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Addressing health challenges that impact human well-being requires a comprehensive, interdisciplinary approach that would be at the crossroad of population-based prevention and individual-level clinical care, which is in line with a Global Health perspective. In the absence of a unifying theoretical framework to guide such interventions, a Dynamic Ecosystem Adaptation through the Allostasis (DEA-A) framework has been proposed, emphasizing the functional adaptation of individuals and organizations in symbiosis with their living ecosystem. While a conceptual model has been presented, this methodological contribution aims at illustrating the practical application of the DEA-A framework for planning Global Health interventions. The methodology combines Intervention Mapping and Cognitive and Behavioral Theory, extended to the ecosystem. Practical guidelines and supporting tools are provided to help public health providers and clinicians in establishing a functional ecosystem diagnosis of the issue; defining not only behavioral, but also emotional and cognitive change objectives (allostasis targets) expected for each stakeholder; and designing intervention plans targeting determinants of these allostasis. The discussion addresses implementation and evaluation perspectives of interventions based on the DEA-A framework, emphasizing the importance of considering change in its processual and ecosystem complexity. Lastly, encouragements for a deeper understanding of individual and ecosystem homeostasis/allostasis processes are made in order to promote more functional interventions.

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Listening to natural sounds, both live and recorded, in either a natural or built environment is considered natural sound exposure (NSE). Sound is closely related to daily life, and research on the restorative effects of natural sounds is expanding. However, there is a lack of quantitative and comprehensive analysis on the impact of NSE on health recovery. This study systematically reviewed and conducted a meta-analysis on the impact of NSE on health recovery. Fifteen studies (1285 participants) were selected for the meta-analysis out of the 1157 literatures about the recovery of the NSE, searched from the Web of Science and Science Direct. The results indicate that NSE has certain positive effects: (a) In terms of emotional changes, NSE significantly reduces anxiety as measured by both the Visual Analog Scale (VAS) -2.31 (95 % CI -2.83, -1.79) and the State Anxiety Inventory (SAI) -12.22 (95 % CI -22.46, -1.98). (b) In terms of physiological reaction, NSE resulted in reduced heart rate (HR) -5.46 (95 % CI -9.62, -1.31), systolic blood pressure (SBP) -11.74 (95 % CI -15.51, -7.97), diastolic blood pressure (DBP) -13.98 (95 % CI -24.96, -2.99) and respiratory rate (RR) -1.58 (95 % CI -3.06, -0.10). (c) While the potential for restoration of cognitive performance by NSE was found, no consistent conclusions have been reached yet. However, there was significant heterogeneity between studies, primarily attributed to variations in study populations and methodologies. Because of the limited literature, we did not conduct subgroup analysis and meta-regression analysis. It is recommended that future studies address this heterogeneity by including more and higher-quality literature and employing rigorous methodologies to establish a robust foundation for evidence-based medicine. This will be of great significance for the application natural sounds in landscape planning and medical rehabilitation environments, and has the potential to promote improvements in public health.

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The emotions attributed to an event can change from occurrence to recall. Autobiographical memories (AMs) exhibit fixed affect (i.e., no change in emotionality), fading affect (i.e., a decrease in emotional intensity), flourishing affect (i.e., an increase in emotional intensity), and flexible affect (i.e., change of valence). Mixed-effects multinomial models were used to predict the likelihood of the different affect change categories. Mixed-effects regression models were used to predict the amount of emotional change within each category. Predictors at the event-level were initial intensity, social rehearsal, and recall frequency. Predictors at the participant-level were components of subjective wellbeing. Analyses were based on 1,748 AMs reported by 117 young participants in response to 16 event cues. Frequency biases, and biases in the amount of change across positive and negative emotionality, were found for all types of emotional change. Specifically, there was more fading of negative (29.98%) than positive affect (11.90%), more flourishing of positive (34.27%) than negative affect (9.61%), and more AMs changing from negative to positive valence (13.33%) than vice versa (3.95%). These biases were also evident in the amount of change within the categories. Moreover, slightly more AMs remained fixed in positive (49.89%) than negative affect (47.08%). Both event and participant level predictors were significantly associated with the likelihood of different affect change categories and the amount of emotional change within the categories. The present findings highlight the importance of considering the different ways in which AMs change emotionally from occurrence to later recall.

