Journal articles on the topic 'National Center for Health Statistics (U.S.)'

Background: As the global climate changes, the number of cases of hand-foot-and-mouth disease (HFMD) is increasing year by year. This study comprehensively considers the association of time and space by analyzing the temporal and spatial distribution changes of HFMD in the Ili River Valley in terms of what climate factors could affect HFMD and in what way. Methods: HFMD cases were obtained from the National Public Health Science Data Center from 2013 to 2018. Monthly climate data, including average temperature (MAT), average relative humidity (MARH), average wind speed (MAWS), cumulative precipitation (MCP), and average air pressure (MAAP), were obtained from the National Meteorological Information Center. The temporal and spatial distribution characteristics of HFMD from 2013 to 2018 were obtained using kernel density estimation (KDE) and spatiotemporal scan statistics. A regression model of the incidence of HFMD and climate factors was established based on a geographically and temporally weighted regression (GTWR) model and a generalized additive model (GAM). Results: The KDE results show that the highest density was from north to south of the central region, gradually spreading to the whole region throughout the study period. Spatiotemporal cluster analysis revealed that clusters were distributed along the Ili and Gongnaisi river basins. The fitted curves of MAT and MARH were an inverted V-shape from February to August, and the fitted curves of MAAP and MAWS showed a U-shaped change and negative correlation from February to May. Among the individual climate factors, MCP coefficient values varied the most while MAWS values varied less from place to place. There was a partial similarity in the spatial distribution of coefficients for MARH and MAT, as evidenced by a significant degree of fit performance in the whole region. MCP showed a significant positive correlation in the range of 15–35 mm, and MAAP showed a positive correlation in the range of 925–945 hPa. HFMD incidence increased with MAT in the range of 15–23 °C, and the effective value of MAWS was in the range of 1.3–1.7 m/s, which was positively correlated with incidences of HFMD. Conclusions: HFMD incidence and climate factors were found to be spatiotemporally associated, and climate factors are mostly non-linearly associated with HFMD incidence.

Abstract Background: Budd-Chiari Syndrome (BCS) is a complex thrombotic disorder caused due to obstruction of hepatic venous outflow involving anywhere from small hepatic venules to the entrance of inferior vena cava into the right atrium. This leads to venous stasis and ischemic injury of hepatic parenchyma and sinusoids, with the risk of liver failure. The prognosis of patients with BCS had improved significantly with long-term anticoagulation and measures like Trans-Jugular-Intrahepatic-Porto-Systemic shunt (TIPS) and liver transplantation. We report the outcomes of patients who follow in our hematology practice and describe the factors predicting the need for TIPS/Liver Transplant. Methods: After appropriate Investigational Review Board permission, we identified patients with a history of BCS following in our thrombosis clinical practice from the year 2010 onwards. We evaluated their laboratory, demographic, anticoagulation data, Model of End-stage Liver Disease (MELD) score, Child-Pugh (CP) score at diagnosis or when earliest available, and other relevant clinical information as outlined. Descriptive statistics with medians, quartiles, frequencies, and percentages are reported. Further, we compared the two categories of patients who needed TIPS/Liver transplants versus those who did not. SAS version 9.4 was used for analysis. For continuous variables, a univariate nonparametric Mann-Whitney test was used. The Fisher's Exact Test was used to associate each variable with the need for TIPS/Liver Transplant. Results: Our study included 23 patients with baseline characteristics, including median age of 36 years (11-59 years), 91% whites, 61% females, 44% smokers, 61% obese(median BMI 29.9 kg/m 2), 6 of 14 women on oral contraceptive pills, 22% with thrombosis history, 17% with stroke history, median hemoglobin 13.4 gm/dL(8.9-20 gm/dL), white blood cell count 9,400/L (3,050-31,500/L), platelet count 294,000/L(14,000-767,000/L), serum creatinine 0.87 mg/L (0.55-2.52 mg/dL), total protein 6.3 gm/dL (5.2-8.8 gm/dL), Bilirubin 2.1 mg/dL(0.1-20.2 mg/dL), Aspartate Aminotransferase (AST) 61 U/L(16-1037 U/L), Alanine Aminotransferase (ALT) 43U/L(18-1694 U/L), MELD score 15 (range 7-38), CP score 9 (5-14), 74% with cirrhosis, 82% with ascites at one point, 57% with myeloproliferative neoplasm (MPN), 4.3% with Paroxysmal Nocturnal Hemoglobinuria (PNH), 17% with Antiphospholipid antibodies positive (APS), 13% had positive antinuclear antibodies, 35% needed TIPS and 44% required liver transplantation. 57% with Janus Kinase (JAK2) V617F mutation (1 patient with a low variant allele frequency of 1%), 1 patient (4.3%) had Calreticulin (CALR) mutation positive MPN, 91% remained on long-term anticoagulation with 40% using warfarin, 35% apixaban, 9% Enoxaparin or Rivaroxaban for long-term anticoagulation, 13% developed heparin-induced thrombocytopenia (HIT). 8.7% had developed BCS after Ad26.COV2.S vaccine to prevent SARS-CoV-2 infection. Excluding the patients with missing variables, 5 of 12 had Protein C deficiency, 3 or 10 had Protein S deficiency, 8 of 20 with Antithrombin (AT) deficiency, 4 of 14 with heterozygous factor V Leiden mutation, 0 of 10 with prothrombin gene mutation, 1 of 13 with hyper-homocysteinemia. 35% had gastrointestinal bleeding though 65% of patients had evidence of varices by endoscopy. When the group needing TIPS/Liver transplant/died is compared to those who did not, they had higher bilirubin, MELD, PC score, AT deficiency, cirrhosis, ascites, and JAK2 mutation (p-value significant: Table 1). With a median follow-up of 90 months, overall survival was not statistically significant between the two groups (Figure 1). Two patients (8.7%) died out of a total of 23. Conclusions: Our data indicate that in patients with BCS, neoplasms (61%), particularly MPN (57%), are very commonly diagnosed. Compared to the historical data in patients with BCS with dismal prognosis (60-80% six-month mortality rate), the overall survival had significantly improved, likely due to supportive measures like TIPS/Liver transplant and long-term anticoagulation. Outside the established variables like CP and MELD, lower antithrombin activity and positive JAK2 mutation status also predicted a higher TIPS/Liver transplant need. Figure 1 Figure 1. Disclosures Bhatt: Partnership for health analytic research, LLC: Consultancy; Abbvie: Consultancy, Research Funding; Jazz: Research Funding; Incyte: Consultancy, Research Funding; Pfizer: Research Funding; Tolero Pharmaceuticals, Inc: Research Funding; National Marrow Donor Program: Research Funding; Abbvie: Consultancy, Research Funding; Genentech: Consultancy; Servier Pharmaceuticals LLC: Consultancy; Rigel: Consultancy. Gundabolu: BioMarin Pharmaceuticals: Consultancy; Blueprint Medicines: Consultancy; Bristol-Myers Squibb Company: Consultancy; Pfizer: Research Funding; Samus Therapeutics: Research Funding.

Annotation. The level of subjective control may vary in different regions depending on social and economic living conditions, moral attitudes and level of education of the population. Circumstances such as age, gender and constitutional variability in the locus of control cannot be ruled out (although there is very little research on this issue). The purpose of the study is to conduct a comparative study of the typological delineation of the emotional-dynamic pattern in practically healthy Ukrainian women without and taking into account the somatotype. Primary anthropo-somatotypological and personality indicators of practically healthy Ukrainian women aged 21 to 35 of different somatotypes were selected from the database of materials of the research center of National Pirogov Memorial Medical University, Vinnytsya. Determination of the components of internality by J. Rotter in the modification of E. F. Bazhin, S. O. Golinkina and O. M. Etkind included the definition (sten): indicator of the scale of general internality of the level of subjective control, indicators of the level of subjective control in the industry achievements, failures, family relationships, educational (professional) relationships, interpersonal relationships, health and disease. Statistical processing of the results was performed in the license package “Statistica 5.5” using non-parametric evaluation methods. The reliability of the difference between the values between the independent quantitative values was determined using the U-Mann-Whitney test. There was a lower level of general internality and subjective control in the field of achievement in mesomorphic women compared to women without taking into account somatotype and women of other somatotypes. According to the scale of internality in the field of failures in women without taking into account somatotype, endo-mesomorphs and representatives of the middle intermediate somatotype, the most developed sense of control over negative situations and the tendency to blame themselves for trouble compared to mesomorphic women. It is characteristic that in the sphere of family relations this image emerges especially clearly in mesomorphic women; they consider their partner, not themselves, to be more responsible for the events of family life. Women of intermediate somatotype compared to women without somatotype and women mesomorphs and ectomorphs have a higher level of internality in the field of interpersonal relationships. The level of subjective health and disease control in endo-mesomorphic women is significantly lower than in ectomorphic women. Thus, the level and various parameters of subjective control can be used as personal markers of the studied somatotype, which will create optimal and most individualized recommendations for psychological support, adaptation and coping strategies.

51 Background: The U. S. Preventative Services Task Force (USPSTF) recommendation regarding prostate-specific antigen (PSA) transitioned to a grade D recommendation against PSA screening for adult males in 2012. The impact of this recommendation against PSA screening on prostate cancer-specific mortality (PCSM) in contemporary cohorts is unknown. Our study evaluated PCSM between 1999-2019, comparing mortality rates before and after this change to screening guidelines. Methods: Age-adjusted PCSM rates per 100,000 men were obtained from the National Center for Health Statistics from 1999 – 2019. Trends in PCSM rates from 1999 – 2012 and 2014 – 2019 were estimated using linear regression with year and binary indicator of pre-2013/post-2013 status as interaction terms. Age-adjusted rates of PCSM were calculated for men ≥50 years and by race, ethnicity, urbanization and census region. Similarly, age-adjusted rates of overall cancer mortality (exclusive of PCSM) were calculated. Behavioral Risk Factor Surveillance System was used to establish trends in PSA screening from 2001 – 2018. North American Association of Central Cancer Registries was used to determine age-adjusted incidence of localized and metastatic PC at the time of diagnosis from 1999 – 2017. Results: The age-adjusted PCSM rate in the U.S. decreased linearly at a rate of (-)0.28 per 100,000/year from 1999 – 2012 and subsequently stalled at a rate of no change from 2014 – 2019 (p < 0.001). This effect was particularly striking for men aged 60 – 69, men > 80 years, and Black men. Men aged 60 – 64 had a decreasing rate of (-)0.009 per 100,000/year prior to 2013, followed by a rise of (+)0.001 per 100,000/year (p < 0.001). Among Black men, PCSM rate was decreasing linearly at (-)0.700/100,000/year from 1999-2012 and flattened at a rate of (-)0.091/100,000/year from 2014-2019 (p < 0.001). These changes were seen across races, urbanization and census regions (p < 0.001) and were accompanied by decreases in PSA screening (p = 0.02) together with increases in diagnosis of metastatic disease. These trends were inconsistent with mortality trends observed across all malignancies. Conclusions: Using comprehensive data on PCSM through 2019, this study illustrates decreasing PCSM over time which flattened or increased following the 2012 change in USPSTF guideline, along with a decrease in PSA screening. The change in PCSM was seen in all ages, races, ethnicities, urbanization and census regions, but particularly in men from 60 – 69 and > 80 years old, and Black men. These changes were accompanied by increased diagnosis of metastatic PC and are discordant from trends across other malignancies. These findings suggest that the change in PSA screening guideline may have contributed to the stagnancy of PCSM rates in recent years. The updated 2018 USPSTF guideline supporting shared-decision making may reverse these trends over time.

Background: Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. Purpose: To systematically review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep. Methods: PubMed and EMBASE databases were systematically searched for studies reporting statistics regarding the relationship between sleep and sports injury in adolescents aged <19 years published between 1/1/1997 and 12/21/2017. From included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. Additionally, a NOS (Newcastle-Ottawa Scale) assessment and an evaluation of the OCEM (Oxford Center for Evidence-Based Medicine) level of evidence for each study was conducted to assess each study’s individual risk of bias, and the risk of bias across all studies. Results: Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive correlation between acutely poor sleep and injury, while the other study reported no significant correlation. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR 1.58, 95% CI 1.05 to 2.37, p = 0.03). OCEM criteria assessment showed that all but one study (a case-series) were of 2b level of evidence—which is the highest level of evidence possible for studies which were not randomized control trials or systematic reviews. NOS assessment was conducted for all six cohort studies to investigate each study’s individual risk of bias. Five out of six of these studies received between 4 to 6 stars, categorizing them as having a moderate risk of bias. One study received 7 stars, categorizing it as having a low risk of bias. NOS assessment revealed that the most consistent source of bias was in ascertainment of exposure: all studies relied on self-reported data regarding sleep hours rather than a medical or lab record of sleep hours. Conclusions: Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates. Our results thus suggest that adolescents who either chronically sleep less than 8 hours per night, or have frequent night time awakenings, are more likely to experience sports or musculoskeletal injuries. [Figure: see text][Figure: see text][Table: see text][Table: see text][Table: see text] References used in tables and full manuscript Barber Foss KD, Myer GD, Hewett TE. Epidemiology of basketball, soccer, and volleyball injuries in middle-school female athletes. Phys Sportsmed. 2014;42(2):146-153. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33(1):75-81. Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206-220. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. Wheaton AG, Olsen EO, Miller GF, Croft JB. Sleep Duration and Injury-Related Risk Behaviors Among High School Students--United States, 2007-2013. MMWR Morb Mortal Wkly Rep. 2016;65(13):337-341. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2016;12(11):1549-1561. Watson NF, Badr MS, Belenky G, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep. 2015;38(8):1161-1183. Juliff LE, Halson SL, Hebert JJ, Forsyth PL, Peiffer JJ. Longer Sleep Durations Are Positively Associated With Finishing Place During a National Multiday Netball Competition. J Strength Cond Res. 2018;32(1):189-194. Beedie CJ, Terry PC, Lane AM. The profile of mood states and athletic performance: Two meta- analyses. Journal of Applied Sport Psychology. 2000;12(1):49-68. Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013;8(12): e83138. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009;6(7): e1000100. Watson A, Brickson S, Brooks A, Dunn W. Subjective well-being and training load predict in- season injury and illness risk in female youth soccer players. Br J Sports Med. 2016. Alricsson M, Domalewski D, Romild U, Asplund R. Physical activity, health, body mass index, sleeping habits and body complaints in Australian senior high school students. Int J Adolesc Med Health. 2008;20(4):501-512. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Luke A, Lazaro RM, Bergeron MF, et al. Sports-related injuries in youth athletes: is overscheduling a risk factor? Clin J Sport Med. 2011;21(4):307-314. University of Oxford Center for Evidence-Based Medicine. Oxford Centre for Evidence-based Medicine – Levels of Evidence. 2009; https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ . von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017;27(11):1364-1371. von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective. Scand J Med Sci Sports. 2017;27(12):2059-2069. Picavet HS, Berentzen N, Scheuer N, et al. Musculoskeletal complaints while growing up from age 11 to age 14: the PIAMA birth cohort study. Pain. 2016;157(12):2826-2833. Kim SY, Sim S, Kim SG, Choi HG. Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents. PLoS One. 2015;10(8): e0135753. Stare J, Maucort-Boulch D. Odds Ratio, Hazard Ratio and Relative Risk. Metodoloski Zvezki. 2016;13(1):59-67. Watson AM. Sleep and Athletic Performance. Curr Sports Med Rep. 2017;16(6):413-418. Stracciolini A, Stein CJ, Kinney S, McCrystal T, Pepin MJ, Meehan Iii WP. Associations Between Sedentary Behaviors, Sleep Patterns, and BMI in Young Dancers Attending a Summer Intensive Dance Training Program. J Dance Med Sci. 2017;21(3):102-108. Stracciolini A, Shore BJ, Pepin MJ, Eisenberg K, Meehan WP, 3 rd. Television or unrestricted, unmonitored internet access in the bedroom and body mass index in youth athletes. Acta Paediatr. 2017;106(8):1331-1335. Snyder Valier AR, Welch Bacon CE, Bay RC, Molzen E, Lam KC, Valovich McLeod TC. Reference Values for the Pediatric Quality of Life Inventory and the Multidimensional Fatigue Scale in Adolescent Athletes by Sport and Sex. Am J Sports Med. 2017;45(12):2723-2729. Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports. 2017;27(3):266-274. Liiv H, Jurimae T, Klonova A, Cicchella A. Performance and recovery: stress profiles in professional ballroom dancers. Med Probl Perform Art. 2013;28(2):65-69. Van Der Werf YD, Van Der Helm E, Schoonheim MM, Ridderikhoff A, Van Someren EJ. Learning by observation requires an early sleep window. Proc Natl Acad Sci U S A. 2009;106(45):18926- 18930. Lee AJ, Lin WH. Association between sleep quality and physical fitness in female young adults. J Sports Med Phys Fitness. 2007;47(4):462-467. Mejri MA, Yousfi N, Hammouda O, et al. One night of partial sleep deprivation increased biomarkers of muscle and cardiac injuries during acute intermittent exercise. J Sports Med Phys Fitness. 2017;57(5):643-651. Mejri MA, Yousfi N, Mhenni T, et al. Does one night of partial sleep deprivation affect the evening performance during intermittent exercise in Taekwondo players? Journal of exercise rehabilitation. 2016;12(1):47-53. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep health. 2015;1(4):233-243. Dennis J, Dawson B, Heasman J, Rogalski B, Robey E. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2016;19(2):113-116. Bergeron MF, Mountjoy M, Armstrong N, et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med. 2015;49(13):843-851. Riley M, Locke AB, Skye EP. Health maintenance in school-aged children: Part II. Counseling recommendations. Am Fam Physician. 2011;83(6):689-694. Spector ND, Kelly SF. Sleep disorders, immunizations, sports injuries, autism. Curr Opin Pediatr. 2005;17(6):773-786. Asarnow LD, McGlinchey E, Harvey AG. The effects of bedtime and sleep duration on academic and emotional outcomes in a nationally representative sample of adolescents. J Adolesc Health. 2014;54(3):350-356. Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health. 2002;31(6 Suppl):175-184. School start times for adolescents. Pediatrics. 2014;134(3):642-649. Bland JM, Altman DG. The odds ratio. BMJ. 2000;320(7247):1468.

