Urochloa decumbens, Urochloa brizantha andMegathyrsus maximus) and four concentrations of Cd applied in soils . Grass growth decreased and increased Cd concentration in shoots of grasses with the increased Cd rates in soils. The toxic effect of Cd resulted in production and Cd occlusion in phytoliths produced in shoots of the grasses. Grasses showed potential for phytolith production, independent of soil type, providing phytoextraction of Cd in phytoliths. Megathyrsus maximus was the grass with the highest tolerance to Cd, evidenced by higher production and Cd capture in phytoliths for the evaluated soils. Phytolith production by grasses in Cd-contaminated soils is related to genetic and physiological differences of the evaluated grasses and Cd availability in soils.Cadmium (Cd) is a very toxic heavy metal occurring in places with anthropogenic activities, making it one of the most important environmental pollutants. Phytoremediation plants are used for recovery of metal-contaminated soils by their ability to absorb and tolerate high concentrations of heavy metals. This paper aims to evaluate the potential of grasses in phytolith production in soils contaminated with Cd. The experiments, separated by soil types , were conducted in a completely randomized design with a distribution of treatments in a 3 × 4 factorial scheme with three replications. The factors were three grasses ( Cadmium (Cd) is an unessential element with elevated mobility and water solubility, being easily uptaken and accumulated in plants . Moreove−1 in dry mass for most plants [Due to the toxicity potential and high persistence of Cd, Cd-polluted soils create an environmental problem that threatens animal, plant and human health. The toxicity and high persistence of Cd carry to soil contamination, causing an environmental problem that threatens plant, animal and human health ,3. Many t plants ,8 and cat plants ,9,10,11,t plants ,15,16,17t plants ,18,19,20t plants .−1 dry mass [Phytoremediation technique has been used in order to restore heavy-metal contaminated soils . This tedry mass ,19. Grasdry mass ,19,21,22dry mass ,24,25,26Phytoliths are particles of amorphous silica with sizes ranging from 1 to 250 µm ,28, formThe production and heavy-metal occlusion in phytolith by plants is still not fully understood, particularly in Cd-contaminated soil. Phytolith production is influenced by phylogenetic and phenological characteristics, as well as soil and its elemental and mineralogical composition . This pap < 0.01) in all evaluated soils  that tend to have higher Cd and Si availability, which may directly reflect the production and Cd capture by phytoliths  that ten. Phytolip < 0.01)  and RH (Cadmium concentrations in grass shoots increased linearly as Cd rates increased in the three soils ( < 0.01) , confirm) and RH .Cadmium accumulation patterns in plants vary in tolerant, nontolerant and hyperaccumulating species ,9. Metal−1 Cd in dry mass [However, the evaluated grasses are not considered Cd-hyperaccumulating plants due to their low capacity to accumulate Cd  above 10dry mass ,19 withodry mass  due to tMegathyrsus maximus absorbs more Cd in sandy soil (TQ) while Urochloa brizantha absorbs more Cd in more clayey soils (XH and RH), which is reflected in the higher Cd concentration of shoots  R.D. Webster cv. Basilisk, Urochloa brizantha (Hochst. ex A. Rich.) R.D. Webster cv. Marandu and Megathyrsus maximus (Jacq.) B.K. Simon and S.W.L. Jacobs cv. Mombaça) and four Cd rates applied in soil  conducted on three soil types. The Cd rates were based on the agricultural intervention values for soil established in São Paulo State, Brazil [Three greenhouse experiments were performed in Diamantina, Brazil . The experiments were conducted in a completely randomized design with three replications arranged in a 3 × 4 factorial scheme. The factors were three grass species  (Arenosols in World Reference Base classification), a Xantic Hapludox (XH) and Rhodic Hapludox (RH) , classified according to Soil Taxonomy  and coll−1) = (V2 − V1)CEC/100, where V2 is the recommended base saturation for grasses (45%) and V1 is the base saturation of soil analysis  was calculated by the formula LR , 150 mg K (potassium chloride), 50 mg S (ammonium sulfate), 1.0 mg B (boric acid), 1.5 mg Cu (copper dichloride), 5.0 mg Fe (ferrous chloride EDTA), 4.0 mg Mn (manganese dichloride) and 5.0 mg Zn (zinc chloride) per kg of soil. Phosphate fertilization was stipulated by the maximum phosphorus-adsorption capacity of each soil using the Langmuir second isotherm adsorption region . Thus, P−1 (urea) at 15-day intervals after thinning of grasses. Grasses were grown in a greenhouse under natural photoperiod, maximum/minimum air temperatures of 21–18 and 21–18 °C at night and day, respectively, and relative humidity between 55% and 78%.Grass sowing was performed in pots of polyvinyl chloride with an inside diameter of 0.18 m and a height of 0.20 m, with 3 kg of soil. Seedling thinning was performed at 14 days after grass emergence with evaluation of one plant per pot. Nitrogen fertilization in top-dressing for grasses was split into four applications of 50 mg kgv/v) and perchloric acid (70% v/v), 2:1 ratio). Cd concentration was determined by graphite-furnace atomic absorption spectroscopy. Cadmium analysis in plant material was controlled with certified reference material NIST SRM 1573a tomato and blank reagents. Samples were reanalyzed if the determination of the NIST standard did not remain within 10% of certified values.Grasses were harvested after 120 days of thinning seedlings. Shoot samples were packed in paper bags and oven-dried with forced-air circulation at 65 °C to a constant weight. Dry plant material was weighed on an analytical balance to measure the shoot dry weight. Materials were ground and subjected to nitroperchloric digestion (nitric acid (65% Phytolith concentration in grass shoots was determined according to the methodology described by . The Cd p < 0.05). Regression equations were adjusted for Cd rates for each variable evaluated.The variables were subjected to joint analysis of variance, which consisted of the study of Cd rates and grasses within each soil type. Means for soil types and grasses were compared by the Tukey test (occluded) in phytoliths of grass shoots for maximum Cd rate (12 mg kg−1) applied to soils was calculated by dividing the Cd concentration in phytoliths by Cd concentration in grass shoots multiplied by 100. Cd concentration values in phytoliths and grass shoots were estimated by substituting the maximum Cd rate (12 mg kg−1) in the equations that correlate Cd rates with these variables.The percentage of Cd occluded (PCdMegathyrsus maximus may be a future grass for the technique of phytostabilization and revegetation of Cd-contaminated soils. However, studies to elucidate Cd sequestration in grasses by phytoliths are needed.Phytolith production by grasses in Cd-contaminated soils is related to genetic and physiological differences of evaluated grasses and Cd availability in soils.


