The Global Burden of Disease (GBD) project provides a long-term, comprehensive, and comparable picture of what disables and kills people across countries, time, age, and sex . The GBDThe main goal of the GBD project is to provide comprehensive data on disease burden to support evidence-based decision-making and policies at local, regional, national, and global levels. Insights at the national and sub-national levels can be gained from the GBD estimates if provided with sufficient detail. For Brazil, considering the plurality of the society and its diversity across the regions of the country, obtaining sufficiently fine-grained burden estimates is challenging but needed.Recognizing this challenge, the GBD Brazil Network was created in 2014 as a collaboration among the Brazilian Ministry of Health, a network of Universities, Research Institutes and Health Departments, led by the Universidade Federal de Minas Gerais (UFMG), and the Institute for Health Metrics and Evaluation (IHME) of the University of Washington, which leads the global project [The GBD Brazil Network conducted several initiatives, both in academia and in health services, to discuss Brazilian health issues and to disseminate tools and metrics developed by the GBD project. These capacity-building and dissemination activities involved face-to-face training and postgraduate courses, lectures, media releases, scientific workshops, and regular meetings of a scientific committee, with participation of researchers from several different Brazilian Institutions and ad hoc participation of researchers from the IHME. A web course in the Portuguese language on GBD methods is being developed to be launched later in 2020.Brazilian Journal of Epidemiology [Population Health Metrics aims to further discuss and disseminate findings on the burden of disease in Brazil to the international academic and scientific community.Regarding the scientific production using GBD estimates, the GBD Brazil Network produced analysis that have resulted in the publication of two capstone papers , 4. In 2In the current supplement, we used the GBD tools and metrics developed by to explore different health conditions and specific populations in Brazil and its federative units, from 1990 to 2017. These studies describe patterns and trends, as well as knowledge gaps and point to possibilities for improving the models and estimates used by the GBD study.The publication covers the life cycle of the Brazilian population, including an evaluation of inequalities in infant mortality and the burden of disease among older people. An emphasis was given to studies on chronic noncommunicable diseases, considering the recent epidemiological transition and including analyses on overall mortality from chronic diseases, and the disease burden of diabetes, hypertension, and breast cancer. Given the triple burden of disease, which continues to challenge the Brazilian health system, communicable diseases were not forgotten, with articles on tuberculosis and malaria. Violence by firearms, one of the main causes of death in the country, is also covered. There is also a comprehensive discussion on the impact of an integrated approach to risk factors for chronic noncommunicable diseases .The GBD Brazil network is continuously discussing with IHME, researchers, and analysts the accuracy and reliability of the estimates, and it also monitors data quality in the country. An article on vital statistics data and another on the quality of death certificate completion calls attention to the advances and challenges concerning vital statistics in Brazil. Finally, the article on health-related “Sustainable Development Goals (SDGs)” analyzes the indicators and trends of 41 health-related SDG indicators in Brazil and its States and covers regional inequalities, aiming to leave no one behind.Sistema Único de Saúde) and its expansion in the last three decades has allowed Brazil to rapidly address the changing population health needs, with dramatic upscaling of health service coverage. However, the situation has deteriorated in the last 4 years of economic crisis and political instability, especially due to the reduction of investments and expenditures in health. Indeed, fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all [Inequality and inequity have been hallmarks of Brazilian society; access to health care and basic sanitary services varies according to the socio-economical position, race/skin color, and region. The creation, 30 years ago, of the Brazilian Unified Health System (SUS—from Portuguese  for all . At presMaintaining and expanding the GBD Brazil Network will assure that the impact of these changes is estimated and the burden estimates remain available for Brazil to guide decisions and health policies in the future. The GBD Brazil Network intends to use GBD data to provide decision-makers at the local, regional, and national levels with the best and most up-to-date evidence on trends and drivers of population health to support decisions and health policy. Providing sound scientific evidence for local managers is challenging due to data gaps, high variability, and the low quality of data from small municipalities. The importance of using models and assumptions for small numbers must be considered as well.Independent groups of researchers are vital in the analysis of country data, reflecting on current and future challenges, tracing trends, and analyzing the living and health conditions of the Brazilian population, from different perspectives. We are aware of the heterogeneity of the quantity and quality of secondary data among the different health conditions we address. Further research is needed, and we advocate for more resources, in Brazil, not only for health care, but also for research. Knowing the health status pattern and its trends in the last decades allows us to take a critical look at progress and what limits it in addressing disease burden. Improved health policies and a strengthened SUS are needed to build a fairer and more equitable society.


Dear Editor,Necrobiosis lipoidica (NL) is a chronic idiopathic disease, of a granulomatous nature, which affects the dermis. The lesions are characterized by brownish-yellow plaques, and the most common location is the pre-tibial region. It more often affects females 3:1) and appears, in general, from the third decade of life onwards. There is an association with diabetes mellitus (DM), and microangiopathy is considered an etiopathogenic factor for the condition. Ulceration is a common complication, while reports of the onset of squamous cell carcinoma (SCC) in NL lesions are rare. and appe5A 62-year-old female patient presented an ulcerated, hyperkeratotic lesion in the NL area, on the right leg, about three months prior, with no history of local trauma. She had been diagnosed with NL in the pre-tibial region of both legs ten years before, with no history of recurrent ulceration. The patient had controlled systemic arterial hypertension and type 2 DM. She used oral hypoglycemic agents, with good control in the last years, and did not present retinopathy or diabetic nephropathy. At the physical examination, the patient presented atrophic bilateral plaques on the pre-tibial region and, on her right leg, a small hyperkeratotic ulcerated plaque over a NL lesion . The anaNL is a chronic degenerative disease of the dermal connective tissue characterized clinically by yellowish plaques with a narrow granulomatous border, central atrophy, and a tendency to ulceration, most commonly affecting the pre-tibial region of the lower limbs. It is more frequently observed in diabetic patients and, unlike in the reported, most patients also present microvascular complications related to DM, such as nephropathy and retinopathy.The etiology and pathogenesis of NL are uncertain; it is believed that external trauma, primary vascular disorders, and microangiopathy can contribute to its development, regardless of the presence of DM.The onset of SCC in areas of ulceration and scarring is well documented in a variety of skin diseases. Ulceration is the main complication of NL, observed in a quarter of patients with this disease. However, despite presenting a chronic course and a tendency to ulceration, the onset of SCC in NL lesions has been seldom reported. It is not clear whether the transformation to SCC is the result of chronic ulceration or of long-standing changes in NL. Risk factors that may be involved in malignant transformation include loss of melanin, which facilitates the lesion, chronic inflammation, and hypoxia.5th case reported in the international literature.5Metastases have been described in the literature, and may be related to delayed diagnosis .The onset of SCC on a NL lesion is very rare. This possibility should be considered in patients with NL with chronic ulcers, as well as in new lesions in patients with NL. Early detection and treatment of SCC associated with NL is of fundamental importance to allow conservative surgical treatment and the best possible clinical outcome.None declared.Maria Emília Vieira de Souza: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.Julia Kanaan Recuero: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.Manoella Freitas Santos: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; critical review of the literature; critical review of the manuscript.Renan Rangel Bonamigo: Approval of the final version of the manuscript, conception and planning of the study, elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of studied cases; critical review of the literature; critical review of the manuscript.None declared.


