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Protocol Topical Sections

Protocol for a systematic review of the effects of gardening physical activity on neuroplasticity and cognitive function

  • Received: 30 January 2023 Revised: 05 May 2023 Accepted: 09 May 2023 Published: 18 May 2023
  • Background 

    The beneficial effects of gardening as a form of physical activity have garnered growing interest in recent years. Existing research suggests that physical activity enhances brain function through modifying synaptic plasticity, growth factor synthesis, and neurogenesis. Gardening physical activity is a promising, cost-effective, non-invasive intervention that can easily be augmented in the rehabilitation of neurodegenerative conditions. However, there is still insufficient literature. This protocol describes a systematic review to be conducted of scientific literature on the benefits of gardening as a physical activity that can promote neuroplasticity and improve cognitive function. This information can be useful as an intervention for persons who experience cognitive impairment brought on by cancer and chemotherapy in developing countries such as South Africa where there is real need to access cognitive rehabilitation.

    Methods and analysis 

    The systematic review strategy will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic literature database search of MEDLINE (PubMed), Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science will be carried out using medical search terms (MeSH), with English as the only permitted language, during the time period of January 2010 to December 2022. We will search for and review studies on how gardening as a physical activity impacts neuroplasticity and cognition. Two reviewers will read the titles, and abstracts and full text of the studies identified during the search to exclude records that do not meet the inclusion criteria. Data will then be extracted from the remaining studies. Any differences in opinion arising between the reviewers during the procedure will be resolved through discussion with a third reviewer. The Joanna Briggs Institute (JBI) Critical Appraisal Tool checklist will be utilized independently by two reviewers to evaluate the possibility of bias. The included articles will be subjected to narrative synthesis, with the results being presented in a thematic manner.

    Ethics and dissemination 

    There are no need for ethical approval because no patient data will be gathered. The results will be disseminated through an open-access peer-reviewed indexed journal, presented scientific meetings.

    PROSPERO registration number: CRD42023394493

    Citation: Antonio G. Lentoor, Tiro B. Motsamai, Thandokuhle Nxiweni, Bongumusa Mdletshe, Siyasanga Mdingi. Protocol for a systematic review of the effects of gardening physical activity on neuroplasticity and cognitive function[J]. AIMS Neuroscience, 2023, 10(2): 118-129. doi: 10.3934/Neuroscience.2023009

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  • Background 

    The beneficial effects of gardening as a form of physical activity have garnered growing interest in recent years. Existing research suggests that physical activity enhances brain function through modifying synaptic plasticity, growth factor synthesis, and neurogenesis. Gardening physical activity is a promising, cost-effective, non-invasive intervention that can easily be augmented in the rehabilitation of neurodegenerative conditions. However, there is still insufficient literature. This protocol describes a systematic review to be conducted of scientific literature on the benefits of gardening as a physical activity that can promote neuroplasticity and improve cognitive function. This information can be useful as an intervention for persons who experience cognitive impairment brought on by cancer and chemotherapy in developing countries such as South Africa where there is real need to access cognitive rehabilitation.

    Methods and analysis 

    The systematic review strategy will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic literature database search of MEDLINE (PubMed), Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science will be carried out using medical search terms (MeSH), with English as the only permitted language, during the time period of January 2010 to December 2022. We will search for and review studies on how gardening as a physical activity impacts neuroplasticity and cognition. Two reviewers will read the titles, and abstracts and full text of the studies identified during the search to exclude records that do not meet the inclusion criteria. Data will then be extracted from the remaining studies. Any differences in opinion arising between the reviewers during the procedure will be resolved through discussion with a third reviewer. The Joanna Briggs Institute (JBI) Critical Appraisal Tool checklist will be utilized independently by two reviewers to evaluate the possibility of bias. The included articles will be subjected to narrative synthesis, with the results being presented in a thematic manner.

    Ethics and dissemination 

    There are no need for ethical approval because no patient data will be gathered. The results will be disseminated through an open-access peer-reviewed indexed journal, presented scientific meetings.