Several prediction models for falls/near falls in Parkinson’s disease (PD) have been proposed. However, longitudinal predictors of frequency of falls/near falls are poorly investigated. Therefore, we aimed to identify short- and long-term predictors of the number of falls/near falls in PD.A prospective cohort of 58 persons with PD was assessed at baseline  and 3.5 years later. Potential predictors were history of falls and near falls, comfortable gait speed, freezing of gate, dyskinesia, retropulsion, tandem gait (TG), pain, and cognition . After each assessment, the participants registered a number of falls/near falls during the following 6 months. Multivariate Poisson regression was used to identify short- and long-term predictors of a number of falls/near falls.Baseline median (q1–q3) motor (UPDRS) and MMSE scores were 10 (6.75–14) and 28.5 (27–29), respectively. History of falls was the only significant short-time predictor  for the number of falls/near falls during 6 months following baseline. Abnormal TG  and lower MMSE scores  were short-term predictors 3.5 years later. Abnormal TG  and lower MMSE scores  at baseline were long-term predictors of the number of falls/near falls 3.5 years later.Abnormal TG and MMSE scores predict the number of falls/near falls in short and long term, and may be indicative of disease progression. Our observations provide important additions to the evidence base for clinical fall prediction in PD. Falls and balance problems in Parkinson disease (PD) are common already in the early stages of disease , 2 and pFurthermore, the previously proposed prediction models were derived to discriminate future fallers from non-fallers –10 and oThe Regional Ethical Review Board in Lund, Sweden approved the study (Dnr 2011/768). All participants gave written informed consent to participate.This prospective cohort study includes two clinical assessments: the baseline assessment (A1) at the start of the study and a second assessment (A2) 3.5 years later. After each assessment, participants were instructed to register all consecutive falls and near falls during the following 6 months; first follow-up (F1) and second follow-up (F2), respectively.n = 349). Exclusion criteria at the start of the study were: age above 80 years (n = 116), inability to stand without support, i.e., spontaneous tendency to fall in standing position (n = 22), unable to understand instructions (n = 14), or having severe comorbidity (n = 11). Of the remaining 186 potential participants, 40 (16 women) declined participation. The study sample at A1 included 146 PwPD. At the time for A2, 24 PwPD had dropped out due to severe comorbidity or death and 49 (17 women) declined participation. Severe comorbidity included metastatic cancer, stroke, heart failure, dialysis-treated renal failure, age-related eye diseases, gastrointestinal diseases, and diabetic complications. The final study sample with available A1 and A2 data included 73 PwPD.All people with PD  diagnoseData on demographics and anti-parkinsonian medications were obtained from medical records. Daily levodopa equivalent (LDE) doses (mg/day) were calculated according to recommended conversion factors . At bothPwPD were provided with a diary consisting of pre-printed pages for recording the date and time of every fall/near fall event and questions (yes/no) clarifying whether it was a fall or a near fall. The question in relation to a fall was phrased as follows: Did you fall in such a way that your body hit the ground? The corresponding question about a near fall incident was phrased: Were you close to falling, but managed to brace yourself at the last moment ? Falls were defined as “an unexpected event in which the person comes to rest on the ground, floor, or lower level” . Near fan (%). Wilcoxon signed-rank and McNemar's tests were used for bivariate analysis of differences in sample characteristics between A1 and A2. The alpha level of significance was set at 0.05.Data were checked regarding underlying assumptions and described accordingly using SPSS version 24 . Normally distributed interval/ratio-level variables were described using means and SDs. In other cases, medians (q1–q3) were used. Categorical variables were described using P value < 0.20 in the simple analyses were entered in multiple Poisson regression models. The < 0.2 P value threshold was chosen to avoid leaving important variables out [P value were subsequently removed by a backwards stepwise deletion approach until only independent predictors with P values < 0.05 remained in the model. Deviance statistic was used to assess the significance of contribution of each independent predictor included in the models. Overall performance of the final models was evaluated with the Omnibus test  and R2 deviance [Further analyses were performed through Poisson regression with robust variance. First, simple analyses were performed with each independent variable investigated on A1 and A2 and number of falls and/or near falls investigated at F1 and F2 as a dependent variable. That is, two analyses of short-term predictors were conducted, using A1 and A2 data as independent variables with the number of F1 and F2 falls/near falls events as dependent variables, respectively. Analysis of long-term predictors included A1 data as independent variables with the number of F2 falls/near falls events as the dependent variable. The incidence rate ratio (IRR) values and 95% confidence intervals (CI) were calculated. Variables with a bles out . Predictdeviance . For theFifteen of the 73 PwPD were excluded due to incomplete prospective records of falls and near falls. The baseline mean (SD) age and PD duration of the remaining 58 32 women) PwPD were 65 (8.8) and 3.2 (3.68), respectively, and their median (q1-q3) UPDRS III score was 10 (6.75–14). Details regarding results from A1 and A2 are provided in Table  women Pwn = 13) during F1 and 74 (n = 26) during F2. The mean number of falls (1.28) during F2 was significantly higher (P = 0.007) than during F1 . The total number of near falls was 122 (n = 18) during F1 and 67 (n = 19) during F2, and the total number of falls and/or near falls was 151 (n = 24) during F1 and 141 (n = 28) during F2. Neither the mean number of near falls nor falls and/or near falls differed between the two periods (Table Twenty-four and twenty-eight PwPD reported at least one fall or near fall during F1 and F2, respectively. The total number of falls was 29 (P < 0.2 (Table The univariate Poisson regression analyses, based on results from A1 and F1, identified five predictors associated with the number of falls and/or near falls at .2 Table . The mul.2 Table .Table 3PP < 0.2 (Table The univariate Poisson regression analyses, based on results from A2 and F2, identified eight predictors associated with the number of falls and/or near falls at .2 Table . The mul.2 Table .Table 4PP < 0.2 (Table The univariate Poisson regression analysis based on A1 and F2 data identified six predictors associated with the number of falls and near falls at .2 Table . The mul.2 Table .Table 5P-term predictors in later stages of the disease.In this prospective cohort study with PwPD, we found history of falls to be a strong short-term predictor of the number of falls and/or near falls in earlier stages of PD, whereas abnormal TG and cognition were identified as both short- and longIn earlier stages of PD, we found that a person reporting history of falls could be expected, on average, to experience approximately 15 times as many falls and/or near falls during the following 6 months than a person without history of falls. This is in line with prior findings, demonstrating that history of falls is associated with higher frequencies of future falls in PD , 15. ThuTo the best of our knowledge, the association between TG and frequency of falls/near falls in PD has not been reported before. However, Lindholm et al. reported a prediction model suggesting that abnormal TG is associated with a fourfold higher risk of the occurrence of future falls and/or near falls in early PD . The basThe critical point of TG is the exact foot placement  and abilThe second predictor in our models was cognitive decline. Our results suggest that every decrease in the MMSE score results in approximately 1.2–1.5 times higher number of falls/near falls. To our knowledge, this is a novel finding not reported before, although MMSE scores lower than 24 have been associated with an almost sevenfold higher risk of the occurrence of future falls in PD .Some variables that were significant short- and/or long-term predictors of the number of falls/near falls in univariate but not in the multivariate analyses may need a special attention. For example, FOG and comfortable gait speed < 1.1 m/s together with history of falls are included in the three-step falls prediction model , 7, 10. Taken together, TG and MMSE are both well-known and easily performed clinical tests that predict the number of falls and/or near falls in PD. These tests seem to be stable predictors over time and may also serve as markers of disease progression. They may, therefore, be of special interest to use in clinical settings as predictive screening tests of increased number of falls/near falls. Such information should serve as a starting point for in-depth examination of additional motor and cognitive symptoms such as FOG , striataThe PwPD in this study had relatively mild PD, and people above the age of 80 years were not included at the start of this study. Our findings may thus not apply to older people or those with more severe PD. However, focusing on PwPD with relatively mild PD has been recommended to work proactively , 43.The number of PwPD that declined participation was high. This means that there is a risk of selection bias and that our sample may not represent the underlying population of PD patients and reduces statistical power and precision in estimates.Several of the predictors were represented by relatively coarse indicators. Using a coarse indicator, one may not capture those having mild problems. For instance, it has been suggested that the Montreal Cognitive Assessment is preferable to the MMSE when screening for early cognitive impairments in PD . FurtherIn this prospective cohort study with PwPD, we found that abnormal TG and cognitive decline predict the number of falls and/or near falls in the short as well as the long term. History of falls is also a strong short-term predictor but only in earlier stages of the disease. Our observations provide important additions to the evidence base for clinical fall prediction in PD.


Many older people use powered wheelchairs and mobility scooters to access the community on buses but have increased injury risk if the mobility device tips or slides. Wheelchair tie-down and occupant restraint systems (WTORS) are mandated on USA transit buses, and their introduction investigated in Australia. This study examined the views of mobility device and ambulant bus users in the USA and Australia on WTORS. A Qualtrics survey with 448 respondents showed strong support for WTORS use and found the most important factors underpinning use were Safety, Comfort, and Transit time. US research indicates dwell time while fitting WTORS is 4 minutes, and participants reported 5.65(SD3.06) minutes is acceptable. There was no difference in USA and Australian participants who have slid or tipped in their device, despite being restrained in the USA: X2=.053,p=.53,phi-.016). This research suggests all bus users are supportive of WTORs, but their effectiveness requires investigation.


