The results strengthen the hypothesis that horticulture and nature-based therapy can help refugees enter the job market. However, the small sample size emphasizes the need for methodologically stronger studies to corroborate these preliminary findings.The unemployment rate among newly arrived refugees in European countries is high and many experience mental health problems. This has negative consequences on integration and mental well-being. In this case series study we investigated the effect of a 30-week program that included horticulture activities, nature-based therapy, and traditional job training on job market affiliation and mental well-being. Fifty-two refugees met initial screening criteria and twenty-eight met all inclusion criteria and were enrolled. The program took place in a small community and consisted of informal therapeutic conversations, exercises aimed at reducing psychological stress, increasing mental awareness and physical wellbeing. At the end of the program traditional job market activities were led by social workers. Provisionary psychiatric interviews showed that at baseline 79% met criteria for either an anxiety, depression, or PTSD diagnosis. After the program, statistical analyses revealed an increase in the one-year incidence of job market affiliation (n = 28) and an increase in mental health according to two of four questionnaire measures (n Ten percent of the world’s 26 million refugees live in European countries  and the Meanwhile, an increasing body of research shows that nature-based therapy can have a positive impact on stress ,16,17 anGenerally, nature-based therapy is comprised of activities and experiences in nature that aim at integrating psychological and physical perspectives . The intTo meet the challenges of high unemployment rates and prevalence of mental distress in refugees, the present study investigated the outcomes of a 30-week program consisting of nature-based therapy and activities directly focused on preparing for a return to the labor market ,29. Resihttps://www.hallingelille.dk/ ). The program was directed by two therapists, each with extensive clinical experience in psychotraumatology from working with refugees from the Danish Red Cross asylum department. Moreover, the therapists were trained in ecotherapy and psycho organic analysis at teaching facilities whose programs rest on theoretical work by, among others, Linda Buzzell [The case series study was conducted at Hallingelille Ecovillage in Region Sjaelland, Denmark . The job centers emphasized for all potential participants that to reject would have no negative consequences, e.g., withdrawal of employment benefits. While enrolled in the program participants were exempt from other activities arranged by the job center. All invited job centers agreed to participate.The foundation of the program was nature-based therapy developed by researchers at the University of Copenhagen, Denmark. The program was designed to specifically enhance psychological and physical factors of relevance for the labor market and was divided into three consecutive periods, each lasting ten weeks with increasing workload see . All parThroughout the program the two therapists would seek out participants and conduct informal and non-directive conversations on topics such as general well-being, family, culture, how they thrive in the project and their mental state. In Period 1, the aim was first to create a safe attachment to the village. This was achieved by helping participants discover and establish a safe and private physical space and by facilitating strong emotional relationships between participants, typically in groups of 2–5. Participants were presented to exercises designed to reduce psychological stress and increase mental awareness and physical wellbeing see . ParticiThe overall aims of Period 2 were to enhance communication skills and a sense of community. Participants were psychoeducated on psychological and bodily reactions to psychological traumas and the possible positive impact of nature on mental health. In this vein, participants were encouraged to pay attention to bodily expressions of mental states and their possible interactions with different activities throughout the program. To increase sense of community, participants were instructed to undertake horticultural activities in collaboration with co-participants, including tasks for the benefit of all participants, such as preparations of bonfire for cooking. Additionally, as a group the participants went hiking in the woods, were instructed in caring for domesticated animals in the village , and participated in regular communal dining. To begin the process of clarifying personal potential, interests, and goals, participants commenced working with their personal life story using creative arts, such as painting, drawings, and clay. This process was facilitated by the therapists in exploratory conversations using open-ended questions. For one day the closest family members of the participants were invited to the village and to participate in the program. The third period aimed more specifically at strengthening work competence. Participants continued to perform daily activities in the village as detailed above but were now strongly encouraged to choose based on curiosity and skills, and not only mental and physical resources. The type of activity was extended to include work at a wood studio, harvesting crops, construction and repairing assignments , caring for hives and animals at the village, sale of local groceries and customer contact in the village store, and participation in workdays arranged for all residents in the village. Participants were encouraged to use the art and craft activities to express emotions, e.g., related to previous traumatic experiences, and to verbalize them in follow-up conversations with the therapists. To simulate ordinary work conditions and employ cognitive functions typically required on the labor market such as working memory, problem solving, and concentration, participants were assisted in designing personal projects with an evaluable result. Concurrent to these activities, participants held meetings with social workers who had expertise in helping the unemployed into the labor market. Based on the uncovered personal resources and goals, the social worker helped facilitate relevant internships, education, and employment. Expeditions to companies, e.g., farms, forestry, agriculture, construction, and educational institutions were arranged and in-depths conversations with the therapists concerning work expectations, opportunities, and dreams, including cultural aspects, were carried out. As in Period 2, close family were invited to the village and to participate in the program for one day.The program was carried out from April–November in both 2017 and 2018. In both years participants were recruited in the preceding months at five job centers bordering the intervention site. Each job center screened their clients using the following criteria: (1) a maximum of 5 years residence in Denmark on the ground of being a refugee; (2) a record of failing Danish courses and hence a minimal Danish language level; (3) a record of being unable to complete employment program activity because of physical complaints  or mental health complaints . To exclude participants with a psychotic condition or alcohol/substance abuse, eligible participants were interviewed with the short full structured Mini-International Neuropsychiatric Interview, version 5, (MINI-5) . The MINOverall, 72 citizens were deemed eligible by caseworkers at the job centers based on their record profile, of which 65 agreed to meet with a research assistant for additional screening for eligibility. Overall, 52 participants met inclusion criteria and agreed to be interviewed with the MINI-5. The interview led to the exclusion of 2 participants due to suspicion of a psychotic condition and 5 participants due to the presence of substance abuse. Of the remaining 45 participants, 7 participants withdrew informed consent due to change-of-mind before study initiation, leaving 38 to be enrolled at start-up. After program initiation, 10 participants (6 from group 1) dropped out during the first period of the program; 1 was physically too weak to participate, 1 had a change of mind when he received pension shortly after commencing the program, 1 unexpectedly left for his home country, 4 had worsening of chronic pain, and 2 had severe worsening of mental health issues. Additionally, 1 participant was excluded due to signs of alcohol abuse. Of the remaining 28 participants, 15 completed the program in 2017 (group 1) and 13 in 2018 (group 2). The quantitative variables from the available questionnaires at baseline for the 10 dropouts in Period 1 fell within one standard deviation from the mean of the completers. Demographic characteristics of the 28 completers are shown in The primary outcome was labor market affiliation defined as internship, educational training, vocational training, or employment. A one-year incidence of failed, initiated, and completed activities were recorded at baseline and one-year post-program completion. The reported activities were confirmed by the job center. For each participant we constructed two affiliation scores (pre-program initiation and post-program completion) with each activity counting equally and dichotomized the score into an affiliation categorical variable for each participant (Yes/No). The categorical variable was used to test the hypothesis that affiliation to labor market would increase following the program. extremely). The WHO-5 consists of 5 questions related to well-being scored on a scale ranging from 1–5 . The GSE aims at capturing self-beliefs used to cope with difficult demands in life and includes 10 questions scored on a scale from 1–4 (4 = exactly true). Where the other questionnaires are self-administered, WHODAS is an interviewer-administered questionnaire that measures level of disability with 12 items rated on a 5-point scale (5 = cannot do). As secondary outcomes we assessed symptoms of mental distress and well-being, disability, and self-confidence. These outcomes were measured with four questionnaires available in the participants’ native language obtained at baseline and at the end of program; (1) the Harvard Trauma Questionnaire (HTQ) , the Wort-tests were used to test the four secondary outcome datasets. All data sets were tested for the assumption of normal distribution with the Kolmogorov–Smirnov test [p-value is consecutively adjusted with each test [p-value, and the threshold for significance was set to α = 0.05.The data were analyzed with MATLAB . McNemar chi-square significance test with Yates’s correction was used to test the paired categorical primary outcome data entered in a 2-by-2 contingency table. Paired nov test  and for nov test . The famach test . We used2  = 5.78, p = 0.016). There were unfortunately no data collected on affiliation to labor market among the 10 dropouts. The distribution of affiliation activities before and after the program is shown in Of the 28 participants, 15 increased their affiliation score following the program, among which 6 obtained employment. Meanwhile, 2 participants decreased their affiliation score. The McNemar analysis of the one-year incidence categorical variable (Yes/No) dichotomized from the affiliation score and measured pre-program initiation and post-program completion revealed a significant increase in affiliation (chit-tests comparing scores at baseline and end of program for participants with complete data sets. We saw no effect of the program on GSE or WHODAS scores but did see a significant decrease in HTQ score (p = 0.039) and increase in the WHO-5 well-being index (p = 0.002). The change in the WHO-5 well-being index was also statistically significant after Bonferroni–Holms correction (p = 0.007).There were only 16 participants with complete WHODAS, GSE, WHO-5 data sets and 15 participants with complete HTQ data set. Between outcome measures were different participants with incomplete data sets. There were no outliers, and all data sets were normally distributed. In this small case series study, we found an association between a 30-week program combining nature-based therapy with traditional job training and improved job market affiliation for newly arrived trauma-affected refugees with poor Danish language skills and a high psychiatric symptom load. We also found a small improvement in self-reported symptoms of PTSD and functioning in everyday situations.The results suggest that the positive effect of horticulture and nature-based therapy on the ability to restore fatigued cognitive resources  and mentThe relevance of obtaining cultural competence and developing a sense of belonging have recently been supported in a qualitative study on refugee health professionals in Germany . DespiteMoreover, from a perspective of salutogenesis, the nature environment, the composition of the program, and the activities may jointly have contributed to a sense of coherence rendering some aspect of life more comprehensible, meaningful, and manageable . In accoThe observed small, but statistically significant, decrease in PTSD-symptomatology and disability measured with the HTQ and WHODAS are in line with some qualitative research on war-veterans showing an effect of nature-therapy on self-assessed improvement in PTSD symptoms, and ability to participate in social activities ,19. It aIn addition to a general restorative effect of horticulture and nature-based therapy on attention and wellbeing among stress-related illnesses ,23, the While more research is needed to disentangle how the specific activities contributed to the overall effect, we believe programs guided by the following headings are of value in bringing trauma-affected refugees a step closer to the labor market: (1) a village community set in natural surroundings, (2) exercises aimed at supporting a positive body–mind experience, and (3) horticultural activities.Several limitations are important to highlight. The absence of a randomly selected control group increases the likelihood that the observed effects were driven by other, possibly unknown, factors including placebo effect, regression toward the mean, the natural course of mental health, and investigator biases . AdditioWe found that nature-based therapy and horticulture mixed with traditional job market interventions can increase job market affiliation and mental well-being among trauma-affected newly arrived refugees. Considering a high unemployment rate and mental health problems among refugees in addition to the absence of successful Danish labor market integration programs, these preliminary results could become of crucial importance. However, considering the methodological limitations, the results primarily contribute to a strengthening of the hypothesis that environmental therapy and horticulture can have positive effects on employment rates and mental health among newly arrived refugees, and call for methodologically stronger studies to investigate the validity of these findings.