Background and Objective: Currently, climate change represents an existential, physical, and psychological threat. Therefore, mitigation and adaptation actions and measures have become increasingly necessary to preserve individual and collective well-being. The psychological distance is one of the main psychological constructs that explains the most concrete or abstract perception of the objects and events surrounding people. The psychological distance is a multidimensional construct, and in accordance with the construal level theory (CLT), temporal, hypothetical, spatial, and social distance are considered the most critical dimensions. This systematic review aims to provide an update of the literature on the role of psychological distance in the commitment to engagement mitigation and adaptation attitudes toward climate change.Method: The review was carried out following PRISMA guidelines and a systematic search was performed on PubMed, Psycinfo, Web of Science, Cochrane, and Scopus databases.Results: Nineteen articles have been identified as being eligible for the final synthesis. Results showed, in general, that individuals have a higher propensity to perform pro-environmental and resilient behaviors against climate change when it is perceived as more proximal and concrete within the construct of psychological distance. However, not all studies show this result. Some studies showed that, despite people considering climate changes as real and tangible, they do not perform mitigation and adaptation behaviors. Other studies showed that people implement these behaviors despite perceiving climate changes as distal and abstract.Conclusions: The current literature shows the existence of a relation among psychological distance and pro-environmental and resilient behaviors applied to climate change. For a deeper understanding of the conflicting results that emerged, more studies are necessary to explore the possible presence of further psychological variables involved in the relation within psychological distance, mitigation, and adaptation in environmental contexts. The theory of the Construal Level explains that there is a relation among the psychological distance and response of people to a specific event , personal capabilities , contextual factors , and habit and routine Stern, . HoweverThe psychological distance can explain the commitment to engage pro-environmental and resilient behaviors and, consequently, a more significant engagement of mitigation and adaptation attitudes toward climate change. Perception, from a personal stance is essential because individuals are more probable to behave in favor of the environment, and/or respond resiliently to changes in the surrounding environment, when they perceive the problem of climate change as a difficulty that can have direct consequences for themselves   and adaptation behaviors to a low psychological distance . For example, the study of Chen  reportedFurthermore, as shown in the analysis of the collected articles, there are several differences in the methodologies used for examining the role of psychological distance and pro-environmental and resilient behaviors. In fact, in the selected studies, different tools and measures were used for both psychological distance dimensions and mitigation and adaptation behaviors. This could explain the conflicting results. Additionally, only a few dimensions of psychological distance were observed in most of the selected studies. Specifically, in 12 studies, only one or two dimensions of psychological distance were measured, as already done in previous studies given the simplest manipulation and the best control of the observed variables  were related to pro-environmental and resilient behaviors. A previous study, which already investigated the constructive level linked to the will to act on climate change  and measured them in relation to psychological distance and pro-environmental and resilient behaviors (Sacchi et al., In conclusion, psychological distance and all its dimensions contributed to the commitment to adopt pro-environmental and resilient behaviors of mitigation and adaptation, respectively. Although, it is an important topic for the psychological and physical well-being of individuals and the well-being of the whole planet, the studies conducted are still limited. This is because the research field has only recently become interested in this topic. The aim of this systematic review is to offer a good scientific starting point for future studies aimed at exploring and deepening the link among psychological distance and mitigation and adaptation behaviors in the hope of encouraging them more and more.All datasets generated for this study are included in the article.DM, RP, LC, ADD, and MV contributed to the conception and project of this review. RM, PL, EP, and ADC conducted the literature search and wrote the first draft of the manuscript. RP, LC, DM, ADD, and MV revised the first draft of the manuscript. All authors participated to the subsequent drafting and rewriting of the manuscript and approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In the everyday life, a large number of pre-hospital emergency missions are including the injurers caused by traumatic events. Meanwhile, the immediate response to the injurers of the mass casualties is of particular importance due to their large number and also the distance to the medical centers. Using of a proper triage scale has a major role in prioritizing the injuries resulted from mass casualty events in order to treat and transfer them to health centers and also in the management of the scene and improving the quality of care of traumatic injuries. Therefore, the purpose of this study is to describe the various methods of triage in the scene, so that we can present a suitable triage scale for prioritizing injuries in mass casualty for pre-hospital emergency.This study is an overview one and is performed by using of databases and library resources and words including triage, pre-hospital emergency, mass casualty, crisis and emergency medical technician.Based on the surveys, a variety of triage methods in the scene were found including Simple triage and rapid treatment (START), Jump start, triage sieve or Major Incident Medical Management and Support (MIMMS), Pediatric Triage Tape (PTT), Move, Assess, Sort, and Send (MASS), Care Flight, Sort, Assess, Lifesaving interventions, and Treatment and/or Transport (SALT), Revised Trauma Score (RTS), Pediatric Trauma score (PTS).In the literature, the use of different triage scales has been recommended in the crisis, the scene of the accident and trauma. By considering the context, structure and dispersion of mass casualty in the country, it isn’t known yet which one of these scales is operational and applicable. Therefore, for the patients in mass casualty, it is suggested that an appropriate and applicable triage scale should be designed for pre-hospital emergency operations.Triage in the scene, Pre-hospital emergency, Mass casualty


The COVID-19 pandemic has significantly affected the elderly and particularly individuals with Alzheimer’s disease and related disorders (ADRD). Behavioral and psychological symptoms of dementia (BPSD) are heterogeneous and common in individuals with ADRD and are associated with more severe illness. However, unlike the cognitive symptoms of ADRD that are usually progressive, BPSD may be treatable. Individuals with BPSD are facing unique challenges during the pandemic due to the inherent nature of the illness and the biological and psychosocial impacts of COVID-19. These challenges include a higher risk of severe COVID-19 infection in individuals with BPSD due to their frailty and medical vulnerability, difficulty participating in screening or testing, and adhering to infection control measures such as physical distancing. Further, biological effects of COVID-19 on the brain and its psychosocial impact such as isolation and disruption in mental health care are likely to worsen BPSD. In this paper, we discuss these challenges and strategies to manage the impact of COVID-19 and to effectively care for individuals with BPSD in community, long-term care, or hospital settings during the pandemic. Despite the ongoing uncertainty associated with this pandemic, we can reduce its impact on individuals with BPSD with a proactive approach. The COVID-19 pandemic has affected the elderly including those with Alzheimer’s disease and related disorders (ADRD), creating numerous challenges to their mental health . BehavioOlder age, medical comorbidities, and other risk factors, such as APOE4 , which aThe recommended treatment approach to BPSD depends on the presenting symptom or the nature of the underlying disorder. However, individualized non-pharmacologic interventions are typically first line, followed by carefully considered pharmacological interventions , 23. FurIn a 4-year retrospective case-control study of an Alzheimer’s Special Care Unit, a higher inherent risk of respiratory infections relative to other units was found . PreviouThere is a need to understand the impact of the current pandemic on individuals with BPSD across various settings from community living to hospital units. Further, there is an urgent need to implement preventive interventions to protect individuals with ADRD from the COVID-19 infection while effectively managing BPSD. In this paper, we discuss unique challenges faced by individuals with BPSD and their caregivers during the COVID-19 pandemic and provide recommendations on how to address these challenges. Our aim is to address these challenges in individuals experiencing significant BPSD across the spectrum of cognitive decline ranging from pre-clinical to dementia, and across different neurodegenerative disorders.i.e. weight loss, exhaustion, weakness, and inactivity) and functional decline and dysregulation of immune and inflammatory mechanisms  in long-term care homes and inpatient units. Caregivers and HCW need to assess for both typical (upper respiratory symptoms and fever) and atypical presentations of COVID-19, including gastrointestinal and neurological symptoms , 45. An e.g. sedative medications in an emergency situation to reduce movement), as well as seclusion, or physical restraints as a last resort. However, these situations require careful examination of ethical, legal, and institutional factors, due to the potential for serious harm   . The comcontact) , 53, 54.contact) . Severalcontact) , 57. Thecontact) , 58. Thecontact) .via neuro-inflammatory mechanisms or vascular mechanisms such as hyper-coagulation   . These fousness)  with neuousness)  and MRI ousness) . In seveousness) , 65 and ousness) , 67. Indousness) . Increasousness) . Howeverousness) .Some individuals who experience worsening of BPSD due to COVID-19 may require additional pharmacological interventions. Many of these individuals are already prescribed multiple psychiatric medications and are likely to experience adverse effects related to polypharmacy , 70. ThiWe expect an increase in all domains of BPSD Figure 1In home environments, family or external caregivers provide support for activities of daily living and management of BPSD. Appointments with physicians and other clinicians may have to be conducted virtually . Thus, fLTCH have been a major focus during this pandemic, given the high morbidity and mortality in these settings , 79. ManAt any given time, a significant number of patients affected by dementia and BPSD are admitted to specialized behavioral units or geriatric inpatient units , 85. TheConsistent staffing is critical to provide effective care to individuals with BPSD because the work demands a high degree of familiarity with the individual. The psychological impact of working in LTCH, hospital, or other institutional settings during a pandemic should be recognized and addressed proactively . There aThe COVID-19 pandemic is disproportionately impacting the elderly including those with BPSD. Individuals with BPSD and their family or professional caregivers are facing unique challenges due to the inherent nature of the illness and superimposed biological and psychosocial factors related to the COVID-19 pandemic. Certain BPSD may lead to a higher risk of infection, a more severe course of illness, and higher mortality rates. These challenges can be addressed with a proactive approach. It is important to implement infection control strategies for individuals with BPSD across settings such as proactive screening and testing, maintaining a high degree of suspicion for atypical presentations of COVID-19, and instituting timely interventions. Individuals with BPSD and COVID-19 should also be monitored for long term biological and psychosocial effects of COVID-19. BPSD need to be managed during the pandemic using evidence-based structured psychosocial and biological interventions through innovative means such as virtual and individualized care, use of structured and algorithmic models of care, and appropriate use of psychosocial interventions across healthcare settings. Individuals with BPSD and their substitute decision makers should be invited to discuss