This study aimed to explore the association between malnutrition, clinical parameters, and health-related quality of life in elderly hospitalized patients with Parkinson’s disease (PD).Cross-sectional study of 92 hospitalized elderly patients with PD (mean age 73.6 ± 6.7 years) without dementia. The Mini Nutritional Assessment (MNA) was used to evaluate nutritional status. Motor impairment and non-motor symptoms burden , depression (Becks Depression Inventory-II), and health-related quality of life  were assessed.Every second patient was malnourished or at risk of malnutrition. In the multivariable analysis, male gender, longer disease duration, higher Hoehn & Yahr and depression were associated with total MNA score. Besides non-motor symptoms and motor impairment, malnutrition was an independent predictor of poor health-related quality of life. In the multivariate analysis, malnutrition had a statistically significant effect on emotional well-being, mobility, social support, stigmatization, and cognition. The strongest association was found between malnutrition and emotional well-being.Elderly male persons with longer PD duration and higher disease stages are more likely to be malnourished or at risk for malnutrition. Malnutrition was mainly associated with poor emotional well-being, suggesting that treatment of depression and anxiety beside diet and physical activity can help improving nutrition status in these subjects. The MNA should not be used independent of other measures of cognition and depression in people with advanced PD. Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by motor impairment and a plethora of non-motor symptoms. People with PD are at a high risk of malnutrition . In PD, A gold standard for the optimal definition of malnutrition is still lacking . The EurMalnutrition is associated with poor health-related quality of life (QoL) and differentially influences distinct domains of health-related QoL, especially well-being and mobility domains , 8, 9. HWhat is the prevalence of malnutrition in hospitalized elderly patients with PD?To what extent does malnutrition predict health-related QoL in elderly patients with PD?Which domains of health-related QoL are mainly affected by malnutrition?This cross-sectional study was approved by the local ethics committee of the Jena University Hospital (4572-10/15), and all patients gave their written informed consent. Data were collected from patients with PD at the beginning of their stay (day 1–3) in the neurological ward of the Department of Neurology at the Jena University Hospital (Germany). All the patients were hospitalized because of the worsening of motor function or complications . All received a multimodal treatment by specialized therapists and medication modifications during their stay in the hospital  . Inclusiwww.mna-elderly.com). It was specifically designed for the elderly and is recommended by the European Society for Clinical Nutrition and Metabolism. It consists of six questions about dietary regime in the last 3 months, weight loss, immobility, recent stress period, neuropsychological disorders (depression and dementia), and body mass index (BMI) or calf circumference  [Several clinical variables were recorded, including the MDS-sponsored revision of the Unified Parkinson's Disease Rating Scale III (MDS-UPDRS III) to assess motor function, the revised Non-Motor Symptoms Questionnaire (NMS-Quest), Hoehn and Yahr staging (H&Y), and levodopa equivalent daily dose (LEDD). Cognition was assessed using the Montreal Cognitive Assessment (MoCa); PD dementia was defined as MoCa < 21 . Beck’s trition) .Epidemiological factors, the MDS-UPDRS III, NMS-Quest, H&Y, LEDD, MoCa and disease duration were derived from the medical records. The BDI and PDQ-39 were self-reports. The MNA was assessed by MT. After exclusion of 8 people with missing data in the BDI or PDQ-39, the data from 92 subjects were used for the following analyses.The SPSS statistical computer package  was used for all statistical analyses. Values are given as mean and standard deviation or median and interquartile range (IQR). Categorical variables are presented as numbers or percentages.Multiple linear regression analysis was subsequently performed to ascertain the independent predictors of the MNA. The clinical parameters / independent variables were derived from the literature and included: age, gender, disease duration, H&Y, MDS-UPDRS III, NMS-Quest, BDI, and LEDD , 16–18. A second linear regression was used to study the association between PDQ-39SI (dependent variable) and MNA and variables known to influence health-related QoL in PD  , 20. BefAnonymized data from this study are available as supplementary material.The detailed clinical characteristics are given in In the linear regression analyses male gender, longer disease duration, higher H&Y stage, and higher BDI were found to be associated with malnutrition .In the next step, we aimed to answer if malnutrition is associated with overall health-related QoL (PDQ-39SI) after controlling for known factors that influence PDQ-39  , 20. In p = 0.016; Wilk's Λ = 0.799, partial η2 = 0.20). However, significant univariate main effects for MNA were only found on emotional well-being , mobility , stigmatization , and social support . As indicated by the partial η2, the strongest association was found between malnutrition and emotional well-being. The MANCOVA was conducted to examine whether these findings could be accounted for by other medical covariates . Here, disease duration , NMS-Quest , and MDS-UPDRS III , but not age (p = 0.13), were significant in the model. In addition, the results did not change after controlling for these variables, as there remained a significant main effect of MNA on the emotional well-being , mobility , stigmatization , social support , and in addition cognition .Given that malnutrition impacts the PDQ-39SI, we then analyzed the relationship between nutrition status and the PDQ-39 domains. A MANOVA was used to study the association between malnutrition and the eight PDQ-39 domains. The MANOVA revealed a significant multivariate main effect for the MNA total score on the eight PDQ-39 subdomains  malnutrition was associated with male gender, longer disease duration, higher H&Y and depressive mood. Three recent studies also investigated the association between MNA and clinical parameters. Fereshtehnejad et al. investigated 150 patients with PD (men age 60.8 ± 10.8) and found in their multivariate linear model that depression, UPDRS total score, LEDD and patients’ sex were significantly associated with the total MNA score . The cohWe found that malnutrition is an independent predictor of the PDQ-39SI in elderly subjects with PD after controlling for other known predictors of health-related QoL, namely NMS which have large impact on QoL in elderly patients , 23–25. The MNA is widely used and is available in multiple languages and many studies in various settings used this tool. A large body of evidence underlines the usefulness of the MNA as screening tool in elderly people. However, despite these benefits of MNA, the sensitivity of the MNA is still debated because it has been related to a high risk of overdiagnosis of malnutrition –32. MoreOur study has some more limitations. The analysis of health-related QoL and malnutrition was restricted to hospitalized patients without dementia, limiting the generalizability of our results. Moreover,—as in the other studies –10—we diThe predictors of malnutrition and the impact on health-related QoL in our cohort of elderly hospitalized patients differ from the existing studies in younger patients. We found that elderly male persons with longer disease duration and higher disease stages are more likely to be malnourished or at risk for malnutrition. Malnutrition was mainly associated with poor emotional well-being. Further studies in elderly patients with PD should therefore answer if the treatment of depression and anxiety beside diet and physical activity can help to improve nutrition status in these subjects. The MNA should not be used independent of other measures of cognition and depression in people with advanced PD.S1 Data(SAV)Click here for additional data file.


Hepatocellular adenoma (HCA) are benign liver tumours that may be complicated by haemorrhage or malignant transformation to hepatocellular carcinoma. Epidemiological data are fairly outdated, but it is likely to assume that the incidence has increased over the past decades as HCA are more often incidentally found due to the more widespread use of imaging techniques and the increased incidence of obesity. Various molecular subgroups have been described. Each of these molecular subgroups are defined by specific gene mutations and pathway activations. Additionally, they are all related to specific risk factors and show a various biological behaviour. These molecular subgroups may be identified using immunohistochemistry and molecular characterization. Contrast‐enhanced MRI is the recommended imaging modality to analyse patients with suspected hepatocellular adenoma allowing to determine the subtype in up to 80%. Surgical resection remains to be the golden standard in treating HCA, although resection is deemed unnecessary in a large number of cases, as studies have shown that the majority of HCA will regress over time without complications such as haemorrhage or malignant transformation occurring. It is preferable to treat patients with suspected HCA in high volume centres with combined expertise of liver surgeons, hepatologists, radiologists and (molecular) pathologists. Epidemiological data on HCA are fairly outdated but it is likely to assume that the incidence has increased over the past decades as HCA are more often incidentally found due to the more widespread use of imaging techniques and the increased incidence of obesity.Various molecular subgroups of HCA have been described with varying biological behaviour.These molecular subgroups may be identified using contrast‐enhanced MRI, immunohistochemistry and molecular characterization.Surgical resection remains to be the golden standard in treating HCA, although resection is deemed unnecessary in a large number of cases.As HCA may be considered a rare disease, it is preferable to treat patients with suspected HCA in high volume centres with combined expertise of liver surgeons, hepatologists, radiologists and (molecular) pathologists.1Hepatocellular adenoma (HCA) is a benign liver tumour that may be complicated by haemorrhage or malignant transformation to hepatocellular carcinoma (HCC). Risk factors for HCA include long‐term use of the oral contraceptive pill (OC),2For a long time, epidemiological data on HCA were severely outdated. In 1979, the