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Antipsychotics in anxiety disorders</strong></p><p>Christer Allgulander</p><p><strong>2. Anxiety in somatic disorders</strong></p><p>Christer Allgulander</p><p><strong>3. Community rehabilitation of the schizophrenic patient</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera</p><p><strong>4. Dual diagnosis: A theory-driven multidisciplinary approach for integrative care</strong></p><p>David Blackbeard</p><p><strong>5. The emotional language of the gut - when 'psyche' meets 'soma'</strong></p><p>Helen Clark</p><p><strong>6. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>7. The Psychotherapy of bipolar disorder</strong></p><p>Franco Colin</p><p><strong>8. Developing and adopting mental health policies and plans in Africa: Lessons from South Africa, Uganda and Zambia</strong></p><p>Sara Cooper, Sharon Kleintjes, Cynthia Isaacs, Fred Kigozi, Sheila Ndyanabangi, Augustus Kapungwe, John Mayeya, Michelle Funk, Natalie Drew, Crick Lund</p><p><strong>9. The importance of relapse prevention in schizophrenia</strong></p><p>Robin Emsley</p><p><strong>10. Mental Health care act: Fact or fiction?</strong></p><p>Helmut Erlacher, M Nagdee</p><p><strong>11. Does a dedicated 72-hour observation facility in a district hospital reduce the need for involuntary admissions to a psychiatric hospital?</strong></p><p>Lennart Eriksson</p><p><strong>12. The incidence and risk factors for dementia in the Ibadan study of ageing</strong></p><p>Oye Gureje, Lola Kola, Adesola Ogunniyi, Taiwo Abiona</p><p><strong>13. Is depression a disease of inflammation?</strong></p><p><strong></strong>Angelos Halaris</p><p><strong>14. Paediatric bipolar disorder: More heat than light?</strong></p><p>Sue Hawkridge</p><p><strong>15. EBM: Anova Conundrum</strong></p><p>Elizabeth L (Hoepie) Howell</p><p><strong>16. Tracking the legal status of a cohort of inpatients on discharge from a 72-hour assessment unit</strong></p><p>Bernard Janse van Rensburg</p><p><strong>17. Dual diagnosis units in psychiatric facilities: Opportunities and challenges</strong></p><p>Yasmien Jeenah</p><p><strong>18. Alcohol-induced psychotic disorder: A comparative study on the clinical characteristics of patients with alcohol dependence and schizophrenia</strong></p><p>Gerhard Jordaan, D G Nel, R Hewlett, R Emsley</p><p><strong>19. Anxiety disorders: the first evidence for a role in preventive psychiatry</strong></p><p>Andre F Joubert</p><p><strong>20. The end of risk assessment and the beginning of start</strong></p><p>Sean Kaliski</p><p><strong>21. Psychiatric disorders abd psychosocial correlates of high HIV risk sexual behaviour in war-effected Eatern Uganda</strong></p><p>E Kinyada, H A Weiss, M Mungherera, P Onyango Mangen, E Ngabirano, R Kajungu, J Kagugube, W Muhwezi, J Muron, V Patel</p><p><strong>22. One year of Forensic Psychiatric assessment in the Northern Cape: A comparison with an established assessment service in the Eastern Cape</strong></p><p>N K Kirimi, C Visser</p><p><strong>23. Mental Health service user priorities for service delivery in South Africa</strong></p><p>Sharon Kleintjes, Crick Lund, Leslie Swartz, Alan Flisher and MHaPP Research Programme Consortium</p><p><strong>24. The nature and extent of over-the-counter and prescription drug abuse in cape town</strong></p><p>Liezl Kramer</p><p><strong>25. Physical health issues in long-term psychiatric inpatients: An audit of nursing statistics and clinical files at Weskoppies Hospital</strong></p><p>Christa Kruger</p><p><strong>26. Suicide risk in Schizophrenia - 20 Years later, a cohort study</strong></p><p>Gian Lippi, Ean Smit, Joyce Jordaan, Louw Roos</p><p><strong>27.Developing mental health information systems in South Africa: Lessons from pilot projects in Northern Cape and KwaZulu-Natal</strong></p><p>Crick Lund, S Skeen, N Mapena, C Isaacs, T Mirozev and the Mental Health and Poverty Research Programme Consortium Institution</p><p><strong>28. Mental health aspects of South African emigration</strong></p><p>Maria Marchetti-Mercer</p><p><strong>29. What services SADAG can offer your patients</strong></p><p>Elizabeth Matare</p><p><strong>30. Culture and language in psychiatry</strong></p><p>Dan Mkize</p><p><strong>31. Latest psychotic episode</strong></p><p>Povl Munk-Jorgensen</p><p><strong>32. The Forensic profile of female offenders</strong></p><p>Mo Nagdee, Helmut Fletcher</p><p><strong>33. The intra-personal emotional impact of practising psychiatry</strong></p><p>Margaret Nair</p><p><strong>34. Highly sensitive persons (HSPs) and implications for treatment</strong></p><p>Margaret Nair</p><p><strong>35. Task shifting in mental health - The Kenyan experience</strong></p><p>David M Ndetei</p><p><strong>36. Bridging the gap between traditional healers and mental health in todya's modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>37. Integrating to achieve modern psychiatry</strong></p><p>David M Ndetei</p><p><strong>38. Non-medical prescribing: Outcomes from a pharmacist-led post-traumatic stress disorder clinic</strong></p><p>A Parkinson</p><p><strong>39. Is there a causal relationship between alcohol and HIV? Implications for policy, practice and future research</strong></p><p>Charles Parry</p><p><strong>40. Global mental health - A new global health discipline comes of age</strong></p><p>Vikram Patel</p><p><strong>41. Integrating mental health into primary health care: Lessons from pilot District demonstration sites in Uganda and South Africa</strong></p><p>Inge Petersen, Arvin Bhana, K Baillie and MhaPP Research Programme Consortium</p><p><strong>42. Personality disorders -The orphan child in axis I - Axis II Dichotomy</strong></p><p><strong></strong>Willie Pienaar</p><p><strong>43. Case Studies in Psychiatric Ethics</strong></p><p>Willie Pienaar</p><p><strong>44. Coronary artery disease and depression: Insights into pathogenesis and clinical implications</strong></p><p>Janus Pretorius</p><p><strong>45. Impact of the Mental Health Care Act No. 17 of 2002 on designated hospitals in KwaZulu-Natal: Triumphs and trials</strong></p><p>Suvira Ramlall, Jennifer Chipps</p><p><strong>46. Biological basis of addication</strong></p><p>Solomon Rataemane</p><p><strong>47. Genetics of Schizophrenia</strong></p><p>Louw Roos</p><p><strong>48. Management of delirium - Recent advances</strong></p><p>Shaquir Salduker</p><p><strong>49. Social neuroscience: Brain research on social issues</strong></p><p>Manfred Spitzer</p><p><strong>50. Experiments on the unconscious</strong></p><p>Manfred Spitzer</p><p><strong>51. The Psychology and neuroscience of music</strong></p><p>Manfred Spitzer</p><p><strong>52. Mental disorders in DSM-V</strong></p><p>Dan Stein</p><p><strong>53. Personality, trauma exposure, PTSD and depression in a cohort of SA Metro policemen: A longitudinal study</strong></p><p>Ugashvaree Subramaney</p><p><strong>54. Eating disorders: An African perspective</strong></p><p>Christopher Szabo</p><p><strong>55. An evaluation of the WHO African Regional strategy for mental health 2001-2010</strong></p><p>Thandi van Heyningen, M Majavu, C Lund</p><p><strong>56. A unitary model for the motor origin of bipolar mood disorders and schizophrenia</strong></p><p>Jacques J M van Hoof</p><p><strong>57. The origin of mentalisation and the treatment of personality disorders</strong></p><p>Jacques J M Hoof</p><p><strong>58. How to account practically for 'The Cause' in psychiatric diagnostic classification</strong></p><p>C W (Werdie) van Staden</p><p><strong>POSTER PRESENTATIONS</strong></p><p><strong>59. Problem drinking and physical and sexual abuse at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>60. Prevalence of alcohol drinking problems and other substances at WSU Faculty of Health Sciences, Mthatha, 2009</strong></p><p>Orlando Alonso Betancourt, Maricela Morales Herrera, E, N Kwizera, J L Bernal Munoz</p><p><strong>61. Lessons learnt from a modified assertive community-based treatment programme in a developing country</strong></p><p>Ulla Botha, Liezl Koen, John Joska, Linda Hering, Piet Ooosthuizen</p><p><strong>62. Perceptions of psychologists regarding the use of religion and spirituality in therapy</strong></p><p>Ottilia Brown, Diane Elkonin</p><p><strong>63. Resilience in families where a member is living with schizophreni</strong></p><p>Ottilia Brown, Jason Haddad, Greg Howcroft</p><p><strong>64. Fusion and grandiosity - The mastersonian approach to the narcissistic disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>65. Not being allowed to exist - The mastersonian approach to the Schizoid disorder of the self</strong></p><p>William Griffiths, D Macklin, Loray Daws</p><p><strong>66. Risky drug-injecting behaviours in Cape Town and the need for a needle exchange programme</strong></p><p>Volker Hitzeroth</p><p><strong>67. Neuroleptic malignant syndrome in adolescents in the Western Cape: A case series</strong></p><p>Terri Henderson</p><p><strong>68. Experience and view of local academic psychiatrists on the role of spirituality in South African specialist psychiatry, compared with a qualitative analysis of the medical literature</strong></p><p>Bernard Janse van Rensburg</p><p><strong>69. The role of defined spirituality in local specialist psychiatric practice and training: A model and operational guidelines for South African clinical care scenarios</strong></p><p>Bernard Janse van Rensburg</p><p><strong>70. Handedness in schizophrenia and schizoaffective disorder in an Afrikaner founder population</strong></p><p>Marinda Joubert, J L Roos, J Jordaan</p><p><strong>71. A role for structural equation modelling in subtyping schizophrenia in an African population</strong></p><p>Liezl Koen, Dana Niehaus, Esme Jordaan, Robin Emsley</p><p><strong>72. Caregivers of disabled elderly persons in Nigeria</strong></p><p>Lola Kola, Oye Gureje, Adesola Ogunniyi, Dapo Olley</p><p><strong>73. HIV Seropositivity in recently admitted and long-term psychiatric inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>74. Syphilis seropisitivity in recently admitted longterm psychiatry inpatients: Prevalence and diagnostic profile</strong></p><p>Christina Kruger, M P Henning, L Fletcher</p><p><strong>75. 'The Great Suppression'</strong></p><p>Sarah Lamont, Joel Shapiro, Thandi Groves, Lindsey Bowes</p><p><strong>76. Not being allowed to grow up - The Mastersonian approach to the borderline personality</strong></p><p>Daleen Macklin, W Griffiths</p><p><strong>77. Exploring the internal confirguration of the cycloid personality: A Rorschach comprehensive system study</strong></p><p>Daleen Macklin, Loray Daws, M Aronstam</p><p><strong>78. A survey to determine the level of HIV related knowledge among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p><strong></strong> T G Magagula, M M Mamabolo, C Kruger, L Fletcher</p><p><strong>79. A survey of risk behaviour for contracting HIV among adult psychiatric patients admitted to Weskoppies Hospital</strong></p><p>M M Mamabolo, T G Magagula, C Kruger, L Fletcher</p><p><strong>80. A retrospective review of state sector outpatients (Tara Hospital) prescribed Olanzapine: Adherence to metabolic and cardiovascular screening and monitoring guidelines</strong></p><p>Carina Marsay, C P Szabo</p><p><strong>81. Reported rapes at a hospital rape centre: Demographic and clinical profiles</strong></p><p>Lindi Martin, Kees Lammers, Donavan Andrews, Soraya Seedat</p><p><strong>82. Exit examination in Final-Year medical students: Measurement validity of oral examinations in psychiatry</strong></p><p>Mpogisheng Mashile, D J H Niehaus, L Koen, E Jordaan</p><p><strong>83. Trends of suicide in the Transkei region of South Africa</strong></p><p>Banwari Meel</p><p><strong>84. Functional neuro-imaging in survivors of torture</strong></p><p>Thriya Ramasar, U Subramaney, M D T H W Vangu, N S Perumal</p><p><strong>85. Newly diagnosed HIV+ in South Africa: Do men and women enroll in care?</strong></p><p>Dinesh Singh, S Hoffman, E A Kelvin, K Blanchard, N Lince, J E Mantell, G Ramjee, T M Exner</p><p><strong>86. Diagnostic utitlity of the International HIC Dementia scale for Asymptomatic HIV-Associated neurocognitive impairment and HIV-Associated neurocognitive disorder in South Africa</strong></p><p>Dinesh Singh, K Goodkin, D J Hardy, E Lopez, G Morales</p><p><strong>87. The Psychological sequelae of first trimester termination of pregnancy (TOP): The impact of resilience</strong></p><p>Ugashvaree Subramaney</p><p><strong>88. Drugs and other therapies under investigation for PTSD: An international database</strong></p><p>Sharain Suliman, Soraya Seedat</p><p><strong>89. Frequency and correlates of HIV Testing in patients with severe mental illness</strong></p><p>Hendrik Temmingh, Leanne Parasram, John Joska, Tania Timmermans, Pete Milligan, Helen van der Plas, Henk Temmingh</p><p><strong>90. A proposed mental health service and personnel organogram for the Elizabeth Donkin psychiatric Hospital</strong></p><p>Stephan van Wyk, Zukiswa Zingela</p><p><strong>91. A brief report on the current state of mental health care services in the Eastern Cape</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri, Heloise Uys, Mo Nagdee, Maricela Morales, Helmut Erlacher, Orlando Alonso</p><p><strong>92. An integrated mental health care service model for the Nelson Mandela Bay Metro</strong></p><p>Stephan van Wyk, Zukiswa Zingela, Kiran Sukeri</p><p><strong>93. Traditional and alternative healers: Prevalence of use in psychiatric patients</strong></p><p>Zukiswa Zingela, S van Wyk, W Esterhuysen, E Carr, L Gaauche</p>

During August, 1988, I was asked by the United States Information Agency to go to Bangladesh to share information about AIDS with the Bangladesh National AIDS Committee and others. In the course of my stay in Dhaka, I met with the Deputy Prime Minister and Minister of Home Affairs, the Minister of Health, the Director of the American Cultural Center of the U. S. Information Service, the Dean of the University of Dhaka Medical School, the Director of the National Health Card Service (an organization administering hundreds of rural health clinics in Bangladesh), and the Chief of the Bureau of Health Education. I gave presentations before the Bangladesh National AIDS Committee, the faculty and student body of the University of Dhaka Medical School, and during a reception given by the National Health Card Service.

Abstract With a growing need for specialized training for direct caregivers and support staff of persons with intellectual and developmental disabilities (IDD) affected by dementia, the National Task Group on Developmental Disabilities and Dementia Practices (NTG) developed a comprehensive evidence-informed Dementia Capable Care Training (DCCT). To overcome the challenge of the training length and cost, and to extend its dissemination, the Sonoran Center developed a shorter version of the NTG-DCCT while retaining its core components, and implemented it in seven cities in the U. S. Southwest (N = 368). The pre- and post-training evaluation (n =260) demonstrated that the short version of the NTG-DCCT is effective in significantly improving participants' knowledge and/or confidence in dementia capable care. The follow-up semi-structured interviews of participants (n = 7) provide some insights.

The aim of the study was search and analysis of the data of review, experimental and clinical scientific and medical publications on the issues of the possible role of VD in pathogenesis of lichenoid dermatoses. Materials and methods: An analysis of the studying of the scientific and medical literature was shown. Searching was carried out through the PubMed/MEDLINE portal from the databases of the National Center Biotechnology Information, Web of Science Core Collection, U. S. National Library of Medicine, National Institute for Health and Clinical Excellence, as well as the portals «Scientific Electronic Library eLIBRARY.RU», «Russian Science Citation Index (RSCI)» and «Index Copernicus». Conclusions: The results of studies had convincingly demonstrated that deficiency of VD in the blood, decrease vitamin D receptors activity can lead to development of lichenoid dermatoses.

Abstract:In Part I of this two-part series, we report the design of a probabilistic reformulation of the Quick Medical Reference (QMR) diagnostic decision-support tool. We describe a two-level multiply connected belief-network representation of the QMR knowledge base of internal medicine. In the belief-network representation of the QMR knowledge base, we use probabilities derived from the QMR disease profiles, from QMR imports of findings, and from National Center for Health Statistics hospital-discharge statistics.We use a stochastic simulation algorithm for inference on the belief network. This algorithm computes estimates of the posterior marginal probabilities of diseases given a set of findings. In Part II of the series, we compare the performance of QMR to that of our probabilistic system on cases abstracted from continuing medical education materials from Scientific American Medicine. In addition, we analyze empirically several components of the probabilistic model and simulation algorithm.

Abstract Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI. Materials and Methods The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention. Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved. Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.

Introduction: The studying of the comorbidity of skin diseases is a priority scientific direction in modern dermatology. Comorbid conditions aggravate the course of the underlying disease, reduce the effectiveness of diagnosis and treatment can lead to chronization of the process, disability of patients. Understanding of the commonality of pathogenesis and the mutually complicating nature of comorbidity makes a possible to prescribe individual rational treatment. The aim of the study was search and analysis of the data of review, experimental and clinical scientific and medical publications on the issues of the comorbidity of LP. Materials and methods: an analysis of the studying of the scientific and medical literature was shown. Searching was carried out through the PubMed/MEDLINE portal from the databases of the National Center Biotechnology Information, U. S. National Library of Medicine, National Institute for Health and Clinical Excellence, as well as the portals «Scientific Electronic Library eLIBRARY.RU», «Russian Science Citation Index (RSCI)» and «Index Copernicus». Conclusions: The main global trends of comorbidity of LP are determined. The results of these studies can form the basis for updating of clinical guidelines for the management of patients with LP at the international and local levels.

Objective The burden of preeclampsia severity on the health of mothers and infants during the first year after delivery is unclear, given the lack of population-based longitudinal studies in the United States. Study design We assessed maternal and infant adverse outcomes during the first year after delivery using population-based hospital discharge information merged with vital statistics and birth certificates of 2,021,013 linked maternal–infant births in California. We calculated sampling weights using the National Center for Health Statistics data to adjust for observed differences in maternal characteristics between California and the rest of the United States. Separately, we estimated the association between preeclampsia and gestational age and examined collider bias in models of preeclampsia and maternal and infant adverse outcomes. Results Compared with women without preeclampsia, women with mild and severe preeclampsia delivered 0.66 weeks (95% confidence interval [CI]: 0.64, 0.68) and 2.74 weeks (95% CI: 2.72, 2.77) earlier, respectively. Mild preeclampsia was associated with an increased risk of having any maternal adverse outcome (relative risk [RR] = 1.95; 95% CI: 1.93, 1.97), as was severe preeclampsia (RR = 2.80; 95% CI: 2.78, 2.82). The risk of an infant adverse outcome was increased for severe preeclampsia (RR = 2.15; 95% CI: 2.14, 2.17) but only marginally for mild preeclampsia (RR = 0.99; 95% CI: 0.98, 1). Collider bias produced an inverse association for mild preeclampsia and attenuated the association for severe preeclampsia in models for any infant adverse outcome. Conclusion Using multiple datasets, we estimated that severe preeclampsia is associated with a higher risk of maternal and infant adverse outcomes compared with mild preeclampsia, including an earlier preterm delivery.

Background Higher mortality rates have been reported in patients admitted to the hospital on weekends. This study aimed to compare maternal mortality ratio (MMR), fetal mortality ratio, and other maternal and neonatal outcomes by day of death or delivery in the United States. Methods Our database consisted of a population-level analysis of live births and maternal and fetal deaths between 2004 and 2014 in the United States from the Centers for Disease Control and Prevention's National Center for Health Statistics. We also examined the relationship between these deaths and various documented maternal and fetal clinical conditions. Results A total of 2,061 maternal deaths occurred on weekends and 5,510 deaths on weekdays. During the same period of time, 65,063 and 210,851 cases of fetal demise were delivered on weekends and on weekdays, respectively. Maternal mortality was significantly higher on weekends than weekdays (22.9 vs. 15.3/100,000 live births, p < 0.001) as was fetal mortality (7.21 vs. 5.85/100,000, p < 0.001), despite a lower frequency of serious comorbidities among women delivering on weekends. Conclusion Our data demonstrate a significant increase in the U.S. MMR and stillbirth delivery on weekends. Relative representation of antepartum, intrapartum, and postpartum deaths cannot be ascertained from these data.

BackgroundThe extended time window for endovascular therapy in adult stroke represents an opportunity for stroke treatment in children for whom diagnosis may be delayed. However, selection criteria for pediatric thrombectomy has not been defined.MethodsWe performed a retrospective cohort study of patients aged <18 years presenting within 24 hours of acute large vessel occlusion. Patient consent was waived by our institutional IRB. Patient data derived from our institutional stroke database was compared between patients with good and poor outcome using Fisher’s exact test, t-test, or Mann-Whitney U-test.ResultsTwelve children were included: 8/12 (66.7%) were female, mean age 9.7±5.0 years, median National Institutes of Health Stroke Scale (NIHSS) 11.5 (IQR 10–14). Stroke etiology was cardioembolic in 75%, dissection in 16.7%, and cryptogenic in 8.3%. For 2/5 with perfusion imaging, Tmax >4 s appeared to better correlate with NIHSS. Nine patients (75%) were treated: seven underwent thrombectomy alone; one received IV alteplase and thrombectomy, and one received IV alteplase alone. Favorable outcome was achieved in 78% of treated patients versus 0% of untreated patients (P=0.018). All untreated patients had poor outcome, with death (n=2) or severe disability (n=1) at follow-up. Among treated patients, older children (12.8±2.9 vs 4.2±5.0 years, P=0.014) and children presenting as outpatient (100% vs 0%, P=0.028) appeared to have better outcomes.ConclusionsPerfusion imaging is feasible in pediatric stroke and may help identify salvageable tissue in extended time windows, though penumbral thresholds may differ from adult values. Further studies are needed to define criteria for thrombectomy in this unique population.

Objective Small-for-gestational age infants are at an increased risk for disabilities and chronic health problems. Smoking and hypertension during pregnancy pose significant risks for fetal growth restriction. The study aims to identify whether (1) the timing of tobacco use modifies the risk of small-for-gestational age, (2) there are differences in association by percentile of small-for-gestational age (3rd, 5th, and 10th percentile), and (3) the effect of tobacco exposure on small-for-gestational age outcome is mediated by hypertension. Materials and Methods Data were obtained from the 2009 Natality public use file available through the National Center for Health Statistics. Women were categorized into 11 groups depending on the trimester of tobacco exposure, the number of daily cigarettes smoked, and presence of hypertension. Multivariable log-linear regression models were performed to determine the association between percentile of singleton small-for-gestational age outcome (3rd, 5th, and 10th), trimester and degree of tobacco exposure, and hypertension. Results Hypertension and smoking worked synergistically to restrict fetal growth. Hypertensive women who smoked heavily in all three trimesters were 4.34 times more likely to give birth to a 3rd percentile small-for-gestational age infant compared with nonsmoking normotensive women. Conclusion The timing and duration of tobacco exposure mediates the risk and severity of fetal growth restriction.

Introduction The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers. Materials and Methods All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics. Results Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth. Conclusion Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.

Despite nearly 12 million Asian Americans living in the United States and continued immigration, this increasingly substantial subpopulation has consistently been left out of national obesity studies. When included in national studies, Chinese-American children have been grouped together with other Asian Americans, Pacific Islanders or simply as “other,” yielding significantly lower rates of overweight and obesity compared to non-Asians. There is a failure to recognize the ethnic diversity of Asian Americans as well as the effect of acculturation. Results from smaller studies of Chinese American youth suggest that they are adopting lifestyles less Chinese and more Americans and that their share of disease burden is growing. We screened 142 children from the waiting room of a community health center that serves primarily recent Chinese immigrants for height, weight and demographic profile. Body Mass Index was calculated and evaluated using CDC growth charts. Overall, 30.1 percent of children were above the 85th we found being male and being born in the U .S. to be statistically significant for BMI > 85th percentile (p=0.039, p=0.001, respectively). Our results suggest that being overweight in this Chinese American immigrant population is associated with being born in the U.S. A change in public policy and framework for research are required to accurately assess the extent of overweight and obesity in Chinese American children. In particular, large scale data should be stratified by age, sex, birthplace and measure of acculturation to identify those at risk and construct tailored interventions.

ABSTRACT Aim The knowledge of specific contributors to mortality is crucial for the improvement of health of the community. Globally, medical certificate of cause of death is used for gathering epidemiological statistics. Our study examines the mortality pattern with sociodemographic characteristics of in-hospital deaths, which occurred at a tertiary health care center in Maharashtra. Materials and methods This study is a descriptive retrospective study in which 1,000 medical certification of cause of death forms (n = 1000) filled at a tertiary care hospital between Aug 2016 and Aug 2019 were analyzed. Results Total 64.5% of cases were males and 35.5% were females. About 42% were elderly (60–80 years). About 23% of the deaths were due to “diseases of the circulatory system.” The highest number of cases died within the first 10 days of admission. The “diseases of circulatory system” was the commonest group causing deaths in “brief” hospital stay ((<10 days), “diseases of digestive system” in “short” (10 days–1 month), “neoplasia” in “long” (1–3 months), and “diseases of nervous system” in “prolong” hospital stay (>3 months). Conclusion The mortality rate among males was more than twice of females and maximum deaths were observed in the geriatric age group. The chief causes of mortality overall and among both males and females individually were the diseases of the circulatory system among which, the cerebrovascular diseases accounted for highest number of cases. Overall demographic data were comparable to observations from various national and international studies. Clinical significance Cause-specific mortality statistics are routinely required by policy makers, researchers, and other professionals for decision-making for resource allocation, monitoring of health indicators, and identifying priorities for health initiatives. Availability of data remains limited and inadequate in many countries. Studies on in-hospital deaths are needed to identify mortality indicators in different regions and channel public health initiatives in the right direction. How to cite this article Chourasia S, Dhaka S, Rautji R, et al. Epidemiological Profile of In-Hospital Deaths in a Tertiary Health Care Centre: A 3-Year Retrospective Study in Western Maharashtra. J Med Acad 2020;3(2):38–42.

Abstract Background: Adult sickle cell patients on chronic transfusion therapy (CTT) garnered special concern during the COVID-19 pandemic, when mass cancellation of blood drives threatened the national blood supply. In response, the American Society of Hematology proposed several strategies to decrease blood utilization, while maintaining adequate disease control for sickle cell patients on CTT. These included targeting a higher end hemoglobin S%, switching patients to simple transfusions when appropriate, and transitioning to alternative disease modifying therapies. There is little evidence to support the safety of altering exchange therapy regimens. Accordingly, at the Johns Hopkins Sickle Cell Center for Adults, a multidisciplinary team of clinicians and transfusion medicine specialists evaluated patients on a case by case basis to determine how their exchanges could be modified to accommodate for anticipated blood supply shortages. We describe our blood conservation efforts during the COVID-19 pandemic and resulting clinical outcomes for adult patients with sickle cell anemia (SCA). Methods: For inclusion in this IRB-approved retrospective study, patients received at least 7 monthly exchange transfusions between March 2019 and February 2020 and continued care through March 2021. Decisions regarding CTT were made prior to data collection. Modifications to chronic exchanges included increasing the fraction of cells remaining (FCR), decreasing the end hematocrit, or switching to a hemodilution method. Additionally, select patients transitioned to monthly simple transfusions if they were clinically stable, had a hemoglobin ≤ 7 g/dL, and had a persistently suppressed hemoglobin S% (≤ 30). We collected basic demographics, pre-exchange laboratory studies, and exchange parameters before and after each transfusion encounter in the year before (March 2019 - February 2020) and during (March 2020 - February 2021) the COVID-19 pandemic. Lastly, we recorded presentations to urgent care and the emergency department; and hospital admissions during each time period. We reported descriptive statistics for the cohort and compared outcomes using the Wilcoxon signed-rank test and Mann Whitney U test. We analyzed data using Stata/SE Version 16.1. Results: We identified 58 patients with SCA who qualified for inclusion (Table 1). Fifty-three patients remained on chronic exchange transfusions during the pandemic, and five were switched to simple transfusions. For patients who remained on chronic exchanges, most received conventional automated red cell exchange (RCE) prior to (85%) and during the pandemic (77%). Use of hemodilution increased (15% to 23% of patients). Forty-three patients experienced an increase in mean FCR (33.6 (SD 11.6) vs 37.7 (4.7), p = .00). Of those, 22 patients saw a concomitant decrease in mean end hematocrit (30.8 (1.7) vs 29.6 (1.1), p = .00). These changes resulted in a decline in the average number of units per procedure (8.6 (1.9) vs 7.3 (1.7), p = .00), which corresponded to 890 units conserved. Mean pre-transfusion hemoglobin values declined (9.4 (1.3) vs 9.2 (1.3), p = 0.01), but hemoglobin S%, reticulocyte count, and ferritin values were unchanged (p &gt; 0.05). Acute care presentations and hospital admissions declined, which were likely spurred by concerns about COVID-19 infection (Table 2, p &lt; 0.05). During the pandemic, three patients died, one of whom had been switched to simple transfusions. This patient experienced a consistent rise in hemoglobin S% until death. Two of the remaining patients on simple transfusions were switched back to automated RCE due to an increase in hemoglobin S% above goal (Figure 1). Conclusions: During the COVID-19 pandemic, we conserved red blood cell units through expanded use of hemodilution, higher FCR values, and switching some patients to simple transfusions. Patients who remained on exchanges maintained hemoglobin S% values near a goal of 30% without increasing iron burden. In contrast, the majority of patients who were switched to simple transfusions were unable to maintain goal hematologic parameters, and one patient died. Our data suggest that in a blood shortage crisis, changing the exchange procedure itself may be the safest means of conserving blood in a population of adult sickle cell patients; however longer follow-up is needed to ensure that these changes are safe. Figure 1 Figure 1. Disclosures Lanzkron: GBT: Research Funding; Shire: Research Funding; Novo Nordisk: Consultancy; CSL Behring: Research Funding; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; Novartis: Research Funding; Imara: Research Funding; Bluebird Bio: Consultancy.

Background: Psychological state, stress level, and gastrointestinal function are intricately related and relevant to symptom exacerbation in patients with irritable bowel syndrome (IBS), but genetic contributors to this brain–gut connection are not fully understood. The purpose of this exploratory study was to compare gene expression in participants with IBS to that of healthy controls (HC) and to examine patterns of expression in participants with IBS by sex and IBS subtype. Method: Participants were recruited to an ongoing protocol at the National Institutes of Health. Differences in demographic and clinical characteristics were assessed using descriptive statistics and Mann–Whitney U tests. Expression levels of 84 genes were evaluated in peripheral whole blood using Custom RT2 Profiler polymerase chain reaction (PCR) Arrays, and data analysis was performed through GeneGlobe Data Analysis Center. Results: Participants with IBS ( n = 27) reported greater levels of perceived stress ( p = .037) and differed in expression values of ±2 for the genes ADIPOR1, ADIPOR2, CNR2, COMT, OXTR, and PPARA compared to HC ( n = 43). Further analyses by sex and IBS subtype revealed differential patterns of gene expression related to the endocannabinoid system, cytokines, stress, and sex steroid hormones. Conclusions: Diverse yet interconnected processes such as metabolism, inflammation, immunity, social behavior, and pain are associated with differences in gene expression between participants with IBS and HC. These findings lend support for genomic associations with the brain–gut connection in patients with IBS and highlight the relevance of sex and IBS subtype in performing such analyses.

