The Effects of WeChat-Based Teach-Back Health Education on Patients With Advanced Cancer Pain.

BACKGROUND: Providing effective health education is essential for patients with cancer-related pain. One solution is leveraging instant messaging tools for teach-back health education. OBJECTIVES: This study investigated the effects of WeChat-based teach-back health education on patients with advanced cancer who underwent patient-controlled intrathecal analgesia implantation and used hydromorphone. METHODS: This retrospective study evaluated 150 hospitalized patients with advanced cancer pain. Patients were classified into a conventional health education group (N = 50) and a teach-back group (N = 100) based on whether they received WeChat-based teach-back health education. Pain was rated using a numeric rating scale, and sleep quality was measured using the Pittsburgh Sleep Quality Index at one, two, and three months postdischarge. FINDINGS: Patients who received remote teach-back health education better managed their pain. Data also demonstrated improvements in patients' sleep quality and caregiver satisfaction, and reductions in the occurrence of adverse reactions.

Social strategies used by dispersing males to integrate into a new group in Tibetan macaques (Macaca thibetana).

In group-living mammals, an individual's fitness depends, in part, on the quality of social relationships it has with others. Among species of nonhuman primates in which one sex is philopatric, individuals of that sex often develop strong social bonds and alliances with closely related kin. Less is known regarding the social processes used by dispersing adults to form stable bonds with nonkin in their new group. From May to December 2009, April to August 2010, September to December 2011, and February to May 2012, we collected data on grooming interactions in wild Tibetan macaques (Macaca thibetana), a female philopatric species, at Mt. Huangshan, China. Our goal was to compare social interactions and bond formation between resident males, recent immigrant males, and resident females. Our results indicate that recent immigrant males formed stable partner relationships with a small number of resident females and groomed these females more frequently or for longer than they received grooming. In contrast, resident males switched female grooming partners more frequently, received more grooming than they gave, and formed relationships with a greater number of female partners. We argue that the ability of recent immigrant male Tibetan macaques to maintain strong and persistent social bonds with a small set of resident adult females is a primary factor that enables them to establish residence in a new multimale-multifemale group. The present study provides new and important insights into the integrated social strategies used by dispersing males and resident females to maintain group stability.

Female behavioral strategies during consortship in Tibetan macaques (Macaca thibetana).

Consortship has been defined as a temporary association between an adult male and an estrous/receptive female. It has been considered as male mating strategies to improve male mating success and potential reproductive success. However, the female roles have been more or less neglected, and thus, less is known about female behavioral strategies during the consortship periods. In this study, during the two consecutive mating seasons, we collected behavioral data of free-ranging Tibetan macaques (Macaca thibetana) habituated in Mt. Huangshan, China, to investigate female behaviors when she was consorted by an adult male. The results showed that (a) females were more likely to approach and exhibit sexual solicitation to their consorting males during the consorted period, and females also exhibited less approach to their nonconsorting males; (b) females exhibited strong responses (either departed distantly or formed affiliative relationships with their consorting male partner) when their consorting males mated with rival females or showed sexual motivation toward rival females; (c) female preferences were positively correlated to the duration of consortships and the frequencies of ejaculation copulations, independent of the social ranks of their consorting male partners. Our results suggested that female strategies played much more important roles in forming and maintaining consortship than previously assumed. It provides new insight into understanding female adaptive strategies to male strategies by forming consortships in multimale-multifemale primate species when males could not identify female's fertile phase accurately.

Habitat characteristics or protected area size: What is more important for the composition and diversity of mammals in nonprotected areas?

The margins of protected areas are usually considered to have greater forest degradation, and given that most mammals live outside protected areas, researchers and conservation practitioners are increasingly recognizing that nonprotected areas must be incorporated into conservation strategy. However, the strategy used to manage these areas still involves increasing the size of protected areas, while not considering the habitat characteristics and requirements of the species. In this study, during a 3-year period, camera trap and habitat characteristic surveys were used to estimate composition, diversity, and habitat characteristics of mammals to determine habitat characteristics or increase the size of protected areas what should be considered first for mammals' conservation in a nonprotected area near the Huangshan Mountains in Anhui Province, China. From June 2017 to October 2019, 18 species of mammals were recorded, more than in any other protected area nearby. The linear model analysis results showed that habitat characteristics of mammals were different and showed a significant correlation with their relative abundance. Most species were related to vegetation characteristics, except primates (Macaca thibetana), and rodents (Leopoldamys edwardsi). Therefore, to establish conservation policies for nonprotected areas, habitat characteristics should be of prime concern, followed by increasing the size of protected areas to provide effective refuge areas for species conservation.