annual incidence rate was estimated at 3‐4 per 100.000 women per year for long‐term OC users, as compared to 0.1 per 100.000 women per year for non‐long‐term users.3HCA results from a monoclonal benign proliferation of hepatocytes. Usually, tumour hepatocytes in HCA look similar to normal hepatocytes. During the last 20 years, genomics analyses of large series of hepatocellular adenomas enabled to progressively identify six major molecular subgroups and additional mixed subtypes of HCA. Each of these molecular subgroups are defined by specific gene mutations and pathway activations. They are all related to specific risk factors and show a various biological behaviour.3.1The first molecular subgroup accounts for 30% to 40% of adenomas and is defined by a mutation inactivating HNF1A, a gene coding for Hepatocyte Nuclear Factor 1 Alpha. This is a transcription factor essential for the differentiation of hepatocytes.3.2I‐HCA is the most frequent subtype (40%‐50% of the cases), defined by the activation of STAT3, a major transcription factor of inflammation. In I‐HCA, an activating mutation of one the factors of the IL6/STAT3 signalling pathway is identified targeting either IL6ST, FRK, STAT3, JAK1, GNAS1 or ROS1.3.3ß‐catenin is an important oncogene in the liver. Two types of mutations in the CTNNB1 gene have been identified in HCA, leading to an activation of ß‐catenin.ex3HCA). These alterations are well‐known oncogenic mutations, that lead, in the vast majority of the cases, to a high activation of the WNT/ß‐catenin pathway.Mutations or deletions at exon 3 of CTNNB1 are identified in 10 to 15% of HCA .Around 7 to 10% of HCA show atypical hotspot mutation at exon 7 or 8 of CTNNB1  that can be demonstrated by immunohistochemistry.3.5ex3IHCA or b‐ex7,8IHCA are observed in around 10% of the cases. Their histological pattern results from the combination of each subtype. In contrast, H‐HCA or sh‐HCA is almost never mixed with another molecular subtype.Mixed molecular subclasses showing both inflammatory and ß‐catenin activation and resulting in b3.6Overall, in less than 7%, HCA remain unclassified. They do not show specific histological features. An overview of all molecular subtypes, risk factors and biological behaviour is given in Figure 4As suggested by the 2016 EASL guidelines on the management of benign liver tumours, contrast enhanced MRI is the recommended imaging modality to analyse patients with suspected HCA allowing to determine the subtype in up to 80%.4.1Most of H‐HCA is characterized microscopically by the presence of fat. The resulting diffuse and homogeneous drop of signal on opposed‐phase T1‐weighted MR images Figure  has a ve4.2I‐HCA is characterized on MRI by strong hyperintensity on T2 images , and persistent enhancement on portal and delayed phases using extracellular MR contrast agents. Combination of these signs has a high specificity (88%‐100%) for classifying inflammatory HCA Use of gadoxetic acid as liver‐specific MRI contrast agent may modify the typical persistent enhancement. During transitional phase (3‐5 minutes) vascular structures including dilated sinusoids within the tumour appear hypointense due to the rapid clearance of the gadoxetic acid from the vascular pool.In the hepatobiliary phase, most I‐HCA are hypointense Figure . Neverth4.3At present, it is not possible to accurately differentiate b‐HCA, sh‐HCA and U‐HCA subtypes with imaging. Differently from I‐HCA, b‐HCA develop mostly in non steatotic livers.ex3IHCA or bex7,8IHCA), are likely to show the same imaging appearance as I‐HCA.The combined form of I‐HCA and exon 3 or exon 7,8 b‐HCA HCA, and patients with HCA showing progressive growth.The chance of regression of HCA to <5 cm appears to be lower in H‐HCA as compared to I‐HCA.Haemorrhage is the most frequent complication in HCA, and has been reported in up to 25% of cases.Pregnancy used to be discouraged in patients with unresected HCA, because of the risk of hormone induced growth and rupture during pregnancy. In 2004, a study was published reporting the mortality risk of ruptured HCA during pregnancy: 44% for the mother and 38% for the foetus.In addition, given the sensitivity of HCA to hormones in fertile women, a study was performed questioning whether surveillance of HCA is still required in post‐menopausal women.When a patient is diagnosed with HCA, a great number of factors should be taken into account when deciding whether the patient should undergo a resection or whether a wait‐and‐see policy is legitimized. The most important patient related factors to be considered include sex, age and co‐morbidity. For instance, resection is advised in men given the far higher risk of malignant transformation .As for every type of liver surgery, the anatomical location of the tumour should be taken into account as well as the quality and volume of the future liver remnant. As a large number of patients with HCA are overweight or obese, the presence and degree of steatosis should be taken into account as these factors impact the perioperative complication‐ and mortality rates of liver resections.7Elective surgical resection is the gold standard in the treatment of patients with HCA. Resection of HCA can safely be performed with either an open or laparoscopic approach.Other treatment methods investigated for the treatment of HCA are transarterial embolization (TAE) and tumour ablation (either radiofrequent ablation or microwave ablation). TAE is a well‐established treatment to use for HCA showing acute haemorrhage with hemodynamic instability,Liver transplantation has been proposed as a treatment for patients with many widespread HCA . To date, this is no longer considered an indication for liver transplantation.8HCA may be considered a rare disease. The small number of patients and the limited epidemiological data pose challenges for research and the clinical development. It is preferable to treat patients with suspected HCA in high volume centres with combined expertise of liver surgeons, hepatologists, radiologists and (molecular) pathologists. To optimize the validity and reliability of future research, it is important to collaborate in (inter)national multicentre consortia to optimize our insights in diagnosis and treatment of this rare disease.


Structural equation modeling indicated that the positive association between cyberbullying victimization and drinking behavior was partly mediated by deviant peer affiliation for both girls and boys. Further, this mediating process was stronger for adolescents with low personal growth initiative than for those with high personal growth initiative. There were no significant gender differences for this moderating effect. These findings underline the importance of deviant peer affiliation and personal growth initiative in understanding how and when cyberbullying victimization impacts adolescent drinking behavior.Research has demonstrated a robust positive association between cyberbullying victimization and adolescent drinking behavior; however, the mediating and moderating mechanisms underlying this relationship remain largely unexplored. Grounded in the social development model and person-environment interactions model, our study explored whether deviant peer affiliation mediated the relationship between cyberbullying victimization and adolescent drinking behavior and whether this mediating effect was moderated by personal growth initiative. A sample of 1,006 adolescents ( Cyberbullying victimization among adolescents represents a serious public health concern, as it has been shown to have an adverse impact on their psychological growth , 2. CybeA considerable number of empirical studies have confirmed that cyberbullying victimization is a strong risk predictor for adolescent alcohol use –11. On tDeviant peer affiliation is defined as the selective interaction with peers who engage in deviant behaviors, such as drinking, aggression and problematic Internet use . Based oMoreover, bonding with deviant peers might increase an adolescent’s chances of adopting beliefs and behaviors consistent with the norms of the deviant peer group, increasing the risk for alcohol use , 21. ComBased on the social development model and existing research, we proposed the following hypothesis:Hypothesis 1: Deviant peer affiliation would mediate the relationship between cyberbullying victimization and adolescent drinking behavior.via deviant peer affiliation, not all adolescents are equally likely to use alcohol after being cyberbullied. The person-environment interactions model  participated.In this study, participants were recruited from three middle schools in Guangdong province, southern China, through stratified and random cluster sampling. The sample was stratified by city size . The data was collected during September 2019. Random cluster sampling was used to select three grade 7 classes and three grade 8 classes of an ordinary middle school from each of city. A total of 1,006 adolescents  ranging from 12 to 15 years old .Cyberbullying victimization was assessed with the Cyberbullying Victimization Scale . Particinever to 5 = six or more times. Scores for all 12 items were averaged, with higher scores representing greater deviant peer affiliation. In this study, the measure demonstrated good reliability (α = 0.81).Deviant peer affiliation was assessed with a 12-item Chinese version questionnaire . Particistrongly disagree to 6 = strongly agree. Scores for all 16 items were averaged, with higher scores representing higher personal growth initiative. In this study, the measure demonstrated good reliability (α = 0.95).Personal growth initiative was assessed using the Personal Growth Initiative Scale-II, developed by Robitschek et al. . Particinever to 6 = 8 or more times. Higher scores indicated higher levels of drinking behavior. This instrument has demonstrated good validity in previous studies (α = 0.88). In this study, drinking behavior was positively correlated with depression , indicating this measure has good criterion validity.Participants reported the average number of times per month they had used alcohol  in the past 6 months using a 6-point scale from 1 =  studies , 23, 35. studies , this st studies , and demmale and 0 = female. The 4-item sensation seeking, subscale of the Impulsive Behavior Scale was used to measure participants’ sensation seeking .Previous literature has found that gender, age, and sensation seeking to be significantly related to adolescent drinking behavior , 39; the seeking . Partici studies . In thisThis research used a collective test method, taking the class as a unit to investigate the students using self-report questionnaires. Before the research was begun, we obtained approval from the Academic Ethics Review Committee of the School of Education, Guangzhou University. Additionally, the adolescent participants and their guardians and school administrators provided informed assent and informed consent, respectively, before participants completed all questionnaires with support from trained research assistants who were students in psychology.