and classifications, but there is still no consensus on the larger themes and subsumed themes categories. Heitin, . To exemSousa and Rocha  explaineThe systematic review the researchers propose is a useful updated instrument of classification and inventory for digital literacy. Considering the latest developments in the economy and in line with current digitalisation needs, digitally literate population may assist policymakers in various fields, e.g., education, administration, healthcare system, and managers of companies and other concerned organisations that need to stay competitive and to employ competitive workforce. Therefore, it is indispensably vital to comprehend the big picture of digital literacy related research.Since the advent of Digital Literacy, scholars have been concerned with identifying and classifying the various (cap)abilities related to its operation. Using the most cited academic papers in this stream of research, several classifications of digital-related literacies, competencies, and skills emerged.Digital literacy, which is one of the challenges of integration of technology in academic courses , the most recent framework proposed by the European Union, which is currently under review and undergoing an updating process, contains five competency areas: (a) information and data literacy, (b) communication and collaboration, (c) digital content creation, (d) safety, and (e) problem solving  have been acknowledged to be a significant element of digital literacy in the educational process context Ferrari, . In factHowever, we have recently witnessed a shift of focus from learning how to use information and communication technologies to using it while staying safe in the cyber-environment and being aware of alternative facts. Digital thinking would encompass identifying fake news, misinformation, and echo chambers Sulzer, . Not leaResearch question 1: What is the yearly distribution of digital literacy related papers?Research question 2: What are the research methods for digital literacy related papers?Research question 3: What are the main themes in digital literacy related papers?Research question 4: What are the concentrated categories  in digital literacy related papers?Ultimately, this systematic review paper focuses on the following major research questions as follows:This study employed the systematic review method where the authors scrutinized the existing literature around the major research question of digital literacy. As Uman  pointed,To address major research objectives, the following five important databases are selected due to their digital literacy focused research dominance: 1. WoS/Clarivate Analytics, 2. Proquest Central; 3. Emerald Management Journals; 4. Jstor Business College Collections; 5. Scopus/Elsevier.The search was made in the second half of June 2021, in abstract and key words written in English language. We only kept research articles and book chapters (herein referred to as papers). Our purpose was to identify a set of digital literacy areas, or an inventory of such areas and topics. To serve that purpose, systematic review was utilized with the following synonym key words for the search: ‘digital literacy’, ‘digital skills’, ‘digital competence’ and ‘digital fluency’, to find the mainstream literature dealing with the topic. These key words were unfolded as a result of the consultation with the subject matter experts . Below are the four key word combinations used in the search: “Digital literacy AND systematic review”, “Digital skills AND systematic review”, “Digital competence AND systematic review”, and “Digital fluency AND systematic review”.A sequential systematic search was made in the five databases mentioned above. Thus, from one database to another, duplicate papers were manually excluded in a cascade manner to extract only unique results and to make the research smoother to conduct. At this stage, we kept 47 papers. Further exclusion criteria were applied. Thus, only full-text items written in English were selected, and in doing so, three papers were excluded (no full text available), and one other paper was excluded because it was not written in English, but in Spanish. Therefore, we investigated a total number of 43 papers, as shown in Table The 43 papers selected after the application of the inclusion and exclusion criteria, respectively, were reviewed the materials independently by two researchers who were from two different countries. The researchers identified all topics pertaining to digital literacy, as they appeared in the papers. Next, a third researcher independently analysed these findings by excluded duplicates A qualitative content analysis was manually performed by calculating the frequency of major themes in all papers, where the raw data was compared and contrasted , Fig. Research question number two  concentrates on what research methods are employed for these digital literacy related papers. As Fig. When forty-three articles were analysed for the main themes as in research question number three , the overall findings were categorized around four major themes: (i) literacies, (ii) competencies, (iii) skills, and (iv) thinking. Under every major theme, the categories were listed and explained as in research question number four  in digital literacy related papers).The authors utilized an overt categorization for the depiction of these major themes. For example, when the ‘creativity’ was labelled as a skill, the authors also categorized it under the ‘skills’ theme. Similarly, when ‘creativity’ was mentioned as a competency, the