Thus, this pilot study aims to describe an intervention program on the training of respiratory patients to maintain airway permeability and preventing complications. (2) Methods: An observational, analytical, and prospective study was proposed. After the initial evaluation of each user during hospitalization, the program started with two sessions, at discharge for the second phase, and fifteen days after discharge for the third phase. Throughout the program’s implementation, the modified Medical Research Council scale and the Barthel Index were applied. (3) Results: The population studied aged between 39 and 76 years, diagnosed with pneumonia or chronic obstructive pulmonary disease, showed a significant improvement in the degrees of dyspnea and levels of functionality, as well as an adequate level of learning. (4) Conclusions: This program positively impacted the patients’ independence by reducing dyspnea and increasing functionality of the patients included in this study. The set of exercises and techniques can be replicated at home and may be fundamental in the management of respective recovery, as well as in the COVID-19 pandemic. Currently, respiratory diseases assume a high economic weight in developed countries, given their incidence and prevalence, leading to high hospital admissions and deaths/year . PulmonaTo combat the spread of COVID-19, different scientific societies and disease control centers have promoted the uptake of preventive behaviors, such as using telemedicine and avoiding non-essential visits to health units. Adherence to these recommendations may pose a challenge among individuals with chronic respiratory conditions, given their increased healthcare needs compared to the general population . Given tRehabilitation, from the perspective of training, involves actively participating in all stages that people go through until they can fully meet their needs and/or find compensatory mechanisms to do so, with the rehabilitation nurse specialist being the guide in this process . The rehHealth units receive patients with a wide variety of diagnoses, namely: respiratory infections (community-acquired pneumonia (CAP)), pleural effusions, chronic obstructive pulmonary disease (COPD), severe dyspnea, pulmonary thromboembolism, and acute lung edema . For mosOf the general population, the elderly are especially vulnerable to respiratory problems, and they can more easily develop respiratory failure, secretion retention and respiratory infections ,6,7. ThiWe can then consider obstructive respiratory diseases and restrictive diseases. The latter is characterized by a reduction in the total lung capacity in the performance of gas exchanges due to the decrease in the expansion of the lung parenchyma . In thisEffectively, respiratory rehabilitation is fundamental in an increasingly aging society, in which, due to demographic, socioeconomic and environmental factors, the prevalence of respiratory diseases is high . In respThe general objective of this study was to train respiratory patients, so that at home they are able to promote hygiene and airway permeability, improve their ventilatory capacity and prevent complications. As specific objectives: to educate and train the user about the fundamentals and purposes of the techniques, exercises, and strategies of the intervention program until reaching a satisfactory level of knowledge and execution of the exercises; to check compliance with the program; and to evaluate its impact on the users’ lives, 15 days after admission.An observational, analytical, and prospective pilot study was proposed.A scientific methodology was followed for this quantitative study by identifying the needs inherent to the studied population concerning self-care and training of participants in the face of acute and chronic conditions, as well as preventing their repetition.For the implementation of the program, an intervention plan was developed, focused on chronic and acute respiratory patients. This plan was directed towards the patient and did not involve caregivers.Teachings were part of the functional respiratory re-education programs implemented in the context of hospitalization, teaching them about their pathology, and the interventions that the participants could replicate autonomously at home, providing them with the means to manage their chronic illness or enhance their recovery in case of acute illness. This pilot study considered patients admitted to a hospital with a diagnosis of respiratory disease, acute or with an episode of acute respiratory illness due to chronic illness, which was conscious and oriented in person, time, and space, constituting a sample of convenience.The dependent variables used in the study for the respective analysis after implementation of the program were: knowledge acquired after teaching during hospitalization; Barthel index at clinical discharge and 15 days after discharge; and degree of dyspnea during hospitalization and 15 days after discharge.This intervention program aims to create a set of exercises and techniques that can be replicated autonomously by patients, allowing them to maintain good hygiene and airway permeability and improve their capacity to execute their daily routines. This was implemented during the respiratory rehabilitation sessions given to admitted patients of the respiratory area, focusing on the knowledge they must acquire, as well as the techniques they can and must master. At the end of hospitalization, the knowledge and skills acquired were evaluated, and 15 days after discharge, a telephone interview was conducted to assess the short-term impact this program had on patients in terms of functionality and independence.During all the functional respiratory re-education sessions, an approach to pathologies, their physiological characteristics, consequences, signs, and symptoms of aggravation were discussed with patients, trying to make the participants understand the importance and relevance of the techniques/exercises taught to transform them in an asset of the rehabilitation process.The program consisted of a first phase  with two exercise sessions . SubsequAt the end of this session, the checklist  was applWere you able to comply with the recommended exercise program? If not, what are the reasons?Were the teachings you received at the hospital enough?How could the teachings be improved?Do you feel improvements reflected in the decrease of bronchial secretions?Have you had frequent episodes of dyspnea?Has your ability to perform daily living activities improved?In addition to the checklist, a telephone interview was also prepared to be applied fifteen days after discharge, which served as a final assessment tool. The questions were designed to understand participants’ compliance with the program, whether they considered that in-hospital education had been sufficient and if it could be improved, and finally, the impact that the program had on functional capacity, episodes of dyspnea, and elimination of bronchial secretions. The telephone interview was conducted 15 days after discharge, with six questions:During the implementation of the program, the scale chosen to assess dyspnea was that used by the Medical Research Council, modified during hospitalization  and integrated into the final evaluation interview.The instrument chosen to assess the participants’ functional capacity was the Barthel Index . This isProcedural measures, such as the confidentiality and protection of the participants’ data involved in the intervention program, have been complied with. The project of the intervention program was approved by all the mediating entities: the University of Évora, the administration council of the hospital unit and the person in charge of that unit’s service. In addition, a request was submitted to request an evaluation of the project from the Ethics Committee—Health and Welfare Area of the University of Évora, which obtained a positive opinion. All patients included in the sample were given informed consent, the right to confidentiality, anonymity, and self-determination. In this way, it was guaranteed through a written commitment that the data collected would always be anonymous and confidential, having been encrypted and used only for this purpose.In this pilot study, the defined target population was patients admitted to a hospital between 19 September and 22 November 2017, with a diagnosis of acute respiratory disease or an acute episode of chronic respiratory disease, who were conscious and oriented in person, time, and space. Five participants were included to whom the intervention program was applied: three males and two females, aged between 39 and 76 years old. Of these, four were diagnosed with CAP and one with acute COPD. Regarding underlying diseases, one patient reported recurrent respiratory infections, five patients reported arterial hypertension, and two reported type II diabetes and moderate alcohol habits. However, the major factor that aggravated the clinical situation was aging. As for the length of stay, it was found that four participants had five days of stay and only one had four days.The older participants in this pilot study had more difficulties, taking longer to assimilate the concepts, demonstrating that they had acquired the desired knowledge only in the last sessions. In contrast, the younger participants quickly incorporated the concepts within the first two sessions. However, despite this, all five participants achieved the intended objective. That is, they all demonstrated basic knowledge about the means to stabilize their disease, symptoms, and signs of worsening.The participants, according to their pathology, were trained with nine predetermined teachings, techniques, and exercises which they would be able to perform independently. To check their understanding and proficiency in the teachings conducted during the second session of functional respiratory re-education and the last session before discharge, a checklist  created In the first application of the checklist, after teaching the techniques of rest/relaxation and awareness/breath control, it was found that all patients subject to the program reached a satisfactory level of understanding of their objectives and procedures and that this remained in the last assessment before discharge. Indeed, dyspnea is the principal limiting agent of the independence and functionality of respiratory patients. Knowledge of all the techniques and knowledge associated with the teaching of energy conservation measures is of great relevance, both in rehabilitating these patients and in the prevention of crises and accidents. These energy-saving measures were easily learned by all users in both evaluations, except for the MR patient who initially showed difficulties; at the end of the hospitalization at the last application of the checklist, however, he demonstrated all the necessary knowledge.The knowledge acquired after the teachings conducted during hospitalization, and the purposes intended in the intervention program, were: to reduce psychological and muscular tension; to prevent and correct ventilatory defects; to promote airway hygiene and permeability; and to empower the user to perform daily living activities .In the first assessment, none of the participants applied the strategies and techniques for energy conservation regularly and proficiently. Only during hospitalization and with the