and make decisions regarding goals of care and end of life care. Efforts should be made to address the psychological health of the frontline HCW and informal caregivers as they are paramount to success in caring for BPSD.The original contributions presented in the study are included in the article/supplementary material; further inquiries can be directed to the corresponding author.AK: Substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EB: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. AR: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. TR: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. BP: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and final approval of the version to be published. BM: Substantial contributions to the conception or design of the work; interpretation of data for the work; revising it critically for important intellectual content; and final approval of the version to be published. SK: Substantial contributions to the conception or design of the work and the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors contributed to the article and approved the submitted version.TR: research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute. He also received in-kind equipment support for an investigator-initiated study from Magstim, and in-kind research accounts from Scientific Brain Training Pro. BP: research support from the Peter & Shelagh Godsoe Endowed Chair in Late-Life Mental Health, CAMH Foundation and Discovery Fund, National Institute of Aging, Brain Canada, the Canadian Institutes of Health Research, the Alzheimer’s Drug Discovery Foundation, the Ontario Brain Institute, the Centre for Aging and Brain Health Innovation, the Bright Focus Foundation, the Alzheimer’s Society of Canada, the W. Garfield Weston Foundation, the Weston Brain Institute, the Canadian Consortium on Neurodegeneration in Aging and Genome Canada. Honoraria from the American Geriatrics Society. He holds United States Provisional Patent No.62/466,651 for a cell-based assay and kits for assessing serum anticholinergic activity. BM: research financial support from Brain Canada, CAMH Foundation, Canadian Institutes for Health Research, and US National Institutes of Health; nonfinancial support from Pfizer , Eli Lilly , Capital Solution Design LLC , and HAPPYneuron . He directly owns shares of General Electric . SK: research support from Brain and Behavior Foundation, National institute on Ageing, BrightFocus Foundation, Brain Canada, Canadian Institute of Health Research, Centre for Ageing and Brain Health Innovation, Centre for Addiction and Mental Health, University of Toronto. He also receives equipment support from Soterix Medical.The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This study shows that Berlin and London are likely candidates for future world record attempts, whilst such a performance is unlikely in New York or Boston.The main goal of this study was to analyse the pacing strategies displayed by the winners of the six World Marathon Majors in order to determine which race offers the greatest potential for future world record attempts. For data analysis, the total distance of the marathon was divided into eight sections of 5 km and a final section of 2.195 km, and time needed to complete each section was calculated in seconds. When we analyzed the mean winning time in the last 13 editions of each of the World Marathon Majors, we observed differences between New York and London (ES = 1.46, moderate effect,  The pacing strategy adopted during competition is crucial in determining marathon running performance  succeeded in lowering the previous record by 1 min and 18 s. This performance has increased speculation regarding the possibility of a sub 2 h performance  providing the winners of the official World Marathon Majors for men between 2006 and 2018, which resulted in a sum of 76 winners. Each set of information included at least: the position, category, official final time, half-marathon time, and time data every 5 km.The total distance of the marathon was divided into eight sections of 5 km and one section of 2.195 km, and time needed to complete each section was calculated in seconds. Full marathon average speed and the average speed of each section were calculated individually. The relative speed of each section for every runner was then calculated and presented as a percentage of the average speed for the full race.The athletes were divided into six groups: (A) group of marathon Berlin (winners between 2006 and 2018), (B) group of marathon Boston (winners between 2006 and 2018), (C) group of marathon Chicago (winners between 2006 and 2018), (D) group of marathon London (winners between 2006 and 2018), (E) group of marathon New York , (F) group of marathon Tokyo .The course information were retrieved through the official internet website for each city marathon, on marathon archive websites and from various media outlets.post-hoc comparisons. The magnitude of the differences or effect sizes (ES) were calculated according to Cohen's d  was used to analyze the data. Each data set was screened for normality of distribution and homogeneity of variances using a Shapiro-Wilk normality test and a Levene test, respectively. One-way analysis of variance (ANOVA) was used to compare the mean winning time in the last 13 editions of each of the World Marathon Majors. Two-way analysis of variance (ANOVA) with repeated measures for time was used to compare the pacing strategies between the winners of the six world marathons majors. When differences were found, a Tukey's range test was used for d Cohen,  and inted Cohen, . SignifiWe acknowledge that such a statistical approach has been criticized as it may induce a greater risk of type I error Sainani,  and may p = 0.0030), New York and Berlin , London and Boston , Boston and Berlin , Boston and Chicago , Berlin and Tokyo , Berlin and Chicago .Mean winning time in the last 13 editions of each of the World Marathon Majors are presented in p = 0.0001), London , Tokyo , Boston , and Chicago . On the other hand, London was faster than Chicago .When individual 5 km segments were analyzed, differences were found in running speed relative to the whole race average . In the p = 0.0133), London , Chicago , Boston , and Tokyo .In section 6, New York again differed from other races, as it was faster than Berlin  and Boston , London was slower than New York , and Boston  and New York was faster than Tokyo .In section 8, we found the following differences: Berlin was slower than New York , London , Boston , and Tokyo .In the final 2.2 km section, New York was faster than Berlin .All datasets generated for this study are included in the article/supplementary material.JD participated in the study design, collected all the data and participated in data analysis, statistical analysis, interpretation of the data, and manuscript editing. AR participated in the study design, participated in data analysis, statistical analysis, interpretation of the data, and manuscript editing. EF-O participated in the conception and design of the study and revised/reviewed the manuscript. MT designed and carried out these experiments, participated in data analysis, and statistical analysis. JS-C participated in the coordination of our study participated in data analysis, statistical analysis, interpretation of the data, and helped to polish the manuscript. All authors have read and approved the final version of the manuscript and agreed with the order of presentation of the authors.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Dear Editor,The first case of the novel coronavirus was reported in Wuhan, Hubei Province, China in December 2019. The disease caused by the virus is called Coronavirus Disease 2019 (COVID-19). Since it is highly contagious and has widely spread throughout the world, the World Health Organization (WHO) declared the pandemic state on 11 March 2020 . In addAfter the pandemic declaration, most of the countries implemented different types of mitigation strategies, such as self-isolation, social distancing, mass quarantine, and city lockdown. During these conditions, infected individuals as well as healthy ones have been exposed to short- and long-term psychological consequences. Death of a COVID-19 patient in quarantine conditions and burial by special equipment deprives the family members of their traditional grief and leads to complicated grief syndrome. Quarantine conditions also impose stress, anxiety, irritability, and sleep disorders on the general public . Due toDissemination of misinformation, misconceptions of people, and the use of negative words are the causes of the social stigma in patients with COVID-19. Individuals who have died, those who have recovered from the disease, and those who have been quarantined as well as their families are exposed to stigma and rejection by the society. The reluctance of friends and relatives to visit the home of a person with COVID-19 due to the fear of spreading the disease to visitors can exacerbate the feelings of isolation, loneliness, and complex emotions. Families and relatives of patients may also experience the feelings of guilt and self-blame due to isolation conditions and inability to care for the sufferers during the pandemic, which can eventually lead to disruption of their daily activities. The mentioned conditions necessitate exceptional psychosocial support for this group of individuals. The adverse psychological effects could be reduced through increasing the general awareness, educating the people about the characteristics of these patients, and having appropriate interaction and empathy among people.The following solutions can also be useful in reducing the adverse psychological effects: providing the possibility of transferring the deceased to the city of residence, selection of the burial place by the family, and creating an opportunity for the patient’s relatives to see the body and face of the deceased person in a safe manner, using clear bags to transport the corpus of the dead one, letting a family member be present during the transfer by ambulance to the burial site, and sharing his or her latest pictures with family members , conducting telephone and internet-based consultations in the form of telemedicine for psychological screening, developing educational startups and applications in this regard, paying attention to and respecting the local and cultural customs of different societies, providing spiritual supports in hospitals and health centers, holding modified debriefing and hot wash sessions using social media for patients and healthy people in quarantine, providing mental preparedness and adequate explanations about the necessary safety measures for post-quarantine conditions, strengthening and respecting religious beliefs and supporting them, holding virtual funerals and ceremonies through the social media, supporting disadvantaged and vulnerable groups both economically and socially, providing an agreement to impose unavoidable restrictions on patients and their families, using relaxation and yoga techniques, and avoiding following the news.The following measures can be used to prevent the social stigma: increasing the general population’s knowledge and awareness of the disease, respecting the personality and self-esteem of the infected patients, not using negative words by healthcare providers, people, and the community, producing scientific and educational contents by celebrities, bloggers, social media influencers, and religious leaders, strengthening the cohesion of social ties, sharing the experiences and narratives of COVID-19 patients with others, putting false information and beliefs aside, strengthening the society members’ sense of social responsibility towards each other, and establishing public and multi-organizational information networks to deal with false news about the disease and patients. Given that there is no consistent and scientifically validated data on COVID-19, it is common to see the disease as a dangerous and frightening event, which can have adverse psychological effects on people. Challenging the feelings of guilt, processing painful emotions, encouraging grieving people to take care of themselves, and strengthening resilience and the ability to adapt with the consequences of bereavement through psychological support in the form of counseling, psychotherapy, and being in touch with other quarantined families in a safe manner can contribute to people's mental health. The large number of deaths and the need for patients and survivors to receive psychosocial support reflect the necessity of counseling services on a large scale. Hence, reduction of the long-term consequences for families and the society is recommended to be addressed by policymakers and health planners both globally and regionally.Ahmad Soltani and Mahmoudreza Peyravi equally contributed as first authors.The authors would like to thank Ms. A. Keivanshekouh at the Research Improvement Center of Shiraz University of Medical Sciences for improving the use of English in the manuscript.The authors have no conflict of interest to declare.Nil.