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Guilin rural homestays are an important support for rural tourism destinations, serving not only as accommodation but also as a representative of the local culture of the town. To improve satisfaction with rural homestays among tourists, enhance destination attractiveness, and better meet tourist demands for accommodation conditions, this study combines literature and network text analysis to construct an evaluation index system for Guilin rural homestay tourist satisfaction. The data collected by a questionnaire survey based on importance-performance analysis (IPA) are analyzed. The results show that actual tourist satisfaction with the experience in the 21 indexes is lower than the pre-consumption expectation, due to the imperfect facilities, lack of special service development, relative optimization of basic road construction, and the need for improvement in the internal and external environment, among other factors. Through the improvement of the above factors, the satisfaction of tourists to the rural homestay can be improved.

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BACKGROUND: Autism spectrum disorder (ASD) is characterized by abnormalities in social communication and limited and repetitive behavioral patterns. Children with ASD who lack social communication skills will eventually not interact with others and will lack peer relationships when compared to ordinary people. Thus, it is necessary to develop a program to improve social communication abilities using digital technology in people with ASD. OBJECTIVE: We intend to develop and apply a metaverse-based child social skills training program aimed at improving the social interaction abilities of children with ASD aged 7-12 years. We plan to compare and analyze the biometric information collected through wearable devices when applying the metaverse-based social skills training program to evaluate emotional changes in children with ASD in stressful situations. METHODS: This parallel randomized controlled study will be conducted on children aged 7-12 years diagnosed with ASD. A metaverse-based social skills training program using digital technology will be administered to children who voluntarily wish to participate in the research with consent from their legal guardians. The treatment group will participate in the metaverse-based social skills training program developed by this research team once a week for 60 minutes per session for 4 weeks. The control group will not intervene during the experiment. The treatment group will use wearable devices during the experiment to collect real-time biometric information. RESULTS: The study is expected to recruit and enroll participants in March 2022. After registering the participants, the study will be conducted from March 2022 to May 2022. This research will be jointly conducted by Yonsei University and Dobrain Co Ltd. Children participating in the program will use the internet-based platform. CONCLUSIONS: The metaverse-based Program for the Education and Enrichment of Relational Skills (PEERS) will be effective in improving the social skills of children with ASD, similar to the offline PEERS program. The metaverse-based PEERS program offers excellent accessibility and is inexpensive because it can be administered at home; thus, it is expected to be effective in many children with ASD. If a method can be applied to detect children's emotional changes early using biometric information collected through wearable devices, then emotional changes such as anxiety and anger can be alleviated in advance, thus reducing issues in children with ASD. TRIAL REGISTRATION: Clinical Research Information Service KCT0006859; https://tinyurl.com/4r3k7cmj. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/35960.

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Emotional experience and change in psychodynamic inpatient psychotherapy Objectives: The subject of the present study is the recording of emotional experience and its change through inpatient psychodynamic psychotherapy, taking into account the factors of age, gender, and traumatic experiences in childhood and adolescence. Methods: The following standardized instruments were used on the clinical sample of 971 patients (413 inpatient, 558 day clinic patients) at the beginning and at the end of the treatment: Questionnaire for the Assessment of Emotional Experience and Emotion Regulation (EER), Childhood-Trauma-Questionnaire (CTQ), Inventory of Interpersonal Problems (IIP), Helping Alliance Questionnaire (HAQ), Symptom-Check-List (SCL-90-R). Results: The mean duration of treatment was 66.8 days (SD = 14.1; range 30-96). Younger patients and polytraumatized patients showed a higher expression of negative emotions. At the end of treatment, the whole group of patients showed a change in emotional experience, especially a strong decrease in passive-negative emotions and a decrease in psychological distress. Age represented a significant factor influencing emotional change. Discussion: The results underline the importance of emotional change as a prerequisite for treatment success and confirm the effectiveness of inpatient psychodynamic treatment. A further differentiation of the patients with regard to their emotional responsiveness seems to make sense with regard to the suitability of the therapeutic offers.