Sex-Specific Variation of Social Play in Wild Immature Tibetan Macaques, Macaca thibetana.

Theories proposed to explain social play have centered on its function in establishing social relationships critical for adulthood, its function in developing motor skills needed to survive, and promoting cognitive development and social learning. In this study, we compared variations in social play among infant and juvenile male and female Macaca thibetana. Given that this species is characterized by female philopatry and male dispersal, we hypothesized that immature females use social play as a mechanism to develop bonds that persist through adulthood whereas immature males use play to develop social skills needed to successfully enter new groups. The results indicated that social play steadily increased during the infant period and peaked at approximately 12 months of age. There were no significant differences in the frequency or types of social play exhibited between infant males and infant females. During the juvenile period, however, social play was found to decrease with age, with males engaging in social play more frequently than juvenile females. Moreover, whereas juvenile males engaged in more aggressive forms of play, juvenile females engaged in more affiliative forms of play. In addition, juvenile females engaged in higher rates of grooming than juvenile males. These results provide evidence of sex-specific differences and imply the functional variation of social play in Tibetan macaques, with immature males using social play to develop skills needed to enter and enhanced their dominance rank in a new social group and immature females using social play to develop long-term same-sex social bonds in their natal group.

Sexual Interference Behaviors in Male Adult and Subadult Tibetan Macaques (Macaca thibetana).

Male nonhuman primate sexual interference, which includes copulation interruption and copulation harassment, has been related to reproductive success, but its significance has been challenging to test. Copulation interruption results in the termination of a copulation before ejaculation, whereas copulation harassment does not. We conducted this study using the all-occurrence behavior sampling method on sexual interference behaviors of seven adult and four subadult male Tibetan macaques (Macaca thibetana) in mating and non-mating seasons at Mt. Huangshan, China, from August 2016 to May 2017. Our results showed that males' individual proportion of copulation interruption and harassment was higher during the mating season than during the non-mating season. In addition, dominant males more often performed interruption, whereas subordinate males more often performed harassment. We found no difference in the individual proportion of copulation interruption or harassment between adult and subadult males. Adult and subadult males both directed copulation interruption and harassment more often toward the mating male than toward the mating female. Lastly, the post-ejaculation phase of copulation was shorter when copulation harassment occurred than when it did not. Our results suggest that sexual interference may be an important mating tactic that adult and subadult males use in male-male sexual competition.

Observation of the effect of a 7-day gradual early functional exercise program in middle-aged and young patients with acute myocardial infarction after percutaneous coronary intervention.

BACKGROUND: Acute myocardial infarction (AMI) is characterized by a critical condition, rapid progression, and a high fatality rate. Percutaneous coronary intervention (PCI) is the treatment of choice for AMI. The purpose of this study was to investigate the efficacy of a 7-day gradual early functional exercise program after PCI in young and middle-aged patients with AMI. METHODS: A total of 106 young and middle-aged patients with AMI at the Affiliated Hospital of Jiangnan University from May 2018 to May 2019 were selected and divided into 2 groups according to the random number table method (n=53 per group). Both groups were treated with PCI, and the control group then received routine functional exercises after surgery, whilst the observation group received a 7-day gradual early functional exercise program after surgery. Functional exercise compliance, daily life ability before and after intervention, changes in quality of life, and postoperative complications after 1 year were compared between the 2 groups. RESULTS: The functional exercise compliance of the observation group was significantly higher than that of the control group (P<0.05). The daily living ability of the observation group was also significantly better than that of the control group after the intervention (PP<0.05). The physical activity, emotional response, diet, adverse drug reactions, and anxiety medication scores of the observation group after the intervention were lower than those of the control group (PP<0.05). Furthermore, the postoperative complications and total complication rate after 1 year in the observation group was lower than the control group (PP<0.05). CONCLUSIONS: The application of a 7-day gradual early functional exercise program in young and middle-aged patients with AMI after PCI can improve functional exercise compliance, daily life ability, quality of life, and reduce the incidence of complications.

Publisher Correction: The prospect of rising in rank is key to long-term stability in Tibetan macaque society.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Infant attraction: why social bridging matters for female leadership in Tibetan macaques.