Synopsis of the Golden Chamber by Zhang Zhongjing. It is a disease of heart and lung internal heat by Yin deficiency, which belongs to the category of emotion disease in Chinese medicine. In recent years, researchers believe that lily disease and depression syndrome of Yin deficiency and internal heat have many similarities in etiology, pathogenesis, and clinical manifestations. This review summarizes the clinical symptoms, etiology, pathogenesis, and therapeutic medication of lily disease and modern Yin-deficient internal heat depression and discusses the relationship between them. Furthermore, the relationship between coronavirus disease 2019 (COVID-19) and lily disease was discussed from the etiology, pathogenesis, and treatment. It provides new ideas for the treatment of COVID-19 and the treatment of psychological problems after recovery.Lily disease was first recorded in  Major depression disorder (MDD) is a mood disorder characterized by sentimentality, despair, anhedonia, and sensitivity for social rejection . These sEmerging evidences from human postmortem and animal studies point out depressive disorders may instigate from human body system imbalance affected by genetic and environmental factors . HoweverAs a critical component of complementary and alternative medicine, traditional Chinese medicine (TCM) is a multicomponent, multitarget, and multipathway therapy, which can achieve its unique therapeutic effect by adjusting the biological network of the human body system , 7. TCM Most of Yin deficiency and internal heat of depression is the deficiency syndrome, and its main clinical manifestations are anxiety, depression, tension, suspicion, irritated fever, night sweat and zygomatic red, palpitation and insomnia, red tongue with little moss, and thready and rapid pulse .Synopsis of the Golden Chamber by Zhang Zhongjing. It is a disease of heart and lung internal heat by Yin deficiency, which belongs to the category of emotion disease in Chinese medicine [Lily disease was first seen in medicine . In receBased on the TCM theory, many disease occurrences are related to personal physical and emotional injury . It willSynopsis of the Golden Chamber: Lily Disease, Huhuo and Yin Yang Toxin: Pulses, Syndromes and Treatment. The manifestations of “lily disease” patients are marked by unclear consciousness, fluctuated appetite, frequent silence, restlessness, confused cold and heat body sensation, bitterness in the mouth and dark urine, red tongue body and less tongue coating, and weak and thready pulse. These characteristics are similar to the manifestations of depressive disorders [The “lily disease” is initially reported in isorders . Based oisorders .Emerging evidences from the ancient Chinese medical text suggest that the etiology factor of lily disease is mainly internal and external injury . The intWith regard to pathogenesis, there are many TCM hypothesis mechanisms underlying internal and external factors inducing lily disease . The mosPlain questions said that “all eleven dirty depends on the gallbladder.” Therefore, if the gallbladder has heat, all veins are affected by Yin deficiency. The gallbladder controls the decision, so the deficiency of gallbladder Qi showed the symptoms of trance. The third view is the theory of liver. Some scholars believe that the location of this disease is the liver and that the failure of sentiment leads to liver Qi stagnation, endogenous heat deficiency, and Yin injury [Golden Chamber described, TCM experts considered that its pathogenesis lies in the damage of coke due to irregular diet [The second view is the theory of gallbladder. For example, Liang et al. believe that “bitterness in the mouth” is a syndrome of Shaoyang gallbladder meridian disease . Plain qn injury . The foular diet .In summary, the cause of lily disease is the damage of viscera by external or internal injury, leading to Yin deficiency of viscera and disorder of Qi and blood; then, the veins will lose nourishment, and hence, it will lead to the symptoms of mental disorder. The Yin deficiency of viscera will lead to the virtual heat coming from the inside of the body, as well as bitterness in the mouth, red-colored urine, and other symptoms.According to the TCM theory, depression can be divided into positive syndromes and deficiency syndromes, including Qi stagnation, fire stagnation, phlegm stagnation, blood stagnation, heart and spirit loss nourish, deficiency of both heart and spleen, and hyperactivity of fire due to Yin deficiency. Most of the Yin deficiency internal heat depression is menopausal depression or depression in old age, and its etiology is plant nerve dysfunction and endocrine dysfunction .Contemporary scholars believe that depression belongs to the category of “no disease” in TCM. Most patients have no obvious organic lesions. The pathogenesis is the imbalance of Qi, blood, Yin, Yang, and the dysfunction of viscera, which makes the body in a state of excessive Yin and Yang or partial decline. Disorders of Qi and blood in the viscera will lead to abnormal mind, and changes in mind will also affect Qi and blood in the five viscera .TCM experts generally considered that depression is closely related to Qi and blood blockage and liver unreel distributing , 26. AllThe intrinsic mechanism of Yin deficiency and internal heat of depression is the imbalance of the kidney, lung, and spleen and other viscera. The clinical manifestation of Yin deficiency and internal heat of depression is a mixture of deficiency and excess syndromes . Vital QBased on the TCM theory, lily disease is a kind of emotional disease, which is closely related to emotional and psychological factors. Lily disease occurs because of the disorder of seven emotions, which will hurt viscera and lead to the imbalance of Qi, blood, Yin, and Yang. In addition, it may be the sequela of exogenous fever or other diseases . With reFrom the pathogenesis, the basic pathogenesis of lily disease is internal heat due to Yin deficiency, and its pathogenesis is the result of the interaction of various pathogenic factors . From thRehmannia root is naturally sweet with bitter flavor, and mostly shows its curative effects in the kidney, liver, and heart. It has effect on promoting body fluid production, nourishing Yin, and controlling heat [Zhang Zhongjing believed that the treatment of emotional diseases should first improve the physical symptoms combined with Chinese herb treatment based on syndrome differentiation . The maiing heat . When twAnemarrhena) is bitter and sweet in properties, and it is also associated to the lung, stomach, and kidney meridian. It has the effect of clearing away heat, eliminating annoyance, draining the lungs, and nourishing the kidneys. Because “blood and sweat are homologous” and “sweat and fluid are homologous,” excessive sweating will lead to more deficiency of body fluid, Qi and blood, and obvious symptoms of dry thirst [Lily Zhimu Decoction (BZD) was another traditional Chinese formula for treatment of lily disease . Zhimu  was used to treat lily disease mistreated with purgative. Talc tastes sweet and is cold in nature. It was used to treat vexation, hot, and thirsty. Hematite tastes bitter and is flat in nature, into Stomach Channel of Foot-Yang Ming. It can reduce stomach gas to stop hiccups, relieve cough, and clear heat and have the characteristic of inducing astringency without hurting vital energy. After the wrong purgation, stomach Qi and body fluid were injured, and internal heat increased. Because the main disease has not changed, lily is still the monarch medicine. Talc is used as minister medicine to diuretic and purgation heat, and hematite is used as adjuvant drug to induce astringency and astringing Yin .Lily disease mistreated with the vomiting method should be treated with Lily Yolk Decoction (LYD) underlying syndrome differentiation . Yolk taLily disease patients with lasting for one month without alleviation can use lily to wash the body. If thirst is severe, it should be treated with Gualou oyster powder (GOP) . TrichosTCM believes that the pathogenesis of depression is related to the deficiency of Qi and Yin in several viscera. Therefore, the main principles for treating Yin deficiency and internal heat of depression are nourishing Yin to clear heat in five viscera . Howeverthe Canon of Internal Medicine, people's spiritual consciousness and thinking activities are coordinated by the five viscera. The heart is the master of all the viscera recorded in Lingjiu. It means that the heart has a controlling effect on the five viscera, and the malfunction of the heart can also lead to the malfunction of other viscera. The treatment of Yin deficiency and internal heat of depression from the heart mainly adopts the method of replenishing Qi and nourishing the heart. Major Heart Supplementing Decoction was clinically used to treat heart Qi deficiency-type depression [Inula japonica acts on Qi, and the two drugs used mutual promotion can benefit heart Qi and enhance heart function. Bamboo leaves can clear the mind and purge fire to remove irritation. Pulp of Cornus can ease the emergency of the heart and prevent dredge too much, leading to the consumption of Qi. Ginseng and dried ginger can benefit heart Qi to enhance heart function. This prescription has the effect of supplementing heart Qi. It is an effective prescription for treating depression due to heart Qi deficiency.Heart Qi deficiency can lead to poor blood flow and blockage of heart vessel. According to pression . Cortex Rehmannia can nourish the heart and Yin, as well as cool blood to clear heat, and the two drugs can nourish the heart and lung and clear heat to calm nerves when they are used together.Yin deficiency and hot of the lung can lead to the failure of the lung to disperse and descend. The treatment of Yin deficiency and internal heat of depression from the lung is mainly based on the method of invigorating Qi and nourishing Yin. Zhang et al. considered that LBRD has a good therapeutic effect in clinical practice . In thisAngelica sinensis, Astragalus, and Arillus Longan have the effect of invigorating Qi, activating blood, and calming spirits. Lanceolata can nourish Qi and enhance the function of the spleen and lungs. Atractylodes, Poria cocos, and spine date seed have the function of calming the mind and eliminating dampness to strengthening the spleen. This prescription has the function of strengthening the spleen and blood to calm the spirit, and it is an effective prescription for the treatment of depression due to spleen deficiency.Lack of body fluid in the spleen makes it become hot and dry and leads to Yin deficiency, which will cause the maladjustment of transport and transformation of the spleen. The spleen is the most negative viscera in the human body. And spleen Yin deficiency will affect the lung, liver, and kidney functions and result in the dry heat performance of the body . TherefoAstragalus is commonly used in clinical practice to replenish liver Qi. For example, Wang et al. [Astragalus can replenish Qi. Salvia