authors listed it under the ‘competencies’ theme. Therefore, it is possible to recognize the same finding under different major themes.Digital literacy being the major concern of this paper was observed to be blatantly mentioned in five papers out forty-three. One of these articles described digital literacy as the human proficiencies to live, learn and work in the current digital society. In addition to these five articles, two additional papers used the same term as ‘critical digital literacy’ by describing it as a person’s or a society’s accessibility and assessment level interaction with digital technologies to utilize and/or create information. Table Computer literacy, media literacy and cultural literacy were the second most common literacy (n = 5). One of the article branches computer literacy as tool (detailing with software and hardware uses) and resource (focusing on information processing capacity of a computer) literacies. Cultural literacy was emphasized as a vital element for functioning in an intercultural team on a digital project.Disciplinary literacy (n = 4) was referring to utilizing different computer programs (n = 2) or technical gadgets (n = 2) with a specific emphasis on required cognitive, affective and psychomotor skills to be able to work in any digital context (n = 3), serving for the using (n = 2), creating and applying (n = 2) digital literacy in real life.Data literacy, technology literacy and multiliteracy were the third frequent categories (n = 3). The ‘multiliteracy’ was referring to the innate nature of digital technologies, which have been infused into many aspects of human lives.Last but not least, Internet literacy, mobile literacy, web literacy, new literacy, personal literacy and research literacy were discussed in forty-three article findings. Web literacy was focusing on being able to connect with people on the web (n = 2), discover the web content , and learn web related skills through practical web experiences. Personal literacy was highlighting digital identity management. Research literacy was not only concentrating on conducting scientific research ability but also finding available scholarship online.Twenty-four other categories are unfolded from the results sections of forty-three articles. Table While above listed personal literacy was referring to digital identity management, network literacy was explained as someone’s social networking ability to manage the digital relationship with other people. Additionally, participatory literacy was defined as the necessary abilities to join an online team working on online content production.Emerging technology literacy was stipulated as an essential ability to recognize and appreciate the most recent and innovative technologies in along with smart choices related to these technologies. Additionally, the critical literacy was added as an ability to make smart judgements on the cost benefit analysis of these recent technologies.Last of all, basic, intermediate, and advanced digital assessment literacies were specified for educational institutions that are planning to integrate various digital tools to conduct instructional assessments in their bodies.The second major theme was revealed as competencies. The authors directly categorized the findings that are specified with the word of competency. Table Problem solving (n = 10)Safety (n = 7)Information processing (n = 5)Content creation (n = 5)Communication (n = 2)Digital rights (n = 1)Digital emotional intelligence (n = 1)Digital teamwork (n = 1)Big data utilization (n = 1)Artificial Intelligence utilization (n = 1)Virtual leadership (n = 1)Self-disruption  (n = 1)The most common category was the ‘digital competence’ (n = 14) where one of the articles points to that category as ‘generic digital competence’ referring to someone’s creativity for multimedia development (video editing was emphasized). Under this broad category, the following sub-categories were associated:Like ‘digital competency’, five additional articles especially coined the term as ‘digital competence as a life skill’. Deeper analysis demonstrated the following points: social competences (n = 4), communication in mother tongue (n = 3) and foreign language (n = 2), entrepreneurship (n = 3), civic competence (n = 2), fundamental science (n = 1), technology (n = 1) and mathematics (n = 1) competences, learning to learn (n = 1) and self-initiative (n = 1).Moreover, competencies were linked to workplace digital competencies in three articles and highlighted as significant for employability (n = 3) and ‘economic engagement’ (n = 3). Digital competencies were also detailed for leisure (n = 2) and communication (n = 2). Furthermore, two articles pointed digital competencies as an inter-cultural competency and one as a cross-cultural competency. Lastly, the ‘digital nativity’ (n = 1) was clarified as someone’s innate competency of being able to feel contented and satisfied with digital technologies.The third major observed theme was ‘skills’, which was dominantly gathered around information literacy skills (n = 19) and information and communication technologies skills (n = 18). Table Table Communication skills (n = 9) were multi-dimensional for different societies, cultures, and globalized contexts, requiring linguistic skills. Collaboration skills (n = 9) are also recurrently cited with an explicit emphasis for virtual platforms.