χ²/df, CFI, and RMSEA) were used to indicate model goodness of fit. The model fit is considered acceptable when χ²/df < 3, CFI > 0.95, and RMSEA < 0.06 , and deviant peer affiliation was positively associated with drinking behavior . Moreover, residual effect of cyberbullying victimization on drinking behavior was significant . Bootstrapping analyses indicated that deviant peer affiliation significantly mediated the relation between cyberbullying victimization and adolescent drinking behavior .The mediation model represented in χ2/df = 2.63, CFI = 0.99, RMSEA = 0.04. The bias-corrected percentile bootstrap results indicated that the indirect effect of cyberbullying victimization on adolescent drinking behavior through deviant peer affiliation was moderated by personal growth initiative. Specifically, personal growth initiative moderated the association between cyberbullying victimization and deviant peer affiliation , and the association between deviant peer affiliation and drinking behavior .The moderated mediation model represented in β = 0.43, SE = 0.04, t = 12.23, p < 0.01, 95% CI ) compared to adolescents with higher personal growth initiative . Moreover, SD above the mean; β = −0.18, SE = 0.04, t = −3.95, p < 0.01, 95% CI ). However, this link between deviant peer affiliation and drinking behavior was not significant among adolescents with lower personal growth initiative .We conducted two simple slopes test, and as depicted in β = −0.12, SE = 0.03, t = −3.99, p < 0.01, 95%CI ) and a significant positive relationship with drinking behavior . However, the interaction between cyberbullying victimization and personal growth initiative in impacting deviant peer affiliation  and drinking behavior  was not significant.Moreover, personal growth initiative had a significant negative association with deviant peer affiliation . However, this indirect link was nonsignificant for those with lower personal growth initiative . Therefore, the mediating effect of deviant peer affiliation between cyberbullying victimization and adolescent drinking behavior was moderated by personal growth initiative.Moreover, the indirect link between cyberbullying victimization and drinking behavior Inspired by the social development model  and the via deviant peer affiliation. Thus, deviant peer affiliation was not only the result of cyberbullying victimization but also served as a catalyst for adolescent alcohol use. These findings are in line with the social development model  to reduce the likelihood they will affiliate with deviant peers. Parents and educators should also increase their behavioral monitoring of adolescents to decrease deviant peer affiliation. Third, the mediating role of deviant peer affiliation was moderated by personal growth initiative, which provided evidence that personal growth initiative might play a crucial role in individual development. Therefore, it may be necessary to increase personal growth initiative by conducting intentional growth training in regular school courses and further improving the effectiveness of related interventions . FinallyThe raw data supporting the conclusions of this article will be made available by the corresponding authors, without undue reservation.The studies involving human participants were reviewed and approved by the Academic Ethics Review Committee of the School of Education, Guangzhou University. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.PC, CW, CY, and WZ conceived and designed the research. PC, CW, CY, and WZ performed the research. CY analyzed the data. PC, MX, QX, CW, CY, XG, XX, and WZ contributed to the writing and the revise of the manuscript. All authors contributed to the article and approved the submitted version.This study was supported by the 13th Five-Year Plan for the Development of Philosophy and Social Sciences of Guangdong Province (GD16XXL07) and National Natural Science Foundation of China (31671154).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The rapid development of short-video social network platforms provides us with an opportunity to conduct health-related advertising and recommendation. However, so far, there are no empirical evidence on whether users are willing to accept health-related short-video advertisements. Here, acceptance refers to purchase intention, meaning that users will read short-video ads, share ads with others, or even open the product link embedded in ads to purchase the product. In this paper, we make the first attempt to model and quantify user acceptance of health-related short-video advertisements. Particularly, we propose a new research model that enhances the Technology Acceptance Model (TAM) with two new designs. First, we propose four new antecedents including social interaction, intrusiveness, informativeness, and relevance into the original TAM to reflect the features of short-video social networks. Second, we introduce two mediator variables including perceived usefulness and attitude so that we can better study how different factors affect user acceptance of health-related short-video ads. We perform a survey on the Internet and conduct an empirical analysis of the surveyed data. The results show that the four antecedents as well as the perceived ease of use have significant influences on perceived usefulness, attitude, and purchase intention. Further, perceived usefulness plays a valid mediating role in attitude and purchase intention. We also found that users’ perceived ease of use on health-related short-video ads cannot significantly predict users’ attitudes toward ads. This is a new finding in social media-oriented ads. Finally, we integrate the empirical findings and present reasonable suggestions for advertisers and marketers to promote health-related short-video ads. In Social media is one of the most promising tools in the digital advertising environment ,2. Sincehttps://www.douyin.com/) provides one-on-one video interaction that allows one user discusses some topics with another user through live video. At the same time, other users can watch the live video and interact with others via barrages, text reviews, emojis, and images. This new form of social interaction on short-video social network platforms has been demonstrated to be an effective way of advertising [The rapid development of short-video platforms introduces new opportunities for health promotion, e.g., health-related advertising and recommendation. Compared with traditional social media, short-video platforms have little time delay and can support one-on-one as well as many-to-many social interaction by videos and the barrage (scrolling texts on the screen). For example, the largest Chinese live-video platform Douyin  as the base model and extend social interaction, intrusiveness, informativeness, and relevance as four new antecedents to the perceived usefulness of health-related short-video ads. Then, we set perceived usefulness and attitude as two mediate factors and validate their mediating effect in the model. Finally, we conduct an empirical analysis of questionnaire data from the Internet and short-video social network platforms based on the structural equation model. Briefly, following the research framework of the TAM model, we aim to study the following research questions:(1)We extend the Technology Acceptance Model (TAM) with new antecedents including social interaction, intrusiveness, informativeness, and relevance to analyze the users’ response to health-related short-video ads. To the best of our knowledge, this is the first study that extends the TAM model to analyze user acceptance of health-related short-video ads.(2)We conduct a survey on the Internet and short-video social network platforms and perform systematical data analysis over the surveyed data. The data analysis consists of many aspects, including measurement model evaluation, structural model evaluation, and mediating effect analysis. The results show that social interaction, intrusiveness, informativeness, relevance, and the TAM factors (perceived usefulness and perceived ease of use) have a significant influence on user acceptance of health-related short-video ads. Further, we find that users’ perceived ease of use on health-related short-video ads cannot significantly predict users’ attitudes toward ads. This is a new finding that is contrary to previous studies in social media-oriented ads.(3)We integrate the empirical findings and present reasonable suggestions for advertisers and marketers to better develop health-related short-video ads.In summary, we make the following contributions in this paper:The remainder of this paper is structured as follows. Digital advertising significantly influences users’ attitudes and intentions to purchase . There aThere have been some existing studies on informativeness and intrusiveness and how such concerns may influence users’ attitudes toward advertising and product purchase intentions ,14,15,16Relevance is another factor that may affect user acceptance of advertising. Relevance has been widely adopted in web search and online recommendation . For insOn the other hand, according to the social influence theory , a high So far, short-video ads are still in the early developing stage. Existing work has paid little attention to how the new features of short videos impact users’ attitudes toward purchase behavior. Based on previous experiences in social media ads, many researchers claimed that two aspects of information should be considered in the context of social media ads ,21,22. TThe Technology Acceptance Model (TAM) was developed to describe users’ behavior to accept or reject the use of new technologies . The TAMAlthough the TAM model is initially designed to explain and predict the behavior of individuals on the use of information systems, it has been used in many studies ,25,26. PThe TAM model has been widely adopted in many existing studies. In this paper, we also adopt the TAM model as the basic research model. There are two reasons. First, many studies in social media have applied the TAM model to analyze the acceptance factors of online advertising and social network advertising. The research scope of this paper, i.e., short video, has the characteristics of both online media and social networks; thus, it is a reasonable choice to select the TAM model. Second, the basic factors in the TAM model, namely perceived usefulness (PU) and perceptual ease of use (PEOU), are suitable to