can activate and nourish blood. Pinellia ternata tastes spicy and can resuscitate and dissipate the lump, and it is an adjuvant drug to inhibit the disadvantage of a large amount of Astragalus. The combination of these three drugs can invigorate Qi and activate blood circulation and has the advantage of supplementing without stagnation.Liver Qi stagnation will make the liver hot and then damage the liver Yin. If the dredge function of the liver is abnormal, the operation of Qi in the viscera and meridians will be obstructed, which will lead to the damage of liver Yin and the appearance of internal heat. The treatment of Yin deficiency and internal heat of depression from the liver is mainly based on the methods of invigorating liver Qi and nourishing Yin of the liver. Common formulations include Ease Powder, Bupleurum Decoction, and so on . In addig et al.  treat deSchisandra chinensis has many functions, including tonifying the lung to collect Qi, nourishing the heart to remove annoyance and tranquility, strengthening the spleen and consolidating the base, regulating the rise and fall, softening the liver to relieve depression, and invigorating Qi to stabilize kidney essence [The kidney essence exhausted will make the kidney dry and hot and lead to the injury of kidney Yin. The kidney is the origin of congenital constitution and holds essence, and the essence of the kidney is the material basis of kidney Yin. It shows that the reason of kidney Yin deficiency is the insufficieny of kidney essence. The treatment of Yin deficiency and internal heat depression from the kidney is mainly based on the method of reinforcing the kidney . Epicedi essence . These tCoronavirus disease 2019 (COVID-19) has the characteristics of fast transmission, wide transmission, strong infection, general population susceptibility, and no specific therapeutic agents . It is aTCM experts believe that COVID-19 was classified as “epidemic disease,” with the lung and spleen as the main disease sites , 49. Qi,The pathogenesis of COVID-19 varies from mild to severe, from surface to entrant, and from solid to deficiency , 52. TheA recent study indicates that exogenous febrile disease and pulmonary diseases are related to the occurrence of lily disease . From thGlycyrrhiza, Pogostemon cablin, bitter almond, honeysuckle, Poria cocos, weeping forsythia, tangerine peel, and Coix seed [TCM has been widely recognized and widely applied in the treatment of COVID-19 during the epidemic. COVID-19 prevention and treatment program and clinical prescription data in various regions of China suggested that the common high-frequency drugs of the prevention and treatment plan and clinical medical records included oix seed . Currentoix seed , fragranWe believe that the treatment prescription of lily disease can be considered as a supplementary treatment for pneumonia in the middle and later stages, to clearing away heat and nourishing Yin, strengthening spleen and benefiting vital Qi, and regulating the function of viscera, Qi, and blood, which is beneficial for novel coronavirus pneumonia rehabilitation.COVID-19 patient medical therapy should be paid not only to the treatment of pneumonia itself but also to the psychological state of patients. The patients' mood changes will affect the treatment and prognosis of the disease. So, it is necessary to carry out psychological intervention and drug therapy for emotional diseases. In addition, COVID-19 patients will still have different psychological problems after recovery and discharge from hospital, and follow-up and psychological intervention after discharge is still an urgent task.We systematically summarize the research status of lily disease and Yin deficiency and internal heat of depression and came to the conclusion that the cause of lily disease is the damage of viscera by external or internal injury, which will lead to Yin deficiency of viscera, and the disorder of Qi and blood; then, the veins will lose nourishment, and hence, it will lead to the symptoms of mental disorder. The Yin deficiency of viscera will lead to the virtual heat coming from the inside of the body, as well as bitterness in the mouth, red-colored urine, and other symptoms.From the clinical symptoms, lily disease showed trance, sleep, anxiety, insomnia, and other symptoms similar to the clinical diagnostic standard of modern depression. And bitterness in the mouth, red-colored urine, and rapid and thready pulse are the typical symptoms of internal heat due to Yin deficiency. Therefore, we can infer that internal heat depression due to Yin deficiency is a major syndrome of lily disease from etiology and pathogenesis.For COVID-19 patients, lung damage can cause spread and decline malfunction, and deficiency of Qi and Yin in the lungs will make it hot and dry. If the residual heat in the late period of febrile disease has not been solved, it will consume Yin-Jin and result in lily disease. Therefore, the treatment of lily disease can also be referenced when treating COVID-19 patients.


The study provides insights into the aspects of creativity, the structure of psychometric intelligence, and personal adaptation resources of senior preschool children. Creativity and intelligence are presented as general adaptation resources. Existing studies of creative ability and creativity as integral individual characteristics in the context of adaptation are analyzed. The aim is to identify varied sets of creativity and personal adaptation resource markers that differentiate groups of children in order to determine possible strategies for adaptation, preservation, and development of their creative abilities at the beginning of lyceum schooling. It embraces the use of the E. Torrance Test of Creative Thinking (TTCT) , the Wechsler Intelligence Scale for Children (WISC), and the G. Rorschach Test. A sample of the study consisted of 122 children, aged 6–7 and enrolled in a school. The average IQ score among the children was above 115 . The entire sample was divided into four groups by the originality-elaboration ratio according to the TTCT. The correctness of the children’s division into the groups according to the markers of creativity and personal adaptation resources is confirmed by the discriminant analysis. We have identified the factor structure of creativity, intelligence, and personal adaptation resources in the entire sample of children and in each of the groups. In the group of preschoolers with high originality and elaboration, the resulting structure integrated the components of creativity with personal adaptation resources and intelligence scores. In the group of children with a low level of originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are not interlinked. The growing frequency and cultural diversity of contemporary creativity studies are connected with the increase in their importance for social progress ,2. TodayThis paper focuses on the personal adaptation resources of children with high intelligence scores and various markers of creativity prior to their enrollment in a lyceum school.The period of schooling is decisive in terms of building creative abilities and adaptation resources in individuals. Schooling nurtures socio-cultural standards of activity and communication. Thus, a conflict is possible between a creative potential and initiative and the need to comply with standards . The speAdaptability in this study is understood as a structural feature of the target future action of subjects and includes personal components that determine its development: Impulse and reflection of forces, desire and anticipation, aspirations and self-confidence, perseverance and performance, forecast of one’s own capabilities and the capabilities of the environment, and situation .Aim: To identify varied sets of creativity and personal adaptation resource markers that differentiate groups of children in order to determine possible strategies for adaptation, preservation, and development of their creative abilities at the beginning of lyceum schooling.To study “creativity in the context of adaptation”, it is imperative to identify the differentiating grounds according to creativity metrics, identify options for combining them with the adaptation resources of preschoolers, and choose activities with a high level of uncertainty so that a child can independently demonstrate various forms of creativity and adaptability.The adaptation processes are explored in the context of intelligence and its development in ontogenesis ,10. HencThe ratio of intelligence and adaptation is complex and variable due to diverse markers of personal adaptation to the world. The adaptation markers include study progress and professional achievements—“subject-symbolic adaptation”, adaptation to the social environment—“social adaptation”, and coping behavior as harmonization of the inner world—“personal adaptation” . It is rFor the study of “creativity in the context of adaptation”, the findings of researching the creativity-intelligence ratio as an adaptation resource are crucial. Some studies identify the creativity-intelligence ratio ,14; otheJ.-H. Guignard et al. found that high verbal ability children showed significantly higher scores on verbal creative potential . The comE. Torrance’s studies revealed that the creativity-intelligence interrelationship does not exist in all samples of subjects. According to the intellectual threshold theory, when IQ is below 115–120, intelligence and creativity form a single factor, with IQ above 120 they are independent factors . B. Shi’Let us review the concepts and approaches to insights into creativity, which identify its key features, which are significant for the differentiation of subject groups.The core approach to the study of the structure of creative abilities is the psychometric approach developed by J. Guilford and E. Torrance ,18,20,21Creativity is measured using the widely popular E. Torrance Test of Creative Thinking (TTCT). Ample studies have confirmed the good psychometrics of the test—high validity and reliability ,18,25. TAccording to E. Torrance, the key criteria differentiating subjects by creativity are scores of originality as the ability to create new things and elaboration as the ability to detail and deepen initial ideas, which increases their complexity and improves presentation. It has been revealed that children with a high level of originality excel in curiosity and independence, and are prone to take risks, while children with a high level of elaboration are distinguished by the desire to have the upper hand and are emotionally insensitive . The studies of the factor structure of creativity by the TTCT revealed sets of variables featuring the innovation and adaptation potentials of subjects, the relationship of creativity with such personal qualities as openness to new things, curiosity, tolerance for uncertainty, and risk acceptance ,29.In addition, studies revealed two-factor structure of variables  in the context of the Adaption-Innovation Theory ,31.To summarize, aforementioned analysis allows us to