reinforcement of training, in respiratory functional re-education sessions, and opportunistically , did the participants begin to apply them correctly and regularly, as verified in the last evaluation before discharge.The degree of dyspnea is a fundamental factor for the independence and functionality of the patients, so it was evaluated at four points: at admission, at the end of the second session of functional respiratory re-education, at discharge, and 15 days after discharge .All participants started with high degrees of dyspnea, which decreased during hospitalization. Although all of them improved significantly, none reached grade 0 until discharge. On the other hand, only one patient had grade 2, and all the others returned home with grade 1. With the application of this program, at 15 days after discharge, three patients decreased their degree of dyspnea.To assess the degree of dependency/functionality according to the evolution of the treatment/intervention of the rehabilitation nurse specialist throughout the pilot study, the Barthel Index was used . EffectiIn this pilot study, all participants started with high degrees of dyspnea, which decreased during hospitalization and after discharge. The scientific literature advises the use of systematic assessment instruments  of the patients before and after the implementation of the intervention plan, considering the functional capacity, quality of life (Qol), respiratory and muscular function ,18. In tIn this context, the role of prevention, treatment and rehabilitation of the rehabilitation nurse specialist stands out, assuming a privileged place within the multidisciplinary team, either because the set of specialized knowledge that it gathers, its proximity, trust, or a holistic approach ,5,21. ThAfter our program, at discharge, all patients were classified as independent with scores between 90 and 100 (Barthel Index), except the MR participant, who remained partially dependent, with a score of 85. Respiratory rehabilitation is one of the most studied areas, due to the high dependence that respiratory diseases can cause, with negative repercussions on autonomy and Qol . They maIn our pilot study, with five participants aged between 39 and 76 years, four had a diagnosis of CAP and one of COPD. The profile of the respiratory patient has changed over time, influenced by economic, social, environmental, and demographic factors. Infectious respiratory diseases are transmitted from person to person by air, so their frequency is directly proportional to higher population concentration and lower health and hygiene conditions , having In more developed countries, the incidence and hospitalization for CAP is high, and these values increase among children, the elderly, and during the winter ,9. The tRespiratory rehabilitation is one of the most studied areas due to the high dependence that respiratory diseases can cause, with negative repercussions on autonomy, but also due to epidemiological data, in an industrialized and aging society, highlighting the need for the rehabilitation nurse specialist intervention in the recovery/rehabilitation of these patients . At the Early intervention , regularThus, we can conclude that this intervention program allowed us to develop a proposal of action based on the training of the respiratory patient. In the long term, these participants need to be accompanied by a rehabilitation nurse specialist at home to reinforce the teachings and training provided and to assist these participants in the management of their disease. At the hospital level, it is essential to involve the entire nursing team in respiratory rehabilitation programs to achieve continuity of care, since the average hospital stay is reduced.In effect, this program positively impacted on the participants’ rehabilitation process, allowing them to be active agents in their own rehabilitation, enabling them with the means to prevent complications. The lack of support that these participants felt after discharge is accurate, and it is necessary to develop support and follow-up mechanisms with the work of the rehabilitation nurse specialist in the community, contributing to the reduction of the number of emergency episodes, the number of hospitalizations and the number of deaths from respiratory disease.The intervention program was designed and applied to patients with respiratory diseases. The COVID-19 symptomatology and comorbidity are similar, so it would also impact these patients. We emphasize the importance of respiratory rehabilitation after infection by COVID-19, based on their needs when hospitalized and after discharge, given the improvement in the degree of dyspnea and functionality of these patients.Some limitations have been included in this study. The use of a pilot study is a limitation because it does not allow the generalization of data. More studies are needed with a larger number of patients and longer duration with follow-up observation. Another current limitation is the scarcity of qualified health professionals trained in home rehabilitation programs, so it was only possible to conduct a telephone interview 15 days after clinical discharge. However, the six questions asked made it possible to assess the level of knowledge acquired by the patients.


A significant improvement was also observed in deliberate rumination after the intervention (p = 0.038). Furthermore, the patients had a statistically significant decrease in anxiety, after the intervention (p = 0.035) and one month later (p = 0.005), as compared to the baseline. Conclusions: Overall, the program encourages activities that promote post-traumatic growth, enabling young breast cancer patients to return to their normal lives. Specifically, the growth allows patients to return to work and maintain a healthy body and mind. The results of this study indicate that this program can be used as an effective psychological intervention for young breast cancer patients.Background: This study aimed to enhance post-traumatic growth in young breast cancer patients by providing them with self-disclosure and social support resources, to reduce intrusive rumination and increase deliberate rumination. This study was conducted at a university-based cancer center in Seoul, South Korea. The study included a four-week group-based psychoeducational program, which supported the post-traumatic personal growth of breast cancer patients. The primary outcome was increased post-traumatic growth, and the secondary outcomes were rumination, distress, and traumatic perception. Methods: The study included 38 young breast cancer patients, with a mean age of 42.21 years and mean time since diagnosis of 13.84 months. Results: Results of the study revealed statistically significant improvements in total post-traumatic growth and all subdomains, after the intervention ( Compared to other countries, South Korea has the highest global rate of breast cancer among women in their 40s. However, breast cancer has a high five-year survival rate of 93.6% , due to Notwithstanding the rising survival rate of cancer patients, cancer remains a serious life threat. It is often perceived as a “suddenly encountered traumatic event”, characterized by uncertainty about the future and changes in social roles and relationships ,5,6. AltAccording to Li et al. , psychosThis study was conducted from November 2016 to January 2017 at a university-based hospital cancer center in Seoul, South Korea. The inclusion criteria were as follows: adults aged 19–50 years who had received or completed active cancer treatment after being diagnosed with breast cancer and who could communicate, understand, and respond to questionnaires in Korean. The exclusion criteria were as follows: patients with mental disorders or other severe complications, patients currently participating in another intervention program, and patients who could not continue participating in the education program.The announcement of program participant recruitment was posted in the appropriate online community. We created a mobile website to provide information about and advice on the program. Those who wished to participate in the study voluntarily applied via phone, text message, or email. The researcher checked the physical and mental status of the participants and then explained the purpose and content of the study. Candidates who provided informed consent were enrolled in the study. The program required small groups of about six people per session. Given a 20% withdrawal rate, up to eight people were able to participate in a session. A total of 38 participants were recruited for three months, and all completed the intervention.The average age of the 38 participants was 42.21 years. Among the participants, 26 (68.4%) were in their 40s, more than two times the number in their 30s. Overall, 30 (78.9%) participants had a spouse, 26 (68.4%) belonged to a religion, and 36 (94.8%) had a university degree or higher. Thirty-three (86.8%) participants had a monthly household income of ≥ USD 3000. Additionally, Stage I cancer diagnoses were most common among participants (34.2%). The average time since diagnosis was 13.84 months, with 21 participants (55.3%) having been diagnosed within six months to a year of the study. Of the 37 (97.4%) patients who underwent breast surgery, 22 (57.9%) had breast-conserving surgery. Twenty-nine participants (76.3%) received chemotherapy, and twenty-eight (73.7%) received radiation therapy. Twenty-one (73.7%) participants received anti-hormone therapy. Additionally, 21 (55.3%) participants were clerks. The average working period was 127.29 months, and 26 (68.4%) participants were on a leave of absence .Based on the PTG model, the most important components of the program were increasing self-disclosure and social support. By enhancing these aspects of patients’ lives, the program aimed to facilitate deliberate rumination, thus promoting PTG .They following needs were identified for patients participating in the PTG program: measures for patients to relieve their difficulties in undergoing treatment and maintaining a job, professional insight into healthy diet and exercise, esthetic management and counseling, and support groups for patients to express their feelings with peers. We determined that the intervention program should help patients understand the meaning of breast cancer, learn methods to cope with various situations, and plan a new life after cancer. These skills would allow patients to minimize the challenges of cancer and to achieve internal and external growth. The preliminary program was developed based on the findings obtained during the design stage, and the content validity was verified by an expert panel. Additionally, the structure, format, and content of the program were verified by seven experts. The program was then modified to fit patient needs. As young female patients often have difficulty finding childcare for weekday activities, the study ran both weekday and weekend classes simultaneously.Each session of the program was divided between self-disclosure and social support resources. Additionally, post-cancer treatment management, exercise, psychology, nutrition, and esthetic management were divided into four sessions as part of a two-hour program. The program also provided group and individual interventions. Group intervention was provided in every session; during this time, the participants