distinguish the usefulness of live advertising and the impact of live-video technologies.On the other hand, differing from the traditional TAM model, we integrate social interaction, intrusiveness, informativeness, and relevance with TAM and propose to use perceived usefulness as the mediate factor, forming an augmented TAM model that is more suitable for studying the intact path of short-video ads. Even though research integrating these external variables with the TAM is limited, available empirical findings generally support the influence of these factors on perceptions about users’ ad attributes and adoption intentions.In addition to the TAM model, another widely used model for predicting user acceptance of short-video ads is the Unified Theory of Acceptance and Use of Technology (UTAUT) model , which wIn summary, both TAM and UTAUT are actively utilized in the research of user adoption of new technologies. Whether or not to use TAM or UTAUT mainly depends on the particular type of the application. In this paper, we select TAM rather than UTAUT as the basic model for analyzing user acceptance of health-related short-video ads for the following reasons. First, UTAUT is a behavioral model aiming to explain the behavior of people in the use of information systems , but in In this paper, we first selected the main factors in the TAM model as basic independent variables, i.e., perceived usefulness (PU), perceived ease of use (PE), and ad attitudes (AT). Further, we introduced social interaction (SI), informativeness (IR), intrusiveness (IN), and relevance (RE) as new antecedents of perceived usefulness. The selection of the four factors  was mostly based on two aspects. First, previous studies in social media have shown that these factors are critical to the usefulness of social media advertising ,12,16. SAccording to the research model, there are three independent variables, namely perceived usefulness (PU), perceived ease of use (PE), and ad attitude (AT), and four antecedent variables, namely social interaction (SI), informativeness (IR), intrusiveness (IN), and relevance (RE). In addition, there are two mediator variables called perceived usefulness (PU) and ad attitude (AT). These variables are supposed to impact the dependent variable named purchase intention (PI).To reveal the relationships among these factors, we propose hypotheses to the research questions presented earlier, as listed in Sociability has been defined as ‘the extent to which the computer-mediated communication environment facilitates the emergence of social space by allowing social affordance . Social Hypothesis 1 (H1).Social interaction of health-related short-video ads positively affects users’ perceived usefulness (PU) of ads.Intrusiveness describes the extent to which the content is messy and irritating to users . IntrusiHypothesis 2a (H2a).The intrusiveness of health-related short-video ads negatively affects users’ perceived usefulness (PU) of ads.Hypothesis 2b (H2b).The intrusiveness of health-related short-video ads negatively affects users’ perceived ease of use of ads.Informativeness represents the information that is helpful and resourceful . It can Hypothesis 3 (H3).Informativeness of health-related short-video ads positively affects users’ perceived usefulness (PU) of ads.Relevance is used to capture users’ general perception of similarity between short-video ads and live video content. According to the limited capacity model of attention , the totHypothesis 4 (H4).The relevance of health-related short-video ads positively affects users’ perceived usefulness (PU) of ads.Perceived usefulness (PU) refers to the degree to which individuals perceive the use of health-related short-video ads. If users think that short-video ads are useful, they are much likely to have a positive attitude on using them. Attracting and motivating short-video ads can also lead to purchase intention . Hence, Hypothesis 5 (H5).Users’ perceived usefulness of health-related short-video ads positively affects their attitudes toward ads.Hypothesis 6 (H6).Users’ perceived usefulness of health-related short-video ads positively affects their purchase intentions.Perceived ease of use (PEOU) is defined as the mobile phone users’ expectations about the effort required to use live video advertising messages. Short-video advertising requires some cognitive effort from users such as maneuvering through screens, reading the advertising, and making a quick evaluation of whether it is worthy (in terms of time or effort) to take further action. Therefore, the easier they perceive using short-video advertisements to be in general, the more likely they are to later engage in the action implied by the ad. Hence, we make Hypotheses 7 and 8:Hypothesis 7 (H7).Users’ perceived ease of use of health-related short-video ads positively affects their perceived usefulness.Hypothesis 8 (H8).Users’ perceived ease of use of health-related short-video ads positively affects their attitudes toward ads.Attitude towards advertising is regarded as an important factor for advertising management because consumers’ attitude can influence purchase intention . PreviouHypothesis 9 (H9).Users’ attitudes of health-related short-video ads positively affect their purchase intentions.Note that we only set up the Hypotheses H1–H4 to measure the impact of the four constructs on PU but not on PEOU. This is mainly because the constructs are all about the information offered by advertisements, but not about the operations or behavior of advertising. On the other hand, the perceived ease of use (PEOU) refers to the ease of operations that users perceive, i.e., PEOU is operation related. Thus, in this paper, we only focus on the impact of the constructs on PU.We mainly conducted questionnaires on users who have online shopping experiences due to mobile live ads, so that we could gain useful feedback from experienced users on short-video platforms. The data for this study were collected using an online survey in Douyu.com (a famous short-video platform in China) during January 2018, which lasted for three weeks. Three hundred and fifty questionnaires were sent to the viewers with anchors’ help, and 289 questionnaires were received. Thirty-three questionnaires that contained inconsistent answers or incomplete information filling were removed from the data set.Note that it is not possible to ask the Douyu platform to only present health-related short-video ads to the participants, because the platform does not offer the function of filtering health-related short-videos . We offered the participants three weeks to return questionnaires, and all questions were restricted to health-related short-video ads .In the data set, the proportions of males and females were 53.5% and 46.5%, respectively. There were 79.8% users that were under 30 years old. The duration of using live videos ranged from 0 to 2 years, and 58.6% of the users had experienced live videos for 1 to 2 years. Furthermore. 50.4% of the users were undergraduates and graduates see . The attThe survey was designed using a multi-item approach. All variables were carried out by a five-point Likert-scale, ranging from strongly disagree (1) to strongly agree (5). Items were borrowed from previous literature and modified for the context of this study.(1)Sample Selection: Users who have online shopping experiences due to mobile live ads are considered as samples in this study.(2)Sample Characteristics: This part mainly measures the sample statistical data of participants.(3)Variable Questionnaire: This study included eight latent variables, including Social interaction (SI), Intrusiveness (IR), Informativeness (IN), Relevance (RE), Perceived Usefulness (PU), Perceived ease of use (PE), Ad attitudes (AT), and Purchase Intention (PI).The questionnaire consisted of three parts:The whole items are shown in The research model was tested using AMOS 21, a structural modeling technique that is well suited for estimating parameters and theoretical models. In p < 0.10 level) for all items. Second, single method-factor approaches indicated that there was no significant difference among the method factors . Thus, we concluded that CMV was not a concern in this data set.Before measuring the model, we examined whether common method bias was a concern in this study with two tests of common method variance (CMV) . First, The measurement model evaluation mainly included three parts, namely reliability analysis, convergent validity, and discriminant validity.Reliability is usually examined by using internal consistency reliability and composite reliability. As shown in Convergent validity is usually examined by using composite reliability (CR) and average variance extracted (AVE). As shown in Discriminant validity is analyzed to examine whether a measurement is not a reflection of any other measurement or not. As shown in The research model was tested by using AMOS 23, and a bootstrapping resampling procedure (2000 samples) was used to ensure the solidity.The resulting indices indicated a good model fit .p < 0.01; β = 0.22, p < 0.01; β = 0.20, p < 0.01). These findings support H1, H3, and H4, respectively, and this supports previous studies [p < 0.01), and H2 is validated. This is consistent with previous research [p < 0.001) and purchase intention ; these results validate H5 and H6. Users’ perceived ease of use of health-related short-video ads was a significant and positive predictor of perceived usefulness of ads , and H7 is validated. However, users’ perceived ease of use of health-related short-video ads could not significantly predict users’ attitudes toward ads. H8 is not validated and this is not consistent with Lin and Kim’ research, as they found users’ perceived ease of use of social media ads significantly predict users’ attitudes [p < 0.05), and H9 is validated. Users’ perceived usefulness of ads and attitudes toward ads accounted for 33% of the variance in purchase intentions. studies ,19. Simiresearch . These fMediation analyses were tested using the Preacher and Hayes’ bootstrapping (2000 bootstrap samples) analysis with the PROCESS macro . We focuThe mediating path  tested the specific indirect effect of social interaction of ads on ad attitudes through perceived usefulness of ads. As both the upper and lower limits of the confidence interval (CI) were above zero , this indirect effect can be interpreted as significantly positive. Similarly, the direct effect of the perceived usefulness of ads can be interpreted as significantly positive. Hence, the perceived usefulness of ads served as a partial mediating variable between social interaction and ad attitudes. That means those who perceived the sociality of health-related short-video ads believed that the ad was more