‘Ethics for digital environment’ encapsulated ethical use of information (n = 4) and different technologies (n = 2), knowing digital laws (n = 2) and responsibilities (n = 2) in along with digital rights and obligations (n = 1), having digital awareness (n = 1), following digital etiquettes (n = 1), treating other people with respect (n = 1) including no cyber-bullying (n = 1) and no stealing or damaging other people (n = 1).‘Digital fluency’ involved digital access (n = 2) by using different software and hardware (n = 2) in online platforms (n = 1) or communication tools (n = 1) or within programming environments (n = 1). Digital fluency also underlined following recent technological advancements (n = 1) and knowledge (n = 1) including digital health and wellness (n = 1) dimension.‘Social intelligence’ related to understanding digital culture (n = 1), the concept of digital exclusion (n = 1) and digital divide (n = 3). ‘Research skills’ were detailed with searching academic information (n = 3) on databases such as Web of Science and Scopus (n = 2) and their citation, summarization, and quotation (n = 2).‘Digital teaching’ was described as a skill (n = 2) in Table Table The last identified major theme was the different types of ‘thinking’. As Table Computational thinking (n = 3) was associated with the general logic of how a computer works and sub-categorized into the following steps; construction of the problem (n = 3), abstraction (n = 1), disintegration of the problem (n = 2), data collection, (n = 2), data analysis (n = 2), algorithmic design (n = 2), parallelization & iteration (n = 1), automation (n = 1), generalization (n = 1), and evaluation (n = 2).Technological advancement Networking Information Creative-cultural industries Academia Citizenship Education Professional life Personal level A transversal analysis of digital literacy categories reveals the following fields of digital literacy application:This systematic review on digital literacy concentrated on forty-three articles from the databases of WoS/Clarivate Analytics, Proquest Central, Emerald Management Journals, Jstor Business College Collections and Scopus/Elsevier. The initial results revealed that there is an increasing trend on digital literacy focused academic papers. Research work in digital literacy is critical in a context of disruptive digital business, and more recently, the pandemic-triggered accelerated digitalisation  affect this concept overtly or covertly. Moreover, the digital divide issue needs to be analysed through the lens of its main determinants.New bibliometric analysis method can be implemented on digital literacy documents to reveal more information on how these works are related or centred on what major topic. This visual approach will assist to realize the big picture within the digital literacy framework.The digital literacy stakeholders, policymakers in education and managers in private organizations, need to be aware that there are many dimensions and variables regarding the implementation of digital literacy. In that case, stakeholders must comprehend their beneficiaries or the participants more deeply to increase the effect of digital literacy related activities. For example, critical thinking and problem-solving skills and abilities are mentioned to affect digital literacy. Hence, stakeholders have to initially understand whether the participants have enough entry level critical thinking and problem solving.Development of digital literacy for different groups of people requires more energy, since each group might require a different set of skills, abilities, or competencies. Hence, different subject matter experts, such as technologists, instructional designers, content experts, should join the team.It is indispensably vital to develop different digital frameworks for different technologies (basic or advanced) or different contexts (different levels of schooling or various industries).These frameworks should be updated regularly as digital fields are evolving rapidly. Every year, committees should gather around to understand new technological trends and decide whether they should address the changes into their frameworks.Understanding digital literacy in a thorough manner can enable decision makers to correctly implement and apply policies addressing the digital divide that is reflected onto various aspects of life, e.g., health, employment, education, especially in turbulent times such as the COVID-19 pandemic is.Lastly, it is also essential to state the study limitations. This study is limited to the analysis of a certain number of papers, obtained from using the selected keywords and databases. Therefore, an extension can be made by adding other keywords and searching other databases.


Impact ejecta are important references to establish regional and global stratigraphy of planetary bodies. Canonical views advocate radial distributions of distal ejecta with respect to the source crater, and their trajectories are significantly deflected on fast-rotating bodies. The Hokusai crater on Mercury formed a peculiar ray that features a hyperbola shape, and the sharp swerve of orientation was interpreted as a sign of a faster planetary rotation in the near past. Here, we show that this ray was not caused by a hypothesized larger Coriolis force, but due to abruptly-steepened ejection angles. Heterogeneous shock impedances of pre-impact impactor and/or target, such as topographic undulations, affect local propagation paths of shock and rarefaction waves, causing sudden changes of ejection angles. Distal ejecta with non-radial distributions are an inherent product of planetary impacts, and their unobvious provenances could mislead stratigraphic interpretations and hamper age estimations based on spatial