differentiate our samples by two variables: originality and elaboration. Those two variables, representing both the potential to create new and adaptational potential, are abilities that are required to bring something new into being.Another approach to the study of creativity is integrative: creativity is cited as a systemic feature, including intelligence, knowledge, mindset, individual traits, motivation, and environment . M. CsikIn the studies of creativity as systemic quality, personal components were identified—intrinsic motivation , intelleIn different age samples, the personal properties that manifest themselves in a situation of uncertainty (according to the G. Rorschach Test) were investigated; properties aimed at changing and creativity, and properties aimed at stabilizing and maintaining standards. The first group of properties includes intellectual initiative, flexibility, composite thinking, originality, and perception, while second one includes intellectual control, emotional reactivity, anxiety, and realistic perception ,39.Based on the theoretical analysis, creativity markers were chosen as grounds for differentiating groups of children—originality and elaboration taking into account intelligence scores (according to E. Torrance). For the study of children’s personal adaptation resources, opposite personality traits were selected, including types of experiences (the ratio of introversion and extratension), emotional reactivity, intellectual initiative and intellectual control, composite thinking, realistic perception, and originality, providing both the creativity and adaptability in situations of uncertainty (according to G. Rorschach).Hypothesis: Children with high intelligence scores who have different levels of manifested creative abilities—originality and elaboration—feature specific sets of personal adaptation resources.The empirical study consisted of the psychological diagnostic of children using three methodics: The Wechsler Intelligence Scale for Children (WISC), the E. Torrance Test of Creative Thinking, and the G. Rorschach Test.For the study of creativity, intelligence, and personal adaptation resources, discriminant and factor analysis of captured psychological screening results were applied. The analysis as a whole covered the entire sample and groups of children with different creativity scores . All calculations were performed using the IBM SPSS Statistics package.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Local Ethics Committee of the Higher Biomedical School South Ural State University of 307/20 of 5 December 2019.The study involved 122 children aged 6–7, 65 boys and 57 girls, enrolled in a school in Chelyabinsk. The sample consisted of children who belonged to the same ethnic group—Russians who live in Chelyabinsk city. Later, all these children were accepted in different classes of the same school.The IQ average scores among the children was above 115 . The sample was divided into four groups by originality  and elaboration ratio . The first group was 25 children with above average originality and elaboration scores. The second group was 22 children with above average originality and below average elaboration. The third group was 25 children with below average originality and above average elaboration. The fourth group was 50 children with below average originality and elaboration.For the psychological assessment of creativity and its key markers, we have used the TTCT; the figural version adapted by E.E. Tunik ,23. The For the psychological screening of intellectual levels, we used the Wechsler Intelligence Scale for Children (WISC) with five verbal subtests  and five non-verbal subtests . In this study, we used the markers of verbal (VIQ) and non-verbal (PIQ) intelligence and a general IQ score.Average results of intelligence, creativity, and adaptive personal resources in groups are shown in For the psychological screening of creative and adaptive resources, the G. Rorschach Test was applied ,41,42. TThe validity of the Rorschach Test results and their combinations were confirmed in multiple scientific studies ,43,44,45The differentiation of children according to the originality-elaboration ratio was tested using discriminant analysis. The captured findings of assessing the correctness of classification and assignment of subjects into groups, the analysis of the contributions of creativity, and personal adaptation resources to the core discriminant function are shown in The greatest contribution to the core discriminant function, which is a linear equation for classifying children with different creativity scores, is made by the variables: Originality, elaboration, and overall creativity (the TTCT), and compositional thinking (the G. Rorschach Test).The structure of children’s creativity, intelligence, and personal adaptation resources was assessed on the basis of the factor analysis of captured psychological screening findings .The factor structure of creativity, intelligence, and personal resources throughout the sample forms five factors (77.62% of explainable variance), in which variables of methods are not included in common factors, while personal resources are represented by two factors (with 18.8% and 16.9% variance). Creativity is represented by two factors (with 17.4% and 11.2% variance) and intelligence by one factor (13.3% variance) in general; in a sample of children with IQ scores above the norm, the factor structure of creativity, intelligence, and personal resources is represented by orthogonal factors, which indicates the unrelated nature of these phenomena.In Group 2, children with above average originality and below average elaboration, the first set of variables is a bipolar factor formed by several features of personal resources  and IQ at one pole and originality according to the TTCT at the other pole. The second set of variables includes only the markers of personal adaptation resources—indicators of intellectual control, “realistic” perception, and psychophysical activity. The third set of variables embraces such features of creativity as fluency and flexibility, as well as indicators of intelligence: total IQ and verbal intelligence (VIQ). The fifth set of variables includes flexibility, total IQ, and non-verbal intelligence (PIQ). The fourth set of variables is represented by overall creativity and elaboration and personal resources; intellectual initiative and compositional thinking . Thus, cIn Group 3, children below average originality and above average elaboration, the first set of variables is a bipolar factor formed by several features of personal resources. At one pole of the factor, there are the amounts of experience, emotional reactivity, compositional thinking, and originality of perception, and at the other pole—standard, realistic perception. The second set of variables also represents the bipolar factor: One pole includes features of creativity—overall creativity, flexibility, and originality, and the other pole embraces the indicators of personal adaptation resources—intellectual initiative, psychophysical activity, and realistic perception. The third set of variables covers all IQs: Total IQ score, VIQ, and PIQ, and fluency as a metric of creativity. The fourth set of variables includes overall creativity and elaboration as well as intellectual control and originality of perception . Thus, fIn Group 4, children demonstrating below average originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are independent and form four orthogonal factors. The first set of variables is formed only by the metrics of personal resources . The second set of variables is formed only by creativity markers. The third set of variables includes the markers of intelligence and its components. Only the fourth set of variables embraces two features of creativity; the overall creativity and elaboration, and the indicator of personal adaptation resources—intellectual control. Thus, as in the whole sample of children with below average originality and elaboration, the markers of creativity, intelligence, and personal adaptation resources are independent.Children with high levels of intellectual abilities differentiated by key characteristics of creativity—originality and elaboration—differ, in general, by characteristics of creativity and personal adaptation resources . The maximum contribution to the proposed classification is made by the indicators of originality, elaboration, overall creativity, and compositional thinking in a situation of uncertainty.In general, in a sample of children with a high level of intellectual abilities, the factor structure of the characteristics of creativity, intelligence, and personal resources is represented by orthogonal factors, showing the unrelated nature of these phenomena. This helps to confirm the “threshold theory” regarding intelligence proposed by E. Torrance. However, in the group of children with high levels of originality and elaboration, and in the group of children with high level of originality, sets of variables were captured, including both characteristics of intelligence and creativity.The factor structure of creativity, intelligence, and personal adaptation resources in each of the four groups of children demonstrating various levels of originality and elaboration has been determined. In the group of preschoolers with a high level of intellectual abilities, originality, and elaboration, the resulting structure is as integrated as possible; creativity is simultaneously linked to personal adaptation resources, and to overall intelligence and its components . Creativity, intelligence, and adaptation resources in the group of children with a high level of intellectual abilities and low levels of originality and elaboration are not connected at all. The most problematic from the point of view of personal adaptation resources are two groups of children. This is the group of children with a high level of intellectual abilities and a high level of originality characterized by interrelations of creativity and intelligence, as well as creativity and those personal resources that support both intellectual activity and creativity—intellectual initiative and complexity of interpretations. It is this complexity of properties that is decisive in the effective strategy of school adaptation, aimed at supporting “innovative creativity” ,47. AnotIn general, the study revealed the possible foundations for a differentiated approach to the adaptation of children with high intellectual and creative abilities prior to the start of schooling.The first limitation is the sample that is shifted by intelligence scores: The mean IQ is 133.7. The second limitation of the sample is that the children included in this study were preparing for the enrolment in a lyceum school with high levels of development. The third limitation is the use of the TTCT to screen the characteristics of creativity. The research findings could be improved through the simultaneous combination of several metrics of creativity and real creative achievements.