Introduction. Antibiotic prophylaxis (AP) in surgery is an important measure that contributes to the prevention of surgical site infection. International and national guidelines provide clear recommendations for the proper implementation of antibiotic prophylaxis. However, many studies indicate poor compliance in many health care centers. Aim: Our study aimed to determine the level of compliance in the application of antibiotic prophylaxis in abdominal surgery with the guidelines. Materials and methods: The retrospective study included all patients which were operated on at the Clinic for Digestive Surgery of the University Clinical Center of Serbia (UCCS), during the period January - March 2019 (270 patients). Medical records provided information about the type of surgery, the choice of antibiotic, the time of application, the route of administration, the need for redosing, the duration of antibiotic prophylaxis administration, as well as the presence of drug allergies. The collected data were analyzed by descriptive and analytical statistics (ch2 test). Results: During the study period, 270 patients were operated on at the Clinic for Digestive Surgery, of whom 227 (84.1%) received antibiotic prophylaxis. Cefazolin, an antibiotic recommended for most abdominal surgeries, was administered to only 17 (6.3%) patients. The majority of patients (64.4%) received antibiotic prophylaxis within 30 minutes of the beginning of surgery. The duration of antibiotic prophylaxis of up to 24 hours after the operation was applied in 13.1% of patients. Conclusion: Compliance with the guidelines was low, while full compliance with the recommendations for antibiotic prophylaxis was achieved only with regards to the route of antibiotic administration.

Objective: To assess whether to have a steady loving relationship changes sexual desire, level of depression and subjective need for sexual counselling to those patients who have suffered an Acute Coronary Syndrome (ACS) episode within the last year Design and Method: The sample consisted of males under 76, with a diagnosis of ACS episode, from September 1st 2014 to August 31st 2015, within the area of The University Health Care Hospital Complex of Palencia. They were appointed by a telephone call at the local Health Center to hold a personal interview in which they answered an inquiry ad hoc and the validated Beck´s Depression Questionnaire and Sexual Desire and Aversion to Sex (DESEA) Questionnaire. Data were analyzed using the statistical program SPSS Statistics 20.0. Results: 73% of patients in our sample had a partner. When applied non-parametric U-Mann-Whitney and Kruskal-Wallis as statistical contrast, it shows that loving relationships do not have any influence neither on patients’ sexual desire, nor on their demand for greater sexual counselling. It was also found that there is a direct correlation between the parameters of DESEA Questionnaire and de score reached on Beck’s Depression Questionnaire. And finally, that a decreased sexual desire will not influence their request for sexual advice. Conclusions: Sexual desire is a characteristic part of each person and that is confirmed in the participants of our research. Patients continued keeping interest for their sexuality after having suffer an ACS within the last year, regardless of the stability of their sexual relationships.

The patient registration service is the starting gate for the health center services. In implementing BPJS, the community expects to get satisfactory health services. Patients will feel or not depends on the quality of registration services provided. If the patient feels satisfied the he will come back to get health care. However, if the patient is not satisfied, there will be many complaints that will not only be delivered face-to-face but more than that it can occur the complaint is submitted thorugh print media, visual media, and even social media. The purpose of study was to determine the comparative satisfaction of BPJS and non BPJS patients on the quality of registration services at the Johar Baru Health Center in Central Jakarta.riptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta Research methods. This research was conducted with a descriptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta. The population in this study were BPJS and Non BPJS patients who registered at the outpatient Registration in October-December 2019. The method of selecting samples was used with probability sampling whie to take samples using the proportionate stratified random sampling technique. The tool used for research with Questionnaire/Questionnaire. With a Likert scale measurement scale. For data analysis techniques using the Vality Test used is the product moment correlation which results in that the whoe question items are valid, which decision considerations are based on the r table for N = 30 at a significance of 5%, amounting to 0.361.Realibility Tests are used to show the extent to which a measurement result is relatively consistent if our measuring instrument repeatedly. Based on the reliability test, for the item questionnaire, the decision consideration is based on Cronbach’salfa value>0.60, the questionnaire is declared reliable or consistent. In this study the Cronvachs’s Alfa Value of 0.699 ‘s was rounded to 0.70, the cronbanch Alfa Value of 0.70>0.60, the questionnaire was declared reliable or consistent. With cross sectional time approach. The Mann Whitney U test was used to prove the hypothesis with the SPSS For Windows 25 software version, the significance value or Symp was obtained. Sig, (2 tailed) of 0.001. Therefore the value of Symp. Sig, (2 tailed) of 0.001>from the probability of 0.0f, the hypothesis “Ha is a accepted” or there is a difference. Based on the average value in the level of BPJS patient satisfaction obtained an average of 79.96 for Non BPJS patients obtained an average of 76.13 while the difference between the two amounted to 3.83. Targeted Output. Is a scientific publication in the National Journal of ISSN submitted, speakers in scientific meetings are registered, teaching material (ISBN) draft newspapaer articles are published. The proposed TKT research is TKT 1 The patient registration service is the starting gate for the health center services. In implementing BPJS, the community expects to get satisfactory health services. Patients will feel or not depends on the quality of registration services provided. If the patient feels satisfied the he will come back to get health care. However, if the patient is not satisfied, there will be many complaints that will not only be delivered face-to-face but more than that it can occur the complaint is submitted thorugh print media, visual media, and even social media. The purpose of study was to determine the comparative satisfaction of BPJS and non BPJS patients on the quality of registration services at the Johar Baru Health Center in Central Jakarta.riptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central JakartaResearch methods. This research was conducted with a descriptive method with a Cross Sectional Comparative approach in the registration section at Johar Baru Health Center, Central Jakarta. The population in this study were BPJS and Non BPJS patients who registered at the outpatient Registration in October-December 2019. The method of selecting samples was used with probability sampling whie to take samples using the proportionate stratified random sampling technique. The tool used for research with Questionnaire/Questionnaire. With a Likert scale measurement scale. For data analysis techniques using the Vality Test used is the product moment correlation which results in that the whoe question items are valid, which decision considerations are based on the r table for N = 30 at a significance of 5%, amounting to 0.361.Realibility Tests are used to show the extent to which a measurement result is relatively consistent if our measuring instrument repeatedly. Based on the reliability test, for the item questionnaire, the decision consideration is based on Cronbach’salfa value>0.60, the questionnaire is declared reliable or consistent. In this study the Cronvachs’s Alfa Value of 0.699 ‘s was rounded to 0.70, the cronbanch Alfa Value of 0.70>0.60, the questionnaire was declared reliable or consistent. With cross sectional time approach. The Mann Whitney U test was used to prove the hypothesis with the SPSS For Windows 25 software version, the significance value or Symp was obtained. Sig, (2 tailed) of 0.001. Therefore the value of Symp. Sig, (2 tailed) of 0.001>from the probability of 0.0f, the hypothesis “Ha is a accepted” or there is a difference. Based on the average value in the level of BPJS patient satisfaction obtained an average of 79.96 for Non BPJS patients obtained an average of 76.13 while the difference between the two amounted to 3.83.Targeted Output. Is a scientific publication in the National Journal of ISSN submitted, speakers in scientific meetings are registered, teaching material (ISBN) draft newspapaer articles are published. The proposed TKT research is TKT 1

Abstract Angiotensin-converting enzyme 2 (ACE2) receptor is required for SARS-CoV-2 entry into human cells. However, emerging evidence shows SARS-CoV-2 infected lung monocytes/macrophages from COVID-19 patients barely express ACE2 mRNA, raising a question how SARS-CoV-2 penetrates macrophages. It’s also under debating whether the peripheral blood cells (HPBCs) can be infected by SARS-CoV-2 that may facilitate viral spread from circulation to other organs besides lung. Herein we demonstrate that resting primary HPBCs harbor abundant cytoplasmic ACE2, regardless of COVID-19 status, and that surface translocation is necessary for viral infection. Upon ex vivo TLR4/7/8 stimulation of HPBCs, ACE2 translocated to the cell surface independent of ACE2 transcription, and this translocation was blocked by an endosomal trafficking inhibitor, suggesting the putative source as ACE2-containing exosomes. However, only stimulated monocytes concurrently expressing ACE2 and cell surface transmembrane serine protease type 2 (TMPRSS2) were efficiently infected by SARS-CoV-2, which was significantly mitigated by remdesivir. Furthermore, ACE2 surface translocation in peripheral myeloid cells from patients with severe COVID-19 correlated with their proinflammatory cytokine production. Collectively, TLR4/7/8-induced ACE2 translocation with TMPRSS2 expression is indispensable for SARS-CoV-2 infection of circulating monocytes. Our work not only provides a new mechanism for the pathogenesis of SARS-CoV-2 and a potential path for its systemic infection, but also unveils a prospective therapeutic strategy by targeting ACE2 trafficking for preventing monocyte/macrophage infection. This study is partially supported by National Institutes of Health grants R61AR076803, R01AR063611, R01AI119041, and R01AR069681 (Q-S. M.), R01AR072046 (L.Z.), R01DK120623 (J.Z.S.), Henry Ford Immunology Program grants (T71016, Q-S. M.; T71017, L. Z.), and funding for the U-M Center for Drug Repurposing - NCATS CTSA UL1TR002240 (J.Z.S.).

Abstract Introduction Resting-state functional connectivity is coherent brain activity in a task-free state that strongly correlates to task-evoked sensory, motor, and higher-order cognitive systems. Certain networks show decreased functional connectivity with aging. Aging is associated with changes in circadian rhythms and sleep-wake cycles. Limited research has been conducted on how circadian activity and sleep are related to markers of functional brain aging. The purpose of this study was to explore whether rest-activity patterns and shorter sleep duration are related to functional connectivity of specific resting-state networks in older adults. Methods A total of 124 cognitively normal participants (mean age (SD) = 67.2 (5.7), 42% men) underwent 3.0 T MRI and week-long wrist actigraphy protocols. Rest-activity pattern was analyzed using an extended cosine model calculating acrophase (time of peak activity) and pseudo-F statistics of goodness-of-fit (a measure of overall rhythmicity). We used resting-state fMRI scans to measure functional connectivity in association and sensory networks as defined by the Schaefer 17 network functional atlas. Multiple linear regression analysis was used to investigate how rest-activity pattern parameters and sleep duration are associated with resting-state functional connectivity, adjusting for age, sex, and sleep apnea. Results We found that the average acrophase was 2:30 PM (SD = 54 min), and delayed acrophase (average vs. delayed [+1SD]) was associated with lower functional connectivity of the right-lateralized default mode network A (p=0.02), and higher pseudo-F statistics was associated with higher functional connectivity in networks including left dorsal attention B (p=0.001), right somatomotor A (p = 0.05), and somatomotor B (both p=0.02). Longer sleep duration was associated with higher right executive control B (p=0.03). Conclusion The overall rhythmicity of diurnal rest-activity patterns and longer sleep duration are associated with some resting-state functional networks. Further investigation is needed to understand the mechanisms between circadian rhythm and brain function. Support National Institute of Health, U of Iowa Aging Mind Brain Initiative, Center on Aging

Background Iron deficiency in children and adolescents maybe dueto an inadequate supply of iron as well as increased iron requirementsfor growth and developmental processes. The incr easing prevalence ofobesity puts children at risk of iron deficiency. Studies on the effectsof obesity on iron deficiency have focused on low grade systemicinflammation as well as examining soluble transferrin receptor levels(sTfR) as an indicator ofiron deficiency.Objective To compare sT fR levels in obese and non-obeseadolescents, assess for correlations between BMI, sTfR and obesity,and determine the risk of iron deficiency in obese adolescents .Method T his cross sectional study was conducted on 20 obeseand 20 non-obese adolescents aged 15-17 in East Aceh District,from September to December 20 11. Subject were chosen throughcluster sampling. The obese subjects had BMI > 95th percentileand the non-obese subjects had BMI s:851h percentile based onthe 2000 National Center for Health Statistics (NCHS). Exclusioncriteria were blood disorders, chronic diseases, and a history ofbleeding. Data were analyzed by Chi-square test and T test witha significance level of P < 0.05, and Pearson's correlation.Results The mean s TfR levels in obese adolescents was higher thanin non-obese adolescents, [2.59 (SD 0.76) vs 2.14 (SD 0.45) μg/mL(P = 0.030)]. Iron deficiency (sTfR> 2.5 μgimL) was more commonin obese than in non-obese adolescents [ (55% vs . 15%, respectively,(P = 0.019) ]. Analysis of the relationship between obesity accordingto BMI andsTfRrevealedan OR of 6.93; 95% CI 1.53 to3 1.38. Ther elationship between the BMI and sTfR levels indicated a positive,moderate strength of association (r = 0.392) .Conclusion The mean sT fR levels in obese adolescents is significantlyhigher than in non-obese individuals. Obese adolescentshave a 6.93 times higher risk of iron deficiency than non-obeseadolescents. Body mass index has a positive and moderate associationwith sTfR.

BackgroundSevere obesity predisposes adults and youth to a higher risk of venous thromboembolism (VTE). Enoxaparin is frequently used for their VTE management. This study evaluates a BMI-stratified prophylactic dosing regimen of enoxaparin in severely obese adolescents undergoing bariatric surgery.MethodsThis prospective study enrolled severely obese adolescents aged 12–20 years undergoing laparoscopic sleeve gastrectomy. Prophylactic enoxaparin was dosed at 40 mg SC (for a BMI less than 50 kg/m2) and 60 mg SC (for a BMI equal to or greater than or 50 kg/m2). Blood samples were drawn until 12 hrs post-dose. Plasma Anti-Factor Xa (Anti-FXa) activity was used as a surrogate marker for enoxaparin plasma concentration and pharmacokinetics were assessed using non-compartmental PK analysis. The primary efficacy outcome was the anti-FXa activity 4–6 hours after dosing, and the primary endpoint was the proportion of patients who reached prophylactic anti-FXa activity of 0.1–0.3 U/mL between 4–6 hours after dosing.ResultsTen female and two male obese adolescents (age range 14–19 years) had a mean body weight of 140.8 kg (93.7–174 kg) and a mean BMI of 49.9 kg/m2 (38.4–58 kg/m2). Four patients received 40 mg enoxaparin, 8 patients were dosed with 60 mg enoxaparin. No VTE or major bleeding occurred. Peak plasma anti-FXa activity (Cmax) ranged from 0.14–0.30 IU/mL (median Cmax 0.205 IU/mL). Median Tmax was 5.67 hours (range 3.78–7.52 hours). Median AUCi was 1.00 h*IU/mL (range 0.42–1.67 h*IU/mL). 10 out of 12 patients (83%) reached the primary endpoint with anti-FXa activity in the range for VTE prevention (0.1–0.3 IU/mL).ConclusionsIn this single center cohort study, the dosing scheme of 40 mg vs 60 mg enoxaparin stratified according to BMI proved to be effective in reaching prophylactic anti-FXa activity in 83% of adolescent patients. This dosing scheme is in accordance with current practice in adults.Disclosure(s)J. Vaughns and J. van den Anker are supported by the Eunice Kennedy Shriver National Institute of Child Health and Development (5T32HD087969).

Introduction. According to the WHO, about 3 % of infants worldwide are born with a congenital malformation (CM). The aim of the study. To conduct a retrospective analysis of the spectrum of congenital malformations diagnosed during pregnancy based on the Lviv Medical Genetics Center during 2018-2020 yy. Materials and methods. Clinical and epidemiological, as well as medical and statistical data on CM diagnosed prenatally between 2018-2020 were collected from primary source documents (Form No. 49) and then analyzed at the Lviv Medical Genetics Center ʺInstitute of Hereditary Pathology, National Academy of Medical Sciences of Ukraineʺ, Lviv. The Student’s t-test was used to determine the difference between the arithmetic means. The null hypotheses were tested using a t-test at the significance level of p-value less than 0.05. Results. A total of 11062 pregnant women were examined between 2018-2020: CM at different stages of pregnancy were diagnosed in 454 cases, which accounted for 4.1 % of cases and did not exceed the population value. There was a 2.3-fold reduction in the number of pregnant women presented to the Medical Genetics Center in 2020, probably due to the global coronavirus pandemic – from 5007 women in 2018 to 2212 females in 2020. However, the number of CM diagnosed prenatally in 2020 was not statistically significant (p-value more than 0.05) as compared to the average value for these years and 2018. In 2018, a total of 5007 pregnant women were examined at the Lviv Medical Genetics Center. In 136 (4.8 %) cases, fetal malformations were diagnosed before 22 weeks of gestation, while in 26 (1.2 %) cases, pregnancy was affected by congenital anomaly in its second half. In 2019, there were examined 3843 pregnant women. In169 (7.8 %) cases, CM were diagnosed before 22 weeks of gestation, that was statistically significant as compared to 2018 (p-value less than 0.05) and in 20 (1.2 %) cases, fetal anomalies were detected in the second half of pregnancy, that was not statistically significant as compared to the previous year (p-value more than 0.05). In 2020, we examined 2212 pregnant women. Reducing the number of visits to our medical center was probably due to the coronavirus pandemic. There were95 (5.0 %) cases of fetal malformations diagnosed before 22 weeks of gestation and 8 (2.5 %) cases of congenital anomalies detected in the second half of pregnancy. The number of CM diagnosed prenatally was the highest in 2019 – 4.9 %; however, there was no statistically significant difference (p-value more than 0.05) in the average values for these years – 4.1 % and 3.2 % in 2020 and 2018, respectively. In 2020, the incidence of congenital malformations diagnosed after 22 weeks of gestation was significantly higher (p-value less than 0.05) than in other years – 2.5 % and 1.2 %, respectively. Conclusions. Between 2018-2020, the incidence of congenital malformations diagnosed at different stages of pregnancy was 4.1 %. Congenital malformation s of the nervous system (Q00-Q07) were the most common anomalies diagnosed before 22 weeks of gestation, while after 22 weeks, the most common malformations were congenital malformations of the urinary system (Q60-Q64). Qualified timely diagnosis of correctable developmental deficiencies, as well as team efforts of obstetricians, neonatologists, pediatric neurologists, pediatricians, and other health care professionals to ensure normal childbirth and provide a baby with specialized care, followed by life-time rehabilitation are the main tasks of prenatal medicine.

Background. Hepatocellular carcinoma is one of the malignant tumors with the highest incidence in the world. According to the latest statistics of the National Cancer Center, the incidence of liver cancer ranks fifth in malignant tumors and its mortality rate ranks second in China, which seriously threatens people’ s life and health. Aim. To investigate the value of CT perfusion parameters and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) in the diagnosis of hepatocellular carcinoma. Methods. 43 patients with hepatocellular carcinoma and 40 patients with hepatic hemangioma treated in our hospital from August 2018 to August 2021 were selected for CT perfusion imaging and MRI examination. Results. The liver blood flow (BF), liver blood volume (BV), and hepatic artery perfusion (HAP) in the hepatocellular carcinoma group were (267.38 ± 35.59) ml/(min·100 g), (30.20 ± 8.82) ml/100 g, and (0.64 ± 0.10) ml/(min·ml), respectively, which were significantly higher than those in the hepatic hemangioma group ( p < 0.05 ). The ADC value of hepatocellular carcinoma DWI sequence was (1.20 ± 0.17) ×10-3 mm2, which was significantly lower than that of hepatic hemangioma ( p < 0.05 ). The area under ROC curve of BF, BV, HAP, and ADC values for hepatocellular carcinoma was 0.860, 0.754, 0.804, and 0.890, respectively. The area under ROC curve of the four groups was compared ( p > 0.05 ). Conclusion. CT perfusion parameters BF, BV, HAP, and DWI sequence ADC values have certain application value in the diagnosis of hepatocellular carcinoma, and there is no significant difference between the diagnostic value of each parameter.

Abstract Background 85% of Americans own a smartphone and there were 230 billion downloads in 2021. 1,2 American diabetic patients have been reported to have limited health literacy. 3 55% of Americans do not graduate from high school. 4 African American, Hispanic patients and Asian patients comprise 20%, 22% and 19% of diabetic patients, respectively, but a greater proportion of hospitalization rates. 5 Many of these patients and their families use mobile apps for health questions. The accessibility of eHealth apps is changing how patients access health information. Purpose To evaluate free diabetes health apps as an intervention to reduce health disparities in our diabetic patients. Methods Using search term, "diabetes" in GooglePlayStore(Android/AD) and AppleAppStore(iOS) to find the best, free diabetes apps. Exclusion criteria: less than 100,000 downloads (DL) on Google and&lt;1600 reviews (RE) on Apple (Apple does not provide download data). The app introduction was "pasted" into readabilityformulas.com and webfx.com for analysis via Flesch-Kincaid Reading Ease (FRE), Flesch-Kincaid Grade Level Score (FGL), Simple Measure of Gobbledygook Index (SI), and the Dale-Chall Adjusted Grade Level (DCGL). Results AD(DL): 1-mySugr(1M),2-OnetouchReveal(1M),3-DiabetesBloodSugar(1M),4-BloodGlucoseTracker(500K),5-Diabetes(500K),6-Health2Sync(500K),7-DiabetesM(500K), 8-GlucoseBuddy(500K), 9-BeatDiabetes(100K), 10- Contour Diabetes App (100K);iOS(RE): 1-OnetouchReveal(87K), 2-GlucoseBuddyDiabetesTracker(21K), 3-Onedrop(20K), 4-GlucoseBloodSugarTracker(17K), 5-Livongo(13K), 6-mySugr(9.6K), 7-Sugarmate(9.4K),8-Klinio(3K), 9- Glycemic Index Load Net Carbs (2.2K), 10- Diabetes Logs (1.6K). Push notification=19/20 apps(AD=9, iOS=10). Connect users to GoodRx=0/20 apps. Connect users to professional care team/diabetes education=8/20 apps(AD=3, iOS=5). Connect users to free/discounted insulin/health products=0/20 apps. Spanish=11/20, Chinese=5/20 apps (AD=3, iOS=8, some apps have both). Only 2/20 apps were at 7-8th grade and the rest were high school and beyond. Free test strips were offered only on 1/20 apps(Livongo). Conclusion Free diabetes apps are helpful and may serve as an easily accessible educational tool for our patients. The physician can play a role in navigating the eHealth space with the patient. References: Perez S. App stores saw record 218 billion downloads in 2020, consumer spend of $143 billion, TechCrunch.com. Posted 13 Jan 2021. https://techcrunch.com/2021/01/13/app-stores-saw-record-218-billion-downloads-in-2020-consumer-spend-of-143-billion/?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAABDcJH4OHOqQiUHWuJW-KMA566Z-7bAE2FfaumvCMoPgE5oC0RoRUDiVnpqdDbe4aYSrlv2Uc-FHkQkx19emxvqXb9Q_ldDGOcYelOSGaj4bldElJyxUIIBaEe5y1vCwJcCagPCmKWjNbMsNhnij34mmepSYbbEqDW0p7BnGlpBk"&gt;https://techcrunch.com/2021/01/13/app-stores-saw-record-218-billion-downloads-in-2020-consumer-spend-of-143-billion/?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAABDcJH4OHOqQiUHWuJW-KMA566Z-7bAE2FfaumvCMoPgE5oC0RoRUDiVnpqdDbe4aYSrlv2Uc-FHkQkx19emxvqXb9Q_ldDGOcYelOSGaj4bldElJyxUIIBaEe5y1vCwJcCagPCmKWjNbMsNhnij34mmepSYbbEqDW0p7BnGlpBk Accessed 17 Jan 2022. Ceci L. Annual number of mobile app downloads worldwide 2021. Statista.com. Posted 14 Jan 2022. https://www.statista.com/statistics/271644/worldwide-free-and-paid-mobile-app-store-downloads/ Accessed 17 Jan 2022. Abdullah A, Lieu SM, Salim H et al. Prevalence of Limited Health Literacy Among Patients with Type 2 Diabetes Mellitus: A Systematic Review. PLoS One. 2019;17(1): e0261430. National Center for Education Statistics. https://nces.ed.gov/naal/kf_demographics.asp. Accessed 20 Jan 2022 Cheng YJ et al. Prevalence of Diabetes by Race and Ethnicity in the United States, 2011-2016. JAMA. 2019;322(24): 2389-2398. doi: 10.1001/jama.2019.19365. Accessed 19 Jan 2022. Presentation: No date and time listed