    PROSPERO registration number: CRD42023394493



    The idea of fuzzy set was introduced by Zadeh[1]. Afterwards, Rosenfeld[2] developed this notion to define fuzzy subgroups. Thus, fuzzy group generalizes the traditional concept of a group. While group theory finds various applications in combinatorics, chemistry, and theoretical physics, fuzzy groups have practical applications in decision-making, pattern recognition, and artificial intelligence [3,4,5]. It should be noted that subgroups of a group arise as α-cuts of fuzzy subgroups [6]. This fact establishes the connection between fuzzy groups and crisp groups.

    There have been several studies on the enumeration of fuzzy subgroups of a group. Sherwood and Anthony[7] discussed the product of fuzzy subgroups in terms of t-norms.

    The enumeration of fuzzy subgroups is a complex task, prompting various authors to compute the number of fuzzy subgroups for specific instances only. Further details are provided below. Filep[8] constructed fuzzy subgroups for groups with order up to six. This is an influential paper in the enumeration of fuzzy subgroups.

    The case of abelian groups isomorphic to ZpnZqm was solved by Murali and Makamba [9].

    Moreover, the interesting case of finite cyclic groups of order pnqm was completed by Volf[10].

    Tˇarnˇauceanu [11] has done extensive work on the enumeration of fuzzy subgroups, including providing explicit formulas for the counting of fuzzy subgroups of finite abelian groups, as well as for specific cases of dihedral and Hamiltonian groups. He has developed explicit formulas for determining the number of unique fuzzy subgroups in finite p-groups that contains a maximal subgroup and introduced a method for identifying all chains of finite elementary p-groups[12].

    Other researchers have studied the cases of finite abelian p-groups, certain dihedral groups, quasi-dihedral groups, quaternion groups, modular p-groups, rectangle groups and finite dicyclic groups [13,14,15]. They have also developed expansion methods, lattice diagrams and recursive formulas to determine the number of fuzzy subgroups in these groups [16,17]. Recently, H. Alolaiyan et al. [18] have developed the notion of (α,β)-complex fuzzy subgroups which is a further generalization of a fuzzy subgroup.

    We would also like to mention the work of L. Ardekani, [19] in which they have computed the fuzzy normal subgroups of the group U6n.

    This paper employs a direct approach by counting the maximal chains in the group G which terminate in G. This method is suitable for the computation of fuzzy subgroups for any finite group.

    Fuzzy groups play a significant role in addressing uncertainty and imprecision within the context of rough set theory. Rough set theory and fuzzy set theory are two important frameworks within the field of computational intelligence that have found numerous applications in various domains. Rough set theory focuses on handling uncertainty and imprecision in data by defining lower and upper approximations. Fuzzy set theory deals with ambiguity and vagueness by assigning degrees of membership to elements. In recent years, both rough set theory and fuzzy set theory have been applied to address important issues in healthcare, particularly in the context of lung cancer [22] and COVID-19. Several notable contributions [23] have been made in these areas.

    Regarding lung cancer, researchers have utilized rough set theory to analyze medical datasets and extract relevant features for effective diagnosis and classification. By employing rough set-based feature selection techniques, they have achieved improved accuracy and efficiency in lung cancer detection. Moreover, fuzzy set theory has been employed to model uncertainty and imprecision in lung cancer risk assessment, aiding in personalized treatment planning and decision-making.

    As for COVID-19, rough set theory has been employed to analyze large-scale datasets, aiding in identifying significant risk factors and predicting disease outcomes. By utilizing rough set-based feature selection and rule induction techniques, researchers have successfully identified key clinical and epidemiological factors associated with disease severity and mortality. Fuzzy set theory has also been applied to model and analyze the linguistic variables associated with COVID-19, enabling better understanding and interpretation of complex and uncertain information [24]. Moreover, the Chikungunya disease can be diagonised using soft rough sets [25]. Extension of fuzzy algebraic structures have been studied in [26,27,28,29,30].

    Fuzzy groups can be employed in decision-making processes related to treatment planning and risk assessment. By considering the varying degrees of membership of patients to different groups, healthcare professionals can make more informed and personalized decisions, taking into account the inherent uncertainty and individual variations present in lung cancer and COVID-19 cases. Thus, fuzzy groups provide a flexible framework for handling uncertainty and imprecision within rough set theory and fuzzy set theory applications. They enable a more robust analysis of medical data, enhancing the accuracy and effectiveness of decision-making processes in the context of lung cancer and COVID-19 research.

