This study examines the psychosocial impact of COVID-19 on cognitive aging Middle Eastern/Arab Americans immigrants and refugees in Michigan. Sociopolitical experiences as an immigrant and/or refugee may have unique effects on late-life cognitive health. Given that social engagement reduces the risk of ADRD, this study sought to examine the consequences of COVID-19 socialization restrictions on familial and communal support systems for aging Middle Eastern/Arab immigrants and refugees. Three focus groups discussions with 8-10 participants each (N=31) conducted at local Arab organizations and religious institutions were conducted followed by inductive analysis. Preliminary results indicate two prominent themes: 1) Social and Familial Hardships; and 2) Isolation. Narratives illustrate the prevalence of psychosocial ADRD risk from COVID-19. Findings are discussed within a stress framework to advance universal and unique elements of Arab immigrant and refugee cognitive aging.


In Alberta, Canada, we quantified the rate of potentially inappropriate oral antibiotic prescribing in emergency departments for viral infections or conditions not likely requiring antibiotics from 2010-2020 and assessed the impact of two Choosing Wisely Canada (CWC) campaigns (2015/2016 and 2018) discouraging inappropriate antibiotic prescribing in emergency medicine.We linked emergency department adult and pediatric records from the National Ambulatory Care Reporting System and medication dispensations from community-based pharmacies in the Pharmaceutical Information Network. From January 2010 to February 2020, we identified emergency department visits for 5 conditions that were potentially inappropriately treated using antibiotics per CWC recommendations . We used an interrupted time series design to detect changes in antibiotic prescribing by fitting Autoregressive Integrated Moving Average (ARIMA) models to account for secular trends and seasonality, allowing for change in slopes to measure the effect of each CWC intervention.Antibiotics were commonly prescribed in emergency departments for bronchitis (proportion of visits with antibiotics: 57%) and asthma (22%) in adults; bronchiolitis in children (43%); pharyngitis (39%) and acute otitis media (54%) in adults and children. Based on visual inspection, the proportion of emergency department visits for each condition where antibiotics were dispensed remained relatively consistent. The ARIMA models demonstrated mixed impacts on potentially inappropriate antibiotic prescribing associated with two interruptions: the 2015/2016 CWC recommendations and subsequent 2018 CWC Using Antibiotics Wisely campaign. Following each interruption, antibiotic prescribing was slightly reduced for bronchitis  and bronchiolitis (not significant) , but unchanged for asthma  and pharyngitis , and slightly increased for acute otitis media (not significant) .Rates of potentially inappropriate antibiotic prescribing remained constant over the past 10 years in Alberta. Campaigns to rethink antibiotic use in emergency medicine may have resulted in small decreases in antibiotic use; however, further initiatives building upon existing campaigns are required to substantially reduce rates of inappropriate antibiotic prescribing.


Children with acute brain damage make up a large group of patients who require multi-stage rehabilitation. Rehabilitation requires the creation of special conditions for psychiatric care and psychological and pedagogical correction of the consequences of severe damage to the nervous system.To identify the options for mental activity during the restoration of the level of consciousness in children after acute severe brain damage.210 children under the age of 18 with severe brain damage . Clinical-psychopathological, pedagogical methods were used; additionally diagnostic scales, questionnaires.4 groups were formed: 1st 37 (18%) patients had manifestations of mental activity with physical, cognitive and social capabilities in the minimal consciousness “+” ; 2nd 67 (32%) - manifestations of physical and cognitive abilities with minimal consciousness “-” (a- / hyperkinetic mutism without reactions); 3rd 95 (40%) - only the manifestation of physical capabilities at the exit from the vegetative status. 4th 11 (10%) - a low manifestation of mental activity in the form of physical capabilities with a vegetative status.4 variants of mental activity in children after acute severe brain damage have been identified: from minimal involuntary reactions or their absence in vegetative status to voluntary actions according to the instructions of an adult in minimal consciousness “+”. Taking into account the variability of mental activity helps to differentiate the methods of psychiatric and psychological-pedagogical assistance in the recovery of children already in the early stages of rehabilitation.