<p>Di abad ini pemanfaatan teknologi informasi sudah menjadi kebutuhan krusial bagi tiap individual, oganisasi, pendidikan, bisnis hingga ke pemerintahan. Dalam menjalankan tugas dan fungsinya Balai Besar Taman Nasional Gunung Gede Pangranggo (BBTNGGP) terus berusaha memberikan pelayanan, informasi dan edukasi prima kepada masyarakat dan pengunjung. Namun tidak sedikit di dapatkan pengunjung dan pengguna merasa kesulitan dalam mendapatkan informasi saat mengakses website Taman Nasional Gunung Gede Pangranggo. Seperti terbatasnya metode pembayaran yang menyulitkan pengunjung dalam pemesanan Surat Izin Masuk Kawasan Konservasi (SIMAKSI) secara <em>daring,</em> Tampilan website yang kurang menarik dan <em>up to date</em>, Kualitas informasi yang kurang efisien dimana pengunjung melakukan transaksi ganda yaitu registrasi secara online , pengambilan tiket secara offline dan mengantri saat cek kesehatan, Kualitas layanan interaksi antara pengelola taman nasional dan pengunjung yang belum maksimal. Sehingga dibutuhkan evaluasi peningkatan kualitas layanan website dengan menganalisis kualitas website tersebut. Penelitian ini membatasi permasalahan yang di bahas yaitu menganalisis kualitas website resmi Balai Besar Taman Nasional Gunung Gede Pangranggo dari sisi <em>end-user</em> dengan menerapkan WebQual 4.0 dengan memakai 3 variable yaitu <em>U</em><em>s</em><em>a</em><em>bility, Quality Information </em>dan<em> Service</em><em> </em><em>Interaction</em> sehingga dari ketiga variable tersebut dapat menghasilkan kepuasan pengguna <em>User Satisfaction</em>. Data penelitian ini menggunakan data 151 responden yang di bantu olah dengan software SPSS dan melalui beberapa tahap uji, seperti uji reliabilitas data, uji validasi data, analisis deskriptif, uji korelasi dan uji regresi linier berganda. Kualitas <em>website</em> Balai Besar Taman Nasional Gunung Gede Pangranggo dengan WebQual 4.0 menggunakan teknik WQI (<em>Webqual</em> <em>Index</em>) dalam menentukan standar (<em>benchmark</em>). Dengan harapan mengetahui tingkat kualitas layanan website Balai Besar Taman Nasional Gunung Gede Pangranggo dari persepsi pengguna akhir dengan menganalisis system yang sesuai harapan para penggunanya.</p><p> </p><p><em><strong>Abstract</strong></em></p><p><em>In this century the use of information technology has become a crucial need for each individual, organization, education, business to government. In carrying out its duties and functions, the Gunung Gede Pangranggo National Park Center (BBTNGGP) continues to strive to provide services, information and education to the public and visitors. However, many visitors find it difficult to get information when accessing the Gunung Gede Pangranggo National Park website. Such as limited payment methods for ordering Conservation Area Entry Permits (SIMAKSI) online, less attractive website appearance, less efficient quality of information where visitors register online by taking tickets and health checks offline, quality of interaction services between national park managers and visitors who have not been maximized.</em><em> </em><em>T</em><em>herefore</em><em> </em><em>it is necessary to evaluate the quality of the website service. This study limits the problems discussed, namely analyzing the quality of the official website of the Gunung Gede Pangranggo National Park Center from the end user side </em><em>by applying</em><em> the WebQual 4.0 using 3 variables, namely Usability, Quality Information and Service Interaction so that the three variables can produce user satisfaction.The data of this study used data from 151 respondents who were assisted by SPSS software and through several test stages, such as data reliability test, data validation test, descriptive analysis, correlation test and multiple linear regression test. </em><em> </em><em>The results of the analysis of the quality of this website concluded that the variable usability and information quality had a good value compared to the variable service interaction quality. This it is necessary to improve the quality of the website of the Gunung Gede Pangranggo National Park Center by analyzing the website according to the perceptions of the end user and the expectations of its users.</em><strong></strong></p><p><em><strong><br /></strong></em></p>

Precise tuning of gene expression by transcriptional regulators determines the response to internal and external chemical signals and adjusts the metabolic machinery for many cellular processes. As a part of ongoing efforts by the Midwest Center for Structural Genomics, a number of transcription factors were selected to study protein-ligand and protein-DNA interactions. HcaR, a new member of the MarR/SlyA family of transcription regulators from soil bacteria Acinetobacter sp. ADP1, is an evolutionarily atypical regulator and represses hydroxycinnamate (hca) catabolic genes. Hydroxycinnamates containing an aromatic ring play diverse, critical roles in plant architecture and defense. HcaR regulates the expression of the hca catabolic operon, allowing this and related bacterial strains to utilize hydroxycinnamates: ferulate, p-coumarate, and caffeate as sole sources of carbon and energy. HcaR appears to be capable of responding to multiple aromatic ligands. These aromatic compounds bind to HcaR and reduce its affinity to the specific DNA sites. As a result, the transcription of genes encoding several catabolic enzymes is up-regulated. The HcaR structures of the apo-form and in a complex with several ligands: ferulic acid, 3,4 dihydroxybenzoic acid, vanillin and p-coumaric acid have been determined to understand how HcaR accommodates various aromatic compounds using the same binding pocket. We also have identified a potential DNA site for HcaR in the regulatory region upstream of the genes of the hca catabolic operon in Acinetobacter sp. ADP1 and have confirmed DNA binding by EMSA. The co-crystal structure of HcaR and palindromic 24-mer DNA has been determined for this DNA site. The crystal structures of HcaR, the apo-form, ligand-bound forms, and the specific DNA-bound form provide critical structural basis of protein-ligand (substrates or product) and protein-DNA interactions to understand the regulation of the expression of hydroxycinnamate (hca) catabolic genes. Our studies allow for better understanding of DNA-binding and regulation by this important group of transcription factors belonging to the MarR/SlyA families. This work was supported by National Institutes of Health grant GM094585 and by the U. S. Department of Energy, Office of Biological and Environmental Research, under contract DE-AC02-06CH11357.

INTRODUCTION: This article presents the results of application of CT densitometry in the computed tomography (CT) of the chest to diagnose various forms of pulmonary hypertension.OBJECTIVES: To determine the diagnostic value of CT densitometry using comparative analysis of lung tissue density in patients with various forms of pulmonary hypertension.MATERIALS AND METHODS: The study included 528 patients diagnosed with pulmonary hypertension by means of right heart catheterization (RHC) of the National Research Cardiac Surgery Center, Republic of Kazakhstan. All patients were divided into 4 groups according to the classification of pulmonary hypertension of the World Health Organization (ESC/ERS Guidelines) from 2015. The first group included 254 patients with pulmonary hypertension pulmonary hypertension due to left heart disease (PHLHD). The second group included 210 patients with pulmonary arterial hypertension (PAH). The third group included 49 patients with chronic thromboembolic pulmonary hypertension (CTEPH). The fourth group — 15 patients with pulmonary hypertension due to respiratory disease (PHDRD). The mean age of the patients was 52.15±16.75 years. Contrast-enhanced chest CT imaging performed with a 64-slice multislice computed tomography system (Somatom Definition AS, Siemens) with post-processing to assess the lung tissue densitometric parameters, analyse the diameters of the pulmonary trunk and its main branches. The CT examination was carried in accordance with an «Embolism» protocol with intravenous administration of a contrast agent according to indications. Statistics: analysis was conducted using the Statistica 10 software. To quantitatively compare the two groups nonparametric Mann-Whitney test and the Kruskal-Wallace test were applied. Mean value and standard deviation in the format of «M±S» were used for quantitative parameters. Correlation analysis was carried out using Spearman’s nonparametric rank correlation.RESULTS: In patients with severe pulmonary hypertension a tendency for fibrotic changes was most clearly observed in cases of pulmonary hypertension due to left heart disease (–809.92±26.52), and emphysematous changes in the pulmonary arterial hypertension group (–843.27±43.88).CONCLUSION: CT lung densitometry should be performed in all patients with suspected pulmonary hypertension as an additional method of examination.

BackgroundMacrophage activation syndrome (MAS) is a severe hyperinflammatory response that develops against the background of juvenile idiopathic arthritis (JIA). It is known that the clinical feature of MAS on biologic therapy has other clinical manifestations, different from biologically naive patients.ObjectivesTo study the clinical and laboratory features of macrophage activation syndrome in patients with juvenile idiopathic arthritis with systemic onset (sJIA) on the biologic therapy.MethodsThe study included 100 patients with MAS (114 cases of MAS) who observed in the rheumatological department of the National Medical Research Center for Children’s health of Ministry of health. All patients met the criteria for the diagnosis of sJIA and MAS. There were children in our study who did not receive biologic therapy – 84 (74%) cases, and children who had MAS in the biologic therapy – 30 cases (26%). The drugs are distributed as follows: tocilizumab - 7 cases (6%), kanakinumab - 20 cases (17%), etanercept – 2 cases (2%), adalimumab – 1 case (1%). For pairwise intergroup comparisons of quantitative variables, the nonparametric Mann-Whitney test was used.ResultsIn comparative analysis of biologic-naive and on biologic patients, the greatest differences were obtained for the following clinical manifestations: rash, lymphadenopathy, myalgia (p<0.05). Fever was the most common symptom in both groups and was present in almost all patients (99%). All patients had elevated level of ferritin in the blood serum (773 ng/ml to 130149 ng/ml). Laboratory picture of MAS in the group of on biologic patients differed significantly from the group of patients naive for biologic therapy (Table 1). The most significant differences were found among the following laboratory parameters: hemoglobin level, the number of erythrocytes and platelets, erythrocyte sedimentation rate (ESR), levels of C-raective protein (CRP), ferritin, lactatedehydrogenase (LDH), albumin.Table 1.Laboratory data of patients with MAS.nReference valuesMedianMinimumMaximumMann-Whitney Criterion (p)Biologic-naive cases of MAS(n= 84)Hemoglobin, g/l84120-14596,5061,00145,000,008Red blood cells, 1012/l844,5-5,33,782,135,010,001Platelets, 109/l84150-440149,0041,00523,000,025White blood cells, 109/l844,5-11,54,420,6925,840,074ESR, mm/h842-2045,002,00111,000,001CRP, mg/l840-5111,567,54368,310,006Ferritin, ng/ml8414-1244195,21702,38130149,200,022LDH, U/l8491-295413,50162,005245,000,059Albumin, g/l8438-5429,0016,1063,000,001On biologic cases of MAS(n = 30)Hemoglobin, g/l30120-145104,5067,00163,000,008Red blood cells, 1012/l304,5-5,34,173,106,150,001Platelets, 109/l30150-440101,504,00362,000,025White blood cells, 109/l304,5-11,53,220,7015,580,074ESR, mm/h302-2017,502,0098,000,001CRP, mg/l300-555,771,86407,120,006Ferritin, ng/ml3014-1242319,59773,90121396,000,022LDH, U/l3091-295600,0010,602148,570,059Albumin, g/l3038-5432,8020,3051,900,001ConclusionOn biologic patients may also develop MAS, which is often difficult to diagnose due to the poor clinical picture and low laboratory activity. In this case, hyperferritinemia remains as a highly specific marker of MAS.References[1]Crayne CB, Albeituni S, Nichols KE, Cron RQ. The Immunology of Macrophage Activation Syndrome. Front Immunol. 2019 Feb 1;10:119. doi: 10.3389/fimmu.2019.00119. PMID: 30774631; PMCID: PMC6367262.[2]Henderson LA, Cron RQ. Macrophage Activation Syndrome and Secondary Hemophagocytic Lymphohistiocytosis in Childhood Inflammatory Disorders: Diagnosis and Management. Paediatr Drugs. 2020 Feb;22(1):29-44. doi:10.1007/s40272-019-00367-1. PMID: 31732958; PMCID: PMC7334831.[3]Ravelli A, Davì S, Minoia F, Martini A, Cron RQ. Macrophage Activation Syndrome. Hematol Oncol Clin North Am. 2015 Oct;29(5):927-41. doi:10.1016/j.hoc.2015.06.010. Epub 2015 Aug 25 PMID: 26461152Disclosure of InterestsIvan Kriulin Speakers bureau: Speaker for Novartis., Ekaterina Alexeeva Speakers bureau: Speaker for Roche, AbbVie, Bristol-Myers, Squibb, MSD, Novartis and Pfizer., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Eli Lilly, AbbVie, Bristol-Myers Squibb, MSD, Sanofi, Amgen and Novartis., Tatyana Dvoryakovskaya Speakers bureau: Speaker for Roche, AbbVie, Bristol-Myers, Squibb, MSD, Novartis and Pfizer., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Eli Lilly, AbbVie, Bristol-Myers Squibb, MSD, Sanofi, Amgen and Novartis., Rina Denisova Speakers bureau: Speaker for Roche, AbbVie, MSD, Novartis., Grant/research support from: Financial grants from Roche, Pfizer, Centocor, Sanofi and Novartis., Ksenia Isaeva Grant/research support from: Financial grants from Roche, Novartis and Sanofi., Aleksandra Chomakhidze: None declared, Anna Mamutova Speakers bureau: Speaker for Novartis., Grant/research support from: Financial grants from Eli Lilly., Olga Lomakina Grant/research support from: Financial grants from Pfizer, Eli Lilly., Anna Fetisova Grant/research support from: Financial grants from Amgen., Marina Gautier: None declared, Kristina Chibisova: None declared, Elizaveta Krekhova Speakers bureau: Speaker for Novartis., Irina Tsulukiya: None declared

This study aims to analyze the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education. The study was conducted in 2 communities of post-rehabilitation education providers in Semarang city. The level of psychological well-being of 40 respondents was measured by filling in the 18-item psychological well-being scale developed by Ryff (r = 0.83; v = 0.97). Measurement includes indicators: (1) self-acceptance; (2) positive relationships with others; (3) autonomy; (4) environmental mastery; (5) purpose in life; and (6) personal growth. Hypothesis test results indicate that the level of psychological well-being of ex-drug addicted counselee in post-rehabilitation education is significantly greater or equal to 80 (t = 49,140; sig = 0,000). Based on the results of this study, it is recommended to further researchers to further explore certain differences in the level of psychological well-being of the counselee by the factors of age, demographics, educational background, and length of abstinence. In addition, further studies with a larger number of samples and questionnaire items are needed so that study results can be generalized to a wider population.Ardiantina, D. (2016). Studi Kasus Kehidupan Remaja Mantan Pecandu Narkoba. Jurnal Bimbingan dan Konseling, 5(1), 1-12.Astuti, R., & Ismandari, F. (2014). Gambaran Umum Penyalahgunaan Narkoba di Indonesia. Buletin Jendela Data dan Informasi Kesehatan. I, pp. 1-52. Jakarta: Kementrian Kesehatan RI.Aztri, S., & Milla, M. N. (2013). Rasa Berharga Dan Pelajaran Hidup Mencegah Kekambuhan Kembali Pada Pecandu Narkoba Studi Kualitatif Fenomenologis. Jurnal Psikologi, 9(1), 48-63.Bhandari, S., Dahal, M., & Neupane, G. (2015). Factors Associated With Drug Abuse Relapse: A Study On The Clients Of Rehabilitation Centers. Al-Ameen Journal of Medicine and Science, 8(4), 293-298.BNN. (2015). Laporan Akhir Survei Nasional Perkembangan Penyalahgunaan Narkoba Tahun Anggaran 2014. Jakarta: Badan Narkotika Nasional Indonesia.Buchanan, T. (2011). Attention Defi cit/Hyperactivity Disorder and Well-being: Is Social Impairment an Issue for College Students with ADHD? Journal of Postsecondary Education and Disability, 24(3), 193-210.Bukoye, R. O. (2017). Academic Stress and Drug Abuse as Factors Inhibiting Psychological Well-Being Among Undergraduates: It’s Counselling Implications. European Scientific Journal, 13(8), 60-74.Chong, J., & Lopez, D. (2008). Predictors of Relapse for American Indian Women After Substance Abuse Treatment. Journal of The National Center, 14(3), 24-47.Dogaheh, E. R., Jafari, F., Sadeghpour, A., Mirzaei, S., Maddahi, M. E., Hosseinkhanzadeh, A. A., & Arya, A. R. (2013). Psychological Well-Being and Quality of Sleep in Addicts under Methadone Maintenance Treatment. Research Papers, 1(2), 71-75.Fard, A. E., Rajabi, H., Delgoshad, A., Rad, S. A., & Akbari, S. (2014). The Possible Relationship between University Students' Personality Traits, Psychological Well-being and Addiction Potential. International Journal of Social Science Studies, 2(2), 120-125.Garcia, D., Nima, A. A., & Kjell, O. N. (2014). The Affective Profiles, Psychological Well-Being, and Harmony: Environmental Mastery and Self-Acceptance Predict the Sense of a Harmonious Life. PeerJ, 1-21.Green, M., & Elliott, M. (2010). Religion, Health, and Psychological Well-Being. Journal of Religion and Health, 49, 149-163.Greenfield, E., Vaillant, G., & Marks, N. (2009). Doformal religious participation and spiritual perceptions have independent linkages with diverse dimensions of psychological well-being? Journal of Health and Social Behavior, 50, 196–212.Haryadi, R. (2018). Prospek Konseling Komunitas bagi Individu Eks-Pecandu Narkoba (Studi Pada Lembaga Pasca-Rehabilitasi Narkoba Di Kota Semarang). Konseli (Jurnal Bimbingan dan Konseling), 5(1), 73 - 84.Ibrahim, F., & Kumar, N. (2009). Factors Effecting Drug Relapse in Malaysia: An Empirical Evidence. Asian Social Science, 5(12), 37-44.Lindfors, P., Berntsson, L., & Lundberg, U. (2007). Total workload as related to psychological well-being and symptoms in full-time employed female and male white-collar workers. International Journal of Behavior and Medicine, 13, 131-137.Martin, R. A., MacKinnon, S., Johnson, J., & Rohsenow, D. J. (2011). Purpose in life predicts treatment outcome among adult cocaine abusers in treatment. Journal of Substance Abuse Treatment, 40, 183–188.Ryff, C. D. (2014). Psychological Well-Being Revisited: Advanced in the Science and Practice of Eudaimonia. Psychoterapy and Psychosmoatics, 83, 10-28.Ryff, C. D., Love, G. D., Miyamoto, Y., Markus, H. R., Curhan, K. B., Kitayama, S., . . . Karasawa, M. (2014). Culture and the promotion of well-being in East and West: Understanding varieties of attunement to the surrounding context. In G. A. Fava, & C. Ruini, Increasing psychological well-being in clinical and education settings: Interventions and cultural contexts (Vol. 8th, pp. 1-19). New York: Springer.Schaefer, S. M., Boylan, J. M., Reekum, C. M., Lapate, R. C., Norris, C. J., Ryff, C. D., & Davidson, R. J. (2013). Purpose in Life Predicts Better Emotional Recovery for Negative Stimuli. Plos ONE, 8(11), 1-9.Schwartz, R. P., Kelly, S. M., O’Grady, K. E., Mitchell, S. G., Peterson, J. A., Reisinger, H. S., . . . Brown, B. S. (2008). Attitudes toward buprenorphine and methadone among opioid-dependent individuals. American Journal of Addicton, 17, 396–401.Seligman, M. E. (2010). Flourish: Positive Psychology and Positive Intervention. Michigan: University of Michigan.Sharma, A. K., Upadhyaya, S. K., Bansal, P., Nijhawan, M., & Sharma, D. (2012). A Study of Factors Affecting Relapse in Substance Abuse. Indian Journal of Science and Technology, 2(1), 31-35.Siddiqui, S. (2015). Impact of self-efficacy on psychological well-being among undergraduate students. The International Journal of Indian Psychology, 2(3), 5-17.Strauser, D., Lustig, D., & Çıftçı, A. (2008). Psychological well-being: its relation to work personality, vocational identity, and career thoughts. Journal of Psychology, 142, 21–35.Vasquez, C., & Castilla, C. (2007). Emociones Positivas y Crecimiento Postraumatico en el Cancer de Mama. Psicooncologia, 4, 385-404.

ImportanceCOVID-19 was the underlying cause of death for more than 940 000 individuals in the US, including at least 1289 children and young people (CYP) aged 0 to 19 years, with at least 821 CYP deaths occurring in the 1-year period from August 1, 2021, to July 31, 2022. Because deaths among US CYP are rare, the mortality burden of COVID-19 in CYP is best understood in the context of all other causes of CYP death.ObjectiveTo determine whether COVID-19 is a leading (top 10) cause of death in CYP in the US.Design, Setting, and ParticipantsThis national population-level cross-sectional epidemiological analysis for the years 2019 to 2022 used data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying cause of death in the US to identify the ranking of COVID-19 relative to other causes of death among individuals aged 0 to 19 years. COVID-19 deaths were considered in 12-month periods between April 1, 2020, and August 31, 2022, compared with deaths from leading non–COVID-19 causes in 2019, 2020, and 2021.Main Outcomes and MeasuresCause of death rankings by total number of deaths, crude rates per 100 000 population, and percentage of all causes of death, using the National Center for Health Statistics 113 Selected Causes of Death, for ages 0 to 19 and by age groupings (&amp;lt;1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years).ResultsThere were 821 COVID-19 deaths among individuals aged 0 to 19 years during the study period, resulting in a crude death rate of 1.0 per 100 000 population overall; 4.3 per 100 000 for those younger than 1 year; 0.6 per 100 000 for those aged 1 to 4 years; 0.4 per 100 000 for those aged 5 to 9 years; 0.5 per 100 000 for those aged 10 to 14 years; and 1.8 per 100 000 for those aged 15 to 19 years. COVID-19 mortality in the time period of August 1, 2021, to July 31, 2022, was among the 10 leading causes of death in CYP aged 0 to 19 years in the US, ranking eighth among all causes of deaths, fifth in disease-related causes of deaths (excluding unintentional injuries, assault, and suicide), and first in deaths caused by infectious or respiratory diseases when compared with 2019. COVID-19 deaths constituted 2% of all causes of death in this age group.Conclusions and RelevanceThe findings of this study suggest that COVID-19 was a leading cause of death in CYP. It caused substantially more deaths in CYP annually than any vaccine-preventable disease historically in the recent period before vaccines became available. Various factors, including underreporting and not accounting for COVID-19’s role as a contributing cause of death from other diseases, mean that these estimates may understate the true mortality burden of COVID-19. The findings of this study underscore the public health relevance of COVID-19 to CYP. In the likely future context of sustained SARS-CoV-2 circulation, appropriate pharmaceutical and nonpharmaceutical interventions (eg, vaccines, ventilation, air cleaning) will continue to play an important role in limiting transmission of the virus and mitigating severe disease in CYP.