    Definition 2.1. [7] Let G be a group then a μFP(G)(setofallfuzzysubsetsofG) is said to be a fuzzy subgroup of G if

    (1) μ(xy)min(μ(x),μ(y)), x,yG.

    (2) μ(x1)μ(x), xG.

    The set of all fuzzy subgroups of G will be denoted by F(G).

    The following Theorem gives a connection between subgroups and fuzzy subgroups of G [6].

    Theorem 2.1. Let G be a group. A μFP(G) is a fuzzy subgroup of G if and only if every α-cut μα is a subgroup of G.

    Definition 2.2. Let G be a finite group. A chain of finite subgroups of G is a set of subgroups of G linearly ordered by set inclusion, i.e., it is a finite sequence

    G0G1Gn=G.

    In the context of fuzzy subgroups of a group G, two fuzzy subgroups μ and ν are considered equivalent, denoted as μν, if the following conditions hold for all x and y in G: μ(x) is greater than or equal to μ(y) if and only if ν(x) is greater than or equal to ν(y), and μ(x) is zero if and only if ν(x) is zero. It can be shown that μν if and only if there exists a one-to-one correspondence between the equivalence classes of fuzzy subgroups of G and the set of chains of subgroups that end at G. Therefore, to count the distinct fuzzy subgroups of G, we simply need to count all chains of subgroups in G that end at G. The following theorem, proved in [20] gives the number of fuzzy subgroups of a finite group.

    Theorem 2.2. Let G be a finite group, Ci be a maximal chain of subgroups of G and F(G) be the set of all fuzzy subgroups of G. If there are r maximal chains in the lattice of subgroups of G then |F(G)| can be calculated by the following formula

    |F(G)|=|F(ri=1Ci)|+1.

    Proof. Let G be a finite group and S(G) be the lattice of subgroups of G. For each chain of G in S(G), we add G in the end of each chain. Obviously, ri=1Ci is disjoint union of maximal chains Ci's and all chains are contained in Ci's. Furthermore, we have a certain unique chain (GiG) of G in S(G). So, by counting all those distinct chains of G in S(G) which terminate in G yields |F(G)|.

    Hence without loss generality, we have

    |F(G)|=|F(ri=1Ci)|+1.

    Now we give a detailed working of the general case to compute the number of of chains of subgroups of G that terminate in G. For a particular chain (GiG) of G, which start from G and terminate in G, for a fix q[0,1] there exists a unique trivial fuzzy subgroup of G having order 1.

    Theorem 2.3. Let G be a finite group, then the |F(G)| (where the order of fuzzy subgroups is greater than one) can be calculated by the following formula:

    |F(ri=1Ci)|=(ri=12ir)(r1i=1r2=j>i2ijr(r1)2)+(r2i=1 r1i<j=2 ri<j<k=32ijk12r1α=2(rα+1)(rα))++(1)r2(2i1=1ζ12i1i2i3ir1  r)+(1)r1(ζ22i1i2i3ir1 ir1),

    where ζ1:i1<i2,2i2<i3<<ir1randζ2:1=i1<i2<i3<<ir1<ir=r.

    Proof. From Theorem 2.2 it follows that,

    |F(ri=1Ci)|=ri=1|F(Ci)|1i<jr|F(CiCj)|+1i<j<kr|F(CiCjCk)|++(1)r1|F(C1C2Cr)|.

    We denote |F(Ci)|, |F(CiCj)|, |F(CiCjCk)| and |F(C1C2Cr)| by Si,(i=1,,r), Sij(1i<jr), Sijk,(1i<j<kr) and S12r respectively.

    Let Si represents the |F(G)| except of first order, formed by corresponding Ci of G and Sij, Sijk, , S12r represents the cardinality of all distinct possible fuzzy subgroups of G excluding first order, formed by corresponding (CiCj), (CiCjCk), , (C1C2Cr) respectively of G. For ease of computations, the above equation can be written as

    |F(ri=1Ci)|=ri=1Si1i<jrSij+1i<j<krSijk+(1)r2ζ1Si1i2i3ir1+(1)r1ζ2Si1i2i3ir1ir.

    Where ζ1:1i1<i2<i3<<ir1r and ζ2:1=i1<i2<i3<<ir1<ir=r.