densities of impact craters. Heterogeneous shock impedances of planetary materials cause abrupt changes of ejection angles, forming non-radial ejecta. Interpretations for provenances of surface deposits and ages derived from crater counts are affected by such untrackable ejecta. Distal ejecta are basic references used to apply the law of superposition on exterrestrial bodies, so regional and global stratigraphic systems can be established2. It is a conventional knowledge that ejection angles during impact cratering are usually 45° ± 15° (refs. 5), and distal ejecta generally follow radial distributions1. Recent impact modeling revealed that topographic roughness of pre-impact target7, inelastic collisions of impact ejecta10, and oblique impact angles11 could affect the overall radial distribution of impact rays. Meanwhile, it is well understood that the Coriolis force, especially on fast-rotating planetary bodies such as the Earth and Mars, possesses significant deflections on trajectories of distal ejecta, causing non-radial distributions14.High-speed collisions of celestial materials are a ubiquitous geological process during the formation and evolution of planetary bodies. Impact cratering forms various forms of ejecta that can be deposited over far-flung areas, and those landed at more than about five radii of the source crater are termed as distal ejecta15, which covered less than half of the planet  Hokusai crater, which is located at the northern high latitude of Mercury  spacecraftury Fig. . Based o12.This curved ray is more-or-less continuous in extension, and it consists of three branches in terms of orientations Fig. . The wes21. However, the western branch cannot be traced radially back to Hokusai , Debussy (D = 81 km), and Xiao Zhao (D = 24 km) craters are visible at not far from this great circle, but visible rays formed by these craters do not extend to the region of the curved ray  are usually visible in such rays, and their morphology is indicative to the azimuth of landing of the impacting ejecta  for large numbers of ejecta particles (see Methods). The model did not include the effect of rotational dissociation27 or mutual collisions10 of ejecta during flight, which may change their post-ejection trajectories. Therefore, ejecta with the same azimuth of landing had the same azimuth of ejection. The model-predicted landing positions were compared with the shape of the curved ray to deduce the azimuths of excavation  from the transient cavity (see Methods), ejection velocities (v), ejection angles with respect to the surface normal , and rotation period of Mercury (P). For each secondary crater in the curved ray, multiple combinations of solutions existed for ϕ, v, θ, and P, because the only known parameters in the inverse calculation were the observed locations of secondaries and their initial region of excavation from the transient cavity. To narrow down the best-fit solution, the uniform azimuth of ejection of ejecta that formed the secondaries in the western ray branch was referred as a critical constraint (see Methods).By updating the ballistic trajectory model for impact ejecta on rotating planetary bodies12, young craters with obvious rays are not observed , and most distal ejecta follow more-or-less radial distributions29.The global ray system of Hokusai, including the eastern branch of this curved ray, is generally consistent with the spatial pattern of landing positions of ejecta that had a uniform 45° Fig. . This goP = 58 Earth minutes, Hokusai’s distal ejecta that had a same ϕ cannot land along the western branch of this curved ray . Therefore, the ejecta that formed the western branch of this curved ray had abnormally steeper ejection angles than those with similar v but different ϕ, demonstrating azimuthally abrupt changes of ejection angles during impact cratering.Unlike the western branch of the curved ray, the other rays of Hokusai that are over 4000 km from the crater center cannot be formed by ejecta with m/s Fig. . For com1, and those with v > 4 km/s , are the vector sum of particle velocities induced by shock and rarefaction waves27. Recent high-resolution numerical simulations are capable to capture the evolution of ejection angles and velocities during jetting and early spallation in planetary impacts35. Spall fragments excavated by oblique impacts exhibit azimuth asymmetry in the ejection velocities and angles33. Those launched toward the downrange have shallower ejection angles (θ > 45°) but larger ejection velocities (up to about 2 times the impactor velocity). Those launched towards the uprange exhibit rather steep ejection angles of θ = ~10° but substantially smaller ejection velocities33. The curved ray on Mercury reflects abrupt changes of θ at certain v and ϕ, instead of systematical variations of ejection conditions36. Therefore, the oblique impact that formed the Hokusai crater was not an obvious reason to form the curved ray.Ejection angles of spall fragments, usually assumed to be 45° . For comparison, most spall fragments with similar v but θ > 25° formed radial rays . With a fast rotation speed of 4Vesta, ejecta with various ejection conditions could form curved chains of secondaries along the throughs , mainly to show the morphology and spatial distribution of impact rays. These include (1) a false color global mosaic that has red, green and blue bands as reflectances at 1000, 750 and 430 nm, respectively; (2) an enhanced global color mosaic of Mercury that is derived from the global eight-color mosaics56 based on a principal component (PC) analysis, and