Medicina. Particular attention was paid to nephrotoxic, hepatotoxic, cardiotoxic, immunotoxic, neurotoxic, and behavioral effects of pyrethroids on human and animal bodies. It could be added that pyrethroids generate oxidative stress, which modifies DNA, RNA, protein, lipid and carbohydrate molecules. However, public awareness of the possible negative effects of the use of insecticides is still low. Further research should be carried out to clarify the molecular basis of the pathomechanism of pyrethroid detrimental action. Proper dissemination of the results seems to be of first importance for public health.Pyrethroids are pesticides commonly used in crop protection; in the forestry, wood, and textile industries; as well as in medicine and veterinary medicine to treat parasitic crustacean infestations. They have been found to be relatively safe for humans and animals. Pyrethroids are recommended for personal protection against malaria and virus Zika by the World Health Organization. Pyrethroids act on voltage-gated sodium channels, which cause an influx of sodium ions into the nerve cells and permanent depolarization. They also influence activities of enzymes, especially in nerve and liver cells. Contact of pyrethroids with the skin, digestive tract, and respiratory tract results in their penetration into the body. Due to the importance of the subject, a summary of the current state of knowledge on the toxic effects of pyrethroids was presented in the comprehensive review by Chrustek et al, published in journal  The interest in protecting humans and animals against insects and diseases transmitted by insects, as well as crops against pests, has been around for nearly 200 years. Undoubtedly, due to the growing population of people, farm animals, and growing agricultural areas, the use of pesticides is constantly increasing ,2,3,4. ATanacetum cinerariaefolium (former name Chrysanthemum cinerariaefolium) [Historically, pyrethroids are a group of compounds of natural origin isolated from the flowers of the plant efolium) ,3,4,5. Nefolium)  (WHO perefolium)  (WHO delefolium)  (WHO cypefolium) .Pyrethroids act on voltage-gated sodium channels ,4. BindiPyrethroids are lipid soluble, so any contact with the skin, digestive tract, and respiratory tract results in their penetration into the body ,18,19,20Children and pregnant women are at risk of faster pyrethroid penetration into the body ,22,23,24Pyrethroids were divided into two groups, depending on the type of intoxication symptoms that appeared in a vertebral organism after their administration . Type I Particularly noteworthy is the fact that it has been proven that the level of pyrethroids in the body, as well as the severity of symptoms of poisoning, depends on the type of diet ,2,3. HigStudies concerning the negative effects of pyrethroids on humans and animals have been conducted for years. The review “Current Research on the Safety of Pyrethroids Used as Insecticides” published in Medicina Lithuania in 2018 , cardiotCurrent knowledge about the site of action of pyrethroids, toxic doses, and induced tissue and organ effects were presented . What deThe article  did not Nevertheless, public awareness of the possible negative effects of the use of insecticides is still low and further research should be carried out to clarify the molecular basis of the pathomechanisms of the pyrethroid detrimental action. The results of these studies should be widely disseminated. The review  presents


Ethanol precipitation is a purification process widely used in the purification of Chinese medicine concentrates. This article reviews the research progress on the process mechanism of ethanol precipitation, ethanol precipitation process application for bioactive component purification, ethanol precipitation and traditional Chinese medicine quality, ethanol precipitation equipment, critical parameters, parameter research methods, process modeling and calculation methods, and process monitoring technology. This review proposes that ethanol precipitation technology should be further developed in terms of five aspects, namely, an in-depth study of the mechanism, further study of the effects on traditional Chinese medicine quality, improvement of the quality control of concentrates, development of new process detection methods, and development of a complete intelligent set of equipment. In the 1950s, a batch of modern dosage forms of traditional Chinese medicine (TCM) appeared in the climax of national dosage form reform, such as tablets, capsules, injections, granules, and mixtures. To meet the higher refining requirements of these dosage forms for the TCM systems, water extraction and ethanol precipitation (EP) technologies have been widely used in the production of TCM. The ethanol precipitation process (EPP) has many advantages, such as simple operation, easy amplification, and solvent safety. The EPP can effectively remove highly polar molecules such as sugars, salts, and proteins, and it is beneficial to reduce the dosage . In the EP is often the first refining process or even the only refining process after the extraction of TCMs. The quality of the EPP has a significant impact on the difficulty of follow-up preparations and the quality of the final drug. In recent years, with the continuous improvement of Chinese medicine standards, the EPP has attracted much attention from academic and industrial circles. This article mainly reviews the research progress on the process mechanism of EPP, EPP application for bioactive component purification, EP and TCM quality, EP equipment, critical parameters, parameter research methods, process modeling and calculation methods, and process monitoring technology and proposes future development directions.d-glucose, d-fructose, sucrose, maltose, raffinose, trehalose, and cyclodextrin has been reported . Th. Th58]. Table The frequency of each critical factor in Table According to the researches shown in Table Many studies have considered the density, water content, and solid content of the concentrate. However, the differences between different batches of concentrate are mainly reflected in the content of each component in the total solid and other physical and chemical properties except density. There are few studies on these factors. Zhang et al.  screenedThere are many process parameters or concentrate properties that may affect EP results. However, the parameters of EPP are usually limited in narrow ranges in industry. Therefore, the quality control of concentrates is very important to keep batch-to-batch consistency of supernatants. By improving the quality control of decoction pieces and upstream processes of EPP, the quality of concentrate can be controlled within a proper range to promote the quality of the EPP.ϕ) of ethanol in the supernatant solvent is defined in Eq. , which is defined in Eq.  ofentclass1pt{minimapKa value, the solubility of the organic acid salt (SA), the pH of the supernatant, the total concentration (CA) of the organic acid and organic acid salts in the supernatant is shown in Eq.  . The parYan et al. established a mathematical model between the contents of active components in concentrates, the process parameters, and the properties of supernatant by adopting a feedforward control strategy. Then, according to the contents of active components in the concentrate, the parameters of the EPP of Danhong injection were adjusted. This method can improve the consistency of the active component contents in the supernatant . The autOperating process parameters with design space, varying process parameters according to the change of concentrate quality, or adjusting controllable parameters to lower the effects of noise parameters can all improve the batch-to-batch consistency of supernatant quality after EPP.In the production of TCM, an ethanol meter is widely used to detect the apparent ethanol content of the supernatants on the spot. This method is simple and practical, but only the density information of the liquid can be obtained.2, squared prediction error, and principal component score) is set up, and the process trajectory diagram is drawn. The multivariate statistical process control model can monitor the EPP in real-time and sensitively judge the normal operation state of the process. The establishment of a multivariate statistical process control model is helpful further to implement the feedback control of the EPP.The monitoring technology and indicators of EPP in the literature are listed in Table In general, spectrum of EP system is rich in information. The process monitoring method based on spectrum can not only judge the process state, but also quantify the concentrations of specific components in combination with chemometrics.Based on the extensive review, great progress has been made in the study of process parameters, optimization methods, and process monitoring methods of EP of TCM. Problems still exist in industrial EP, including the loss of active components, the long time necessary for refrigeration, the quality difference between batches of EP supernatants, etc. In the future, EP technology research can be carried out from the following directions:The difference in concentrates between batches is mainly reflected in the fluctuation of the content of the components. At present, there have been reports about the influence of ethanol content in the supernatant on the solubility of Chinese herbal medicinal components. Nevertheless, there is no study on the influence of the content of Chinese herbal medicinal components on the solubility of other components. Therefore, it is not yet possible to describe the effect of the composition change of concentrate on the effect of EP. It is also difficult to accurately predict the material transfer and drug delivery rule of EPP.EPP is widely used in TCM industry from the last century. However, the quantitative effects of EPP on TCM quality are still unclear. The relationship between TCM substances and its quality is generally nonlinear. Therefore, some newly developed artificial intelligence technology can probably be used for the investigation of EPP and TCM quality. For example, as a typical algorithm of deep learning, convolutional neural network (CNN) can be a useful tool to deal with nonlinear quantitative problems , 154.At present, the concentrate quality in the industry is mostly controlled by density or volume. However, less attention has been paid to the chemical composition of the concentrate. It is recommended that the concentrate be used as one of the critical intermediates, and the quality standard of its composition should be set. Yan et al. used the quantitative model of process parameters, raw material properties, and EP evaluation index to back-calculate the quality standard of a concentrate . This woNIR combined with multivariate statistical analysis is used to detect indicators/major components or to detect process trajectories. NIR has many advantages, but the equipment cost is high, and the renewal and maintenance of the multivariate statistical model require professionals. In addition, there is still no means to detect the amount of encapsulation loss. Therefore, it is still necessary to develop simpler and easier-to-use detection technology.At present, the structure of EP equipment is simple, and process control relies heavily on manual work. The energy and material consumption are still high. Therefore, a complete set of intelligent EP equipment should be developed based on multidisciplinary technology. This equipment should be able to improve the efficiency of heat and mass transfer, quickly collect and analyze process data, and realize the automatic control of EPP.