attended lectures at the hospital’s lecture hall or participated in discussions or role-playing activities. Individual interventions involved counseling via social networking sites and a mobile community. Through this platform, participants were able to express themselves in writing, drawings, and photographs at any time.Participants completed self-report questionnaires three times during the study period: before the program (T1), immediately after program completion (T2), and one month after program completion (T3). Measurement of PTG in breast cancer patients was developed by Tedeschi and Calhoun  and SongIntrusive and deliberate rumination are cognitive processes that occur in patients who are diagnosed with breast cancer and undergoing treatment. These aspects were measured in participants using the Event-Related Rumination Inventory in a Korean Population (K-ERRI), which was originally developed by Cann et al.  and adapAfter experiencing breast cancer diagnosis and treatment, patients often suffer psychological pain as a result of failing to achieve growth, and they may even continue to suffer even after growing from the experience. This distress was measured using both anxiety and depression. The Korean standardized version  of the HTraumatic-experience-related characteristics include perception of trauma. Horowitz et al.  developeData were analyzed using IBM SPSS 23.0 software, and the effectiveness of the PTG program was evaluated. The general characteristics of the participants were evaluated using descriptive statistics . Paired t-tests were used to compare outcomes before the program, immediately after the end of the program, and one month after the end of the program.p < 0.001). More specifically, all PTG subdomains  significantly differed immediately after the program ended and one month later, as compared to the baseline (The results indicated that PTG increased immediately after program completion (T2) (72.87/105 points) and one month later (T3) (72.23/105 points), as compared to the baseline (60.66/105 points). Furthermore, statistically significant changes in PTG occurred immediately after the program and one month later . Deliberate rumination increased immediately after program completion (20.24/30 points) and one month later (19.23/30 points), as compared to the baseline (18.53/30 points). However, statistically significant changes in deliberate rumination only occurred immediately after the program (p = 0.038) (Intrusive rumination decreased immediately after the program (10.66/30 points) and one month later (11.46/30 points), as compared to the baseline (12.03/30 points). However, there were no statistically significant changes in intrusive rumination after the program (= 0.038) .p = 0.038). Similarly, depression decreased immediately after the program (6.63/21 points) and one month later (6.86/21 points), as compared to the baseline (7.34/21 points). However, there were no statistically significant changes in depression immediately after the program (p = 0.104) or one month later (p = 0.517)  and one month later (5.74/21 points), as compared to the baseline (7.13/21 points). There were also statistically significant changes in anxiety immediately after the program (= 0.517) .p = 0.081) and one month later (p = 0.059) (Traumatic perception decreased immediately after the program (38.95/88 points) and one month later (39.03/88 points), compared to the baseline (42.74/88 points). There were also statistically significant changes in traumatic perception immediately after the program (= 0.059) .This study confirmed the effectiveness of a PTG program developed to support young women diagnosed with breast cancer in recovering and returning to daily life, including work. Most patients with breast cancer have traumatic experiences during their diagnosis and treatment. Therefore, this study used the PTG model  to develPrevious studies have shown that PTG-related interventions include meaning-based therapy ,26, acceThe contents of the program were constructed by identifying the needs of patients with breast cancer. A previous study indicated that it is necessary for patients to eat and exercise, manage a changed appearance, alleviate difficulties when balancing work and treatment, and share feelings with like-minded individuals . Therefop > 0.001). Additionally, the mean scores improved for total PTG and all its five subdomains immediately after the intervention and one month afterward. These results confirm that the program was effective in enhancing PTG. In a previous study, Danhauer et al. [Among participants of this study, the mean PTG score improved immediately after the program ended and one month afterward; furthermore, this difference was statistically significant . Recruiting participants among younger breast cancer patients (under 50) was especially difficult. The program’s effectiveness had to be confirmed through a pre-test/post-test study, with one group and no control condition. Therefore, we could not observe a spontaneous increase in PTG over time, the most significant limitation in evaluating the results’ validity. In the future, the program’s effectiveness should be confirmed through a larger experiment–control group study. Furthermore, repeated studies are needed to confirm the program’s long-term effects. Finally, since this study targeted a specific ethnic minority in Asia, programs should be developed and studied to examine the effects concerning cultural differences and suitability for various races/ethnicities.The methods used in this study can be immediately applied to other clinical settings, as the program was operated by a nurse in a hospital environment. Furthermore, as the program did not yield any dropouts, its clinical applicability was confirmed. Many PTG facilitation programs focus only on psychological approaches, such as cognitive behavioral therapy. However, this study will be helpful for promoting patients’ growth by strengthening healthy behaviors and coping mechanisms through multidisciplinary education. Additionally, this program can help patients prepare for returning to daily life.This study confirmed the positive effect of a PTG program for young breast cancer patients based on the PTG model. Patients who participated in the program had significantly higher PTG scores after the intervention, indicating its effectiveness. Additionally, the rates of deliberate rumination among patients increased, while the symptoms of anxiety decreased. This program can help breast cancer patients return to their daily lives with a healthy body and mind. It may also be used to help prepare patients for returning to work. As the program was developed and operated by nurses and confirmed to be effective, it may be easily and widely applied to patients in clinical practice. In the future, controlled studies with large samples should confirm the effectiveness of the program. In addition, repeated studies and measures are needed to determine its long-term effects.


Many wellness programs for older adults focus on physical health or specific conditions, such as heart disease prevention or diabetes management. To supplement these efforts, there is a need for holistic wellness programming to enhance well-being in later life. We developed and piloted a novel wellness coaching program for residents of senior living communities to address this need. The theoretical framework of the program is based on a holistic, multidimensional wellness model and self-determination theory. Staff members from eight residential communities were trained on wellness coaching techniques, such as motivational interviewing, active listening, and group facilitation skills, before they led the 9-week resident wellness coaching program. A total of 79 residents, ages 71 to 97 , completed the pilot program. The resident wellness coaching program included a mixture of individual and group coaching sessions. The coaching sessions provided wellness education, social support, and space to share progress on wellness goals. Participants completed surveys at three time points: pre-program, post-program, and 1-month follow-up. Residents reported high satisfaction with the overall program and its components. Repeated measures ANOVAs were conducted to examine changes in wellness over time. Comparison of pre- and post-test scores revealed significant improvements in health satisfaction, physical and psychological quality of life, purpose, loneliness, relatedness, and competence. Some of these changes, such as increases in psychological quality of life and decreases in loneliness, persisted at the one-month follow-up. These findings have implications for the development and implementation of wellness coaching programs with older adults.


Mentorship supports professional development, academic outcomes, and wellness. Effective mentorship can develop careers of faculty through greater access, and equity, diversity, and inclusion (EDI). At a Department of Psychiatry in Canada, a recent survey showed more than 60% faculty were without mentors and would like to have one; and 75% mentors received no training nor resources to support mentorship. The aims of the Psychiatry Mentorship Program are to facilitate sharing of expertise, self-reflection, and career growth among faculty.A Mentorship Working Group was formed in 2020–2021. The Mentorship Program design was evidence-informed by a literature review and consultation with other mentorship programs. While a traditional primary mentor-mentee relationship is at the core of the program, the mentorship dyad will be further supported by mentorship groups focused on academic roles, areas of scholarship and career development  or specific groups . The program offers an online mentor/mentee matching process, based on faculty self-reported scholarship interests, academic roles, and preferences related to social identity. A three-year evaluation strategy, guided by a logic model, is integrated throughout program implementation. Mentees and mentors are expected to complete a baseline assessment upon program enrolment and annual follow-up questionnaires. Continuous quality improvement of the Mentorship Program will be based on user experience collected via focus groups and interviews where perception and concepts, such as intersectionality, wellness, and EDI, will be explored.The Mentorship Program pilot was launched in fall 2021 with mentor and mentee virtual orientation workshops offering best practices and opportunities for reflection on challenges that may be encountered during a mentoring relationship. Thirty-six faculty mentors and 60 newly appointed faculty mentees attended the orientation workshops respectively. Workshop evaluations were positive. For example, 93% participating mentors indicated that the workshop met its learning objectives; 80% rated the workshop as excellent. Eighty-seven percent of mentor participants reported increased awareness of best practices to support successful mentorship, including the use of contracts and developmental plans, and indicated the workshop stimulated reflection and learning.This preliminary positive feedback suggests faculty found the orientation workshops on mentorship to be useful and thus represents an effective mode of facilitating implementation of a department wide mentorship program. We anticipate the implementation of our mentorship program could be adapted to other academic settings.