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The proportion of people with dementia has been increasing yearly, and the decision-making capacity of these people has become a major concern in fields such as the financial industry and in medical settings. In this narrative review, we discuss decision-making in people with Alzheimer's disease (AD), and we propose the support for decision-making in people with AD, especially financial and medical decision-making. We summarize several hypotheses and theories on the decision-making capacity of people with AD. These include the frontal lobe hypothesis, physiological theory, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and the Person-Task-Fit (PTF) framework. Both internal and external factors can affect decision-making by people with AD. Internal factors are affected by changes in the brain and neurotransmitters, as well as alterations in cognitive ability and emotion. External factors include task characters, task contents, and situation influence. Since feedback has a significant effect on decision-making capacity, a series of suggestions may be helpful to improve this capacity, such as explicit advice, simple options, pleasant rewards, the Talking Mats approach, memory and organizational aid, support by caregivers, cognitive training and feedback. Thus, in providing decision-making support for people with AD, it is important to identify the internal and external factors that impair this process and to deal with these factors.

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OBJECTIVE: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. METHODS: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. RESULTS: Parent-child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent-child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. CONCLUSION: Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

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OBJECTIVE: This research examines changes in emotionality following adverse experiences in daily life. We tested whether daily self-distancing (vs. self-immersing) in reflections on adversity results in positive change in emotionality. Additionally, we probed the "dosage" effect of repeated self-distancing. METHOD: A micro-longitudinal field experiment combined 4-week daily diary and experimental manipulation of perspective during diary-based reflections on adverse experiences to explore the trajectory of change in emotionality. Each day, participants (N = 149) described and reflected on one significant event from that day and rated emotionality. We randomly assigned participants to reflect from a self-immersed or self-distanced perspective. RESULTS: Self-distanced participants showed a change toward positive emotionality while maintaining the same level of negative emotionality, whereas self-immersed participants did not show changes in positive or negative emotionality. We also observed that self-distancing reached its maximum effect ("dosage") for positive emotionality in the third week of the diary. CONCLUSIONS: Repeated self-distanced reflections can promote positive change in emotionality in the face of everyday adversity. Notably, repeated self-distancing effectiveness has a saturation point. In contrast, self-immersed reflections on adversity do not promote positive emotional change. Together, these observations raise the question how the default self-immersed reflection on traumatic experiences impacts personal growth.

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BACKGROUND: crying therapy is currently being applied in some countries to treat cancer patients, manage pain, and promote mental health. However, little nursing and medical research on the effects of crying therapy has been conducted in other parts of the world. This study aimed to develop a crying therapy program for breast cancer survivors and assess its effects. Interventions/method: data from 27 breast cancer survivors in South Korea were analyzed. The intervention, employing a single group, pre-post-test quasi-experimental design, was divided into three phases, and effects were verified for emotional (distress, fatigue, and mood conditions) and physiological (cortisol, immunoglobulin G, and blood pressure) variables. RESULTS: there were significant changes in distress, mood changes, and immunoglobulin G and smaller changes in blood pressure postintervention. Fatigue and cortisol showed no significant changes. CONCLUSIONS: this study demonstrated the effectiveness of a short-term crying therapy program that can induce positive emotional changes and physiological effects in breast cancer survivors. This intervention can improve quality of life, indicating its value as a self-care program for cancer survivors.

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Hemorrhagic shock and resuscitation (HSR) may lead to long-term neurological dysfunction, such as depression and anxiety. Carbon monoxide (CO) has emerged as an excellent neuroprotective agent against caspase-1-associated pyroptosis, following HSR. We evaluated the effects and determined the mechanism through which CO protects against emotional changes in a model of HSR, in rats. We subjected rats to treatments with an exogenous, CO-releasing compound (CORM-3, 4 mg/kg), in vivo, after HSR. We measured sucrose preference and performed tail suspension and open field tests 7 days after HSR, assessed brain magnetic resonance imaging 12 h after HSR and evaluated pyroptosis, and neuronal and astrocyte death in the amygdala 12 h post-HSR. We also measured changes in behavior and pathology, following an injection of recombinant murine interleukin (IL)-18 into the amygdala. HSR-treated rats displayed increased depression-like and anxiety-like behaviors, increased amygdalar injury, as indicated by T2-weighted magnetic resonance imaging (MRI) and cerebral blood flow with arterial spin labeling (CBFASL), associated with both neuronal and astrocytic death and pyroptosis, and upregulated IL-18 expression was observed in astrocytes. CORM-3 administration after resuscitation, via a femoral vein injection, provided neuroprotection against HSR, and this neuroprotective effect could be partially reversed by the injection of recombinant murine IL-18 into the amygdala. Therefore, CORM-3 alleviated HSR-induced neuronal pyroptosis and emotional changes, through the downregulation of IL-18 in astrocytes.