    We define lengths of chains as under

    1i=|Ci|1(1ir),1ij=|CiCj|1(1i<jr),
    1ijk=|CiCjCk|1(1i<j<kr),,1i1i2i3ir1=|Ci1Ci2Ci3Cir1|1(1i1<i2<i3<<ir1r),
    1i1i2i3ir1ir=|Ci1Ci2Ci3Cir1Cir|1(1=i1<i2<i3<<ir1<ir=r).

    We compute the lengths of chains in the following steps.

    (1) We calculate,

    ri=1Si,       1ir.

    Since, i is the length for the maximal chain Ci and i=|Ci|1.

    We have

    Si=2i1,
    ri=1Si=(211)+(221)++(2r1)=ri=12ir.

    (2) In this step, we calculate 1=i<jrSij,(1i<jr).

    Let ij be the length for the overlapping of maximal chains Ci and Cj which is ij=|CiCj|1.

    Fix i=1  for  2jr,

    S1r=21r1,

    Now,

    rj=2S1j=rj=2(21j1j)=rj=221j(r1).

    Fix i=2,for3jr

    S2r=22r1.

    We have

    rj=3S2j=rj=3(22j1j)=rj=322j(r2).

    Now fix i=r2,forr1jr,

    Sr2 r1=2r2 r11,
    Sr2 r=2r2 r1,
    rj=r1Sr2 j=rj=r1(2r2 j1j)=rj=r12r2 j2.

    Fixing i=r1, j=r,

    Sr1 r=2r1 r1.
    j=rSr1 j=j=r(2r1 j1j)=j=r2lr1 j 1.
    1i<jrSij=rj=2S1j+rj=3S2j++rj=r1Sr2 j+j=rSr1 j,

    hence,

    1i<jrSij=r1i=1r2=j>i2ijr(r1)2.

    (3) In this step, we calculate 1=i<j<krSijk,(1i<j<kr).

    Let ijk be the length for overlapping of maximal chains Ci, Cj and Ck which is ijk=|CiCjCk|1.

    We fix i=1,  for  2j<km.

    When j=2 and 3kr,

    S123=21231,
    S12r=212r1,
    rk=3S12k=rk=3(212k1k)=rk=3212k(r2).

    When j=3 and 4kr,

    S134=21341,
    S13r=213r1,
    rk=4S13k=rk=4(213k1k)=rk=4213k(r3),

    When j=r2 and r1kr,

    S1 r2 r1=21 r2 r11.
    S1 r2 r=21 r2 r1.
    rk=r1S1 r2 k=rk=r1(21 r2 k1k)=rk=r121 r2 k2.

    When j=r1 and k=r,

    S1 r1 r=21 r1 r1,
    k=rS1 r1 k=k=r(21 r1 k1k)=k=r21 r1 k1.
    2j<krS1jk=rk=3S12k+rk=4S13k++rk=r1S1 r2 k+k=rS1 r1 k,

    Thus,

    2j<krS1jk=r1j=2rj<k=3212k(r1)(r2)2.

    Similarly, fix i=2, for 3j<kr,

    3j<krS2jk=r1j=3rj<k=422jk(r2)(r3)2.

    Fix i=r3, for r2j<kr,

    r2j<krSr3 j k=r1j=r2rj<k=r12r3 j k3.

    Fix i=r2, for r1j<kr

    r1j<krSr2 j k=k=rSr2 r1 k=k=r2lr2 r1 k1
    1i<j<krSijk=2j<krS1jk+3j<krS2jk++r2j<krSr3 j k+r1j<krSr2 j k
    1i<j<krSijk=r1j=2rj<k=321jk(r1)(r2)2+r1j=3rj<k=422jk(r2)(r3)2++r1j=r2rj<k=r12r3 j k3+k=r2r2 r1 k1,
    1i<j<krSijk=r2i=1 r1i<j=2 ri<j<k=32ijk12r1α=2(r+1α)(rα).

    (r1)th Step:

    We find, ζSi1i2i3ir1        where     i1<i2<i3<<ir1,

    ζSi1i2i3ir1=2i1=1  2i2<i3<<ir1r2i1i2i3ir1r.