Due to the high pathogenicity and mortality, the COVID-19 disaster caused global panic and anxiety. At present, diagnosis and treatment are of great concern. As time progresses, however, the sequelae caused by many other organ system complications and treatments will become increasingly obvious, and psychosomatic symptoms are one of these changes with great potential impact. Studies have shown that symptoms like poor sleep quality, anxiety and even delirium are not uncommon in patients during isolation. By summarizing the follow-up study on mental and psychological health of SARS in the past 10 years, and combining the characteristics of the existing cases of COVID-19, we will provide suggestions for the prevention and treatment of psychological diseases in clinical practice. Nearly 8 months have passed since the first confirmed case of Corona Virus Disease-2019 (COVID-19) was found in Wuhan, China, in December 2019, and now the world is threatened by this highly infectious and devastating viral pneumonia. As of 26th August 2020, around 23,965,059 people in the world have been infected with the virus, and this number is still surging every day in Europe and America, the case fatality rate even exceeded 5%. In China, the earliest outbreak point, although the infection has been basically controlled, a large number of discharged patients are facing the burden brought by the complications of various organ systems and the mental pressure from the change of social roles and environment. As for the 187 countries where the outbreak is still raging, effective mental health interventions are needed to respond to the treatment pain of a large number of isolated patients, the depression of severe patients and the psychological pressure of medical staff under overload work.In view of the strong homology between the COVID-19 genome sequence and Severe Acute Respiratory Syndrome (SARS) , and menCurrently, we know little about the long-term impact of mental health of COVID-19 patients, so the importance of detection and treatment of comorbidity is self-evident, and mental health services can play an important role in rehabilitation. By summarizing the potential impact of major emergent events on mental health and behavioral symptoms such as anxiety, stress, fear, violence, progressive neurological dysfunction and cognitive impairment of survivors, and combining previous research and data characteristics of mental disorders caused by infectious diseases such as SARS, this paper concluded the mental and psychological symptoms that may appear on a large scale in the prognosis of patients with COVID-19 a highly dangerous disease spreading globally today, the risk factors and possible effective intervention programs. Then, it can further provide a comprehensive reference for the researchers in the field of global mental health and front-line workers, such as improving the medication plan in the treatment period, conducting certain psychological counseling as early as possible, and focusing on high-risk groups in the follow-up period of prognosis, moreover, regularly carrying out psychological assessment and psychological intervention treatment and giving certain drugs to control the further development of mental and psychological problems and the progressive damage of other organs for patients with severe emotional stress.Excluding acute lung, heart, kidney and other organic damage, psychological damage may have a wide and long-term impact. The outbreak of SARS in 2003 can be regarded as a mental health disaster. PTSD is the most common chronic psychosis, followed by depression. The problem of mental illness after the epidemic is extremely serious, and its influence covers all fields and is closely related to everyone. In one follow-up study of 195 adult SARS patients, 10 to 18% reported PTSD 1 month after discharge, and the severity of symptoms was related to higher perceived life threat and lower emotional support . AnotherSARS survivors also showed worrisome depression, anxiety and post-traumatic symptoms, with an alarming proportion (64%) of those who had reached the diagnostic criteria for psychosis . More stNotably, the mental health of survivors in terms of stress, anxiety, depression and post-traumatic symptoms did not improve over time, but gradually deteriorated . The stuIt is reported that neuroendocrine, neural structure and neuroimmune disorders play an important role in depression and PTSD. On the one hand, coronavirus can guide the immune damage mechanism in the body and induce a large number of inflammatory reactions. In the blood and Cerebrospinal fluid (CSF) of patients with coronavirus pneumonia, Interleukin-6(IL-6), C-reactive protein (CRP), Interleukin-1(IL-1), Tumor Necrosis Factor (TNF) and other proinflammatory factors are all increased to varying degrees , among wSecondly, in PSTD, the increase of corticotropin releasing factor (CRF) induced by traumatic stress may play an important role in the process of enhancing activated macrophage releasing facto , and theThe long-term prognosis of COVID-19 patients with mental disorders after rehabilitation is similar to that of SARS and other major epidemics , and itsIn previous retrospective studies, the occurrence of psychosocial diseases is often strongly associated with specific population or special environmental factors. For example, although the stress level of medical staff among SARS survivors during the outbreak was similar to that of non-medical staff, a year later, the pressure level of medical staff was significantly higher, with higher levels of depression, anxiety, post-traumatic symptoms and scores. After controlling factors such as age, gender and education, health care workers are six times more likely to score above the General Health Questionnaire-12 (GHQ-12) threshold due to the dual pressure of being patients and medical staff , so the The infection of virus is not only the battle of patients and medical staff, but also the battle of the whole country and people, as it is closely related to everyone and no one can stay out of the business. Studies have showed that the residents in the areas with high prevalence of SARS, regardless of age, continued to develop more serious post-traumatic interference than those in the areas with low prevalence of SARS. In addition, the prevalence of PTSD was significantly higher in the elderly and residents in SARS epidemic areas . The mosWe found that the high-risk factors for the prognosis of patients with COVID-19 are not only related to the specific population, but also highly related to the treatment drugs in the acute phase. For example, the use of a large number of interferon in the treatment of coronavirus will lead to emotional depression, anxiety, short-term memory disorders of sleep disorders through the impact on endocrine and changes in neurotransmitter and immune system changes ; meanwhiFrom the current situation of transmission, we are concerned about the mental state of people around the world. With regard to SARS, whose outbreak was brought under control in a few months mainly due to the two characteristics of SARS coronavirus: First, coronavirus is a large virus and is not easy to mutate; second, the infected people show obvious symptoms when they are likely to spread the disease, so they can be identified and isolated in time . HoweverPsychological intervention is very necessary for patients, health care workers and the general public. We should pay attention to the high-risk groups prone to disease, and at the same time eliminate the stimulation factors that induce PTSD and depression as much as possible, and timely and early intervention is beneficial to reduce the incidence of PTSD . We shouIt should be noted that stigmatization of disease may have a longer-term impact than disease itself. Two thousand three SARS virus, HIV and Spanish influenza, which was mistakenly associated with Spanish people, all of them have caused huge psychological and economic losses to specific groups and regions. The stigmatization of diseases, especially of certain ethnic groups, can lead to adverse social emotions and promote racism. In 2006, don C. des jarlais PhD proposed a positive and effective strategy for the United States to remove the stigma of Acquired Immune Deficiency Syndrome (AIDS) and protect people suffering from AIDS, such as the President of the United States posing with AIDS patients, and the promulgation of the Americans with Disabilities Act . It is tGenerally speaking, it is of great significance to carry out active and effective mental health education for the whole people, popularize relevant mental education assistance work as soon as possible, and provide timely psychological support with self-coping strategies to enhance their resilience and reduce their fear, anxiety and pressure. At the same time, it is more important to ensure the psychological status of specific occupations and high-risk groups, and the possibility of long-term subjective pain and occupational difficulties for medical workers infected with COVID-19 could be included in the data model, which will provide a better basis for future prevention and treatment . EffectiThe mental and psychological impact of major public health events may be long-term and even far outweigh the initial threat to life. The psychological symptoms of COVID-19 patients and cured survivors include poor sleep quality, low mood, anxiety, inattention, and two of the most common and severe long-term mental illnesses-depression and PSTD, which will cause great burden and threat to society in the long run. Age, gender, incidence rate and risk factors of acute phase are highly correlated with psychological morbidity, thereby providing a reliable basis for early identification and psychological support. At the same time, medical staff, as a special group fighting against epidemics and susceptible to infection, are facing multiple and complex pressures and are more prone to mental and psychological diseases, especially in the infected medical staff. Inflammatory response and other organ system prognosis sequelae are the possible mechanism for the generation and continuous progression of depression and PSTD. Therefore, it will exert a significant effect by reducing the dosage of corticosteroids in the treatment period, actively treating the psychiatric or psychological complications in the rehabilitation period with psychological counseling and treating severe cases of depression with chronic antidepressant medication. In addition, the government should provide public policy support to survivors, de-stigmatize the disease, and develop follow-up research programs to strengthen the evaluation of COVID-19 for long-term mental illness.