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Traditional tonic spinal cord stimulation has been shown to improve locomotor behaviour of Parkinson's disease (PD), but may induce paresthesia. Recently developed new stimulation mode, called BurstDR, improved pain, gait and posture of later developed PD patients without inducing paresthesia, in addition to improve emotional symptoms.

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We constructed a near infrared spectroscopy-based real-time feedback system to estimate the subjects' emotional states using the changes in oxygenated hemoglobin concentration [Δ(oxy-Hb)] in the prefrontal cortex (PFC). Using this system, we investigated the influences of continual mild and equivocal stimuli consisting of lights and a reconstructed waterfall sound on Δ[oxy-Hb] in the PFC. The visual (light) and auditory (sound) stimuli changed randomly and independently, depending on the emotional states of the individual subjects. The emotional states induced by the stimuli were examined via a questionnaire rated on an 11-point scale, from +5 (pleasant) to -5 (unpleasant), through 0 (neutral), after the 5-min experiments. Results from 757 subjects revealed that Δ[oxy-Hb] in the PFC exhibited a weak, but significant, correlation with emotional change, with the given continual and mild stimuli similar to that experienced in response to the intense pleasant/unpleasant stimuli. Based on the results we discuss the generation of pleasant/unpleasant weak emotional change induced by mild and weak stimuli such as light and sound.

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Recent findings on audiovisual emotional interactions suggest that selective attention affects cross-sensory interaction from an early processing stage. However, the influence of attention manipulation on facial-vocal integration during emotional change perception is still elusive at this point. To address this issue, we asked participants to detect emotional changes conveyed by prosodies (vocal task) or facial expressions (facial task) while facial, vocal, and facial-vocal expressions were presented. At the same time, behavioral responses and electroencephalogram (EEG) were recorded. Behavioral results showed that bimodal emotional changes were detected with shorter response latencies compared to each unimodal condition, suggesting that bimodal emotional cues facilitated emotional change detection. Moreover, while the P3 amplitudes were larger for the bimodal change condition than for the sum of the two unimodal conditions regardless of attention direction, the N1 amplitudes were larger for the bimodal emotional change condition than for the sum of the two unimodal conditions under the attend-voice condition, but not under the attend-face condition. These findings suggest that selective attention modulates facial-vocal integration during emotional change perception in early sensory processing, but not in late cognitive processing stages.

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The ability to detect emotional changes is of primary importance for social living. Though emotional signals are often conveyed by multiple modalities, how emotional changes in vocal and facial modalities integrate into a unified percept has yet to be directly investigated. To address this issue, we asked participants to detect emotional changes delivered by facial, vocal and facial-vocal expressions while behavioral responses and electroencephalogram were recorded. Behavioral results showed that bimodal emotional changes were detected with higher accuracy and shorter response latencies compared with each unimodal condition. Moreover, the detection of emotional change, regardless of modalities, was associated with enhanced amplitudes in the N2 and P3 component, as well as greater theta synchronization. More importantly, the P3 amplitudes and theta synchronization were larger for the bimodal emotional change condition than for the sum of the two unimodal conditions. The superadditive responses in P3 amplitudes and theta synchronization were both positively correlated with the magnitude of the bimodal superadditivity in accuracy. These behavioral and electrophysiological data consistently illustrated an effect of audiovisual integration during the detection of emotional changes, which is most likely mediated by the P3 activity and theta oscillations in brain responses.