performance of current athletes by building confidence and contributing to favorable conditions of retired athletes. This study investigated the influences of the years of retirement and physical self-inventory on human sufferings experienced by the retired athletes. Based on the literature review, there were limited empirical studies on the conditions of former athletes after years of retirement, their glory, physical inventory, and sufferings, and the relationships among these characteristics. Using mixed research methods, this research studied the conditions of retired athletes in Metro Manila. The study confirmed that physical self-inventory influenced post-retirement human suffering. Post-retirement athletic identity, financial status and decisions to voluntary retire were observed to be the most prevalent experiences related to human suffering. However, retired athletes enjoy experiences with their educational status, other career benefits, health condition, control of lives, management of changes, and the warm support of their families and colleagues. References Bernes, K. B. (2009). Life after sport: Athletic career transition and transferable skills. Journal of Excellence, 13, 63-77. Retrieved from http://opus.uleth.caBlanco, D. V. (2016). Sports governance stakeholders, actors and policies in the Philippines: Current issues, challenges and future directions. Asia Pacific Journal of Sport and Social Science, 1-9. http://dx.doi.org/10.1080.21640599.2016.1227544Brinkman, S. (2014). Languages of suffering. Theory and Psychology, 24 (5), 630-648. DOI: 10.1177/0959354314531523Brand, S., Gerber, M., Beck, J., Hatzinger, M., Puhse, U., & Holsboer-Trachsler, E. (2010). High exercise levels are favorable to sleep patterns and psychological functioning in adolescents: A comparison of athletes and control. Journal of Adolescent Health, 46, 133-141. DOI:10.1016/j.jadohealth.2009.06.018Beehr, T. A. & Bennett, M. M. (2015). Working after retirement: Features of bridge employment and research directions. Work,Aging and Retirement, 1(1), 112–128. DOI:10.1093/workar/wau007Bollousa, D. A., Abreu, L., Varela-Sanz, A. & Mujica I. (2013). Do Olympic Athletes train in the Paleolithic era? Sports Medicine,43, 909-917. DOI: 10.1007/s40279-013-0086-1Cloninger, C. R. & Zohar, A. H. (2011). Personality and the perception of health and happiness. Journal of Affective Disorders, 128, 24-32. Doi:10.1016/j.jad.2010.06.012Cosh, S., Crabb, S. & LeCouteur, A. (2012). Elite athletes and retirement: Identity, choice and agency. Australian Journal of Psychology, 2012, 1-9. DOI: 10.1111/j.1742-9536.2012.00060.xCosh, S., Crabb, S. & Tully, P. J. (2015). A champion out of the pool? A discursive exploration of two Australian Olympic swimmers'transition from elite sport to retirement. Psychology of Sport and Exercise 19(2015), 33-41. http://dx.doi.org/10.1016/j.psychsport.2015.02.006Cover, R. (2017). The lived experience of retired college athletes with a history of 1 or more concussions. South Dakota State University Open PRAIRIE: Open Public Research Access Institutional Repository and Information Exchange. Retrieved from: h8p://openprairie.sdstate.edu/etdDaigle, B. (2016). Longitudinal examination of perceived stress and depression symptomology in Division I Student- Athletes. South Dakota State University Open PRAIRIE: Open Public Research Access Institutional Repository and Information Exchange. Retrieved from: h8p://openprairie.sdstate.edu/etdDebois, N., Ledon, A. & Wylleman, P. (2014). A lifespan perspective on the dual career of elite male athletes. Psychology of Sport and Exercise, 2014, 1-12. http://dx.doi.org/10.1016/j.psychsport.2014.07.011De Bosscher, V., Shibli, S., Van Bottenburg, M., De Knop, P. & Truyens, J. (2010). Developing a method for comparing the elite sport systems and policies of nations: A mixed research methods approach. Journal of Sport Management, 24, 567-600. Retrieved from https://dspace.library.uu.nl/bitstream/handle/1874/203933/567-600[1].pdf?sequence=1DosSantos, A. L. P., Nogueira, M. DP. G. R. & Bohme, M. T. S. (2016). Elite athletes’ perception of retirement support systems. International Journal of Physical Education, Sports and Health, 3(1), 192-199. P-ISSN: 2394-1685Effelsberg, D., Solga, M., & Gurt J. (2014). Getting followers to transcend their self-interest for the benefit of their company: Testing a core assumption of transformational leadership theory. Journal of Business Psychology, 29, 131-143. DOI: 10.1007/s10869-013-9305-xEmile, M., Chalabaev, A., Stephan, Y., Corrion, K. & d’Arripe-Longueville, F. (2013). Aging stereotypes and active lifestyle: Personal correlates of stereotype internalization and relationships with level of physical activity among older adults. Psychology of sport and exercise, 2013. DOI: 10.1016/j.psychsport.2013.11.002 Fox, K. R. & Corbin, C. B. (1989). The physical self-perception profile: Development and preliminary validation. Journal of Sport and Exercise Psychology, 11, 408-430. Doi: 10.1123/jsep.11.4.408Golden, C. R. (2011). Student athletes' perceptions of academic support, career support and personal support. Unpublished paper.Retrieved from: h7p://thekeep.eiu.edu/theses/153Hernandez, M. (2012). Toward an understanding of the psychology of stewardship. Academy of Management Review, 37(2), 172-193. http://dx.doi.org/10.5465/amr.2010.0363Hatamleh, M. R. (2013). The life transitions of high performance athletes retirement from sport. European Scientific Journal, 9,11. ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431Iglesias-Gutierrez, E., Garcia-Roves, P. M., Garcia, A., & Patterson, A. M. (2008). Food preferences do not influence adolescent highlevelathletes’ dietary intake. Appetite, 50, 536-540. DOI:10.1016/j.appet.2007.11.003Kadlcik, J. & Flemr, L. (2008). Athletic career termination model in Czech Republic: A qualitative exploration. International Review for the Sociology of Sport, 43(3), 251-269. Retrieved from: http://irs.sagepub.comKlassen, R. M., Krawchuck, L. L., Lynch, S. L. & Rajani, S. (2008). Procrastination and motivation of Undergraduates with learning disabilities: A mixed-methods inquiry. Learning Disabilities Research & Practice, 23 (3), 137–147. Retrieved from http://www.academia.edu/Koonce, G. E. J. (2013). Role transition of National Football League retired Athletes: A grounded theory approach. 23 MarquetteSports Law Review, 23 (2), 250-338. Retrieved from: http://scholarship.law.marquette.edu/sportslaw/vol23/iss2/10Li, L. (2017). Study on Chinese retired athletes job placement countermeasure based on Bayes Discriminant Analysis classification method. Revista de la Facultad de Ingeniería U.C.V., 32(5), 416-422.Li, Y. R., Niu, C. & Quian, J. X. (2016). Dissociation and Missing: Evaluation of Athletes' Disability Security System in China. 2016 2nd International Conference on Modern Education and Social Science (MESS 20160). ISBN: 978-1-60595-346-5.Maiano, C., Morin, A. J. S., Ninot, G., Monthuy-Blanc, J., Stephan, Y., Florent, J. F., & Vallee, P. (2008). A short and very short form of the physical self-inventory for adolescents: Development and factor validity. Psychology of Sport and Exercise, 9, 830–847. Doi:10.1016/j.psychsport.2007.10.00McKnight, K. M., Bernes, K. B., Gunn, T., Chorney, D., Orr, D. T., & Bardick, A. D. (2009). Life After Sport: Athletic Career Transition and Transferable Skills. Journal of Excellence, 13, 63-77. Retrieved from http://hdl.handle.net/10133/1175McMillan, W. (2016). The phenomenological analysis of psychospiritual transformation in athletic retirement and everyday narcissism in former athletes. University of Lethbridge Research Repository. Retrieved from: http://hdl.handle.net/10133/4450Maffulli, N., Longo, U. G., Spiezia, F. & Denaro V. (2010). Sports injuries in young athletes: Long-term outcome and prevention strategies. The Physician and Sports Medicine, 2 (38), 29-34. ISSN – 0091-3847Mohamed, Z. (2017). The reflection physical education and sports on configuration self- physical in adolescents. International Journalof Fitness Health, Physical Education and Iron Games, 4(2), 62-69. Retrieved from: https://www.researchgate.net/publication/325742983O'Brien, J. C. & Eller, C. (2016). Representing retired athletes. Arts, Sports & Law. Hennepin Lawyer, 12-14. Retrieved from: thl@hcba.orgPark, S. & Lavallee, D. (2015). Roles and influences of Olympic athletes’ entourages in athletes’ preparation for career transition out of sport. Sport and Exercise Psychology Review, 11 (1), 3-19. ISSN: 1745-4980.Park, S., Lavallee, D., & Tod, D. (2012). Athletes’ career transit ion out of sport. International Review of Sport and Exercise Psychology, 6, 22-53.Polit, D. F., & Beck, C. T. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International Journal of Nursing Studies, 47, 1451-1458. Doi: 10.1016/j.ijnurstu.2010.06.004 Potgieter, S. (2013). Sport nutrition: A review of the latest guidelines for exercise and sport nutrition from the American College of Sport Nutrition, the International Olympic Committee and the International Society for Sports Nutrition. South African Journal of Clinical Nutrition, 26(1), 6-16.Runeson, P., & Host, M. (2009). Guidelines for conducting and reporting case study research in software engineering. Empirical Software Engineering, 14(2), 131-164. doi:10.1007/s10664-008-9102-8Saunders, M., Lewis, P., & Thornhill, A. (2010). Research Methods for Business Students (5th ed.). Philippines: Pearson Education. Thompson, W. R. (2018). Worldwide survey of fitness trends: The CREP edition. American College of Sports Medicine (ACSM's) Health and Fitness Journal.Tshube, T. & Feltz, D. L. (2015). The relationship between dual- career and post-sport career transition among elite athletes in South Africa, Botswana, Namibia and Zimbabwe. Psychology of Sport & Exercise. DOI: 10.1016/j.psychsport.2015.05.005Tulle, E. (2008). Acting your age? Sports science and the ageing body. Journal of Aging Studies, 22, 340-347. doi:10.1016/j.jaging.2008.05.005Wessa P. (2017). Cronbach alpha (v1.0.5) in Free Statistics Software (v1.2.1), Office for Research Development and Education. Retrieved from: https://www.wessa.net/rwasp_cronbach.wasp/Villanova A. & Puig, N. (2014). Personal strategies for managing a second career: The experiences of Spanish Olympians. International Review for the Sociology of Sport, 1–18. DOI: 10.1177/1012690214536168Wiles, R., Crow, G., Heath, S., & Charles, V. (2008). The management of confidentiality and anonymity in social research. International Journal of Social Research Methodology, 11(5), 417-428. Retrieved from http://eprints.ncrm.ac.uk/651/1/The_Management_of_Confidentiality_and_Anonymity_in_ Social_Research.pdf

Background Chronic hemolysis is a hallmark of sickle cell disease (SCD). Intravascular hemolysis in particular is associated with severe vasculopathic complications including pulmonary hypertension (PH) and early mortality. Free heme causes oxidative damage and recently was identified as erythrocyte-derived Danger Associated Molecular Pattern (e-DAMP), associated with endothelial activation and vaso-occlusion in SCD (Belcher et al., Blood. 2014; Ghosh et al., J. Clin. Invest. 2013). Intravascular hemolysis is associated with elevated levels of serum lactate dehydrogenase (LDH). Heme catabolism leads to endogenous carbon monoxide (CO) production by heme oxygenase-1 (HO1), and CO is eliminated in exhaled breath. CO is transported primarily as the conjugate carboxyhemoglobin (HbCO), and end-alveolar CO (EACO) is an accepted proxy marker for its concentration in blood. We evaluated several lab values and ratios that might reflect the relative contribution of intravascular heme release and overall heme processing. Methods We investigated the relationship between EACO, HbCO (NCT01547793, cohort A) and other biomarkers of hemolysis in adults with SCD at steady state as part of the clinical cohort at the National Institutes of Health Clinical Center, Bethesda, Maryland, USA (NCT00011648, cohort B). Of the patients included in the cohort B, all routine samples with results on HbCO were included in the analyses. In a subgroup of the cohort B with data available on HbCO, echocardiography and/or mortality, we evaluated the correlation between LDH/HbCO ratio and echocardiographic markers of PH and all-cause mortality (cohort C). Combining all recognized available markers for hemolysis (total bilirubin, AST, absolute reticulocyte count, hemoglobin, median LDH, median HbCO and LDH/HbCO ratio) in a multivariate Cox proportional hazards model for survival led to selection of a predictive model encompassing three biomarkers: LD/HbCO ratio, AST and hemoglobin. Of these three markers, the LD/HbCO ratio was the most predictive factor. We also conducted univariate correlations with clinical outcome indicators. Main findings Erythropoietic and hemolytic laboratory parameters of the cohorts are provided in Table 1. HbCO concentrations and EACO were strongly correlated (Pearson's correlation r=0.66, p<0.01). In both cohort A and cohort B, HbCO and EACO were not correlated to LDH. However, EACO and HbCO did correlate with absolute reticulocyte counts (respectively r=0.46, p<0.01 and r=0.58, p<0.01). The patients of cohort C were divided into low (peak TRV <2.5m/s, N=34), intermediate (peak TRV 2.5-3m/s, N=38) and high risk (peak TRV >=3.0m/s, N=13) categories, based upon prior cut-points determined by risk of development of PH and early mortality (Mehari A. et al. JAMA. 2012) (Figure 1, panel A). LDH/HbCO ratios were positively correlated with TRV (r=0.38, p<0.01), and were significantly higher in patients with TRV >=3.0m/s (Mann-Whitey U test; p=0.02). In contrast, LDH values alone were not discriminative. All patients (25/25) with a LDH/HbCO ratio <1,200 had a TRV <3.0m/s; 94% (15/16) of the patients with catheterization-proven PH had a LDH/HbCO ratio >1,200. In the intermediate risk subgroup, PH was only diagnosed in individuals with LDH/HbCO ratios exceeding 1,200. Median follow-up was 12.1 years (IQR 10.3; 16.3), 25% (23/91) of the patients died during follow-up. Five-year, 10-year and 15-year overall survival in the group with LDH/HbCO ratio >1,200 were respectively 92.1%, 76.0% and 69.1%, whereas 5-year, 10-year and 15-year overall survival in the group with LDH/HbCO ratio <1,200 were respectively 100%, 92.9% and 88.0% (Figure 1, panel B). LDH/HbCO ratios were associated with all-cause mortality in a Cox proportional hazards model (p<0.01) and remained significantly associated with all-cause mortality when adjusted for age, C-reactive protein and ferritin (p=0.02). LDH alone was not associated with all-cause mortality in the unadjusted analysis. Main conclusions A ratio of two readily available clinical laboratory markers, LDH and HbCO, is promising as a potential biomarker in SCD. Increased LDH/HbCO ratios are strongly associated with elevated TRV and all-cause mortality, and thereby might improve the individual risk prediction in SCD patients. These markers deserve additional validation in future prospective trials. Disclosures van Wijk: Agios Pharmaceuticals: Consultancy, Research Funding; RR Mechatronics: Research Funding. Minniti:Doris Duke Foundation: Research Funding. Kato:Novartis, Global Blood Therapeutics: Consultancy, Research Funding; Bayer: Research Funding. van Beers:Novartis: Consultancy, Research Funding; Pfizer: Research Funding; RR Mechatronics: Research Funding; Agios Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Abstract BACKGROUND: In the early 1990’s, the Cooperative Study of Sickle Cell Disease (CSSCD) estimated a median life expectancy of 42 years for males, and 48 years for females with sickle cell anemia. We used death certificate data from the late 1990’s and early 2000’s to examine age at death and contributing causes of death for persons with sickle cell disease (SCD). METHODS: We used the National Center for Health Statistics Multiple Cause of Death (MCOD) files to examine age at death and contributing causes of death for persons in the U.S. with SCD during the years 1999 to 2004. The MCOD files contain data from all death certificates filed in the U.S. Each observation in the data has listed an underlying (primary) cause of death, as well as up to 20 conditions thought to contribute to the death. We used ICD-10 codes D570-D578 to identify all deaths attributed to SCD during the time period under study. Records with the ICD-10 code for sickle cell trait (D573) were excluded from further analyses. We used the Clinical Classification Software provided by the Healthcare Cost and Utilization Project to collapse all listed ICD-10 codes into smaller categories. Analyses of age at death were conducted using t-tests, median tests, ANOVA, and multiple linear regression as appropriate. RESULTS: From 1999 to 2004, there were 4553 deaths in the U.S. attributed to SCD (mean = 759/yr, sd = 42.6). SCD was listed as the primary cause in 65% of the deaths. 95% of the deaths were attributed to HbSS disease, and approximately 1% of the deaths were attributed to double heterozygous sickle cell disorders (SC/SD/SE/Thal). 50.4% of the deaths were among males. 64% of the decedents had a high school education or less. 54% of the decedents lived in the South. 68% of the decedents died as inpatients in a hospital. The mean age at death for the time period was 38.2 years (sd = 15.6). There was no change in the mean age at death during the time period. Females were older than males at death (39.4 vs. 36.9, p < 0.0001). Those with HbSS were younger than those with a double heterozygous disorder (38 vs. 47, p < 0.02). Having SCD listed as the primary cause of death was associated with younger age at death (36.8 vs. 40.7, p < 0.0001). Decedents with at least some college education were older at death than those with high school educations or less (40.9 vs. 37.0 p < 0.0001). There were no regional differences in mean age at death. In a multivariate model of age at death with the predictors gender, region, education, and whether or not SCD was listed as the primary cause of death, being female and having some college education remained associated with older age at death, while having SCD listed as the primary cause of death remained associated with younger age at death. Septicemia, pulmonary heart disease, liver disease and renal failure were among the top contributing causes of death for adults, while septicemia, acute cerebrovascular disease and pneumonia were among the top contributing causes of death for kids. CONCLUSIONS: Persons dying from SCD during 1999 to 2004 experienced ages at death that are not improved over those reported by the CSSCD, suggesting the continued need for societal efforts aimed at improving the quality of care for SCD, especially among adults with the condition. Educational attainment is associated with age at death among the SCD population, though it is not possible from the cross-sectional nature of this data to determine the causal directionality of this association.

BackgroundThe CQRA-PREM has been developed in the United Kingdom to evaluate the perspective of patients with rheumatoid arthritis (RA) about the care provided in rheumatology units of the National Health Service (1). This PREM might also be feasible to be used in Portugal, yet an adaptation and validation process is needed.ObjectivesWe aimed to translate and cross-cultural adapt CQRA-PREM to Portuguese and evaluate the reliability and content validity of this version.MethodsA study combining qualitative and quantitative approaches was conducted with patients with RA from a single rheumatology center. The translation and cultural adaptation of Portuguese CQRA-PREM included initial translation and cultural adaptation by 2 native Portuguese researchers, evaluation of this initial translation by a panel of 5 experts during an online meeting and back translation by 1 bilingual researcher. Authors of the original version approved this initial translation. CQRA-PREM includes 7 domains for patient-centered care: Needs and preferences (5 items); Coordination of care and communication (4 items); Information, education, and self-care (4 items); Daily living and physical comfort (2 items); Emotional support (2 items); Family and friends (1 item); Access to care (5 items) and 1 question for the overall experience with the care provided. Answers are given on a 5-point Likert scale (strongly disagree-1 to strongly agree-5). A total of 21 patients were invited to participate in online focus groups and 14 accepted. Patients were then asked to fill in a consent form and the preliminary version of the CQRA-PREM. The focus groups were transcribed and analyzed using thematic analysis. Questionnaire responses were analyzed with descriptive statistics and reliability (internal consistency) with the Cronbach´s alpha (α).ResultsA total of 12 patients (53±9y; 92% female) with a mean disease duration of 14±9 years participated in 2 focus groups (duration 95±7min). The focus groups revealed that patients considered CQRA-PREM “simple” and “objective” and that all questions were easy to understand. Nevertheless, patients suggested the addition of synonyms for certain terms and of daily living examples to clarify some items. The “Needs and preferences” and “Access to care” were the domains with better experience (Table 1). The Cronbach’s alpha was 0.94 for the total questionnaire and between 0.71 and 0.91 for the domains.Table 1.Median’s responses and quartile (Q) for each domain (1-Strongly disagree; 2-Disagree; 3-Neither agree nor disagree; 4-Agree; 5- Strongly agree).CQRA-PREM domainsMedian (Q1-Q3)1.Needs and preferences4.5(4.25-4.5)2.Coordination of care and communication4(3.25-4.5)3.Information, Education and Self-care3(2-4)4.Daily living and physical comfort3.255.Emotional support3.256.Family and friends4(3-4)7.Access to care4.5(2.5-5)ConclusionOur findings suggest that both content validity and internal consistency of the Portuguese version of CQRA-PREM are acceptable. In future, a field-testing study to assess other psychometric properties (e.g., test-reliability and validity) should be conducted. We believe this PREM will contribute to optimize patient-centered care in Portugal.References[1]Bosworth A, et al. Curr. Rheumatol. Rev. 2015;11.Disclosure of InterestsNone declared

Introduction The treatment landscape of Hodgkin Lymphoma (HL) has undergone a revolution in recent years, providing multiple options for providers and patients in their shared goal for disease control. However, these successful treatment options (e.g. multi-agent chemotherapy, radiotherapy, or combined modality) come at a high cost in the form of late effects, with little known about long-term toxicity of novel agents (e.g., Brentuximab vedotin, immunotherapy). As part of an international effort to develop tools to enhance treatment decision-making for providers and patients, we developed a survey to learn about what role HL survivors played in their initial treatment decision(s) as well as to understand survivors' knowledge and experience of late effects. Methods The survey titled Understanding of Decision-Making among HL Survivors included three themes: 1) initial treatment plan; 2) role in decision-making about the plan and factors important to the treatment selection; and 3) understanding of late effects. The survey was initially piloted at a cancer conference in Spring 2019 after which modest revisions were made to improve clarity. The revised survey was then distributed nationally in a single push through the Leukemia & Lymphoma Society's voluntary email listserv (Summer 2019). Responses were captured in the HIPAA complaint, web-based application, REDCap®, and then analyzed with descriptive statistics. Results A total of 129 HL survivors responded to the survey. The majority of respondents (n=98, 76%) identified as female. While nearly half (46%) were between 1-5 years from treatment, 27% were <1 year off therapy or still in treatment, and 27% were treated > 5 years ago. Age distribution at diagnosis ranged from <18 years (n=3, 2%), 18-25 years (n=35, 27%), and >26 years (n=91, 71%). Two-thirds (n=83, 64%) of patients were treated with chemotherapy alone. Overall, 90% of survivors reported receiving ABVD or a close variant (e.g., AVD). The majority of survivors (n=88, 68%) reported only receiving one treatment option by their oncologist. Half (n=69, 54%) engaged in shared decision-making with their physician, with or without family/friends, 24% (n=31) deferred to their physician, 20% (n=26) decided on their own or with family/friend, and 2% (n=3) followed the plan determined by their physician and family on their behalf. Most respondents were treated in the community (n=77, 60%) with an additional 34% (n=44) reporting having been treated at an academic medical center. For 8 respondents (6%) the treatment site was categorized as other. Survivors were asked to rate the importance of factors in their initial treatment decision-making on a 3-point scale. Results were then dichotomized to important or not important. Health systems factors (e.g., cost, distance) were deemed less important, while patient-level factors (e.g., side effects, late effects) were widely endorsed (Table 1). The majority of survivors (n=107, 83%) were aware they are/may be at risk for late effects. Seventy percent (n=68 of 97) had been told at the time of discussion of treatment option(s) with their oncologist. The remainder (n=29 of 97, 30%) learned after completion of treatment or when transitioning care from their treating oncologist to survivorship or primary care. One third of respondents (n=46, 36%) reported they have been diagnosed with a late effect, which included substantial late effects of secondary malignancy (n=5, 11%) and cardiac toxicity (n=4, 9%). Discussion We report the results of a recent national survey of HL survivors, represented by an activated cohort that elects to participate in cancer advocacy groups. While two-thirds of respondents had little choice in initial treatment options, the majority endorsed the importance of side effects and late effects in treatment selection. Only half of survivors engaged in shared decision-making with their physician, indicating ample room for improvement and the development of tools to facilitate this process. Disclosures No relevant conflicts of interest to declare.