Salvia miltiorrhiza, and the insight into their transcriptional regulatory mechanisms is an essential process to increase their content in vivo. SmMYB36 has been found to have important regulatory functions in the synthesis of tanshinone and phenolic acid; paradoxically, its mechanism of action in S. miltiorrhiza is not clear. Here, we demonstrated that SmMYB36 functions as a promoter of tanshinones accumulation and a suppressor of phenolic acids through the generation of SmMYB36 overexpressed and chimeric SmMYB36-SRDX (EAR repressive domain) repressor hairy roots in combination with transcriptomic-metabolomic analysis. SmMYB36 directly down-regulate the key enzyme gene of primary metabolism, SmGAPC, up-regulate the tanshinones biosynthesis branch genes SmDXS2, SmGGPPS1, SmCPS1 and down-regulate the phenolic acids biosynthesis branch enzyme gene, SmRAS. Meanwhile, SmERF6, a positive regulator of tanshinone synthesis activating SmCPS1, was up-regulated and SmERF115, a positive regulator of phenolic acid biosynthesis activating SmRAS, was down-regulated. Furthermore, the seven acidic amino acids at the C-terminus of SmMYB36 are required for both self-activating domain and activation of target gene expression. As a consequence, this study contributes to reveal the potential relevance of transcription factors synergistically regulating the biosynthesis of tanshinone and phenolic acid.Tanshinone and phenolic acids are the most important active substances of  The different phenylpropanoid-derived compounds have a multitude of biological functions, including pigments, cell wall components, UV-absorbing compounds, phytoalexins, and modulators of developmental signaling. The MYB family of proteins is one of the largest transcription factor families and is regulator of phenylpropanoid synthesis in plants. Most subgroup 5 R2R3-MYB proteins are responsible for proanthocyanidin synthsis, most subgroup 6 R2R3-MYB proteins take part in anthocyanin synthesis, while the majority of R2R3-MYB subgroup 7 proteins contribute to flavonol synthesis. Most 1R-MYB and subgroup 4 R2R3-MYB proteins tend to be negative regulators of phenylpropanoid synthesis. MYB-bHLH-WD40 (MBW) complexes containing R2R3-MYB (subgroup 5 and 6), bHLH and WD40- repeat proteins regulate anthocyanin and proanthocyanidin synthsis [Vitis vinifera VvMYB5b increased β-carotene in tomato fruits and decreased its content in leaves [Citrus reticulate CrMYB68 repressed the transformation of α- and β-branch carotenoids [Arabidopsis AtPAP1 in rose flowers led to increased levels of terpenoid scent compounds, including monoterpenes, sesquiterpenes, and norisoprenes [Pinus taeda subgroup 4 R2R3-MYB stimulatedsesquiterpene accumulation in conifers [Terpenoids—including monoterpenes, sesquiterpenes, diterpenes, triterpenes, and tetraterpenes—play important roles as secondary metabolites in plant growth, development and protection in abiotic and biotic environments . Overexpn leaves . Citrus conifers .Salvia miltiorrhiza Bunge  is a well-known member of the Labiatae family.Generally, phenolic acids and tanshinones are the primary bioactive components of S. miltiorrhiza, with phenolic acids produced by both the phenylpropanoid pathway and tyrosine-derivedpathways [SmDXR (1-deoxy-Dxylulose −5-phosphate reductoisomerase) [SmHMGR1 (3-hydroxy-3-methylglutaryl-CoA reductase) [SmHMGR2 30 [SmIPI1 (isopentenyl diphosphate isomerase) [SmGGPPS1 (geranylgeranyl diphosphate synthase) [SmCPS1 , SmKSL1 (kaurene synthase-like) [SmHMGR1,SmCYP76AH1 (cytochrome P450-dependent monooxygenase) [SmCYP76AK1, SmCYP76AH3 [SmCYP76AK2, SmCYP76AK3 [Sm2OGD25 (Fe(II)/2-oxoglutarate-dependent dioxygenase) [SmPAL1  [SmTAT1 (tyrosine aminotransferase),SmC4H1 (cinnamic acid 4-hydroxylase), SmRAS (rosmarinicacid synthase), SmHPPR1 (4-hydroxyphenylpyruvate reductase), SmCYP98A14 [S. miltiorrhiza [SmRAS [SmKSL1 and SmCPS1 promoters and activating their transcription to promote tanshinone biosynthesis [S. miltiorrhiza, enhancing the biosynthesis of tanshinones and reducing the accumulation of phenolic acids [As a perennial medicinal plant, pathways , 9. As domerase) , SmHMGR1ductase) , SmHMGR2HMGR2 30 , SmIPI1 omerase) , SmGGPPSynthase) , SmCPS1 se-like) , SmHMGR1ygenase) , SmCYP76CYP76AH3 , SmCYP76CYP76AK3 , Sm2OGD2ygenase)  and phena-lyase) , SmTAT1 CYP98A14  have beea [SmRAS . SmERF6 ynthesis . SmMYB98ynthesis , while Synthesis , 25 onlyynthesis –28 and Synthesis . Ternaryic acids . In shorSmMYB36 overexpression and chimeric SmMYB36-SRDX repressor hairy roots and combining them with transcriptome-metabolome analysis. SmMYB36 was found to promote tanshinone synthesis and inhibit phenolic acid synthesis in three main regulatory ways: balance of primary and secondary metabolism; direct and indirect combination; and simultaneous positive and negative regulation. Additionally, the acidic amino acids of SmMYB36154–160 are required for the structural domains of transcriptional activation, also for the activation of target genes. Taken together, these results show the specific diversity, complexity, and regulatory gene expression network of SmMYB36 regulation of tanshinones and phenolic acids.In this study, we elucidated the regulatory functions of SmMYB36 on tanshinone and phenolic acid biosynthesis more deeply by generating SmMYB36 (M36O) and pK7WG2R-SmMYB36-SRDX (36R) were transformed into hairy roots  was 1.96-fold, 3.11-fold, and 3.77-fold higher than the control, respectively (P < 0.05), with an average increase of at least 1.6-fold, 1.5-fold, and 1.3-fold in RA, Sal B, and TSA contents (P < 0.05), while the CT content did not change significantly. Furthermore, as shown in SmPAL1 and SmRAS were up-regulated 2.12–5.27-fold, SmCYP98A14 was down-regulated about 0.45–0.59-fold, and tanshinone biosynthesis pathway genes SmCPS1, SmKSL1, and SmCYP76AH1 were down-regulated 0.31–0.77-fold, respectively, compared with the control.To investigate the role of SmMYB36 in the synthesis of tanshinone and phenolic acid, pGWB18-Myc-contents . In contSmMYB36 expression was 2.5-, 3.5-, and 7.3-fold higher in the overexpression lines M36O1, M36O2, and M36O3 than the control (P < 0.05), and all could be decreased by up to more than 50% , two sesquiterpenoids , one diterpenoid (phytol), of which all were down-regulated. Considering that the content of DTI, CT, TA1, and TAIIA was also significantly increased in 36O lines, overexpression of SmMYB36 increased diterpenoid yield in S. miltiorrhiza. As a result, these results also suggest that SmMYB36 up-regulates tanshinone content and down-regulates phenolic acid content by influencing the synthesis of various primary and secondary metabolites.Then, comparing the SmMYB36 overexpression line compared with the control line. Compared to control lines, a total of 6726 DEGs were detected in the SmMYB36 overexpression line,which was comprised of 3583 genes up-regulated and 3143 genes downregulated. All the DEGs were annotated according to GO, KEGG, KOG, Nr, Swiss-Prot, and TrEMBL  (SMil_00005750) was reduced.As shown in SmPAL3 (SMil_00012897) in general phenylpropanoid parthway and tyrosine aminotransferase 2 (SmTAT2) (SMil_00024925) in tyrosine-derived parthway was up-regulated.Among flavonoid biosynthesis enzyme genes, the transcripts coding for flavonoid-3-hydroxylase (SmF3H) (SMil_00027265), anthocyanidin isoflavone 2′-hydroxylase (SmI2’H) (SMil_00022945) andconiferyl-alcohol glucosyltransferase (SmUGT72E) (SMil_00001451) were down-regulated, while the transcript coding for flavonol synthase (SmFLS) (SMil_00009012) was upregulated. Among other phenylpropanoid biosynthesis enzyme genes, the transcripts coding for shikimate hydroxycinnamoyl transferase (SmHCT1/2/3/4)  were down-regulated, while the transcripts coding for cinnamoyl-CoA reductase (SmCCR) (SMil_00003258) were up-regulated.Among phenylpropanoid biosynthesis enzyme genes, thegenes coding for SmDXS2)(SMil_00017330), 1-deoxy-D-xylulose 5-phosphate reductoisomerase (SmDXR) (SMil_00018777), hydroxy-2-methyl-2-(E)-butenyl-4-diphosphate reductase1, 3  in the MEP pathway was up-regulated. Among MVA pathway genes, the transcripts coding for hydroxymethylglutaryl-CoA synthase1/2 (SmHMGS1/2)  were upregulated. The genes for vetispiradiene synthase (SmVS) (SMil_00016476) in sesquiterpenoid; SmGGPPS1 (SMil_00005164), SmCPS1, 13, gibberellin 2-beta-dioxygenase1/2/3/4/5 (SmGA2OX1/2/3/4/5)  in diterpenoid; farnesyl diphosphate synthase(SmFPPS) (SMil_00006065) and squalene monooxygenase (SmSQLE) (SMil_00016482) in triterpenoid; phytoene synthase (SmPSY) (SMil_00007246), 9-cis-epoxycarotenoid dioxygenase1/2/3/4 (SmNCED 1/2/3/4) (SMil_00013378) (SMil_00022546)(SMil_00022547) (SMil_00022548) in tetraterpenoid biosynthesis enzyme genes were increased.Among terpenoid biosynthesis enzyme genes, a gene coding for 1-deoxy-D-xylulose-5-phosphate synthase 2 (SmERF6 (ethylene responsive factor) (SMil_00020272) was up-regulated and SmERF115 (SMil_00025335) was down-regulated.In addition, two transcription factor genes involving in tanshinone and salvianolic acids regulation were detected by transcriptome profiling. To validate the transcriptome profiling results, 10 DEGs were chosen for qPCR analysis, including two transcription factor genes, 2 phenylpropanoid biosynthetic pathway genes, and 6 flavonoid biosynthetic pathway genes . ConsistSmGAPC, SmRAS, SmDXS2, SmGGPPS1, SmCPS1, SmERF6 and SmERF115, but not to the mutation probes.To verify whether SmMYB36 acts directly on genes or regulators of tanshinone and phenolic acid biosynthesis, in vitro experiments EMSA were performed. As shown in in vivo experiments were performed with dual-LUC. SmGAPC, SmRAS, SmDXS2, SmGGPPS1, SmCPS1, SmERF6, and SmERF115 promoters drive the LUC gene to form a reporter, and SmMYB36 was overexpressed as an effector in the presence of the 35S promoter. LUC luminescence assays showed that co-expression with SmMYB36 increased the expression of SmDXS2pro::LUC, SmGGPPS1pro::LUC, SmCPS1pro::LUC, and SmERF6pro::LUC reporter genes, and declined the expression of SmGAPCpro::LUC, SmRASpro::LUC, and SmERF115pro::LUC expression, compared to controls lacking 35Spro::SmMYB36  lost transcriptional activity  and 1–153SmMYB36(36 T) were obtained. As shown in SmMYB36 expression levels than the controls (ATCC and EV) were selected separately for follow-up experiments , the overexpression lines of 1–153SmMYB36  showed lower levels of tanshinones  and their biosynthesis-related target genes , while the levels of phenolic acids  and biosynthesis-related target genes  were largely unchanged  [In this study, EMSA and Dual-luc assays revealed that SmMYB36 specifically binds to  4 (SG4) , the exa 4 (SG4) . Similar 4 (SG4) . It is p 4 (SG4) . The JAZ 4 (SG4) . The rep 4 (SG4) . TherefoDAHPS) gene, which enhances the activity of the shikimate pathway [ENO) in primary metabolic enzyme genes in glycolysis and DAHPS gene in the