PC2, PC1 and the ratio of reflectances at 430 nm wavelength to that of 1000 nm are used as the red, green and blue channels, respectively; (3) a global map of slopes of reflectance spectra at visible to near-infrared wavelengths, and each pixel is the ratio between reflectances at 1000 and 430 nm wavelengths57; and (4) a global map of optical maturity of Mercury, and each pixel is the ratio between the average reflectance of the eight-band MDIS WAC spectrum and the spectral slope mosaic57. In addition, single frames of MDIS NAC images are used to study the detailed morphology of secondaries inside impact rays.For Mercury, images obtained by both the 750 nm band narrow angle camera (NAC) and the multiple-band wide angle camera (WAC) of the Mercury Dual Imaging System58 are used to investigate the lateral extension of impact rays. High-resolution monochrome images obtained by the Terrain Camera onboard the SELENE-Kaguya spacecraft are used to investigate the morphology of secondaries in impact rays.For the Moon, multiband images obtained by the Lunar Reconnaissance Orbiter Camera59, Mars Odyssey, are used to investigate the lateral extension of impact rays. Images obtained by the Context Camera onboard the Mars Reconnaissance Orbiter60 are used to investigate the morphology of secondaries in impact rays.For Mars, both the daytime and nighttime global mosaics obtained by the Thermal Emission Imaging System61 are used to investigate the morphology of the circumferential troughs that are developed around the Rheasilvia basin.For 4Vesta, the global digital elevation model constructed using data obtained by the Dawn mission and its shade relief models62.For Europa, the global monochrome mosaic obtained by the Voyager and Galileo spacecrafts are usedAll the imagery and topography data used in this study are available in the public domain, and their IDs and available addresses are in the Supplementary Table 26. The main criteria used in the manual mapping were the radial distribution of rays that are obviously sourced from the Hokusai crater and the visual similarities of reflectances of rays along a given azimuth. This work follows the same criteria when updating the ray system of Hokusai. To assist the mapping, the global spectral slope map and optical maturity index map (see Methods) are used additional to the other datasets. The two new maps have advantages in stressing reflectance contrasts of rays that were formed by different craters  of Mercuryers Fig. . It is nv; less than the escape velocity of the target body), ejection angle (θ) with respect to the surface normal , ejection azimuth (ϕ) with respect to the local north , and ejection position (colatitude ψ and longitude λ) in the transient cavity.Forward modeling for landing positions of impact ejecta is performed to investigate the required ejection conditions of ejecta that formed secondaries in distal impact rays. Model inputs include the initial ejection velocity . For each input parameter, the best-fit value was derived based on comparison with the observed distribution patterns of distal ejecta. The effect of local topography on landing positions and processes that may change post-ejection trajectories of particles, such as mutual collisions and rotational separation during flight, are not included in the model.Large numbers of ejecta particles are seeded in each simulation, typically over 10,000, according to assigned interval of w is rotation angular velocity, r is the radius of the target body. For each simulated particle, the inertial speed of planetary rotation at the ejection position, b = wrsinψ, is added to the homodromous component of ejection velocity, i.e., eastward for Mercury, 4Vesta and Europa. The new v0, θ0, ϕ0 relative to the sidereal frame are then derived with a simple trigonometry:The effect of planetary rotation on ballistic trajectories of impact ejecta is considered in the model, and vis-viva equation, G and M are the gravitational constant and target mass, respectively, is used to obtain the semimajor axis a of the trajectory ellipse:To derive the landing position of the ejecta, the conservation of energy in terms of the M, the specific relative angular momentum is calculated as a(1-e2)G(M + m))1/2, which equals ν0rsinθ0. Afterward, the ellipse eccentricity (e) is determined as:Based on the conservation of angular momentum and ignoring the minor ejecta mass as compared to r = a(1-e2)/(1+ecosν), where ν is the true anomaly at the beginning of the trajectory.The ballistic range of ejecta (Δ) is then calculated based on the ellipse equation ψ′ and longitude λ′) of ejecta are predicted following ref. 12, and the flight time (T) is calculated as T = 2(π-E + esinE)a3/2, where E = arc cos (ν02/e-1/e).δ = arc cos ((cosΔ-cosψcosψ′)/(sinψsinψ′)), and δ is considered negative if ϕ0 is between π and 2π.Landing positions , generally follow radial distributions. Ejection conditions of their source ejecta are generally consistent with the canonical knowledge of impact ejectionD = 114 km, and the empirical relationship between D and the diameter of the transient crater Dt64 is used to estimate the diameter (Dt) for its transient crater.D0 is the transition diameter from simple to complex craters, which is about 11.7 km on Mercury65. Therefore, the transient crater during the formation of Hokusai is Dt ≈ 61 km.The effect of different positions of ejection from a transient on ballistic trajectories of impact ejecta are considered in this work. The Hokusai crater on Mercury has a rim-to-rim diameter of Supplementary InformationPeer Review File