Based on the data of daily maximum temperature in 26 meteorological stations in the North Center Region, Vietnam over the period of 1980 to 2013, the authors conducted the research on the spatial distribution of the number of hot days. The initial result shows that in general, in the north of the study area, the large number of hot days occurred in the plain, and tended to decrease westward and eastward. In the south, this number tends to increase from the west to the east. Especially, the largest number occurred in two areas: The Ma and Ca River's valleys (Thanh Hoa and Nghe An provinces) and the coastal areas (Thua Thien Hue province), creating two heat centers in Tuong Duong district, Nghe An province and Nam Dong district, Thua Thien Hue province.ReferencesAdina-Eliza Croitoru, Adrian Piticar, Antoniu-Flavius Ciupertea, Cristina FlorinaRosca, 2016 Changes in heat wave indices in Romania over the period 1961-2015. Global and Plantary Change 146. Journal homepage: www. Elsevier.com/locate/gloplacha.Chu Thi Thu Huong et al., 2010. Variations and trends in hot event in Vietnam from 1961-2007, VNU Journal of Science and Technology, 26(3S).Climate Council, 2014a. Angry Summer 2013/2014. Accessed at http://www.climatecouncil.org.au/ angry-summer.Climate Council, 2014b. Angry Summer 2013/2014. Accessed at http://www.climatecouncil.org.au/ angry-summer.CSIRO and BoM, 2012. State of the Climate 2012.CSIRO and Bureau of Meteorology, Melbourne.Accessed at http://www.csiro.au/Outcomes/ Climate/Understanding/State-of-the-Climate-2012.aspx.D'Ippoliti D., Michelozzi P., Marino C., De'Donato F., Menne B., Katsouyanni K., Kirchmayer U., Analitis A., Medina-Ramon M., Paldy A., Atkinson R., Kovats S., Bisanti L., Schneider A., Lefranc A., Iñiguez C., Perucci C., 2010. The impact of heat waves on mortality in 9 European cities: results from the EuroHEAT project. Environ. Health 9, 37. http://dx.doi.org/10.1186/1476-069X-9-37.Gerald A. Meehl, 1992. Effect of tropical topography on global climate, Ann. Rev. Earth Planet. Sci., 20, 85-112.Hayhoe K., Cayan D., Field C.B., Frumhoff P.C., Maurer E.P., Miller N.L., Moser S.C., Schneider S.H., Cahill K.N., Cleland E.E., Dale L., Drapek R., Hanemann R.M., lkstein L.S., Lenihan J., Lunch C.K., Neilson R.P., Sheridan S.C., Verville J.H., 2004. Emissions pathways, climate change, and impacts on California. PNAS, 101(34), 12422-12427.Ho Thi Minh Ha, Phan Van Tan, 2009. Trends and variations of extreme temperature in Vietnam in the period from 1961 to 2007, VNU Journal of Science and Technology, 25(3S).IPCC, 2007: Climate Change 2007: Synthesis Report. Contribution of Working Groups I, II and III to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, Pachauri R.K and Reisinger A. (eds.)]. IPCC, Geneva, Switzerland, 104p.IPCC, 2014. Climate Change 2014: Synthesis Report. Contribution of Working Groups I, II and III to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change [Core Writing Team, R.K. Pachauri and L.A. Meyer (eds.)]. IPCC, Geneva, Switzerland, 151p.Liu G., Zhang L., He B., Jin X., Zhang Q., Razafindrabe B., You H., 2015. Temporal changes in extreme high temperature, heat waves and relevant disasters in Nanjing metropolitan region, China. Nat. Hazards, 76, 1415–1430. http://dx.doi.org/10.1007/s11069-014-1556-y.Manton M.J et al., 2001. Trends in extreme daily temperature in Southeast Asia Rainfall ad and the South Pacific, J. Climatol. 21.Nairn J.R., Fawcett R.J.B., 2015. Int. J. Environ. Res. Public Health 12, 227–253. http://dx.doi.org/10.3390/ijerph120100227.Nguyen Duc Ngu, 2009. Climate Change Challenges to development, Journal of Economy and Environment, No. 1.Perkins S.E., Alexander L.V., 2013. On the measurement of heat waves. J. Clim. 26, 4500–4517. http://dx.doi.org/10.1175/JCLI-D-12-00383.1.Peterson T.C., Heim Jr. R.R., Hirsch R., Kaiser D.P., Brooks H., Diffenbaugh N.S., Dole R.M., Giovannettone J.P., Guirguis K., Karl T.R., Katz R.W., Kunkel K., Lettenmaier D., McCabe G.J., Paciorek C.J., Ryberg K.R., Schubert S., Silva V.B.S., Stewart B.C., Vecchia A.V., Villarini G., Vose R.S., Walsh J., Wehner M., Wolock D., Wolter K., Woodhouse C.A., Wuebbles D., 2013. Monitoring and understanding changes in heat waves, cold waves, floods, and droughts in the United States: state of knowledge. Bull. Amer. Meteor. Soc., 94, 821–834.Pham Thi Ly, Hoang Luu Thu Thuy, 2015. Variation of heat waves in the North Central Region over the period of 1980-2013, Journal of natural resources and environment, 9, 81-89.Phan Van Tan et al., 2010. Study impact of global climate change on extreme weather phenomena and factors in Vietnam, prediction and adaptation strategies. Project final report, KC 08.29/06-10, Hanoi University of Science.Spinoni J., Lakatos M., Szentimrey T., Bihari Z., Szalai S., Vogt J., Antofie T., 2015. Heat and cold waves trends in Carpathian Region from 1961 to 2010. Int. J. Climatol, 35, 4197–4209. http://dx.doi.org/10.1002/joc.4279.Toreti A., Desiato F., 2008.Temperature trends over Italy from 1961 to 2004, Theor. Appl. Climatol 91.Tran Cong Minh, 2007. Principle of meteorology and climate, Book, Public House of Hanoi National University.Tran Quang Duc, Trinh Lan Phuong, 2013. Changes of Hot day and Fohn Activities at Ha Tinh- Central Vietnam, VNU Journal of Science, Science and Technology, 29(2S).Trewin B., Smalley R., 2013.Changes in extreme temperature in Australia, 1910 to 2011. In: 19th AMOS National Conference, Melbourne, 11-13.Unal Y.S., Tan E., Mentes S.S., 2013. Summer heat waves over western Turkey between 1965 and 2006.Theor. Appl. Climatol, 112, 339–350. http://dx.doi.org/10.1007/s00704-012-0704-0.Will Steffen, 2015. Quantifying the impact of climate change on extreme heat in Australia. Published by the Climate Council of Australia Limited. ISBN: 978-0-9942453-1-1 (print) 978-0-9942453-0-4 (web).

Abstract Background: Vitamin C is an essential water-soluble vitamin required for many redox reactions in our body and its deficiency causes scurvy, a well characterized disease with multiple hematological manifestations. Studies dating back to 1950's demonstrated that patients with myeloid neoplasms tend to have lower plasma levels of vitamin C than healthy controls. Recent studies have shown that as much as 80% of patients with hematological malignancies in a cohort from Denmark had low vitamin C levels. Myeloid neoplasms tend to harbor mutations in epigenetic regulators which play a role in DNA methylation. One such mutation commonly seen in myeloid neoplasms and clonal hematopoiesis of indeterminate potential (CHIP) is TET2 for which vitamin C serves as a cofactor. There is a scarcity of clinical data on patients with low vitamin C level in myeloid neoplasms. Our study investigated the rates of vitamin C deficiency and the disease clinical and genomic characteristics associated with it at our center. Methods: We retrospectively collected data from a prospectively maintained list of patients treated for myeloid neoplasms at a large tertiary cancer center on whom vitamin C levels where serially collected during the study period. We obtained multiple baseline characteristics at the time of diagnosis including cytogenetic and molecular mutational data. Baseline characteristics were defined using descriptive statistics. Categorical variables were compared using a Fisher's exact test and continuous variables were analyzed using Mann Whitney U test for statistical significance. Institutional review board approval was obtained for the study. Statistical analysis was done using R Studio version 1.4.1717. Results: A total of 50 patients with myeloid neoplasms were identified with vitamin C levels available at least once during the study period. Nine (18%) patients had a low vitamin C level (LOW) defined as less than 0.4 mg/dl as per the Mayo lab testing with a reference range between 0.4 to 2.0 mg/dl. Baseline characteristics of patients with low vitamin C level and patients with normal vitamin C level (NORMAL) are shown in Table 1. The median vitamin C level in the LOW group was 0.2 mg/dl and NORMAL group was 1 mg/dl (p &lt;0.001). The median age at diagnosis for patients in the LOW cohort was 64 years compared to 72 years for patients with normal vitamin C level (p = 0.015). Twenty-two (53.6%) of patients were female in the NORMAL cohort while six patients (66.7%) were females in the LOW cohort (p=NS). In the vitamin C LOW group only 55% of the patients were white compared to 83% in the NORMAL group (p = 0.093). The majority of patients in the Vit C LOW group had acute myeloid leukemia (AML) 44.5%, compared to 9.8% in the group with normal vitamin C levels (p = 0.03). Median white blood cell count, platelet counts, peripheral blast count and bone marrow blast count were not statistically significant amongst the 2 groups. Majority of patients in both groups 56.1% (NORMAL) vs 77.8% (LOW) had normal cytogenetics at the time of diagnosis (p = 0.284). There was a higher tendency to harbor ASXL1 and IDH2 mutation in the cohort with LOW levels 44.5% (p = 0.09) and 22.2% (p value = 0.143) compared to 17% and 4.8% respectively in the NORMAL cohort. Conclusions: Our analysis of the baseline characteristics of patients with myeloid neoplasms with vitamin C levels reveals interesting findings including a lower age at diagnosis for patients with low vitamin C levels and higher proportion of patients with acute myeloid leukemia compared to the cohort with normal levels. We also noted a higher tendency for occurrence of certain molecular mutations including ASXL1 and IDH2 among the patients with low vitamin C level. With recent papers implicating the role of ASXL1 in leukaemogenesis these findings suggest the hypothesis that vitamin C deficiency could accelerate clonal evolution with a higher tendency to transform into acute leukemia at a lower age. Further multi-institutional studies are needed to understand the relevance of low vitamin C level in myeloid neoplasms and the role of therapeutic vitamin C supplementation to retard leukaemogenesis. Figure 1 Figure 1. Disclosures Patel: Celgene-BMS: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; PVI: Honoraria. Awan: Cardinal Health: Consultancy; Abbvie: Consultancy; Merck: Consultancy; Beigene: Consultancy; Johnson and Johnson: Consultancy; Astrazeneca: Consultancy; BMS: Consultancy; Janssen: Consultancy; Genentech: Consultancy; Dava Oncology: Consultancy; Verastem: Consultancy; ADCT therapeutics: Consultancy; Incyte: Consultancy; MEI Pharma: Consultancy; Karyopharm: Consultancy; Kite pharma: Consultancy; Celgene: Consultancy; Gilead sciences: Consultancy; Pharmacyclics: Consultancy. Anderson: Celgene, BMS, Janssen, GSK, Karyopharm, Oncopeptides, Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Madanat: Blue Print Pharmaceutical: Honoraria; Stem line pharmaceutical: Honoraria; Onc Live: Honoraria; Geron Pharmaceutical: Consultancy.

Abstract Introduction: Myelodysplastic syndromes (MDS) comprise a group of clonal hematopoietic disorders characterized by ineffective hematopoiesis, cytopenias, dysplasia in ≥ 1 cell line, cytogenetic and molecular abnormalities, and variable risk of progression to acute myeloid leukemia. Treatment goals for MDS classified as lower-risk (LR-MDS) include transfusion independence, improvement in hemoglobin (Hb) levels, and maintenance of or improvement in quality of life. Erythropoiesis-stimulating agents (ESAs) are the first-line (1L) treatment for anemia in most patients with LR-MDS lacking del(5q), but a proportion of patients do not respond to ESA treatment, or experience progression of anemia despite ESA treatment. The objective of this real-world analysis was to describe patient characteristics, treatment patterns (including ESA use), and outcomes in patients with LR-MDS. Methods: A retrospective, observational, US multisite, cohort study was conducted among adult patients initially diagnosed with LR-MDS between January 1, 2017 and June 25, 2020. Eligible patients had ≥ 1 year of follow-up after diagnosis (unless the patient died during this time) and did not receive luspatercept or any MDS treatment as part of a randomized, controlled trial. Community oncologists abstracted data from medical records, and descriptive statistics were used to summarize patient characteristics, treatment patterns, and outcomes. Data presented are from an interim analysis of an ongoing study; the last date of data collection for this analysis was July 6, 2021. Results: Among 125 eligible patients with LR-MDS, median follow-up time was 16 months, and 83% of patients were still alive at the time of data collection. In the 8 weeks prior to diagnosis, 54% of patients did not receive any red blood cell (RBC) or platelet transfusions, while 42% and 4% had low or moderate transfusion burden, respectively. Overall, 75% of patients were negative for del(5q), and 80% of patients were negative for ring sideroblasts (RS). At diagnosis of LR-MDS, serum erythropoietin levels were &lt; 200 U/L in 49% of patients, ≥ 200 U/L in 25%, and unknown in 26%. In terms of disease management, 35% of patients did not receive any systemic therapy or transfusions, 14% received RBC and/or platelet transfusions, but no systemic therapy for MDS, and 50% were reported to have received ≤ 2 lines of systemic therapy following LR-MDS diagnosis (Table). Of the 42% of patients who received an ESA, 70% received an ESA for MDS as a single agent (SA) only, 15% as combination therapy only, and 8% as both SA and combination therapy. A further 8% received SA ESA followed by a non-ESA-based regimen. Among 45 patients who received SA ESA as 1L treatment, 18% went on to receive a hypomethylating agent (HMA) or immunomodulatory imide drug as an SA, or ESA combined with HMA or a granulocyte or granulocyte-macrophage colony-stimulating factor (G-CSF/GM-CSF) in a subsequent line. Among patients who received an ESA, 72% were still on ESA-based therapy at the time of data collection. Abstracting physicians reported that 17% of patients who received an ESA failed ESA treatment. Among these patients, physicians' determination of ESA failure was based on the National Comprehensive Cancer Network guidelines/International Working Group 2006 response criteria for 78% of patients, and on physicians' own clinical judgement for 22%. At data collection, ESA was still being administered to 22% of patients considered to have failed ESA treatment. Finally, 34% of those who received an ESA also received RBC transfusion(s) during ESA-based treatment and therefore were not transfusion independent for the entire duration of ESA-based treatment (Table). Conclusions: Results from this real-world cohort study indicate that over a third of patients with LR-MDS have been managed using watchful waiting only, with no systemic treatment or transfusions received; among those patients who received treatment, most received an ESA. Nearly one-fifth of patients in this study treated with an ESA were considered to have failed ESA treatment by abstracting physicians, though this proportion is likely to be higher with extended follow-up; 2 of 9 patients who failed ESA treatment were still receiving an ESA. Further research including longer follow-up is warranted to understand how patients with LR-MDS respond to different treatment regimens. Figure 1 Figure 1. Disclosures Zimmerman Savill: Cardinal Health: Current Employment; Roche/Genentech: Ended employment in the past 24 months. Gajra: Cardinal Health: Current Employment, Current equity holder in publicly-traded company. Price: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Kish: Cardinal Health: Current Employment, Current equity holder in publicly-traded company, Research Funding. Brown-Bickerstaff: Cardinal Health: Current Employment. Falkenstein: Cardinal Health: Current Employment. Miller: Cardinal Health: Current Employment. Laney: Cardinal Health: Current Employment. Mukherjee: Acceleron: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research/Independent Contractor, Research Funding; McGraw Hill: Honoraria, Other: Editor of Hematology Oncology Board Review (ongoing); Celgene Corporation: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Research/Independent Contractor, Research Funding; AbbVie: Membership on an entity's Board of Directors or advisory committees; Genentech: Membership on an entity's Board of Directors or advisory committees; AAMDS in Joint Partnership with Cleveland Clinic Taussig Cancer Institute: Honoraria; Eusa Pharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Teaching and Speaking; Jazz Pharmaceuticals: Research Funding; Bristol-Myers Squibb Co.: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; BioPharm: Consultancy; Partnership for Health Analytic Research: Honoraria; Blueprint Medicines: Membership on an entity's Board of Directors or advisory committees.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. Available at: https://covid19.who.int/ [Accessed on 23 August 2020] Sim K, Chua HC. The psychological impact of SARS: a matter of heart and mind. CMAJ. 2004; 170:811e2. https://doi.org/10.1503/cmaj.1032003. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54:302e11. https://doi.org/10.1177/070674370905400504. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912e20. https://doi.org/10.1016/S0140-6736(20)30460-8. Robertson E, Hershenfield K, Grace SL, Stewart DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. Can J Psychiatr. 2004; 49:403e7. https://doi.org/10.1177/070674370404900612. Barbisch D, Koenig KL, Shih FY. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015; 9:547e53. https://doi.org/10.1017/dmp.2015.38. Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiol Health. 2016;38: e2016048. https://doi.org/10.4178/epih.e2016048. Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatr. 2012; 53:15e23. https://doi.org/10.1016/j.comppsych.2011.02.003 Chadda RK, Deb KS. Indian family systems, collectivistic society and psychotherapy. Indian J Psychiatry. 2013;55: S299‑ https://dx.doi.org/10.4103%2F0019-5545.105555. Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID‑19 lockdown: An online survey from India. Indian J Psychiatry. 2020; 62:354-62. https://doi.org/ 10.4103/psychiatry.IndianJPsychiatry _427_20. Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010; 40: 218–27. https://dx.doi.org/10.1007%2Fs12160-010-9210-8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-6736(20)30211-7. Bhandari S, Sharma R, Singh Shaktawat A, Banerjee S, Patel B, Tak A, et al. COVID-19 related mortality profile at a tertiary care centre: a descriptive study. Scr Med. 2020;51(2):69-73. https://doi.org/10.5937/scriptamed51-27126. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117: 497–529. https://doi.org/10.1037/0033-2909.117.3.497. Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160(8):805-11. https://doi.org/10.1001/archpedi.160.8.805. Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135(8):854-64. https://doi.org/10.1093/oxfordjournals.aje.a116381. Luo Y, Hawkley LC, Waite LJ, Cacioppo JT. Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med. 2012 Mar; 74(6):907-14. https://dx.doi.org/10.1016%2Fj.socscimed.2011.11.028. Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14-year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33(10):1189-95. https://doi.org/10.1016/0277-9536(91)90235-5. Patterson AC, Veenstra G. Loneliness and risk of mortality: a longitudinal investigation in Alameda County, California. Soc Sci Med. 2010; 71(1):181-6. https://doi.org/10.1016/j.socscimed.2010.03.024. Savikko N, Routassalo P, Tilvis RS, Strandberg TE, Pitkalla KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatrics. 2005; 41:3;223-33. https://doi.org/10.1016/j.archger.2005.03.002. Health Advisory for Elderly Population of India during COVID19. Available at: https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 13 August 2020]. Dicks D, Myers R, Kling A. Uncus and amygdala lesions: effects on social behavior in the free-ranging rhesus monkey. Science. 1969; 165:69–71. https://doi.org/10.1126/science.165.3888.69. Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain structure links loneliness to social perception. Curr Biol. 2012; 22(20):1975-9. https://dx.doi.org/10.1016%2Fj.cub.2012.08.045. Bender AR, Daugherty A, Raz N. Vascular risk moderates associations between hippocampal subfield volumes and memory. J Cogn Neurosci. 2013; 25:1851–62. https://doi.org/10.1162/jocn_a_00435. Raz N. Diabetes: brain, mind, insulin–what is normal and do we need to know? Nat Rev Endocrinol. 2011; 7:636–7. https://doi.org/10.1038/nrendo.2011.149. Colcombe SJ, Erickson KI, Naftali R, Andrew GW, Cohen NJ, McAuley E, et al. Aerobic fitness reduces brain tissue loss in aging humans. J Gerontol A Biol Sci Med Sci. 2003; 58:176–80. https://doi.org/10.1093/gerona/58.2.m176. Maass A, Düzel S, Goerke M, Becke A, Sobieray U, Neumann K, et al. Vascular hippocampal plasticity after aerobic exercise in older adults. Mol Psychiatry. 2015; 20, 585–93. https://doi.org/10.1038/mp.2014.114. Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and Risk of Alzheimer Disease. Arch Gen Psychiatry. 2007;64(2):234–240. https://doi.org/10.1001/archpsyc.64.2.234. Kogan JH, Frankland PW, Silva AJ. Long-term memory underlying hippocampus-dependent social recognition in mice. Hippocampus. 2000;10(1):47-56. https://doi.org/10.1002/(sici)1098-1063(2000)10:1%3C47::aid-hipo5%3E3.0.co;2-6. Yorgason JT, España RA, Konstantopoulos JK, Weiner JL, Jones SR. Enduring increases in anxiety-like behavior and rapid nucleus accumbens dopamine signaling in socially isolated rats. Eur J Neurosci. 2013;37(6):1022-31. https://doi.org/10.1111/ejn.12113. Bledsoe AC, Oliver KM, Scholl JL, Forster GL. Anxiety states induced by post-weaning social isolation are mediated by CRF receptors in the dorsal raphe nucleus. Brain Res Bull. 2011;85(3-4):117-22. https://dx.doi.org/10.1016%2Fj.brainresbull.2011.03.003. Lukkes JL, Engelman GH, Zelin NS, Hale MW, Lowry CA. Post-weaning social isolation of female rats, anxiety-related behavior, and serotonergic systems. Brain Res. 2012; 1443:1-17. https://dx.doi.org/10.1016%2Fj.brainres.2012.01.005. Ago Y, Araki R, Tanaka T, Sasaga A, Nishiyama S, Takuma K, et al. Role of social encounter-induced activation of prefrontal serotonergic systems in the abnormal behaviors of isolation-reared mice. Neuropsychopharmacology. 2013; 38(8):1535-47. https://doi.org/10.1038/npp.2013.52. Veenema AH. Early life stress, the development of aggression and neuroendocrine and neurobiological correlates: what can we learn from animal models? Front Neuroendocrinol. 2009;30(4):497-518. https://doi.org/10.1016/j.yfrne.2009.03.003. Zhao X, Sun L, Jia H, Meng Q, Wu S, Li N, et al. Isolation rearing induces social and emotional function abnormalities and alters glutamate and neurodevelopment-related gene expression in rats. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33(7):1173-1177. https://doi.org/10.1016/j.pnpbp.2009.06.016. Sciolino NR, Bortolato M, Eisenstein SA, Fu J, Oveisi F, Hohmann AG, et al. Social isolation and chronic handling alter endocannabinoid signaling and behavioral reactivity to context in adult rats. Neuroscience. 2010;168(2):371-86. https://dx.doi.org/10.1016%2Fj.neuroscience.2010.04.007. Ghasemi M, Phillips C, Trillo L, De Miguel Z, Das D, Salehi A. The role of NMDA receptors in the pathophysiology and treatment of mood disorders. Neurosci Biobehav Rev. 2014; 47:336-358. https://doi.org/10.1016/j.neubiorev.2014.08.017. Olivenza R, Moro MA, Lizasoain I, Lorenzo P, Fernández AP, Rodrigo J, et al. Chronic stress induces the expression of inducible nitric oxide synthase in rat brain cortex. J Neurochem. 2000;74(2):785-791. https://doi.org/10.1046/j.1471-4159.2000.740785.x. Maeng S, Zarate CA Jr, Du J, Schloesser RJ, McCammon J, Chen G, et al. Cellular mechanisms underlying the antidepressant effects of ketamine: role of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors. Biol Psychiatry. 2008;63(4):349-352. https://doi.org/10.1016/j.biopsych.2007.05.028. Kalia LV, Kalia SK, Salter MW. NMDA receptors in clinical neurology: excitatory times ahead. Lancet Neurol. 2008;7(8):742-755. https://dx.doi.org/10.1016%2FS1474-4422(08)70165-0. Waxman EA, Lynch DR. N-methyl-D-aspartate Receptor Subtypes: Multiple Roles in Excitotoxicity and Neurological Disease. The Neuroscientist. 2005; 11(1), 37–49. https://doi.org/10.1177/1073858404269012. Hermes G, Li N, Duman C, Duman R. Post-weaning chronic social isolation produces profound behavioral dysregulation with decreases in prefrontal cortex synaptic-associated protein expression in female rats. Physiol Behav. 2011;104(2):354-9. https://dx.doi.org/10.1016%2Fj.physbeh.2010.12.019. Sestito RS, Trindade LB, de Souza RG, Kerbauy LN, Iyomasa MM, Rosa ML. Effect of isolation rearing on the expression of AMPA glutamate receptors in the hippocampal formation. J Psychopharmacol. 2011;25(12):1720-1729. https://doi.org/10.1177/0269881110385595. Toua C, Brand L, Möller M, Emsley RA, Harvey BH. The effects of sub-chronic clozapine and haloperidol administration on isolation rearing induced changes in frontal cortical N-methyl-D-aspartate and D1 receptor binding in rats. Neuroscience. 2010;165(2):492-499. https://doi.org/10.1016/j.neuroscience.2009.10.039. Alò R, Avolio E, Mele M, Storino F, Canonaco A, Carelli A et al. Excitatory/inhibitory equilibrium of the central amygdala nucleus gates anti-depressive and anxiolytic states in the hamster. Pharmacol Biochem Behav. 2014; 118:79-86. https://doi.org/10.1016/j.pbb.2014.01.007. St JP, Petkov VV. Changes in 5-HT1 receptors in different brain structures of rats with isolation syndrome. General pharmacology. 1990;21(2):223-5. https://doi.org/10.1016/0306-3623(90)90905-2. Miachon S, Rochet T, Mathian B, Barbagli B, Claustrat B. Long-term isolation of Wistar rats alters brain monoamine turnover, blood corticosterone, and ACTH. Brain Res Bull. 1993;32(6):611-614. https://doi.org/10.1016/0361-9230(93)90162-5. Van den Berg CL, Van Ree JM, Spruijt BM, Kitchen I. Effects of juvenile isolation and morphine treatment on social interactions and opioid receptors in adult rats: behavioural and autoradiographic studies. Eur J Neurosci. 1999;11(9):3023-3032. https://doi.org/10.1046/j.1460-9568.1999.00717.x. Vanderschuren LJ, Stein EA, Wiegant VM, Van Ree JM. Social play alters regional brain opioid receptor binding in juvenile rats. Brain Res. 1995;680(1-2):148-156. https://doi.org/10.1016/0006-8993(95)00256-p. Moles A, Kieffer BL, D'Amato FR. Deficit in attachment behavior in mice lacking the mu-opioid receptor gene. Science. 2004;304(5679):1983-1986. https://doi.org/10.1126/science.1095943. Panksepp J, Herman BH, Vilberg T, Bishop P, DeEskinazi FG. Endogenous opioids and social behavior. Neurosci Biobehav Rev. 1980;4(4):473-487. https://doi.org/10.1016/0149-7634(80)90036-6. Gong JP, Onaivi ES, Ishiguro H, Liu Q, Tagliaferro PA, Brusco A, et al. Cannabinoid CB2 receptors: immunohistochemical localization in rat brain. Brain Res. 2006;1071(1):10-23. https://doi.org/10.1016/j.brainres.2005.11.035. Breivogel CS, Sim-Selley LJ. Basic neuroanatomy and neuropharmacology of cannabinoids. Int Rev Psychiatry 2009; 21:2:113-121. https://doi.org/10.1080/09540260902782760. Haj-Mirzaian A, Amini-Khoei H, Haj-Mirzaian A, Amiri S, Ghesmati M, Zahir M, et al. Activation of cannabinoid receptors elicits antidepressant-like effects in a mouse model of social isolation stress. Brain Res Bull. 2017; 130:200-210. https://doi.org/10.1016/j.brainresbull.2017.01.018. Banach M, Piskorska B, Czuczwar SJ, Borowicz KK. Nitric Oxide, Epileptic Seizures, and Action of Antiepileptic Drugs. CNS & Neurological Disorders - Drug Targets 2011;10: 808. https://doi.org/10.2174/187152711798072347. Förstermann U, Sessa WC. Nitric oxide synthases: regulation and function. Eur Heart J. 2012;33(7):829-37, 837a-837d. https://dx.doi.org/10.1093%2Feurheartj%2Fehr304. Hu Y, Wu D, Luo C, Zhu L, Zhang J, Wu H, et al. Hippocampal nitric oxide contributes to sex difference in affective behaviors. PNAS. 2012, 109 (35) 14224-14229. https://doi.org/10.1073/pnas.1207461109. Khan MI, Ostadhadi S, Zolfaghari S, Mehr SE, Hassanzadeh G, Dehpour, A et al. The involvement of NMDA receptor/NO/cGMP pathway in the antidepressant like effects of baclofen in mouse force swimming test. Neuroscience Letters. 2016; 612:52-61. https://doi.org/10.1016/j.neulet.2015.12.006. Matsumoto K, Puia G, Dong E, Pinna G. GABAA receptor neurotransmission dysfunction in a mouse model of social isolation-induced stress: Possible insights into a non-serotonergic mechanism of action of SSRIs in mood and anxiety disorders. Stress. 2007; 10:1:3-12. https://doi.org/10.1080/10253890701200997. Zlatković J, Filipović D. Chronic social isolation induces NF-κB activation and upregulation of iNOS protein expression in rat prefrontal cortex. Neurochem Int. 2013;63(3):172-179. https://doi.org/10.1016/j.neuint.2013.06.002. Haj-Mirzaian A, Amiri S, Kordjazy N, Momeny M, Razmi A, Balaei MR, et al. Lithium attenuated the depressant and anxiogenic effect of juvenile social stress through mitigating the negative impact of interlukin-1β and nitric oxide on hypothalamic-pituitary-adrenal axis function. Neuroscience. 2016; 315:271-285. https://doi.org/10.1016/j.neuroscience.2015.12.024. Larson HJ. The biggest pandemic risk? Viral misinformation. Nature 2018; 562:309. https://doi.org/10.1038/d41586-018-07034-4. Zarocostas J. How to fight an infodemic. Lancet 2020; 395:676. https://doi.org/10.1016/S0140-6736(20)30461-X. World Health Organization, 2019. Ebola Virus Disease – Democratic Republic of the Congo. Geneva, Switzerland: WHO. Available at: https://www.who.int/csr/don/28-november-2019-ebola-drc/en/ [Accessed on August 8, 2020] Times of India. Covid-19: doctors gone to collect samples attacked in Indore. Available at: https://timesofindia.indiatimes.com/videos/news/covid-19-doctors-goneto- collect-samples-attacked-in-indore/videoshow/74942153.cms; 2020 [Accessed on August 8, 2020]. Withnall A. Coronavirus: why India has had to pass new law against attacks on healthcare workers. The Independent. April 23, 2020. Semple K. “Afraid to be a nurse”: health workers under attack. The New York Times. 2020 Apr 27. The Economist. Health workers become unexpected targets during COVID-19. The Economist. May 11, 2020. Turan B, Budhwani H, Fazeli PL, Browning WR, Raper JL, Mugavero MJ, et al. How does stigma affect people living with HIV? The mediating roles of internalized and anticipated HIV stigma in the effects of perceived community stigma on health and psychosocial outcomes. AIDS Behav. 2017; 21: 283–291. https://doi.org/10.1007/s10461-016-1451-5. James PB, Wardle J, Steel A, Adams J. An assessment of Ebola-related stigma and its association with informal healthcare utilisation among Ebola survivors in Sierra Leone: a cross sectional study. BMC Public Health. 2020; 20: 182. https://doi.org/10.1186/s12889-020-8279-7. Aljazeera, 2020. Iran: Over 700 Dead after Drinking Alcohol to Cure Coronavirus. Aljazeera. Available at: https://www.aljazeera.com/ news/2020/04/iran-700-dead-drinking-alcohol-cure-coronavirus200427163529629.html. (Accessed June 4, 2020) Delirrad M, Mohammadi AB, 2020. New methanol poisoning outbreaks in Iran following COVID-19 pandemic. Alcohol Alcohol. 55: 347–348. https://doi.org/10.1093/alcalc/agaa036. Hassanian-Moghaddam H, Zamani N, Kolahi A-A, McDonald R, Hovda KE. Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran-a cross-sectional assessment. Crit Care. 2020; 24: 402. https://doi.org/10.1186/s13054-020-03140-w. Soltaninejad K. Methanol Mass Poisoning Outbreak: A Consequence of COVID-19 Pandemic and Misleading Messages on Social Media. Int J Occup Environ Med. 2020;11(3):148-150. https://dx.doi.org/10.34172%2Fijoem.2020.1983. Islam MS, Sarkar T, Khan SH, Kamal AM, Hasan SMM, Kabir A, et al. COVID-19–Related Infodemic and Its Impact on Public Health: A Global Social Media Analysis. Am J Trop Med Hyg. 2020; 00(0):1–9. https://doi.org/10.4269/ajtmh.20-0812. Hawryluck L, Gold W, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206–1212. https://dx.doi.org/10.3201%2Feid1007.030703. Lee S, Chan LYY, Chau AAM, Kwok KPS, Kleinman A. The experience of SARS-related stigma at Amoy Gardens. Soc Sci Med. 2005; 61(9): 2038-2046. https://doi.org/10.1016/j.socscimed.2005.04.010. Yoon MK Kim SY Ko HS Lee MS. System effectiveness of detection, brief intervention and refer to treatment for the people with post-traumatic emotional distress by MERS: a case report of community-based proactive intervention in South Korea. Int J Ment Health Syst. 2016; 10: 51. https://doi.org/10.1186/s13033-016-0083-5. Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect. 2008; 136: 997-1007. https://dx.doi.org/10.1017%2FS0950268807009156. Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: an online questionnaire survey. Int J Nurs Stud. 2007; 44(6): 991-998. https://doi.org/10.1016/j.ijnurstu.2006.02.012. Bai Y, Lin C-C, Lin C-Y, Chen J-Y, Chue C-M, Chou P. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr Serv. 2004; 55: 1055-1057. https://doi.org/10.1176/appi.ps.55.9.1055. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforHomeIsolationofverymildpresymptomaticCOVID19cases10May2020.pdf [Accessed on 25 August 2020]. Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/AdvisoryformanagingHealthcareworkersworkinginCOVIDandNonCOVIDareasofthehospital.pdf (Accessed on 25 August 2020). Ministry of Health and Family Welfare. Available at: https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf [Accessed on 25 August 2020]. Cost of the lockdown? Over 10% of GDP loss for 18 states. Available at: https://timesofindia.indiatimes.com/india/cost-of-the-lockdown-over-10-of-gdp-loss-for-18-states/articleshow/76028826.cms [Accessed on 21 August 2020]. Jorda O, Singh SR, Taylor AM. Longer-Run Economic Consequences of Pandemics. Federal Reserve Bank of San Francisco Working Paper. 2020-09. https://doi.org/10.24148/wp2020-09. Firdaus G. Mental well‑being of migrants in urban center of India: Analyzing the role of social environment. Indian J Psychiatry. 2017; 59:164‑ https://doi.org/10.4103/psychiatry.indianjpsychiatry_272_15. National Crime Record Bureau. Annual Crime in India Report. New Delhi, India: Ministry of Home Affairs; 2018. 198 migrant workers killed in road accidents during lockdown: Report. Available at: https://www.hindustantimes.com/india-news/198-migrant-workers-killed-in-road-accidents-during-lockdown-report/story-hTWzAWMYn0kyycKw1dyKqL.html [Accessed on 25 August 2020]. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20:689-96. https://doi.org/10.1016/S1473-3099(20)30198-5. Dalton L, Rapa E, Stein A. Protecting the psychological health of through effective communication about COVID-19. Lancet Child Adolesc Health. 2020;4(5):346-347. https://doi.org/10.1016/S2352-4642(20)30097-3. Centre for Disease Control. Helping Children Cope with Emergencies. Available at: https://www.cdc.gov/childrenindisasters/helping-children-cope.html [Accessed on 25 August 2020]. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child & Adolesc Health. 2020; 4(5):347-349. https://doi.org/10.1016/S2352-4642(20)30096-1. Sprang G, Silman M. Posttraumatic Stress Disorder in Parents and Youth After Health-Related Disasters. Disaster Med Public Health Prep. 2013;7(1):105-110. https://doi.org/10.1017/dmp.2013.22. Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, Anxiety and Stress Among Indians in Times of Covid-19 Lockdown. Community Ment Health J. 2020:1-7. https://doi.org/10.1007/s10597-020-00664-x. Cao W, Fang Z, Hou, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934. Wang C, Zhao H. The Impact of COVID-19 on Anxiety in Chinese University Students. Front Psychol. 2020; 11:1168. https://dx.doi.org/10.3389%2Ffpsyg.2020.01168. Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry 2020;7(3): e14. https://doi.org/10.1016/s2215-0366(20)30047-x. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020;3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976. Lancee WJ, Maunder RG, Goldbloom DS, Coauthors for the Impact of SARS Study. Prevalence of psychiatric disorders among Toronto hospital workers one to two years after the SARS outbreak. Psychiatr Serv. 2008;59(1):91-95. https://dx.doi.org/10.1176%2Fps.2008.59.1.91. Tam CWC, Pang EPF, Lam LCW, Chiu HFK. Severe acute respiratory syndrome (SARS) in Hongkong in 2003: Stress and psychological impact among frontline healthcare workers. Psychol Med. 2004;34 (7):1197-1204. https://doi.org/10.1017/s0033291704002247. Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003. Koh D, Meng KL, Chia SE, Ko SM, Qian F, Ng V, et al. Risk perception and impact of severe acute respiratory syndrome (SARS) on work and personal lives of healthcare workers in Singapore: What can we learn? Med Care. 2005;43(7):676-682. https://doi.org/10.1097/01.mlr.0000167181.36730.cc. Verma S, Mythily S, Chan YH, Deslypere JP, Teo EK, Chong SA. Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore. Ann Acad Med Singap. 2004; 33(6):743e8. Yeung J, Gupta S. Doctors evicted from their homes in India as fear spreads amid coronavirus lockdown. CNN World. 2020. Available at: https://edition.cnn.com/2020/03/25/asia/india-coronavirus-doctors-discrimination-intl-hnk/index.html. [Accessed on 24 August 2020] Violence Against Women and Girls: the Shadow Pandemic. UN Women. 2020. May 3, 2020. Available at: https://www.unwomen.org/en/news/stories/2020/4/statement-ed-phumzile-violence-against-women-during-pandemic. [Accessed on 24 August 2020]. Gearhart S, Patron MP, Hammond TA, Goldberg DW, Klein A, Horney JA. The impact of natural disasters on domestic violence: an analysis of reports of simple assault in Florida (1999–2007). Violence Gend. 2018;5(2):87–92. https://doi.org/10.1089/vio.2017.0077. Sahoo S, Rani S, Parveen S, Pal Singh A, Mehra A, Chakrabarti S, et al. Self-harm and COVID-19 pandemic: An emerging concern – A report of 2 cases from India. Asian J Psychiatr 2020; 51:102104. https://dx.doi.org/10.1016%2Fj.ajp.2020.102104. Ghosh A, Khitiz MT, Pandiyan S, Roub F, Grover S. Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? Indian J Psychiatry 2020; [In Press]. The Economic Times. 11 Coronavirus suspects flee from a hospital in Maharashtra. March 16 2020. Available at: https://economictimes.indiatimes.com/news/politics-and-nation/11-coronavirus-suspects-flee-from-a-hospital-in-maharashtra/videoshow/74644936.cms?from=mdr. [Accessed on 23 August 2020]. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 2020;(3):228–229. https://doi.org/10.1016/S2215-0366(20)30046-8. Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma A, Muana A, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210–214. https://dx.doi.org/10.2471%2FBLT.15.158543. Kumar A, Nayar KR. COVID 19 and its mental health consequences. Journal of Mental Health. 2020; ahead of print:1-2. https://doi.org/10.1080/09638237.2020.1757052. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020; 62(4):370-8. https://doi.org/10.4103/psychiatry.indianjpsychiatry_523_20. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4): P300-302. https://doi.org/10.1016/S2215-0366(20)30073-0. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020; 14(5): 779–788. https://dx.doi.org/10.1016%2Fj.dsx.2020.05.035. Wright R. The world's largest coronavirus lockdown is having a dramatic impact on pollution in India. CNN World; 2020. Available at: https://edition.cnn.com/2020/03/31/asia/coronavirus-lockdown-impact-pollution-india-intl-hnk/index.html. [Accessed on 23 August 2020] Foster O. ‘Lockdown made me Realise What’s Important’: Meet the Families Reconnecting Remotely. The Guardian; 2020. Available at: https://www.theguardian.com/keep-connected/2020/apr/23/lockdown-made-me-realise-whats-important-meet-the-families-reconnecting-remotely. (Accessed on 23 August 2020) Bilefsky D, Yeginsu C. Of ‘Covidivorces’ and ‘Coronababies’: Life During a Lockdown. N. Y. Times; 2020. Available at: https://www.nytimes.com/2020/03/27/world/coronavirus-lockdown-relationships.html [Accessed on 23 August 2020]