shikimate pathway, but also activated flavonoid enzyme genes to drive carbon flux toward phenylpropanoid biosynthesis [SlMIXTA-like can increase phenylpropanoid content by binding to the promoter region of the gene encoding DAHPS, thereby increasing the flux of downstream secondary metabolites [PhmCS or ATP-citrate lyase genes PaACLA1-A2 and PaACLB1-B2 reduced total anthocyanin content in petunia [SmGAPC in the primary metabolic glycolytic pathway and SmRAS gene in the secondary metabolic phenolic acid synthesis and SmDXS2, SmGGPPS1, and SmCPS1 genes in the tanshinone synthesis. In the glycolytic pathway, GAPC catalyzes the conversion of 3-phosphoglycerate to 1,3-diphosphoglycerate. GAPC deficient mutant line shows a decrease in ATP levels and reduced levels of pyruvate and several TAC intermediates in Arabidopsis [SmGAPC by SmMYB36 results in less succinate in the Krebs cycle and reduced biosynthesis of phenylalanine and tyrosine, the precursors of salvianolic acids synthesis. This is detrimental to the availability of substances and energy for the synthesis of phenolic acids. In combination with the fact that SmMYB36 down-regulated the expression of SmRAS, a key enzyme for phenolic acid synthesis, which further exacerbated the decrease in the accumulation of phenolic acid synthesis. Taken together, the down-regulation of phenolic acid accumulation in SmMYB36 overexpressing hairy roots is a result of the superimposed reduction in primary and secondary metabolism. Alternatively, for the increased accumulation of tanshinones in SmMYB36 overexpressing hairy roots was mainly attributed to the positive regulation of secondary metabolism key enzymes SmDXS2, SmGGPPS1, and SmCPS1 by SmMYB36, while the negative regulation of SmGAPC by SmMYB36 was clearly detrimental to its accumulation.Recently, large-scale yeast monohybrid experiments have demonstrated that most transcription factors in plants bind to the promoters of multiple metabolic pathway genes, instead of binding specifically to the promoter of a particular pathway gene. In general, different transcription factors can co-regulate different metabolic pathways . It is w pathway , 43. Homynthesis . Overexpabolites . Silenci petunia , 47. As bidopsis . Of noteSmERF6 and SmCPS1 promoters by EMSA and dual-LUC. Previous studies have demonstrated that SmERF6 binds to the GCC-box of the SmCPS1 promoter by EMSA and yeast one-hybrid (Y1H) and that it acts as an activator of tanshinone analog synthesis [SmERF115 and SmRAS promoters to repress their expression. It has been previously demonstrated by yeast one-hybrid, EMSA and dual-LUC that SmERF115 binds and activates the GCC-box of the SmRAS promoter and that it acts as an activator of phenolic acid synthesis [Arabidopsis [AaMYC2 and AabZIP1 can be regulated by forming a bifurcated feedforward loop with TRICHOME-SPECIFIC WRKY 1 (AaGSW1), respectively [SmMYB36 was shown to bind and activate ynthesis . These rynthesis . Thus, Synthesis . Just asbidopsis –52. Partectively . The robectively . In geneS. miltiorrhiza have been reported extensively. SmMYC2a (SmMYC2), SmMYC2b and SmMYB98 as positive regulators and SmbHLH3 as negative regulators, while SmERF1L1, SmERF115, SmGRAS1, SmGRAS2 and SmbZIP1 are positive and negative bidirectional regulators [et al. (2017) [SmMYC2 upregulated genes in the mangiferous acid synthesis pathway, but the necessary experimental evidence is lacking as to whether SmMYC2 directly initiates the expression of these genes and whether the upregulated expression of these genes enhances the accumulation of phenylalanine and tyrosine. Consequently, it cannot be ruled out that SmMYC2 has a direct up-regulatory effect on downstream genes of key enzymes for phenolic acid synthesis and forms a ‘pull’ on the upstream manganate pathway, rather than a simultaneous direct regulation of primary and secondary metabolic pathways by SmMYC2. Deng et al. (2020) [SmERF1L1, and the two formed a feed-forward loop to positively regulate the accumulation of tanshinones and phenolic acids. It can be understood that SmERF1L1 acts as a positive regulator of tanshinones and a negative regulator of phenolics, and SmbZIP1 inhibits the expression of phenolics negative regulators and thus promotes phenolics accumulation. It is puzzling that SmbZIP1 inhibited the positive regulator of tanshinones and the result of SmbZIP1 as the positive regulator of tanshinones is contrary. This suggests that there may be some complex regulatory mechanisms of SmbZIP1 as a positive regulator of tanshinones that have not been revealed. Hence, we found that SmMYB36 coordinates the regulation of tanshinone and phenolic acid through three levels: it acts as both activator and repressor in the first level; coordinates the regulation of primary and secondary metabolic pathways in the second level; and coordinates the regulation of tanshinone and phenolic acid biosynthetic enzyme genes directly and indirectly in the third level. Unexpectedly, the regulatory mechanisms for SmMYB36 specifically for the accumulation of tanshinone and phenolic acid are still remarkably different. SmMYB36 enhances tanshinone biosynthesis in S. miltiorrhiza through two mechanisms: (i) SmMYB36 initiated the transcription of SmDXS2, SmCPS1, and SmGGPPS1 to directly promote tanshinone biosynthesis; and (ii) SmMYB36 promotes the expression of SmERF6, the activator of tanshinone biosynthesis, and indirectly promotes tanshinone biosynthesis. Moreover, SmMYB36 decreased salvianolic acid biosynthesis in S. miltiorrhiza through three directions: (i) SmMYB36 directly down-regulated SmGAPC expression, which directly reduced accumulation of phenylalanine and tyrosine; (ii) SmMYB36 directly down-regulated SmRAS transcription abundance and thus directly inhibited phenolic acid synthesis; and (iii) SmMYB36 indirectly inhibited phenolic acid synthesis by suppressing SmERF115 expression, an activator of phenolic acid synthesis   demonstr. (2020)  showed tynthesis .S. miltiorrhiza, and provides a useful tool for the future use of genetic engineering to improve the quality of S. miltiorrhiza and precisely regulate the active ingredients.In conclusion, the synthesis of phenolic acids was comprehensively inhibited by SmMYB36 from primary to secondary, and from direct to indirect; whereas the synthesis of tanshinones was positively regulated by SmMYB36 only for secondary metabolic pathways, both directly and indirectly. Our results fully demonstrate that SmMYB36 is functionally pleiotropic in regulating the synthesis of tanshinone and phenolic acid substances, one transcription factor acts on multiple pathways to exert multiple effects, which lays the foundation for a comprehensive understanding of the regulatory mechanism of the active ingredients of SmMYB36 and its C-terminus containing SRDX (LDLDLELRLGFA) nucleotide sequence were cloned separately by PCR amplification and constructed onto the entry vector pDNOR207 using BP clonase enzyme. After that, the target sequences on the entry vector were constructed on pGWB18 and pK7WG2R using LR clonase enzyme to obtain pK7WG2R-SmMYB36-SRDX and pGWB18-Myc-SmMYB36, respectively. For transcriptional activation experiments, the amplified fragments  were constructed into the pDONR207 entry vector and pDEST-GBKT7 destination vector, separately and sequentially, using Gateway technology. For the functional characterization of SmMYB361–153 in transgenic hairy roots, the coding sequences (CDS) of SmMYB36 and SmMYB361–153 (LELDEDE with seven amino acids removed) were constructed into the pK7WG2R vector using Gateway technology. The above vector construction method was performed using gateway technology and the procedure follows the instructions of the BP and LR Clonase Kits .For constructing the hairy root genetic transformation vector, the complete open reading frame (ORF) sequence of SmGAPC, SmRAS, SmDXS2, SmGGPPS1, SmCPS1, SmERF6, and SmERF115 were cloned and constructed into the pGreenII 0800-LUC vector as reporter vectors. The sequences of SmMYB36 and 1–153SmMYB36 were cloned into pCsGFPBT, and the full length of the ORFs of SmERF6 and SmERF115 were cloned into pGreenII 62-SK as effector vectors. The vector was constructed by a double digestion method according to the instructions of Clon Express MultiS One Step Cloning Kit . For EMSA assays, the CDS of SmMYB36 was constructed into the pET32a vector to obtain the fusion expression vector pET32a-His-SmMYB36. The gene sequence information involved in this study was obtained from the National Genome Data Center (https://ngdc.cncb.ac.cn/search/) under the accession number GWHAOSJ00000000. All primers involved in the above vector construction process are shown in For dual-LUC experiments, promoters of 1–160SmMYB36, pDEST-GBKT7-1–111SmMYB36, pDEST-GBKT7-1–153SmMYB36, pDEST-GBKT7-112–160SmMYB36, and pDEST-GBKT7- 153–160SmMYB36 plasmids were grown on defective medium SD/−Trp after transformation into yeast strain Y2HGold. The pDEST-GBKT7 plasmid was used as control. Subsequently, the transformed yeast cells were inoculated on SD/−Trp/-His/−Ade/X-α-gal/AbA (200 ng/ml) medium using the pDEST-GBKT7 plasmid as a control to observe the results.To identify the transcriptional activation domain of SmMYB36, pDEST-GBKT7-SmMYB36 (M36O), pK7WG2R-SmMYB36-SRDX (36R), pK7WG2R-SmMYB36 (36O), and pK7WG2R-1–153SmMYB36 (36 T) were transformed with Agrobacterium rhizogenes ATCC15834 to induce S. miltiorrhiza hairy roots, ATCC15834 (ATCC) and transformants containing empty vector (EV) induced hairy roots and served as controls. Positive lines of transgenic hairy roots were validated using the reported method [The plasmids pGWB18-Myc-d method .With the SteadyPure plant RNA extraction kit , total RNA was extracted from transgenic hairy roots  and converted to cDNA with EvoM-MLV reverse transcription kit (ACCURATE). The qRT-PCR was performed following the previous method . Three bThe dried hairy root samples of M36O, 36R, 36O, and 36 T transgenic and control lines were powdered with a mortar and pestle, weighed precisely 0.02 g in a 10 mL centrifuge tube, extracted with 4 mL of 70% methanol overnight and then treated with ultrasonic shaking for 45 min, centrifuged at 10000 rpm for 10 min at room temperature, the supernatant was removed and stored at 4°C on a 0.45 μm filter membrane. As described previously, HPLC analysis was performed on three biological replicates of every sample . Total pSmMYB36-transformed hairy roots were the experimental sample and ATCC15834-induced hairy roots were the control sample. Three replicates of each sample.The widely targeted metabolome analysis and RNA sequencing were carried outby Wuhan Metware Biotechnology Co., Ltd . The analysis of metabolic pathways was perpformed by using the KEGG metabolic pathway database. A threshold for factors of variable importance in projection (VIP) ≥ 1 and fold change ≥2 or ≤ 0.5 was established