Leadership is a key issue in the study of collective behavior in social animals. Affiliation-leadership models predict that dyadic partner preferences based on grooming relationships or alliance formation positively affect an individual's decision to follow or support a conspecific. In the case of many primate species, females without young infants are attracted to mother-infant dyads. However, the effects of mother-infant-female associations on affiliation-leadership models remain less clear. In free-ranging Tibetan macaques Macaca thibetana, we used social network analysis to examine the importance of "mother-infant-adult female" social bridging events as a predictor of who leads and who follows during group movement. Social bridging is a common behavior in Tibetan macaques and occurs when 2 adults, generally females, engage in coordinated infant handling. Using eigenvector centrality coefficients of social bridging as a measure of social affiliation, we found that among lactating females, initiating bridging behavior with another female played a significant role in leadership success, with the assisting female following the mother during group movement. Among nonlactating females, this was not the case. Our results indicate that infant attraction can be a strong trigger in collective action and directing group movement in Tibetan macaques and provides benefits to mothers who require helpers and social support in order to ensure the safety of their infants. Our study provides new insights into the importance of the third-party effect in rethinking affiliation-leadership models in group-living animals.

Grooming networks reveal intra- and intersexual social relationships in Macaca thibetana.

The analysis of grooming networks is a powerful tool to examine individual social and sexual relationships and how these relationships change over time. In this study, we investigated the seasonal dynamics of intra- and intersexual social relationships in Tibetan macaques (Macaca thibetana) based on grooming interactions. Similar to other female philopatric and male dispersal primates, female Tibetan macaques form the core of the social group with higher values of centralities, compared to the males who tend to be distributed on the periphery of the grooming network. The results of this study indicate that females formed stable clusters with maternal kin-related female partners both during the mating and non-mating season. Males were not included in the females' clusters during the mating season, however, during the non-mating season high-ranking males joined females to form loosely connected clusters. Male-female clustering was associated with the frequency of grooming (bouts per hour) rather than grooming duration (bout length). Our results illustrate that Tibetan macaque social networks fluctuate in response to reproductive seasonality and appear to play a role in mating choice and male reproductive success. Moreover, our results indicate that the frequency of grooming interactions might be more effective than the duration of grooming interactions in establishing cluster pattern on group level. It appears that changes in male mating strategies may drive these shifting social relationships and networks. Future studies on Tibetan macaques will need to investigate the degree to which changes in male grooming strategies directly correlate with male reproductive success.

Social connectivity among female Tibetan macaques (Macaca thibetana) increases the speed of collective movements.

Social network analysis provides insights into patterns of group movements in primates, but fewer studies to date have focused on the dynamics of how such movements occur. In this study, we proposed and tested two hypotheses about the influence of sex on social connectivity and group movement in Tibetan macaques (Macaca thibetana): (1) adult females are socially more connected than are adult males and (2) social connectivity facilitates the speed of collective decision-making. We collected data from 128 successful collective movements (≥ 2 individuals followed an initiator within 5 min) over a 2-month period in a group of adult Tibetan macaques at Mt. Huangshan, China. Although high-ranking individuals of both sexes in our dataset were more central in their social network than were low-ranking individuals, our results show that affiliations between females were stronger, with more preferred associations than those between males. Groups with more females reached collective decisions faster than groups with fewer females. We conclude that female Tibetan macaques use their social networks to enhance the speed of collective decision-making, which may have associated fitness benefits.

Playing it cool: Characterizing social play, bout termination, and candidate play signals of juvenile and infant Tibetan macaques (Macaca thibetana).

Play behaviors and signals during playful interactions with juvenile conspecifics are important for both the social and cognitive development of young animals. The social organization of a species can also influence juvenile social play. We examined the relationships among play behaviors, candidate play signals, and play bout termination in Tibetan macaques (Macaca thibetana) during juvenile and infant social play to characterize the species play style. As Tibetan macaques are despotic and live in groups with strict linear dominance hierarchies and infrequent reconciliation, we predicted that play would be at risk of misinterpretation by both the individuals engaged in the play bout and by those watching, possibly leading to injury of the players. Animals living in such societies might need to frequently and clearly signal playful intent to play partners and other group members to avoid aggressive outcomes. We gathered video data on 21 individually-identified juvenile and infant macaques (one month to five years of age) from the Valley of the Wild Monkeys, Mt. Huangshan, China. We used all-occurrence sampling to record play behaviors and candidate play signals based on an ethogram. We predicted that play groups would use multiple candidate play signals in a variety of contexts and in association with the number of audience members in proximity to the players and play bout length. In the 283 playful interactions we scored, juvenile and infant macaques used multiple body and facial candidate play signals. Our data showed that juvenile and infant Tibetan macaques use a versatile repertoire of play behaviors and signals to sustain play.

The prospect of rising in rank is key to long-term stability in Tibetan macaque society.