BackgroundColorectal cancer (CRC) presents a significant public health burden, responsible for the second most cancer-related deaths in the United States, with an increasing incidence in young adults observed globally.1,2 While the blockade of immune checkpoints received FDA approval as a CRC therapeutic, only patients with microsatellite instability, accounting for 15% of sporadic cases, demonstrate partial or complete responses.3 We present a third-generation chimeric antigen receptor (CAR)-T cell directed towards the extracellular domain of the mucosal antigen guanylyl cyclase C (GUCY2C), which is over-expressed in 80% of CRC cases, as a therapeutic alternative for late stage disease. Here, we demonstrate that human GUCY2C CAR-T cells can selectively kill GUCY2C-expressing colorectal cancer cells in vitro and produce inflammatory cytokines in response to antigenic stimulation.MethodsPeripheral blood mononuclear (PBMCs) cells were isolated from leukoreduction filters obtained from the Thomas Jefferson University Hospital Blood Donor Center (IRB #18D.495). Magnetic Activated Cell Sorting (MACS) technology was used to negatively select pan-T cells (Miltenyi Biotec), followed by activation and expansion using anti-CD3, anti-CD28, and anti-CD2 coated microbeads (Miltenyi Biotec) and supplemented with IL-7 and IL-15 (Biological Resources Branch Preclinical Biologics Repository – NCI). T-cells were transduced with a lentiviral vector encoding the anti-GUCY2C CAR. Our CAR utilizes a single chain variable fragment of human origin directed towards the extracellular domain of GUCY2C, the CD28 hinge, transmembrane, and intracellular signaling domain (ICD), 4-1BB (CD137) ICD, and CD3ζ ICD. CAR-T cells were used for experiments between 10 to 14 days after activation in vitro using the xCELLigence real time cytotoxicity assay and intracellular cytokine staining.ResultsGUCY2C-directed CAR-T cells specifically lysed the GUCY2C-expressing metastatic CRC cell line T84, while the control CAR did not. GUCY2C-negative CRC cells were not killed by either. In addition to cell killing, GUCY2C-directed CAR-T cells of both the CD8+ and CD4+ co-receptor lineage produced the inflammatory cytokines IFN-γ and TNFα in response to GUCY2C antigen.ConclusionsWe demonstrate that human GUCY2C-directed CAR-T cells can selectively target GUCY2C-expressing cancer cells. We hypothesize that GUCY2C-directed CAR-T cells present a viable therapeutic option for metastatic CRC. In vivo animal models to examine this potential are currently on-going.AcknowledgementsThis work was supported by the Department of Defense Congressionally Directed Medical Research Programs (W81XWH-17-1-0299, W81XWH-191-0263, and W81XWH-19-1-0067) to AES and Targeted Diagnostic & Therapeutics to SAW. AES is also supported by a DeGregorio Family Foundation Award. SAW is supported by the National Institutes of Health (NIH) (R01 CA204881, R01 CA206026, and P30 CA56036), and the Department of Defense Congressionally Directed Medical Research Program W81XWH-17-PRCRP-TTSA. SAW and AES were also supported by a grant from The Courtney Ann Diacont Memorial Foundation. SAW is the Samuel M.V. Hamilton Professor of Thomas Jefferson University. JS, EC, and AZ were supported by an NIH institutional award T32 GM008562 for Postdoctoral Training in Clinical Pharmacology.Ethics ApprovalThis study was approved by the Thomas Jefferson University Institutional Review Board (IRB Control #18D.495) and the Institutional Animal Care and Use Committee (Protocol #01529).ReferencesSiegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin2020;70: 7–30. doi:10.3322/caac.21590Araghi M, Soerjomataram I, Bardot A, Ferlay J, Cabasag CJ, Morrison DS, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol 2019;4: 511–518. doi:10.1016/S2468-1253(19)30147-5Overman MJ, McDermott R, Leach JL, Lonardi S, Lenz H-J, Morse MA, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study. Lancet Oncol 2017;18: 1182–1191. doi:10.1016/S1470-2045(17)30422-9

Background: The COVID-19 pandemic has various unfavorable effects on individuals and the community. This study aims to assess the psychological impact of the COVID-19 epidemic and the subsequent social isolation on the general population of Karnataka, India. Methods: A web-based cross-sectional survey was conducted in Karnataka from 8 to 14 April 2020 using the snowball technique. The psychological impact was assessed with the help of the nine-item Patient Health Questionnaire-9 (PHQ-9) and seven-item General Anxiety Disorder-7 (GAD-7) questionnaires. IBM SPSS Statistics Subscription version 16.0 was recruited to analyze the data. Descriptive (Mean + Standard Deviation) and bivariate (Pearson chi-square and ANOVA tests) analysis used to present data with the significance level set at less than 0.05. Results: This study included 1537 participants from 26 cities in Karnataka. About two-thirds of the respondents were undergraduate students (951, 61.9%), females (768, 50.0%), and 40.1% stayed about 15-20 days in social isolation. The prevalence of depression was 47.0%, and anxiety was 41.5%, respectively, among the surveyed sample. After the analysis, the age group 21-30 year old (P < 0.001), females P < 0.001), urban residents (P = 0.021), and the students (P p < 0.001) were significant for depression. However, only the age group 31-40 years was found to be more susceptible to anxiety. Conclusion: As important as addressing the psychological effects, knowing people at risk of developing mental illnesses will contribute effectively to providing appropriate psychological rehabilitation programs at the right time. References World Health Organization, Novel Coronavirus (2019-nCoV) Situation Report –1, 21 January 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf, [Accessed on 30 August 2020]. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health. 2020 Mar 6;17(5):1729. https://doi.org/10.3390/ijerph17051729. World Health Organization, WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 [Accessed on 13 April 2020] Coronavirus in India: Latest Map and Case Count. Available from: https://www.covid19india.org/ [Accessed 13 April 2020]. Arakal RA. First COVID-19 case in Karnataka: Techie who returned to Bengaluru from US tests positive, (9 March2020). Available from: https://indianexpress.com/article/cities/bangalore/coronavirus-karnataka-first-case-covid-19-bengaluru-6307223/ [Accessed on 13 April 2020] India Today on 24 March 2020. Modi announces lockdown Updates: No panic buying please. Stay indoors, tweets PM. Available from: https://www.indiatoday.in/india/story/pm-modi-address-the-nation-at-8-pm-today-speech-covid-19-coronavirus-live-updates-1659215-2020-03-24 [Accessed on 13 April 2020] Ali Jadoo SA. Was the world ready to face a crisis like COVID-19? Journal of Ideas in Health2020;3(1):123-4. https://doi.org/10.47108/jidhealth.Vol3.Iss1.45 Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013;110(15):5797-5801. https://doi.org/10.1073/pnas.1219686110 Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020; 287:112934. https://doi.org/10.1016/j.psychres.2020.112934 Taylor HO, Taylor RJ, Nguyen AW, Chatters L. Social Isolation, Depression, and Psychological Distress Among Older Adults. Journal of Aging and Health2018; 30(2): 229–246. https://doi.org/10.1177/0898264316673511 Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195-202. https://doi.org/10.1016/j.jpsychores.2009.04.004 Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr. 2020; 51:102083. https://doi.org/10.1016/j.ajp.2020.102083. Karnataka Population. Available from: http://www.populationu.com/in/karnataka-population [Accessed on 8 April 2020] Sample Size Calculator: Understanding Sample Sizes. Available from: https://www.surveymonkey.com/mp/sample-size-calculator/ [Accessed on 5 March 2020] Toussaint A, Hüsing P, Gumz A, Wingenfeld K, Härter M, Schramm E, Löwe B. Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). J Affect Disord. 2020; 265:395–401. https://doi.org/10.1016/j.jad.2020.01.032 Williams N. The GAD-7 Questionnaire [Review of the test Generalized anxiety disorder (gad-7) Questionnaire, by R. L. Spitzer]. Occupational Medicine2014; 64(3): 224. https://doi.org/10.1093/occmed/kqt161 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606. Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219-221. https://doi.org/10.1503/jpn.150205 Patten SB, Wang JL, Williams JV, Wang JL, McDonald K, Bulloch ACM. Descriptive epidemiology of major depression in Canada. Can J Psychiatry. 2006; 51:84–90. https://doi.org/10.1177/070674371506000106 Jones C. Student anxiety, depression increasing during school closures, survey finds. EdSorce, 13 May 2020. Available from: https://edsource.org/2020/student-anxiety-depression-increasing-during-school-closures-survey-finds/631224 [Accessed on 29 August 2020]. Frasquilho D, Matos MG, Salonna F, Guerreiro D, Storti CC, Gaspar T, Caldas-de-Almeida JM. Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health2015; 16:115. https://doi.org/10.1186/s12889-016-2720-y. Ali Jadoo SA. COVID -19 pandemic is a worldwide typical Biopsychosocial crisis. Journal of Ideas in Health2020;3(2):152-4. https://doi.org/10.47108/jidhealth.Vol3.Iss2.58 Prabhu N. Bengaluru urban tops state in per capita income, Kalaburagi last, (20 March 2016). Available from: https://www.thehindu.com/news/cities/bangalore/bengaluru-urban-tops-state-in-per-capita-income-kalaburagi-last/article8376124.ece [Accessed 13 April 2020].