useful, and this increased usefulness enhances the viewers’ positive attitudes toward the ad.The mediating path (Intrusiveness→PU→AT) tested the specific indirect effect of intrusiveness of ads on ad attitudes through perceived usefulness of ads. As both the upper and lower limits of the confidence interval (CI) were above zero , this indirect effect can be interpreted as significantly positive. The perceived usefulness of ads served as a partial mediating variable between intrusiveness and ad attitudes. That means those who perceived intrusiveness of health-related short-video ads believed that the ad was less useful, and this decreased usefulness enhances the viewers’ negative attitudes toward the ad.The mediating path (Informativeness→PU→AT) tested the specific indirect effect of informativeness of ads on ad attitudes through perceived usefulness of ads. Perceived usefulness of ads served as a partial mediating variable between informativeness and ad attitudes . That means those who perceived informativeness of health-related short-video ads believed that the ad was more useful, and this increased usefulness enhances the viewers’ positive attitudes toward the ad.The mediating path (PEOU→PU→AT) tested the specific indirect effect of perceived ease of use of ads on ad attitudes through perceived usefulness of ads. Perceived usefulness of ads served as a partial mediating variable between perceived ease of use and ad attitudes . That means those who perceived ease of use of health-related short-video ads believed that the ad was more useful, and this increased usefulness enhances the viewers’ positive attitudes toward the ad.Similarly, the perceived usefulness of ads served as a partial mediating variable between perceived ease of use and purchase intentions . That means those who perceived ease of use of health-related short-video ads believed that the ad was more useful, and this increased usefulness enhances the viewers’ purchase intentions.Finally, the mediating path (PU→AT→PI) tested the specific indirect effect of perceived usefulness of ads on purchase intention through ad attitudes. The indirect effect was significant  while the direct effect was not significant . Hence, ad attitudes served as a full mediating variable between perceived usefulness and purchase intention. That means users’ attitude toward health-related short-video ads was a key path to the effectiveness of ads.In summary, there were four impact paths of user responses to health-related short-video advertisements. First, social interaction had an indirect effect on purchase intentions through perceived usefulness and ad attitudes in serial (SI→PU→AT→PI). Second, intrusiveness had an indirect effect on purchase intentions through perceived usefulness and ad attitudes in serial (IR→PU→AT→PI). Third, informativeness had an indirect effect on purchase intentions through perceived usefulness and ad attitudes in serial (IN→PU→AT→PI). Fourth, perceived ease of use had an indirect effect on purchase intentions through perceived usefulness and ad attitudes in serial (PE→PU→AT→PI).By combing the results described in The validation-result column in Regarding hypotheses H5, H7, and H8, which aim to answer RQ3, only the perceived usefulness of health-related short-video ads helped produce positive user attitudes. H9 answers RQ4, finding that positive user attitudes significantly promotef purchase intentions. Combined with the analysis of the mediating effects in (1)The study of this paper is based on the background of online ads in the health-related short video, which has become an important field for the expansion of social media and a part of people’s daily life. Due to the value of short-video ads, it is necessary to explore user responses to short-video advertisements. We propose a research model based on the integration of the TAM model, social interaction, intrusiveness, informativeness, and relevance. This model augments the application of the widely used TAM model and offers referential values for other related researches. In addition, we present empirical results on user acceptance of participating in health-related short-video ads. These results can provide new research insights for advancing health-related short-video advertisements, e.g., a socially interactive mechanism for mobile ads.(2)This paper studies users’ purchase intention towards health-related short-video ads and is valuable for advertisers and marketers to realize the importance of developing health-related short-video advertisements. With the rapid development of technologies and social entertainment, users’ attitudes toward online ads may have changed a lot. Short video has been a promising tool for seeking business opportunities and establishing brand expression, and advertisers need to keep reforming their advertising strategy to meet user needs.(3)According to the empirical study conducted in this paper, the five factors  defined in the research model are helpful to enhance the perceived usefulness of health-related short-video ads, which can in turn affect user acceptance of health-related short-video ads. The results indicated that social interaction, informativeness, and relevance of advertisements are all positive factors, while intrusiveness is a negative factor, meaning that the increasing of intrusiveness will lower the user acceptance of health-related short-video ads. These results are consistent to what were revealed by previous studies ,15,19. F(4)We also find that users’ perceived ease of use of health-related short-video ads cannot significantly predict users’ attitudes toward short-video ads. This does not support Lin and Kim’ research conclusions , i.e., u(5)We find four impact paths of user responses to health-related short-video advertisements  by mediating effects analysis. Thus, advertisers and marketers can maximize resource utilization through the impact paths and promote the effectiveness of health-related short-video ads.(1)Consider various factors when promoting short-video ads.The empirical analysis of this study can offer some useful hints for advertisers to advance short-video ads. Below, we present some suggestions for advertisers and marketers to better develop health-related short-video ads:The results of this study show that the five factors  defined in the model can all positively affect the perceived usefulness of short-video ads. Thus, we suggest that advertisers should consider all five factors rather than focusing on one or some specific factors. For example, if advertisers neglect the ‘relevance’ factor, they might issue short-video ads in which the video content is irrelevant to the topic of the ads.(2)Emphasize the social interactions of short-video ads.Our study shows that social interaction is more influential to the perceived usefulness of short-video ads compared with other factors. Thus, we suggest advertisers to pay more attention to the social interactions of short-video ads, which is a shortcoming of current short-video ads. As shown in (3)Focus on users’ perceived usefulness of short-video ads.Through the mediating factor analysis, we found that users’ perceived usefulness of short-video ads plays an important role in the impact path from the influential factors to users’ purchase intention. Therefore, enhancing users’ perceived usefulness of short-video ads is the key point of improving the effectiveness of short-video ads. On the one hand, advertisers should improve the quality of short-video ads, e.g., by increasing the informativeness and relevance of ads, or by providing new kinds of social interactions to attract users’ attention. On the other hand, advertisers should avoid issuing any false advertisements, which are much harmful to consumers’ confidence on products. Once users find that the short-video ads issued by an advertiser are over-claimed or false, the fast spreading of word-of-mouth on social network platforms will do considerable harm to the reputation of the advertiser.(4)Advance ads on short-video social network platforms.Short videos provide a free, real-time, and easy-to-access online way for enterprises to deliver ads to potential users. Recently, the number of the users on short-video social network platforms has shown a dramatical increasing trend, because live videos provide more attractive presentation than conventional textual web pages or tweets. Thus, it is important for enterprises to develop their short-video-based advertising systems and departments to advance ads on short-video social network platforms. Accordingly, the live short video as a new style of advertising could be utilized as a new tool to enhance the market competitiveness of enterprises.In this paper, we analyze the major factors that influence user responses to health-related short-video advertisements. Particularly, we made three contributions. First, we extended the Technology Acceptance Model (TAM) with new antecedents including social interaction (SI), intrusiveness (IR), informativeness (IN), and relevance (RE) to analyze the users’ response to health-related short-video ads. We also introduced two mediate factors, i.e., perceived usefulness (PU) and ad attitude (AT), to reflect the influence of independent variables on the dependent variable named purchase intention (PI). To the best of our knowledge, this is the first study that extends the TAM model to analyze user acceptance of health-related short-video ads. Second, we conducted a survey on the Internet and short-video social network platforms and performed systematical data analysis over the surveyed data. The data analysis consisted of many aspects, including measurement model evaluation, structural model evaluation, and mediating effect analysis. The results showed that social interaction, intrusiveness, informativeness, relevance, and the TAM factors (perceived usefulness and perceived ease of use) had a significant influence on user acceptance of health-related short-video ads. Further, we found that users’ perceived ease of use on health-related short-video ads could not significantly predict users’ attitudes toward ads. This is a new finding that is contrary to previous studies in social media-oriented ads. Third, we presented reasonable suggestions for advertisers and marketers to better develop health-related short-video ads.This study is beneficial for advertisers to realize the importance of understanding the effectiveness of health-related short-video ads. Base on the empirical results of this study, we gained some new findings, some of which are contrary to existing research. These findings are helpful to reveal the major factors that influence users’ ad attitudes and intentions to purchase and to quantify the impacts of these factors on them. The suggestions made based on the empirical results of this study can provide some management ideas for advertisers and academia to develop health-related short-video ads.Some limitations of this study can be summarized as follows. First, although hundreds of valid questionnaires are theoretically enough to conduct data analysis, in this big data era, this number is relatively small to draw reliable and robust conclusions. Second, the results of this study have shown that the four antecedents, as well as the perceived ease of use, have significant influences on perceived usefulness, attitude, and purchase intention towards mobile live ads. However, the inherent theoretical basis has not been revealed yet. Third, the survey in this study has some limitations. Currently, we are only able to survey people on a Chinese short-video platform. The model, as well as the results, may not extend to people in other countries or on other platforms. In addition, as the respondents in the survey mainly cover young people (79.8% of them were under 30 years old), the results may not suit those advertisements that target old people.Thus, in the future, there are some research issues that are worth further investigating. First, a further study on secondary data collected from some crowdsourcing platforms like Amazon Mechanical Turk  could be