One of the most fundamental questions in behavioural biology is why societies can persist for a long period of time. While researchers in animal behaviour have been hindered by a lack of an aggregate measure (such as social mobility) to quantify the dynamics of animal societies, researchers in social sciences have been challenged by the complexity and diversity of human societies. As a result, direct empirical evidence is still lacking for the hypothesized causal relationship between social mobility and social stability. Here we attempt to fill the void by examining a much simpler society in the Tibetan macaque (Macaca thibetana), which we have tracked for 30 consecutive years. By testing two group-level hypotheses based on benefit-cost analysis and social stratification, we show the first quantitative evidence that an annual 2-to-1 stay/change ratio in the hierarchy with a 3-to-1 upward/downward ratio in intragenerational social mobility provides a substantive expected benefit for adult members to stay in the group and wait for their chances to advance. Furthermore, using a Markov transition matrix constructed from empirical data, we demonstrate that the 3-to-1 upward/downward ratio could lead to long-term structural stability in Tibetan macaque society.

Social rank versus affiliation: Which is more closely related to leadership of group movements in Tibetan macaques (Macaca thibetana)?

Research on leadership is a critical step for understanding collective decision making. However, only 4 of the 22 extant macaque species have been examined for the impact of social rank and affiliation on the initiation of collective movement. It is far from clear whether such impact exists and, if so, how it works among other macaques. To answer these questions, we investigated free-ranging, Tibetan macaques' (Macaca thibetana) group departures from a provisioning area and tested two alternative hypotheses: personal versus distributed leadership. Personal leadership predicts that a single, highest ranking individual initiates the most group movements, whereas distributed leadership predicts that different members lead the group on different occasions and affiliative individuals have more initiations. We recorded how often and how successfully adults initiated group movements from a provisioning area into the forest, and related these variables to the duration of interindividual proximity and grooming time in the forest. All adults initiated group movements, but did so variably. Social rank was related neither to the number of successful initiations nor to the success ratio of initiations. By contrast, eigenvector centrality based on proximity relations was positively correlated with the number and ratio of successful initiations. Moreover, successful initiations were positively correlated with social grooming. Overall, Tibetan macaques showed a pattern of distributed leadership. Our study demonstrated the relationship between social affiliation and individual leadership in a macaque society. Am. J. Primatol. 78:816-824, 2016. © 2016 Wiley Periodicals, Inc.

Collective Movement in the Tibetan Macaques (Macaca thibetana): Early Joiners Write the Rule of the Game.

Collective behavior has recently attracted a great deal of interest in both natural and social sciences. While the role of leadership has been closely scrutinized, the rules used by joiners in collective decision making have received far less attention. Two main hypotheses have been proposed concerning these rules: mimetism and quorum. Mimetism predicts that individuals are increasingly likely to join collective behavior as the number of participants increases. It can be further divided into selective mimetism, where relationships among the participants affect the process, and anonymous mimetism, where no such effect exists. Quorum predicts that a collective behavior occurs when the number of participants reaches a threshold. To probe into which rule is used in collective decision making, we conducted a study on the joining process in a group of free-ranging Tibetan macaques (Macaca thibetana) in Huangshan, China using a combination of all-occurrence and focal animal sampling methods. Our results show that the earlier individuals joined movements, the more central a role they occupied among the joining network. We also found that when less than three adults participated in the first five minutes of the joining process, no entire group movement occurred subsequently. When the number of these early joiners ranged from three to six, selective mimetism was used. This means higher rank or closer social affiliation of early joiners could be among the factors of deciding whether to participate in movements by group members. When the number of early joiners reached or exceeded seven, which was the simple majority of the group studied, entire group movement always occurred, meaning that the quorum rule was used. Putting together, Macaca thibetana used a combination of selective mimetism and quorum, and early joiners played a key role in deciding which rule should be used.

Park Rangers' Behaviors and Their Effects on Tourists and Tibetan Macaques (Macaca thibetana) at Mt. Huangshan, China.

Previous studies have reported the negative impacts of tourism on nonhuman primates (NHPs) and tourists and advocated the improvement of tourism management, yet what constitutes good quality management remains unclear. We explored whether rates of macaque aggression and self-directed behaviors (SDBs) differed under the supervision of two park ranger teams at the Valley of the Wild Monkeys (VWM) in Mt. Huangshan, Anhui Province, China. The two ranger teams provisioned and managed a group of macaques on an alternating monthly basis. Monkey, tourist and ranger behaviors were collected from August 16-September 30, 2012. Macaque aggression and SDB rates did not differ significantly under the management of the two teams. Overall, there was little intervention in tourist-macaque interactions by park rangers, and even when rangers discouraged tourists' undesirable behaviors, tourist interactions with monkeys persisted. Furthermore, only one or sometimes two park rangers managed monkeys and tourists, and rangers established dominance over the monkeys to control them. In order to effectively manage tourists and monkeys by a single park ranger, we recommend that rangers: (1) prohibit tourists from feeding; (2) move around the viewing platform more frequently; and (3) limit the number of tourists each visiting session.