The Covid-19 pandemic had a dangerous impact on early-childhood education, lost learning in almost all aspects of child development. The house-to-house learning, with the name Moving Home Learning Program (MHLP), is an attractive offer as an emergency remote teaching solution. This study aims to describe the application of MHLP designed by early-childhood education institutions during the learning process at home. This study used a qualitative approach with data collection using interviews, observation, and documentation. The respondents involved in the interview were a kindergarten principal and four teachers. The research data were analyzed using the data content analysis. The Findings show that the MHLP has proven to be sufficiently in line with the learning needs of early childhood during the Covid-19 pandemic. Although, the application of the MHLP learning model has limitations such as the distance from the house that is far away, the number of meetings that are only once a week, the number of food and toy sellers passing by, disturbing children's concentration, and the risk of damage to goods at home. The implication of this research can be the basis for evaluating MHLP as an adaptive strategy that requires the attention of related parties, including policy makers, school principals, and teachers for the development of new, more effective online learning models. Keywords: Moving Home Learning Program (MHLP), Children Remote Teaching References:Abdollahi, E., Haworth-Brockman, M., Keynan, Y., Langley, M. J., & Oghadas, S. M. (2020). Simulating the effect of school closure during COVID-19 outbreaks in Ontario , Canada. BMC Medicine, 1–8. https://doi.org/https://doi.org/10.1186/s12916-020-01705-8 Arends, R. I., & Kilcher, A. (2010). Teaching for Student Learning: Becoming an Accomplished Teacher (1st ed.). Routledge. Arysandhi, K. N., & Meitriana, M. A. (2014). Studi Komparatif Motivasi Belajar Siswa pada Mata Pelajaran IPS antara Moving Class dengan Kelas Menetap di SMPN 1 Kerambitan dan SMPN 2 Tabanan Tahun Pelajaran 2013/2014. Ekuitas-Jurnal Pendidikan Ekonomi, 2(1), 30–39. Bawa, P. (2020). Learning in the age of SARS-COV-2 : A quantitative study of learners ’ performance in the age of emergency remote teaching. Computers and Education Open, 1(October), 100016. https://doi.org/10.1016/j.caeo.2020.100016 Bialek, S., Gierke, R., Hughes, M., McNamara, L., Pilishvili, T., & Skoff, T. (2020). Morbidity and mortality weekly report (mmwr) - Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. Morbidity and Mortality Weekly Report, 69, 2–6. https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf. Boardman, M. (2003). Changing Times: Changing Challenges for Early Childhood Leaders. Australasian Journal of Early Childhood, 28(2), 20–26. https://doi.org/10.1177/183693910302800205 Bronfenbrenner, U. (1979). The ecology of human development (1st ed.). Harvard University Press. Chen, Y. T. (2020). An investigation of young children’s science and aesthetic learning through a science aesthetic thematic curriculum: A mixed-methods study. Australasian Journal of Early Childhood, 45(2), 127–141. https://doi.org/10.1177/1836939120918503 Choi, N., & Jung, H. (2020). Temperament and Home Environment Characteristics as Predictors of Young Children ’ s Learning Motivation. Early Childhood Education Journal, 1994. https://doi.org/10.1007/s10643-020-01019-7 Counselman, K. P., & Jones, E. (2001). Distance learning in early childhood teacher education: The experience of Pacific Oaks College. Journal of Early Childhood Teacher Education, 22(4), 225–230. https://doi.org/10.1080/1090102010220402 Daniel, S. J. (2020). Education and the COVID-19 pandemic. PROSPECTS, 6. https://doi.org/10.1007/s11125-020-09464-3 Dick, W., Carey, L., & Carey, J. O. (2015). The Systematic Design of Instruction (8th ed.). Pearson. Diningrat, S. W. M., Nindya, M. A., & Salwa. (2020). Cakrawala Pendidikan ,. Cakrawala Pendidikan, 39(3), 705–719. https://doi.org/10.21831/cp.v39i3.32304 Dong, C., Cao, S., & Li, H. (2020). Young children’s online learning during COVID-19 pandemic: Chinese parents’ beliefs and attitudes. Children and Youth Services Review, 118(June), 105440. https://doi.org/10.1016/j.childyouth.2020.105440 Dong, Y., Dong, Y., Mo, X., Hu, Y., Qi, X., Jiang, F., Jiang, Z., Jiang, Z., Tong, S., Tong, S., & Tong, S. (2020). Epidemiology of COVID-19 among children in China. Pediatrics, 145(6). https://doi.org/10.1542/peds.2020-0702 Eliza, D. (2013). Penerapan Model Pembelajaran Kontekstual Learning (CTL) Berbasis Centra di Taman Kanak-Kanak. Pedagogi: Jurnal Ilmiah Ilmu Pendidikan, XIII(2), 93–106. Fadlilah, azizah nurul. (2021). Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini Strategi Menghidupkan Motivasi Belajar Anak Usia Dini Selama Pandemi COVID-19 melalui Publikasi Abstrak. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(1), 373–384. https://doi.org/10.31004/obsesi.v5i1.548 Fenech, M. (2013). Quality early childhood education for my child or for all children?: Parents as activists for equitable, high-quality early childhood education in Australia. Australian Journal of Early Childhood, 38(4), 92–98. https://doi.org/10.1177/183693911303800413 Gibson, M. (2013). “I want to educate school-age children”: Producing early childhood teacher professional identities. Contemporary Issues in Early Childhood, 14(2), 127–137. https://doi.org/10.2304/ciec.2013.14.2.127 Hamzah, N. (2016). Pelaksanaan Pembelajaran BCCT Bagi Anak Usia Dini ; Study Pelaksanaan BCCT Di Tk Islam Mujahidin Pontianak. At-Turats: Jurnal Pemikiran Pendidikan Islama, 10(2), 119–131. Hasan, M. S., & Saputri, D. E. (2020). Pembelajaran PAI Berbasis Moving Class di SMP Negeri 1 Gudo Jombang. Attaqwa: Jurnal Ilmu Pendidikan Islam, 16(September), 113–125. Hew, K. F., Jia, C., Gonda, D. E., & Bai, S. (2020). Transitioning to the “new normal” of learning in unpredictable times: pedagogical practices and learning performance in fully online flipped classrooms. International Journal of Educational Technology in Higher Education, 17(1). https://doi.org/10.1186/s41239-020-00234-x Hodges, C. B., Moore, S., Lockee, B., Trust, T., & Bond, A. (2020). The Difference Between Emergency Remote Teaching and Online Learning. Educase Review. Hussein, E., Daoud, S., Alrabaiah, H., & Badawi, R. (2020). Children and Youth Services Review Exploring undergraduate students ’ attitudes towards emergency online learning during COVID-19 : A case from the UAE. Children and Youth Services Review, 1–7. https://doi.org/10.1016/j.childyouth.2020.105699 Işıkoğlu, N., Ero, A., Atan, A., & Aytekin, S. (2021). A qualitative case study about overuse of digital play at home. Current Psychology. https://doi.org/https://doi.org/10.1007/s12144-021-01442-y A Kilgallon, P., Maloney, C., & Lock, G. (2008). Early childhood teachers coping with educational change. Australian Journal of Early Childhood, 33(1), 23–29. https://doi.org/10.1177/183693910803300105 Kim, J. (2020). Learning and Teaching Online During Covid ‑ 19 : Experiences of Student Teachers in an Early Childhood Education Practicum. International Journal of Early Childhood, 52(2), 145–158. https://doi.org/10.1007/s13158-020-00272-6 Kurniati, E., Kusumanita, D., Alfaeni, N., & Andriani, F. (2021). Analisis Peran Orang Tua dalam Mendampingi Anak di Masa Abstrak. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(1), 241–256. https://doi.org/10.31004/obsesi.v5i1.541 Lopes, H., & Mckay, V. (2020). pandemics : The COVID ‑ 19 experience. International Review of Education, 0123456789. https://doi.org/10.1007/s11159-020-09843-0 Macartney, K., Quinn, H. E., Pillsbury, A. J., Koirala, A., Deng, L., Winkler, N., Katelaris, A. L., & Sullivan, M. V. N. O. (2020). Articles Transmission of SARS-CoV-2 in Australian educational settings : a prospective cohort study. Lancet Child Adolesc Health 2020, 4642(20), 1–10. https://doi.org/10.1016/S2352-4642(20)30251-0 Marina, Indrawati, H., & Suarman. (2019). Application of Moving Class Learning Models and Teacher Pedagogical Competence on Learning Motivation and Student Learning Discipline. Journal of Educational Sciences, 3(1), 72–83. https://doi.org/doi.org/10.31258/jes.3.1.p.72-83 McLean, K., Edwards, S., & Mantilla, A. (2020). A review of community playgroup participation. Australasian Journal of Early Childhood, 45(2), 155–169. https://doi.org/10.1177/1836939120918484 Muhdi, Nurkolis, & Yuliejantiningsih, Y. (2020). The Implementation of Online Learning in Early Childhood Education During the Covid-19 Pandemic. Jurnal Pendidikan Usia Dini, 14(2), 248–261. https://doi.org/https://doi.org/10.21009/JPUD.142.04 Panovska-griffiths, J., Kerr, C. C., Stuart, R. M., Mistry, D., Klein, D. J., Viner, R. M., & Bonell, C. (2020). Articles Determining the optimal strategy for reopening schools , the impact of test and trace interventions , and the risk of occurrence of a second COVID-19 epidemic wave in the UK : a modelling study. The Lancet Child and Adolescent Health, 4642(20), 1–11. https://doi.org/10.1016/S2352-4642(20)30250-9 Piquero, A. R., Riddell, J. R., Bishopp, S. A., Narvey, C., Reid, J. A., & Piquero, N. L. (2020). Staying Home , Staying Safe ? A Short-Term Analysis of COVID-19 on Dallas Domestic Violence. American Journal of Criminal Justice, 601–635. https://doi.org/https://doi.org/10.1007/s12103-020-09531-7 Pramling, I., Judith, S., Elin, T. W., & Ødegaard, E. (2020). The Coronavirus Pandemic and Lessons Learned in Preschools in Norway , Sweden and the United States : OMEP Policy Forum. International Journal of Early Childhood, 0123456789. https://doi.org/10.1007/s13158-020-00267-3 Pribadi, H., & Harjati, P. (2013). Analisis Pembelajaran Fisika dalam Sistem Moving Class di SMP Negeri 1 Pekalongan Lampung Timur Tahun Pelajaran 2012/2013. JPF, 32–41. Project Tommorow & Blackboard. (2017). Trends in Digital Learning: Building teachers’ capacity and competency to create new learning experiences for students. https://tomorrow.org/speakup/speak-up-2016-trends-digital-learning-june-2017.html Rahiem, M. D. H. (2020). The Emergency Remote Learning Experience of University Students in Indonesia amidst the COVID-19 Crisis. International Journal of Learning, Teaching and Educational Research, 19(6), 1–26. http://orcid.org/0000-0002-5618-2486%0AAbstract. Ramdhani, M. T. (2016). Model Pelaksanaan Pembelajaran Pendidikan Agama Islam dengan Sistem Moving Class dalam Meningkatkan Motivasi dan Prestasi Belajar Siswa SMP IT Sahabat Alam. Anterior Jurnal, 15(2), 212–221. Reigeluth, C. M., Beatty, B. J., & Myers, R. D. (2017). Instructional-Design Theories and Models (R. D. Myers (Ed.); IV). Routledge. Sangsawang, T. (2020). Indonesian Journal of Science & Technology An Instructional Design for Online Learning in Vocational Education according to a Self-Regulated Learning Framework for Problem Solving during the CoViD-19 Crisis. 5. Schmerse, D., Anders, Y., Wieduwilt, N., & Tietze, W. (2018). Differential effects of home and preschool learning environments on early language development. British Educational Research Journal, 44(2), 338–357. https://doi.org/10.1002/berj.3332 Schreier, M. (2013). Qualitative Content Analysis (First Edit). SAGE Publications. Shisley, S. (2020). Emergency Remote Learning Compared to Online Learning. Learning Solution. https://learningsolutionsmag.com/articles/emergency-remote-learning-compared-to-online-learning Son, S., & Morrison, F. J. (2010). The Nature and Impact of Changes in Home Learning Environment on Development of Language and Academic Skills in Preschool Children. 46(5), 1103–1118. https://doi.org/10.1037/a0020065 Stephen, C., Ellis, J., & Martlew, J. (2010). Taking active learning into the primary school: A matter of new practices? International Journal of Early Years Education, 18(4), 315–329. https://doi.org/10.1080/09669760.2010.531916 Sudrajat, C. J., Agustin, M., Kurniati, L., & Karsa, D. (2021). Strategi Kepala TK dalam Meningkatkan Mutu Pendidikan pada Masa Pandemi Covid 19 Abstrak. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(1), 508–520. https://doi.org/10.31004/obsesi.v5i1.582 Sumindar, A., & Wahyu, L. (2012). Model Pembelajaran Moving Class Mata Pelajaran Seni Budaya dan Implikasinya terhadap Kemandirian Siswa (Kajian Kasus) di SMA Karangturi Semarang. Catharsis: Journal of Arts Education, 1(2), 21. Supriatna, R., Hafidhuddin, D., & Syafri, U. A. (2018). Model Pembelajaran Beyond Center and Circle Time (BCCT) Berbasis Q.S Lukman Ayat 12-19. Tawazun: Jurnal Pendidikan Islam, 11(2), 1–11. Syarah, E. S. (2020). Understanding Teacher ’ s Perspectives in Media Literacy Education as an Empowerment Instrument of Blended Learning in Early Childhood Classroom. Jurnal Pendidikan Usia Dini, 14(2), 202–214. https://doi.org/https://doi.org/10.21009/JPUD.142.01 Tang, Y., & Hew, K. F. (2020). Does mobile instant messaging facilitate social presence in online communication? A two-stage study of higher education students. International Journal of Educational Technology in Higher Education, 17(1). https://doi.org/10.1186/s41239-020-00188-0 Thompson, M. (2019). Early Childhood Pedagogy in a Socio ‑ cultural Medley in Ghana : Case Studies in Kindergarten. International Journal of Early Childhood, 51(2), 177–192. https://doi.org/10.1007/s13158-019-00242-7 Togher, M., & Fenech, M. (2020). Ongoing quality improvement in the context of the National Quality Framework: Exploring the perspectives of educators in ‘Working Towards’ services. Australasian Journal of Early Childhood, 45(3), 241–253. https://doi.org/10.1177/1836939120936003 UNESCO. (2020). UNESCO’s support: Educational response to COVID-19. Unesco. https://en.unesco.org/covid19/educationresponse/support Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological Processes. Harvard University Press. Wiresti, R. D. (2021). Analisis Dampak Work From Home pada Anak Usia Dini di Masa Pandemi Covid-19. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 5(1), 641–653. https://doi.org/10.31004/obsesi.v5i1.563 Wiwatowski, M., Page, J., & Young, S. (2020). Examining early childhood teachers’ attitudes and responses to superhero play. Australasian Journal of Early Childhood, 45(2), 170–182. https://doi.org/10.1177/1836939120918486 Yin, R. K. (2018). Case Study Research and Applications Design and Methods (Eliza Wells (Ed.); Sixth Edit). SAGE Publications. Yoshikawa, H., Wuermli, A. J., Britto, P. R., Dreyer, B., Leckman, J. F., Lye, S. J., Ponguta, L. A., Richter, L. M., & Stein, A. (2020). Effects of the Global Coronavirus Disease-2019 Pandemic on Early Childhood Development: Short- and Long-Term Risks and Mitigating Program and Policy Actions. The Journal of Pediatrics, 223(1), 188–193. https://doi.org/10.1016/j.jpeds.2020.05.020 Zhu, X., & Liu, J. (2020). Education in and After Covid-19 : Immediate Responses and Long-Term Visions. Postdigital Science and Education. https://doi.org/https://doi.org/10.1007/s42438-020-00126-3

Self-regulation in children is an important thing that needs to be prepared from an early age. Besides affecting children's school readiness, this also makes it easier for children to have good academic achievements. This study aims to determine the influence of moving to the beat of early childhood self-regulation. This research was conducted on kindergarten group B students in East Jakarta. The research method used is a quasi-experiment method with a sample of 20 students. The data collection technique uses observations by analysing paired t-test statistical data. The results of the study explained that there was a significant effect of moving to the beat of early childhood self-regulation. The significance level is 0.000 < 0.05, which means that H0 is rejected and H1 is accepted, this indicates a significant difference between the pre-test and post-test. For further research, it is recommended to look at the influence of other factors on early childhood self-regulation. Keywords: Beats, Early childhood, Moving, Self-Regulation References: Baltazar, M., Västfjäll, D., Asutay, E., Koppel, L., & Saarikallio, S. (2019). Is it me or the music? Stress reduction and the role of regulation strategies and music. Music & Science, 2, 205920431984416. https://doi.org/10.1177/2059204319844161 Blair, C., & Raver, C. C. (2012). Individual development and evolution: Experiential canalization of self-regulation. Developmental Psychology, 48(3), 647–657. https://doi.org/10.1037/a0026472 Blair, C., & Raver, C. C. (2015). School Readiness and Psychobiological Approach. August 2014, 1–21. https://doi.org/10.1146/annurev-psych-010814-015221 Blair, C., & Razza, R. P. (2007). Relating Effortful Control, Executive Function, and False Belief Understand... Child Development, 78(2), 647–663. https://doi.org/10.2307/4139250 Booth, A., O’Farrelly, C., Hennessy, E., & Doyle, O. (2019). ‘Be good, know the rules’: Children’s perspectives on starting school and self-regulation. Childhood, 26(4), 509–524. https://doi.org/10.1177/0907568219840397 Cadima, J., Verschueren, K., Leal, T., & Guedes, C. (2016). Classroom Interactions, Dyadic Teacher–Child Relationships, and Self–Regulation in Socially Disadvantaged Young Children. Journal of Abnormal Child Psychology, 44(1), 7–17. https://doi.org/10.1007/s10802-015-0060-5 Charissi, V., & Rinta, T. (2014). Children’s musical and social behaviours in the context of music-making activities supported by digital tools: examples from a pilot study in the UK. Journal of Music, Technology and Education, 7(1), XXXXX. https://doi.org/10.1386/jmte.7.1.39_1 Dalla Bella, S., Berkowska, M., & Sowiński, J. (2015). Moving to the Beat and Singing are Linked in Humans. Frontiers in Human Neuroscience, 9(December), 1–13. https://doi.org/10.3389/fnhum.2015.00663 Danielsen, A., Haugen, M. R., & Jensenius, A. R. (2015). Moving to the Beat: Studying Entrainment to Micro-Rhythmic Changes in Pulse by Motion Capture. 0315. Diamond, A. (2013). Functions, Executive. Annual Reviews Psychology, 29(146), 13–15. https://doi.org/10.1146/annurev-psych-113011-143750 Diamond, A. (2016). Why improving and assessing executive functions early in life is critical. In Executive function in preschool-age children: Integrating measurement, neurodevelopment, and translational research. (pp. 11–43). American Psychological Association. https://doi.org/10.1037/14797-002 Duckworth, A. L., Quinn, P. D., & Tsukayama, E. (2012). What No Child Left Behind Leaves Behind: The Roles of IQ and Self-Control in Predicting Standardized Achievement Test Scores and Report Card Grades. Journal Education Psycology, 104(2), 439–451. https://doi.org/10.1037/a0026280.What Edossa, A. K., Schroeders, U., Weinert, S., & Artelt, C. (2018). The development of emotional and behavioral self-regulation and their effects on academic achievement in childhood. International Journal of Behavioral Development, 42(2), 192–202. https://doi.org/10.1177/0165025416687412 Eunhye, H., Cynthia, K. B., & Jeon, L. (2015). The Association Between Teachers’ Child-Centered Beliefs and Children’s Academic Achievement: The Indirect Effect of Children’s Behavioral Self-regulation. Developmental Psychology, 44, 309–325. https://doi.org/DOI 10.1007/s10566-014-9283-9 Flook, L., Smalley, S. L., Kitil, M. J., Galla, B. M., Kaiser-Greenland, S., Locke, J., Ishijima, E., & Kasari, C. (2010). Effects of mindful awareness practices on executive functions in elementary school children. Journal of Applied School Psychology, 26(1), 70–95. https://doi.org/10.1080/15377900903379125 Fujii, S., & Schlaug, G. (2013). The Harvard Beat Assessment Test (H-BAT): a battery for assessing beat perception and production and their dissociation. Frontiers in Human Neuroscience, 7(November), 1–16. https://doi.org/10.3389/fnhum.2013.00771 Gammage, P. (2019). Early childhood education and care in context. In Early Years Education and Care. https://doi.org/10.4324/9781315768700-2 George, E. M., & Coch, D. (2011). Music training and working memory: An ERP study. Neuropsychologia, 49(5), 1083–1094. https://doi.org/10.1016/j.neuropsychologia.2011.02.001 Hallam, S. (2010). The power of music : Its impact on the intellectual , social and personal development of children and young people. https://doi.org/10.1177/0255761410370658 Howes, C., Burchinal, M., Pianta, R., Bryant, D., Early, D., Clifford, R., & Barbarin, O. (2008). Ready to learn? Children’s pre-academic achievement in pre-Kindergarten programs. Early Childhood Research Quarterly, 23(1), 27–50. https://doi.org/10.1016/j.ecresq.2007.05.002 Jacobson-Chernoff, J., Flanagan, K. D., McPhee, C., & Park, J. (2007). Preschool: First findings from the preschool follow-up of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). In National Center for Education Statistics. NCES Publication No. 2008-025. Lobo, Y. B., & Winsler, A. (2006). The effects of a creative dance and movement program on the social competence of head start preschoolers. Social Development, 15(3), 501–519. https://doi.org/10.1111/j.1467-9507.2006.00353.x Marsden, E., & Torgerson, C. J. (2012). Article in Oxford Review of Education ·. May 2016. https://doi.org/10.2307/41702779 McClelland, M. M., & Cameron, C. E. (2012). Self-Regulation Early Childhood: Improving Conceptual Clarity and Developing Ecologically Valid Measures. Child Development Perspectives, 6(2), 136–142. https://doi.org/10.1111/j.1750-8606.2011.00191.x OCDE. (2013). Education at a Glance 2013. https://doi.org/10.1787/gov_glance-2011-en Pianta, R., Howes, C., Burchinal, M., Bryant, D., Clifford, R., Early, D., & Barbarin, O. (2005). Features of Pre-Kindergarten Programs, Classrooms, and Teachers: Do They Predict Observed Classroom Quality and Child-Teacher Interactions? Applied Developmental Science, 9(3), 144–159. https://doi.org/10.1207/s1532480xads0903_2 Ponitz, C. C., McClelland, M. M., Matthews, J. S., & Morrison, F. J. (2009). A Structured Observation of Behavioral Self-Regulation and Its Contribution to Kindergarten Outcomes. Developmental Psychology, 45(3), 605–619. https://doi.org/10.1037/a0015365 Putkinen, V., Tervaniemi, M., & Huotilainen, M. (2013). Informal musical activities are linked to auditory discrimination and attention in 2-3-year-old children: an event-related potential study. European Journal of Neuroscience, 37(4), 654–661. https://doi.org/10.1111/ejn.12049 Putkinen, Vesa, Tervaniemi, M., Saarikivi, K., & Huotilainen, M. (2015). Promises of formal and informal musical activities in advancing neurocognitive development throughout childhood. Annals of the New York Academy of Sciences, 1337(1), 153–162. https://doi.org/10.1111/nyas.12656 Salisch, M. Von, Haenel, M., & Denham, S. A. (2015). Early Education and Development Self-Regulation , Language Skills , and Emotion Knowledge in Young Children From Northern Germany. July 2015. https://doi.org/10.1080/10409289.2015.994465 Schibli, K., Van Roon, P., MacDougall, K., & D’Angiulli, A. (2015). Practicing self-regulation through music: An ERP study comparing child musicians and nonmusicians. International Journal of Developmental Neuroscience, 47(2015), 97. https://doi.org/10.1016/j.ijdevneu.2015.04.265 Thomason, A. C., & La Paro, K. M. (2009). Measuring the Quality of Teacher–Child Interactions in Toddler Child Care. Early Education and Development, 20(2), 285–304. https://doi.org/10.1080/10409280902773351 Varela, W., & Abrami, P. C. (2014). Self-regulation and music learning : A systematic review. https://doi.org/10.1177/0305735614554639 Wiebe, S. A., Espy, K. A., & Charak, D. (2008). Using Confirmatory Factor Analysis to Understand Executive Control in Preschool Children: I. Latent Structure. Developmental Psychology, 44(2), 575–587. https://doi.org/10.1037/0012-1649.44.2.575 Williams, K. E. (2018). Moving to the Beat: Using Music, Rhythm, and Movement to Enhance Self-Regulation in Early Childhood Classrooms. International Journal of Early Childhood, 50(1), 85–100. https://doi.org/10.1007/s13158-018-0215-y Williams, K. E., Barrett, M. S., Welch, G. F., Abad, V., & Broughton, M. (2015a). Associations between early shared music activities in the home and later child outcomes: Findings from the Longitudinal Study of Australian Children. Early Childhood Research Quarterly, 31, 113–124. https://doi.org/10.1016/j.ecresq.2015.01.004 Williams, K. E., Barrett, M. S., Welch, G. F., Abad, V., & Broughton, M. (2015b). Associations between early shared music activities in the home and later child outcomes: Findings from the Longitudinal Study of Australian Children. Early Childhood Research Quarterly, 31, 113–124. https://doi.org/10.1016/j.ecresq.2015.01.004 Williams, K. E., & Berthelsen, D. (2019). Implementation of a rhythm and movement intervention to support self-regulation skills of preschool-aged children in disadvantaged communities. Psychology of Music, 47(6), 800–820. https://doi.org/10.1177/0305735619861433 Williford, A. P., Whittaker, J. E. V., Virginia, E., Downer, J. T., Williford, A. P., Whittaker, J. E. V., & Vitiello, V. E. (2013). Early Education and Development Children ’ s Engagement Within the Preschool Classroom and Their Development of Self-Regulation Children ’ s Engagement Within the Preschool Classroom and Their Development of Self-Regulation. Early Education and Development, 24, 162–187. https://doi.org/10.1080/10409289.2011.628270 Zachariou, A., & Whitebread, D. (2016). Musical play and self-regulation : does musical play allow for the emergence of self-regulatory behaviours ? 4937(February). https://doi.org/10.1080/21594937.2015.1060572 Zimmerman, B. J. (2010). Self-Regulated Learning and Academic Achievement: An Overview. Educational Psychologist, 25(1), 3–17. https://doi.org/10.1207/s15326985ep2501