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To examine changes in the performance of physicians after working in busy outpatient clinics, we conducted a prospective study, involving full-time clinicians who held morning and afternoon outpatient clinics on the same day. The participants completed three measures of attention, the psychomotor vigilance task, two-back test, and trail-making test, and a measure of emotion, the State-Trait Anger Expression Inventory (STAXI), before and after the two clinic sessions. The physicians saw a mean of 91.3 patients in the two outpatient clinics on the day of testing. Overall, performance in the attention test did not deteriorate after the two successive outpatient sessions. However, we observed an increased STAXI score in 24 (54.3%) participants and saw a significant overall increase in STAXI scores. Our results indicate that busy outpatient sessions may increase physicians' anger although their attentional capacity appears to be maintained.

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El objetivo de este trabajo fue construir y presentar evidencia preliminar sobre la validez y confiabilidad de una escala para medir la disposición al conocimiento y al cambio emocional (EACCE), en estudiantes universitarios. A partir de una muestra de 91 participantes, se validó una escala de 33 ítems con formato Likert, con una consistencia interna evidenciada a partir de un coeficiente alfa de Cronbach de 0,899 y 3 factores que explican un 41 por ciento de la varianza total. Adicionalmente, el instrumento mostró que las mujeres obtienen una mejor disposición al conocimiento y al cambio emocional que los hombres, y que los estudiantes de psicología tienen mejor disposición que los estudiantes de ingeniería. Los resultados muestran que el instrumento propuesto tiene características psicométricas suficientes como para continuar con el estudio de su validación.

The aim of this study was to construct and present preliminary evidence on the validity and reliability of a scale to measure willingness for knowledge and emotional change (EACC) in university students. From a sample of 91 participants, validated a scale of 33 items with Likert format, with an Cronbach's alpha of 0.899 and 3 factors that explaining 41 percent of the total variance. In addition, the method showed that women express a greater openness towards learning and emotional change than men while psychology students showed more willingness than engineering students. The results show that the proposed instrument has sufficient psychometric properties to continue the study of validation.

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AIM: Abnormalities in water balance are manifested as hyponatremia and hypernatremia and the present investigation shows the effect of water deprivation in hot and humid climatic condition of north eastern part of India. METHODS: Twenty four BALB/c mice of either sex (weight 30-40 g) were used for a 13-week experiment to determine the effects of water deprivation on behavioral and physiological changes. Mice were divided into control group (I) (n = 8), given water ad libitum, water-deprivation male group (15 ml/day) (Group II, n=8) and water-deprivation female group (15 ml/day) (Group III, n=8). RESULTS: The water deprivation mice shows significantly (P<0.05) deteriorated of reflex, progressive visual placement, emotional whereas body weight, grip strength and rectal temperature were significantly (P<0.05) increased as compared to the control group. This information is useful to those living or deployed in crisis situations where the water supply limited in a hot-humid climate.

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BACKGROUND: This study was designed to determine whether sevoflurane induction without painful procedures, such as intravenous catheter (IVC) insertion, has any emotional benefit compared with intravenous induction using a prepared IVC. METHODS: Children undergoing outpatient surgery were randomized to 2 groups: inhalation induction with sevoflurane (sevoflurane group, n = 24) or intravenous induction with thiopental sodium (control group, n = 21). In the sevoflurane group an IVC was inserted after chidren had been anesthetized by sevoflurane inhalation, while in the control group, an IVC was placed in the preoperative holding area. Total time and the number of IVC insertion attempts were recorded in both groups. Anesthesia times, agitation scores and the views of medical staff on technique benefits were also noted. Patients and parents were interviewed the following day. RESULTS: Time required for IVC insertion was significantly greater in the control group. No statistically significant differences were found in terms of; the number of attempts required for IVC insertion, anesthesia induction times, extubation times, recovery times, or agitation scores. Though interviews with patients and parents produced similar results in both groups, medical staff satisfaction levels were significantly higher in the sevoflurane group. CONCLUSION: Inhalation induction with sevoflurane had no beneficial effect on postoperative emotional changes. However, this method provides benefit to both children and medical staff because it avoids stressful, time-wasting, painful experiences.

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