Grooming reciprocity in female tibetan macaques macaca thibetana.

Grooming among nonhuman primates is widespread and may represent an important service commodity that is exchanged within a biological marketplace. In this study, using focal animal sampling methods, we recorded grooming relationships among 12 adult females in a free-ranging group of Tibetan macaques (Macaca thibetana) at Huangshan, China, to determine the influence of rank and kinship on grooming relationships, and whether females act as reciprocal traders (exchange grooming received for grooming given) or interchange traders (interchange grooming for social tolerance or other commodities). The results showed that: (1) grooming given was positively correlated with grooming received; (2) kinship did not exert a significant influence on grooming reciprocity; and (3) grooming reciprocity occurred principally between individuals of adjacent rank; however, when females of different rank groomed, females tended to groom up the hierarchy (lower ranking individuals groomed higher ranking individuals more than vice versa). Our results support the contention that both grooming reciprocity and the interchange of grooming for tolerance represent important social tactics used by female Tibetan macaques.

First occurrence of twins in provisioned free-ranging Tibetan macaques (Macaca thibetana) at Huangshan, China.

A first case of newborn Tibetan macaque (Macaca thibetana) twins was observed in a free-ranging group at Huangshan, China. The female that gave birth to the twins was studied during their first 5 months post-partum, and her activity budget was compared to those of adult females with single or no offspring in order to assess her behavioral changes. Our report shows that female Tibetan macaques can produce twins, and that twins can successfully survive. The adult female with twins spent more time foraging and resting, but less time moving and engaged in other social behaviors than adult females with a single infant or no infant. Our report provides a case of successfully surviving twins in a wild environment and suggests that the mother modified her behavior patterns to adapt to the heavy burden. We conclude that both food provisioning and the mother's behavioral strategies facilitated the survivorship of twins. This expands our understanding of the reproductive biology of Tibetan macaques.

Foxn1 gene knockout suppresses sexual attractiveness and pheromonal components of male urine in inbred mice.

The immunocompetence handicap hypothesis (ICHH) posits that females prefer signals emitted by immunocompetent males over immunocompromised males and that these signals are honest. However, mechanisms of mate choice under an ICHH model may be impacted by levels of genetic variation (inbred animals vs. outbred animals). Here, we conducted 2-choice female preference experiments and chemical analyses of male urine in inbred BALB/c and outbred CD-1 mice, both of which have immunocompromised nude (nu) strains resulting from a Foxn1 gene knockout. We found that inbred BALB/c females but not outbred CD-1 females preferred the urine of healthy males over that of immunocompromised males despite measured differences in the qualities of their urine. There was a clear increase in female-attracting pheromones (such as farnesenes) in the preputial glands and urine metabolites in healthy BALB/c males but no such difference between CD-1 and CD-1 nu males. Therefore, CD-1 male urine failed to provide an honest mate-choice cue for females. Our results suggest that deleterious traits associated with male odor in mice might be jointly affected by the level of inbreeding and immunodeficiency caused by a single-gene knockout.

Dual role of preputial gland secretion and its major components in sex recognition of mice.

This study was aimed at validating the sexual attractiveness of hexadecanol and hexadecyl acetate, two putative pheromone compounds, from preputial gland secretion of mice. These two compounds have been reported to be among the major components of preputial gland secretion in both sexes but higher in quantity in males than females. In this study, we show that castration suppressed the production of the two compounds, further suggesting their association with maleness. Adding preputial gland secretion and the synthetic analogs of the two compounds to castrated male urine at their physiological levels in intact males increased the attractiveness of castrated male urine to female mice, showing that the two compounds were indeed male pheromones. Furthermore, their sexual attractiveness disappeared upon removing the vomeronasal organs (VNOs) from female recipients. Replenishing castrated male urine with preputial gland secretion and the two compounds at their physiological levels in females increased the attractiveness of castrated male urine to males. Such a reversal of sexual attractiveness for hexadecanol and hexadecyl acetate suggests that they had opposing dual effects in sexual attractiveness in a dosage-dependent manner.