    Where ζ:1i1<i2<i3<<ir1r.

    rth Step:

    We find ζSi1i2i3ir1ir     where     i1<i2<i3<<ir1<ir,

    ζSi1i2i3ir1ir=ζ  2i1i2i3ir1ir1,

    and ζ:1=i1<i2<i3<<ir1<ir=r. Summing together all previous steps,

    |F(ri=1Bi)|=ri=1Si1i<jrSij+1i<j<krSijk+(1)r21i1<i2<i3<<ir1rSi1i2i3ir1+(1)r11=i1<i2<i3<<ir1<ir=rSi1i2i3ir1ir.

    Finally, we have:

    |F(ri=1Bi)|=(ri=12ir)(r1i=1r2=j>i2ijr(r1)2)+(r2i=1 r1i<j=2 ri<j<k=32ijk12r1α=2(rα+1)(rα))++(1)r2(2i1=1  i1<i2,2i2<i3<<ir1r  2i1i2i3ir1  r)+(1)r1(1=i1<i2<i3<<ir1<ir=r  2i1i2i3ir1 ir  1).

    The following algorithm is the consequence of the Theorem 2.3.

    Algorithm 1: Enumerating fuzzy subgroups of a finite group
      We enumerate the fuzzy subgroups of the quaternion group of Q8 as an illustration of the above algorithm.
      Input: A finite group G and C1, C2,, Cr, the maximal chains of subgroups of G.
      Output: Number of all distinct possible fuzzy subgroups (having the order greater than one) of G.
      Data: Lattice of subgroups of the group G.
    Step 1. Determine all distinct fuzzy subgroups corresponding to every maximal chain, excluding the fuzzy subgroup of order 1. |F(Ci)| is the number of fuzzy subgroups corresponding to the ith maximal chain, where 1ir.
    Step 2: Find the sum ri=1|F(Ci)|.
    Step 3. Find intersections of l maximal chains, where 2r.
    Step 4: Find number of all distinct fuzzy subgroups (except of first order) corresponding to the intersection of every pair of maximal chains CiCj, |F(CiCj)| is the number of fuzzy subgroups corresponding to the intersection of every pair of maximal chains CiCj maximal chain, where 1i<jr.
    Step 5: Find the sum 1i<jr|F(CiCj)|.
    Step 6. Find number of all distinct fuzzy subgroups (except of first order) corresponding to the intersection of every l maximal chains, where 3lr. Thus, we find |F(CiCjCk)| where (1i<j<kr), , |F(Ci1Ci2Ci3Cir1)| where (1i1<i2<i3<<ir1r) and |F(C1C2Cr)|.
    Step 7: Find the following sums 1i<j<kr|F(CiCjCk)|, , ζ1|F(Ci1Ci2Ci3Cir1)| and ζ2|F(Ci1Ci2Ci3Cir1Cir)|, where, ζ1:1i1<i2<i3<<ir1r and ζ2:1=i1<i2<i3<<ir1<ir=r.
    Step 8. By using combinatorial tools on maximal chains, find the overall sum of both the sum of all distinct fuzzy subgroups (excluding first order) corresponding to every ith maximal chain, where 1ir and the sum of all distinct fuzzy subgroups (except of first order) corresponding to the intersection of every maximal chains, where 2r. Thus, we have computed |F(ri=1Ci)|.

    Example 2.3. The quaternion group Q8 is generated by i,j, where i2=1=j2=k2=ijk. Let B1,B2,B3 be the possible maximal chains of Q8. The subgroups of Q8 are:

    H1=1, H2=1, H3=i, H4=j, H5=k and H6=Q8.

    The maximal chains of Q8 are:

    B1 : H1q0H2q1H3q2H6q3
    B2 : H1q0H2q1H4q2H6q3
    B3 : H1q0H2q1H5q2H6q3
    where1q0>q1>q2>q30.

    Step 1:

    Here B1 defines the following distinct possible fuzzy subgroups (except of first order) Q8;

    H1q0H2q1H3q2H6q3

    λ1(g)={q0,      for  g=e,q1,      for  gH2H1,q2,      for  gH3H2,q3,      for  gH6H3.

    H1q0H2q1H6q2

    λ2(g)={q0,      for  g=e,q1,      for  gH2H1,q2,      for  gH6H2.

    H1q0H3q1H6q2

    λ3(g)={q0,     for  gH1,q1,      for  gH3H1,q2,      for  gH6H3.