for metabolites with significant differences in content. pGWB18-Myc-S. miltiorrhiza [All clean reads were used with HISAT2 to map to the reference genome of iorrhiza . Transcriorrhiza . All DEGSmGAPC, SmRAS, SmDXS2, SmGGPPS1, SmCPS1, SmERF6, and SmERF115 using the plantcare online site revealed core sequences containing MBSI and MBSII. Then, a 48 bp sequence containing the promoter fragment of the MBSI 3 × (CNGTT(G/A)) and 3 × MBSII (TNGTT(G/A)) core sequences was used as a probe, and the mutant MBSI 3 × (AAAAAA) and MBSII 3 × (AAAAAA) core sequences were used as control probes. The single-stranded probe was synthesized by Sangon Biotech, and only the biotin marker was added at the end of the 3′ end of the sense strand, and no marker was added to the complementary strand. The solution was aspirated at F chain: R chain = 1:1, mixed well in the centrifuge tube, and placed in a PCR instrument for annealing at 90°C for 10 min, and then slowly cooled down to room temperature to obtain a double-stranded probe master mix at a concentration of 10 μM. Follow-up experiments were performed according to the instructions of the LightShift EMSA Optimization and Control Kit .HIS protein and recombinant protein His-SmMYB36 were purified as reported before . AnalysiNicotiana benthamiana) leaves. GloMax20/20 luminometers  instrument and dual-Luciferase® Reporter Assay System were used to determine the results. The results were performed in three biological replicates.Experiments with dual-LUC were conducted as previously described . Differet-test was used for significance analysis between two groups of samples.Data were processed with SPSS26.0 software, and one-way ANOVA and Duncan’s multiple range test were used for significance analysis between three or more groups of samples, and Student’s We thank Ningjuan Fan, Xiyan Chen and Hui Duan of the Center for Teaching and Research Equipment, College of Life Sciences, Northwest A&F University for their technical support. This work was supported by the National Natural Science Foundation of China (Project No. 32270278).P.M. and J.D. conceived the idea of the review and made the final modification. Q.L., X.F., and Y.Z. performed the experiments and data processing. R.C. provided assistance in the qPCR experiments. Q.L. and P.M. wrote the manuscript. All authors approved the final manuscript.Detailed data supporting the findings of this study can be found in the supplementary material.The authors have no conflicts of interest to declare.Horticulture Research online.Web_Material_uhac238Click here for additional data file.


Resilience-focused programs advocate nurturing positive adoptive traits to inform prevention and intervention efforts. Considering that no resilience intervention programs have been developed specifically for at-risk youth in correctional centers in Eswatini, the authors developed a program with this focus through a combination of literature review and earlier empirical research with correctional officers and youth in a correctional center in Eswatini. This study aimed to evaluate the program through exploration and description of experiences of at-risk youth in a correctional center in Eswatini regarding the program. A purposive sample of 16 youths in a correctional center in Eswatini participated in a World Café, and data were analyzed thematically. Three themes were identified: Positive outcomes of participation, challenges encountered in the program, and recommendations for the program. This article forms part of a (excluded for review) PhD degree study focused on developing a resilience intervention program for at-risk youth in correctional centers in Eswatini. Correctional centers housing youth are intended as developmentally appropriate spaces for rehabilitation of those deemed to have deviated from the law . HoweverHistorically, resilience has been presented as an individual’s ability to deal with significantly adverse factors and sustain positive development in the process . The proIntervention programs have been reported to increase the likelihood of positive outcomes . ResilieIn South Africa, a context-developed resilience program, Khazimula, which accounted for cultural significance among participants, was implemented on non-incarcerated youth. Post-Khazimula, these youths were able to identify and access supportive resources . Also inFor example, in an American correctional center, male youth who participated in a resilience program demonstrated improved engagement with factors associated with positive adaptation, such as identification and viewing of adults and authority figures as positive support resources  . In OhioIn a South African juvenile offenders center, a trauma group intervention, which provided trauma education, concluded that there was a need for the provision of comprehensive trauma counseling for juvenile offenders, mainly due to the correlation between recidivism and unmitigated traumatic experiences . AnotherConsidering the need for resilience intervention programs specifically for at-risk youth in correctional centers in Eswatini, the authors developed a program for this population through a multi-phase, multi-method approach in earlier research that consisted of five phases outlined in The first phase consisted of a literature review to understand existing resilience intervention programs and a critical review of strengths and weaknesses of available knowledge . The litn = 15) perceptions of the resilience of at-risk youth in a correctional center in Eswatini, which were explored using the World Café  (n = 25)   and a Wo(n = 25) . The finPhase four, the development of a resilience intervention program for at-risk youth offenders in Eswatini, was informed by the findings of the first three phases. Data collected from correctional officers and youth were analyzed separately and then integrated to identify similarities or differences in the findings. The integration focused on what at-risk youth experienced as contributing to, supporting and promoting their resilience and what correctional officers perceived as doing the same. The knowledge empirically acquired from these phases contributed to the structure, scope, themes, sequence of strategies, messages, and communication channels of the program. Once developed, the preliminary program was submitted for review to a panel of experts who reviewed and recommended adjustments to the program before presenting it to the sample applicable to this article.The fifth phase focused on an exploration and description of the experiences of at-risk youth in a correctional center in Eswatini with regard to the preliminary resilience intervention program. These experiences were explored using the World Café .Emachawe is the SiSwati word for “heroes,” and the program was named: Emachawe: A resilience intervention program for youth in correctional centers in Eswatini. The theme of superheroes was chosen for the program as it was considered relatable to participants. The program outcomes included contributing to the understanding of resilience among at-risk youth, identifying the factors that hinder and those that contribute to the resilience of youth in different contexts, and lastly to identify and utilize available and accessible resources to support resilience. The program structure presented above was implemented with the help of two program guides: a guide for the program presenter and a guide for youth. Each participant received a copy of the guide for youth used for the duration of the program, consisting of seven sessions. The program structure is expanded upon in the guides regarding each session’s needed materials, lesson content and focus, icebreakers, group activities, and outcomes.The program presenter was trained by the program developer, as will be required for any future presenter of this program. The presenter must also be particularly knowledgeable on resilience, specifically, the social-ecological theory of resilience . Skills The program further encourages continued awareness of the difference between superheroes and real life, good and bad role models, responsibility, and false responsibility. The final session involves youth performing a play/dramatization of resilience to an audience constituted by their various ecologies and an awards ceremony and receipt of a certificate of participation.This study aimed to evaluate the resilience intervention program described in this article by exploring and describing the experiences of at-risk youth in a correctional center in Eswatini who participated in the program.This study utilized a qualitative, explorative-descriptive research design to provide rich, thick, and context-informed data . The proThe recruitment of participants followed institutional ethical approval from the [excluded for review] and permission from His Majesty’s Correctional Services. Program participants between and including the ages of 15 and 25 volunteered participation. Participants were purposively sampled , and thoThe demographic profile of participants was all single Black Africans of which the majority were male, between the ages of 17–25 years and in grades 10–12.The program presenter, a clinical psychologist, was involved in phases 2 and 3 and was also engaged in three training sessions with the first author, who familiarized and educated them on aspects of the program as outlined in To gather data on participants’ experiences, a World Café session was conducted . The WorThe presence of COVID-19 necessitated the adherence to the safety guidelines of the World Health Organization and, specifically, Eswatini’s health guidelines with regards to the pandemic. This adherence was also in line with the non-maleficence ethical obligation toward participants, and therefore COVID-19-related amendments were submitted for institutional approval. Additionally, HMCS was already practicing COVID-19 safety protocols such as wearing masks, hand washing/sanitizing, bi-weekly sanitizing of buildings, and social distancing. These safety measures were maintained throughout the research.The first author took field notes during the World Café to capture responses regarding the World Café outputs during collective discovery. These notes provided clarification and an accurate understanding regarding inputs from participants and were included as data.Trustworthiness, referring to study robustness , was achThe program was presented as a preliminary program on an actual sample of youth participants in a correctional facility. Participants were informed in the first session that they can withdraw from the program at any time and that there would be no adverse consequences. Parts of the program deal with sensitive information and, as such, there is potential for emotional distress. Therefore, it is essential to identify a qualified and accessible professional—before program implementation—if any adverse reactions result from participation in the program. A qualified psychologist was identified within the correctional center in the event distress was experienced from participation. During this study there were no incidences.The collected data were analyzed using thematic analysis and the six phases described by The findings consist of three themes: positive outcomes of participation, challenges encountered during the program, and recommendations for the program.The program had direct benefits and beneficial aspects for those who participated. The four sub-themes that constitute this theme are explored below.Participants highlighted that the program encouraged them to appreciate the need for behavior change regarding problem-solving and decision-making through patience, cultivating positive habits, focus and perseverance—including post-incarceration:“Patience is a way to handle every situation because you can think before.”