In the present work, we consider the transmission properties of a Gaussian wavepacket when transmits through few double and multi-slit systems in a fractional medium. For this purpose, we have solved the two-dimensional fractional Schrodinger equation utilizing a split-step Fourier method. Then, we have investigated the effects of different parameters such as the number of slits, slit width, barrier width, layer width, layer heights, fractional order, and wavepacket width on the transmission coefficient, and wavepacket evolution. The quantum mechanical description of the double-slit experiment can change one's ideas about different classical concepts such as waves, particles, movement, location, etc. In a double-slit experiment on 1909 by Taylor, a very dim light emits just a single photon at a time, led to Paul Dirac’s famous claim: each photon interferes only with itself2.Young double-slit experiment . However, this fact is consistent with our common physics insight. In this figure, increasing the layer height to 50 can decreases the transmission coefficient by 50%. Using a small decrease of the fractional parameter α = 1.3, the transmission coefficient at first decreases and then increases if layer height increases. This fact is not consistent with our common physical insight. Panel (C) of this figure shows the variation of the transmission coefficient T as a function of the layer width for standard non-fractional Schrodinger equation with α = 1.9, 1.6, and 1.3. In these two panels, we see that by increasing the layer width the transmission coefficient decreases. Also, by increasing the fractional parameter α = 1.3, the layer width is a less critical parameter in the transmission coefficient because in all of the studied layer widths, the transmission coefficient is approximately 100%.In the panel (A) of the Fig. In the Fig. entclass1pt{minimaentclass1pt{minimaα = 1.6 and 1.3. Besides, in the panel (C), we also observe that increasing the barrier width the transmission coefficient decreases. Panel (C) of this figure, shows the variation of the transmission coefficient T as a function of the slit width for Schrodinger equations with α = 1.9, 1.6 and 1.3. We assumed the layer width = L/30. Finally, the panel (F) illustrates the variation of the transmission coefficient T as a function of the number of slits for Schrodinger equations with Now, in the panel (A) of the Fig. Figure }α) = L/40, 2, (L/}α) = L/40, 2,  is also that the diagram of the transmission coefficient as a function of the slit width in a nonlinear one. Besides, for large values of the slit width that are greater than 3, all three diagrams saturate, and further increasing the slit width does not change the transmission coefficient any more. Also, the Fig. We present the variation of the transmission coefficient T as a function of the second slit width for standard non-fractional Schrodinger equation with α = 1.9, 1.6, 1.3 and 1.1. In this figure, we assumed system length L = 45, number of slits = 2, slit width = L/50, barrier width = L/70, layer width = L/30, layer height = 100, Laplacian coefficient β = 0.5, and nonlinearity strength γ = 0. Comparing the panels (A) and (B) shows that the behavior of the wavepacket in the standard Schrodinger equation is completely different from propagation characteristics in the fractional system. In the panel (A), there are two characteristic wavepacket widths for them that the diagram of the transmission coefficient has a local minimum and a local maximum. The interesting region is the interval between these two characteristic wavepacket widths. In this region, by increasing the wavepacket widths, the transmission coefficient increases that is not consistent with our common physics insight. In the panel (B), there is a similar behavior for the system with fractional orders α = 1.9 for wavepacket width smaller than 0.25. Another interesting fact is that for wavepacket width larger than 0.25, the transmission coefficient is 100% for the systems with the fractional orders α = 1.1. Figure In the panel (A) of the Fig. α = 1.9 and 1.6. As we mentioned in the introduction section, the fractional Laplacian means a non-parabolic dispersion, i.e., the dispersion of the system directly changes. In the standard Schrodinger equation on the panel (A), the transmission coefficient varies monotonically in an increasing manner, when the Laplacian coefficient increases. However, in the studied diagrams in the panel (B), the transmission diagrams have a maximum value. This means there is a critical Laplacian coefficient that leads to the maximum transmission coefficient. Figure γ for standard non-fractional Schrodinger equation with α = 1.9, 1.6, 1.3 and 1.1. In this figure, we assumed system length L = 45, number of slits = 2, slit width = L/100, barrier width = L/60, layer width = L/30, and layer height = 100. When the nonlinearity strength γ increases, the transmission coefficient decreases. However, the fractional order α = 1.9 is an exception, and in this case, we have an increasing diagram. Finally, Fig. γ.Other parameters are the same as the panels (A) of the Fig. Finally, in panel (A) of the Fig. α the transmission coefficient increased. For systems with small slit, the transmission coefficient was quantized when the slit width changed. By increasing the barrier width the transmission coefficient decreased. In some slit number intervals, the transmission coefficient was quantized concerning the number of slits variations and this was true for different values of the Gaussian wave parameter ‘a’ and fractional parameter α. In strongly fractional systems, the wavepacket could transmit through small and extensive slit width systems with approximately the same probability. We observed the wavepacket reconstruction after transmission through the multi-slit systems and this reconstruction was more perfect in the systems with a larger number of slits. For the incident angels greater that π/4, the transmission coefficients were almost perfect for many studied fractional parameters. For some values of the wavepacket widths, by increasing the wavepacket widths, the transmission coefficient increased. By decreasing the fractional parameter α, the wavepacket was localized within a smaller region. Finally, the double slit interference pattern exists for fractional cases, but by increasing the degree of fractionality , the interference effect gradually vanishes.In the current work, we studied the transmission through double and multi-slits systems as well as wavepacket evolution in the fractional Schrodinger framework. We showed that, by increasing the layer height, the transmission coefficient decreases in the standard Schrodinger equation, but in strongly fractional Schrodinger equation, the transmission coefficient at first decreases and then increases if layer height increases. By decreasing the fractional parameter Supplementary video legends.Supplementary video 1-1-1.Supplementary video 1-1-2.Supplementary video 1-1-3.Supplementary video 1-1-4.Supplementary video 1-1-5.Supplementary video 1-1-6.Supplementary video 1-1-7.Supplementary video 1-1-8.Supplementary video 1-1-9.Supplementary video 1-1-10.Supplementary video 1-1-11.Supplementary video 1-1-12.Supplementary video 1-2-1.Supplementary video 1-2-2.Supplementary video 1-2-3.Supplementary video 1-2-4.Supplementary video 1-2-5.Supplementary video 1-2-6.Supplementary video 1-2-7.Supplementary video 1-2-8.Supplementary video 1-2-9.Supplementary video 1-2-10.Supplementary video 1-2-11.Supplementary video 1-2-12.Supplementary video 2-1-1.Supplementary video 2-1-2.Supplementary video 2-1-3.Supplementary video 2-1-4.Supplementary video 2-1-5.Supplementary video 2-1-6.Supplementary video 2-1-7.Supplementary video 2-1-8.Supplementary video 2-1-9.Supplementary video 2-1-10.Supplementary video 2-1-11.Supplementary video 2-1-12.Supplementary video 2-2-1.Supplementary video 2-2-2.Supplementary video 2-2-3.Supplementary video 2-2-4.Supplementary video 2-2-5.Supplementary video 2-2-6.Supplementary video 2-2-7.Supplementary video 2-2-8.Supplementary video 2-2-9.Supplementary video 2-2-10.Supplementary video 2-2-11.Supplementary video 2-2-12.Supplementary video 3-1.Supplementary video 3-2.Supplementary video 3-3.Supplementary video 3-4.Supplementary video 3-5.Supplementary video 3-6.Supplementary video 3-7.Supplementary video 3-8.Supplementary video 3-9.Supplementary video 3-10.Supplementary video 3-11.Supplementary video 3-12.Supplementary video 4-1.Supplementary video 4-2.Supplementary video 4-3.Supplementary video 4-4.Supplementary video 4-5.Supplementary video 4-6.Supplementary video 4-7.Supplementary video 4-8.Supplementary video 4-9.Supplementary video 5-1.Supplementary video 5-2.Supplementary video 5-3.Supplementary video 5-4.Supplementary video 5-5.Supplementary video 5-6.Supplementary video 5-7.Supplementary video 5-8.Supplementary video 5-9.Supplementary video 5-10.Supplementary video 5-11.Supplementary video 5-12.Supplementary video 6-1-1.Supplementary video 6-1-2.Supplementary video 6-1-3.Supplementary video 6-1-4.Supplementary video 6-1-5.Supplementary video 6-1-6.Supplementary video 6-1-7.Supplementary video 6-1-8.Supplementary video 6-1-9.Supplementary video 6-2-1.Supplementary video 6-2-2.Supplementary video 6-2-3.Supplementary video 6-2-4.Supplementary video 6-2-5.Supplementary video 6-2-6.Supplementary video 6-2-7.Supplementary video 6-2-8.Supplementary video 6-2-9.