    H2q0H3q1H6q2

    λ4(g)={q0,      for  gH2,q1,      for  gH3H2,q2,      for  gH6H3.

    H1q0H6q1

    λ5(g)={q0,      for  gH1,q1,      for  gH6H1.

    H2q0H6q1

    λ6(g)={q0,      for  gH2,q1,      for  gH6H2.

    H3q0H6q1

    λ7(g)={q0,      for  gH3,q1,      for  gH6H3.

              |F(B1)|=7.

    On the same pattern, |F(B2)|=7 and |F(B3)|=7.

    |F(B1)|=|F(B2)|=|F(B3)|=7.

    Step 2:

    |F(B1B2)|=|F(B1B3)|=|F(B2B3)|=3.

    Step 3:

    |F(B1B2B3)|=3,
    since   |F(Q8)|=|F(3i=1Bi)|+1.

    Thus, we have,

    |F(3i=1Bi)|=|F(B1)|+|F(B2)|+|F(B3)||F(B1B2)||F(B1B3)||F(B2B3)|+|F(B1B2B3)|
    |F(3i=1Bi)|=(7+7+7)(3+3+3)+3=15.

    Hence

    |F(Q8)|=|F(3i=1Bi)|+1=16,

    which is in agreement with the above Theorem 2.3.

    We give another example of computing fuzzy subgroups.

    Example 2.4. The Dihedral group D8 has elements {e,a,a2,a3,b,ab,a2b,a3b}. The subgroups of D8 are:

    H1={e}, H2={e,a,a2,a3}, H3={e,b}, H4={e,a2}, H5={e,ab}, H6={e,a2b}, H7={e,a3b}, H8={e,a2,ab,a3b}, H9={e,b,a2,a2b} and H10={e,a,a2,a3,b,ab,a2b,a3b}.

    The maximal chains of D8 are:

    B1:Hq01Hq15Hq29Hq310.
    B2:Hq01Hq13Hq29Hq310.
    B3:Hq01Hq16Hq29Hq310.
    B4:Hq01Hq16Hq28Hq310.
    B5:Hq01Hq16Hq27Hq310.
    B6:Hq01Hq12Hq27Hq310,
    where1q0q1q2q30.

    We find that |F(D8)|=|i=7i=1Bi|5=32. Thus, there are 32 fuzzy subgroups of D8.

    The number of fuzzy subgroups of a finite group G depend on its maximal chains because every maximal chain and intersection of maximal chains define fuzzy subgroups of a finite group G. We can get exactly one distinct fuzzy subgroup (trivial) of G of order 1, corresponding to a unique chain (GiG) of G. We can find the number of all distinct possible fuzzy subgroups (of order greater than one) of a finite group G by an algorithm which is consequence of above Theorem 2.3 as

    |F(mi=1Bi)|=mi=1|F(Bi)|1i<jm|F(BiBj)|+1i<j<km|F(BiBjBk)|++(1)m1|F(B1B2Bm)|.

    This formula is only valid and useful for all chains in the lattice of G of ith length and terminate in G, where i1. Due to the comlexity of the algorithm used, this method is feasible for groups of reasonably small orders. Moreover, the computer algebra system GAP[21] can be used to find the number of fuzzy subgroups of a group using the approach given in this paper.

    The authors declare they have not used Artificial Intelligence (AI) tools in the creation of this article.

    This project was funded by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah, Saudi Arabia, under grant No. (D1441-149-130). The authors, therefore, gratefully acknowledge DSR technical and financial support.

    The authors declare no conflict of interest.



    Ethics and dissemination



    Ethics approval is not necessary because this study is a systematic review of previously published studies. Any modifications to the systematic review process will be evaluated and approved using the PROSPERO registry, and the specifics of those modifications will be included in the study's final report. Dissemination of the results of this study will be through peer-reviewed publications, a national and international conferences and interdepartmental webinars.

    Funding



    This research was supported by the National Research Foundation Thuthuka grant number [129528]; the Sefako Makgatho Health Sciences University Capacity Development Grant; and the Biological Psychiatry Early-Mid Career Development grant.

    Conflict of interest



    The authors declare no conflict of interest.

    Disclaimer



    The funding agencies had no role in the study design; decision to publish the manuscript; or portion of the manuscript.

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