“Knowing what you want in life, not being everywhere.”when you fall down you need to figure out a way to bounce back.”“…These behavioral changes were also applicable to the context outside correctional facilities:“Expected to be taught on how to behave when we get out of here, so now I know some ways.”This is significant in the context and role of correctional centers that have the objective of rehabilitated individuals at time of release.Participants demonstrated an understanding of the importance of, and their role in, identifying and utilizing available and accessible resources—including seeing themselves as resources:“Knowing where to get support.”things are possible in life if you put in effort in what you do and ask for help if it is hard.”“…Furthermore, youth identified themselves as potential resources for others,“I learnt a lot that I want to teach my friends.”and they named immediately available and accessible resources, as well as other desired resources:“We must talk more with the sirs and madams, so they know what we need.”we need [correctional authorities] to bring people like you here to teach us about life…”“…Participants reported that the program contributed to positive realizations such as self-acceptance, awareness of risks, identifying internal protective factors, and a positive outlook:“It helps us to accept the things we can never change in life.”Additionally, youth took ownership of their history and demonstrated knowledge of the inevitability of risk factors:we should not let the past determine our future.”“…“We learnt that risks can block the journey to victory, but we should be resilient, and face them.”Lastly, youth experienced a positive perception of themselves:“We are stronger than we think.”“It boosted my self-esteem.”Youth highlighted that the program provided cathartic release regarding their psychological distress, mental health conditions, and general sense of connection:“Therapy session I got it here because it is what I needed most to do well in life.”“The programme was a therapy session because some who are here are here because of depression.”Participants further experienced cognitive relief, a sense of connection and hope:“It helps us to relax our minds and not think too much.”“I felt like I finally found people I can share my feelings with, someone who understands us.”we were treated like young people and given hope.”“…Psychotherapy is not part of the program, but the program is mindful of the potential need due to the sensitive material covered in some sessions. Therefore, the program can function as a bridge toward acknowledging the need for help and reaching out for therapeutic help if necessary.This theme focused on what was experienced as obstacles during the preliminary program.One of the obstacles experienced, specifically by female participants, were time constraints due to transport issues:“Maybe we can have a girl’s only programme because transport then limits our time.”This challenge refers to the fact that female participants reside at a different correctional center from the research site, End Gate, and a strict transport schedule was maintained. Owing to security reasons, the presence of a correctional officer, though positioned outside the actual room, during the programme contributed negatively in that youth felt censored in the level of expression:“It’s like [correctional officers] will hear and you don’t know what will happen.”“Sometimes [correctional officers] are a risk, like now some things I can’t say.”The correctional officer signed a confidentiality agreement before the presentation of the preliminary program and this was explained to participants.This theme focused on what participants felt could be added, changed, or improved in the preliminary intervention program.The youth felt that the program needed to involve more participants generally from various contexts such as families, schools, communities and businesses:“The situation we are facing, we are not the first or the last, so you must teach more people.”To add more people in the class to find more different ideas.”“and these were identified from different ecologies such as businesses, schools, the family, and the community:“To encourage more people in our community or in school to join (the programme) so they know.”“My family does not know resilience, so they must be involved in the programme.”“To do competition with other schools after the programme.”In the context of Eswatini, competitions between schools, in the form of sports, debates, science, function as resources for potential recruitment and transfer to better-resourced schools and access to potential sponsors and/or employers.The youth highlighted the need to increase the entire program duration, their desire to function as resources (sharing knowledge gained), and the inclusion of more ecologies in the program:“The programme needs more time together…”The increase in the frequency of the programme was also encouraged:“To continue with the programme every year.”Youth proposed programme implementation in contexts outside the correctional setting such as schools and communities:so [the programme] must happen a lot with different groups.”“…Lastly, at the individual level, youth suggested that they can function as mentors to other youth:“Some of us must attend more groups, so we become peer educators when you guys are gone.”only under the supervision of the program presenter.However, this is ideal for future program participants and This study aimed to evaluate a preliminary resilience intervention program by exploring and describing participants’ experiences, namely at-risk youth in a correctional center in Eswatini who participated in the program. Generally, similar to previous research , the parThe program is grounded in the social-ecological theory of resilience, highlighting the positive significance of environments that avail and make accessible resources . The parkuchutjwa). As a result, youth may decide not to initiate communication regarding resource access due to the logistics involved. The significance of the role of culture in resilience has been highlighted by Another possible explanation for this is the Swati sociocultural practice that young people should not directly access and address adults—they need a person to function as a go-between to give depth and sincerity to whatever resource they require (known as The correctional population is known to be vulnerable to adversity  and mentThe challenges experienced during the program included time constraints, particularly for female participants due to a strict transport schedule and the presence of a correctional officer for security reasons. The transport schedule appears to have presented a challenge in that female participants would have to leave the day’s session maybe during a discussion that would emanate post the scheduled session activities—which, they felt, they wanted to be a party to, even though they were assured the day’s intended activities were completed. Female participants further proposed a girls-only resilience intervention program for this reason. The correctional setting requires a correctional officer to ensure security in any engagements with their population. This security measure presented a challenge in that, at times, the youth felt they had to be careful in what they shared for fear of consequences; whether these are real or imagined is uncertain in the event they were overheard. To counter this challenge, the correctional officer signed a confidentiality agreement, and this was explained to participants. Additionally, the correctional officer was positioned outside the room’s door where the program was presented.Youth recommended that the program participants should also be from other ecologies external to the correctional setting. This recommendation is in line with authors who have consistently indicated that resilience buffering or protection cannot be divorced from contexts  and, maiLastly, participants recommended an increase in the duration for each session and to regularly provide the program across their population. This is possibly an indication that youth found the program to be helpful. Additionally, this could also be linked to the significance of interpersonal relations, such as family support, as resources protective to their resilience which the program informed them about. Furthermore, a session helped youth identify their positive coping mechanisms—an approach advocated by positive psychology . This coThe findings indicate the potential value of the program for youth in corrections in Eswatini in that they shed light on youth’s experiences thereof, which underscores the need for, and the importance of resilience-focused intervention programs tailored for the juvenile correctional population. The findings will also be applied to improve the program prior to further presentation. Therefore, the program can be applied in correctional facilities in Eswatini to intentionally buffer, promote, and protect incarcerated youth’s resilience, which can contribute positively to rehabilitation.A limitation of the study is that the participants were of a homogeneous race and excluded other age groups, particularly those below 15 years, within the juvenile correctional population. It is recommended that future studies involve other age groups within the juvenile population. Furthermore, there was only qualitative data collection regarding evaluation of the program. Future studies can focus on quantitative evaluation and the longitudinal effect. Research focused on similar programs for parents/caregivers, families, communities, and other ecologies such as schools, which meaningfully interact with youth, help with resource-creation, and access and availability, is recommended.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Health Research Ethics Committee of the North-West University. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.