A key facet of innate immunity in plants entails the recognition of pathogen “effector” virulence proteins by host Nucleotide-Binding Leucine-Rich Repeat Receptors (NLRs). Among characterized NLRs, the broadly conserved ZAR1 NLR is particularly remarkable due to its capacity to recognize at least six distinct families of effectors from at least two bacterial genera. This expanded recognition spectrum is conferred through interactions between ZAR1 and a dynamic network of two families of Receptor-Like Cytoplasmic Kinases (RLCKs): ZED1-Related Kinases (ZRKs) and PBS1-Like Kinases (PBLs). In this review, we survey the history of functional studies on ZAR1, with an emphasis on how the ZAR1-RLCK network functions to trap diverse effectors. We discuss 1) the dynamics of the ZAR1-associated RLCK network; 2) the specificity between ZRKs and PBLs; and 3) the specificity between effectors and the RLCK network. We posit that the shared protein fold of kinases and the switch-like properties of their interactions make them ideal effector sensors, enabling ZAR1 to act as a broad spectrum guardian of host kinases. Arabidopsis thaliana, the extracellular domains of leucine-rich repeat receptor kinases form a complex and multi-layered network through physical interactions to regulate their roles in a wide range of biological functions  also form extensive networks, both with other NLRs and distinct receptor classes, to mediate immunity against a broad range of pathogens  was first characterized for its genetic requirement in the recognition of the Pseudomonas syringae acetyltransferase effector HopZ1a (zed1 (hopZ-ETI-deficient1) mutant as also being deficient in HopZ1a ETI  Kinase7) to suppress immunity   in thaliana . Membersthaliana . Severalthaliana , all of or AvrAC . ZRK3 is HopF2a)  and ZED1 HopF2a) . OverallX. campestris effector AvrAC provided crucial mechanistic insights into ZAR1 activation, culminating in the first structure of a plant resistosome  . HoweverA. thaliana has no apparent effect on PTI or plant development  also share a similar distribution pattern to AtZAR1 orthologs and have been identified across several angiosperm lineages (Solanum lycopersicum (tomato), the Magnoliid Liriodendron chinense (Chinese tulip tree), and the monocot Colocasia escuelenta (taro), among others are able to interact with their corresponding ZRKs , a member of the RLCK XII family of proteins and a paralog of ZED1, to mount an immune response against the Xanthomonas perforans YopJ family effector XopJ4 , sesame (Sesamum indicum), rice (Oryza sativa), false flax (Camelina sativa), canola (Brassica napus), and N. benthamiana , Natural Sciences and Engineering Research Council of Canada Postgraduate Awards (CB-M and BL), an Ontario Graduate Scholarship (CB-M), and the Centre for the Analysis of Genome Evolution and Function (DSG and DD).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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Scientific Reportshttps://doi.org/10.1038/s41598-022-13850-6, published online 14 June 2022Correction to: The original version of this Article contained an error.As a result of an administrative mistake the incorrect number of the IRB approval was included in this manuscript. The study was performed under two protocols approved by the Institutional Review Board of Seoul National University Dental Hospital: CRI14037 and CRI20004. As a result, in Methods, under the subheading ‘Subjects’,“The study was approved by the Institutional Review Board of Seoul National University Dental Hospital and informed consent was obtained from all individual participants included in the study (CRI 08027).”now reads:“The study was approved by the Institutional Review Board of Seoul National University Dental Hospital and informed consent was obtained from all individual participants included in the study (CRI14037 and CRI20004).”The original Article has been corrected.


Depressive symptoms in schizophrenia have a high prevalence – up to 20-60 %, at the different illness stages. Non-pharmacological treatment, namely rTMS, seems like a promising approach that lacks side-effects typical for antidepressants. RTMS is widely applied in the treatment of depression, however the studies within schizophrenia domain are still rather fewThe aim was to examine a potential of neurophysiological data for prediction of the effects of rTMS in the treatment of patients with schizophrenia with depressive symptoms20 male patients with schizophrenia  were examined at the stage of incomplete remission with predominance of prolonged (more than 6 months) treatment resistant depressive symptoms. An examination  fragments)) was repeated twice - before and after a course of 10 Hz rTMS .Poor outcome was associated with initially higher coherence in alpha and lower - in beta1 EEG bands. The amplitudes of non-target N100 and mismatch negativity didn’t differ the groups of responders and nonrespondersThe disturbances within brain networks of beta1 and alpha generators merit attention as potential neurophysiological markers with predictive value in rTMS treatment of patients with schizophrenia with depressive symptoms.No significant relationships.


As the restaging [18F]FDG PET showed intense [18F]FDG uptake in the urinary bladder at the resection site concerning for recurrence, the lesion was subsequently resected and histopathology showed extensive granulation tissue with foreign body-type giant cell reaction with no suspected foreign bodies or neoplasia.Foreign body-type giant cell reaction is typically a biological and immunological reaction to the presence of foreign bodies such as catheters, parasites or biomaterials with a collection of fused macrophages (giant cell). We reported an unusual case of [ The main limitation of Lugano criteria with a high false-positive rate of FDG avid lesions is well recognized  post-initial resection and chemotherapy, with histopathologic findings of foreign body-type giant cell reaction.We present a case of intense FDG PET/CT in May 2021, an intensely hypermetabolic bladder wall lesion at the prior resection site was identified with a maximum standard uptake value (SUVmax) of 67.9 (SUVmax of radiourine was 32.3), with a ratio of 30.9 and 25.1 when scaled to uptake of blood pool and liver . In the present case, the markedly intense uptake (SUVmax of 68) is rarely observed, likely indicative of rapid tumor response to chemotherapy with extensive tumor necrosis and active inflammatory process.The inflammatory process with foreign body-type giant cell reaction is known to be associated with increased [18F]FDG avid lesion with foreign body-type giant cell reaction could occur without the presence of a foreign body and may be indicative of rapidly dying tumor cells in initial response to chemotherapy. We concluded that the intensity of [18F]FDG uptake in the suspected lesion in diffuse large B cell lymphoma following chemotherapy may be nonspecific and should not be used as the diagnostic criterion for malignancy.In conclusion, highly [


The 2019 coronavirus epidemic (CoViD-19) in Italy originated in Lombardy, on February 21, 2020. Crowding has been defined as a worldwide problem and causes reduced quality of care. It is due and identified by three orders of factors: those at the access (input); those related to the patient’s process (throughput); and those at the exit from the ED (output).We evaluated all the population who went to ED for mental disorder. Due to the high level of care needed and the simultaneous exposure to risk factors, an excessive duration of ED process can be counterproductive.We evaluated all patients accessing our ED for mental disorder from February 22 to May 1, 2020 and during the same period of the previous year.We enrolled 345 patients. The Crowding input factors are lower in the pandemic period: reduced attenders (142 vs 203) and reduced average waiting times (40 min vs 54 min). The Crowding throughput factors have instead worsened: LOS (length of stay) for both visit rooms (383 vs 271 min) and holding area (1735 min vs 797 min). The Crowding output factors also worsened: the percentage of access block is higher during the pandemic (100% vs 20%). The Total Access Block Time is significantly higher in the CoViD period for both the visit rooms (3.239 vs 649 min) and the holding area (590 vs 185 min).The pandemic period presented a worsened crowding for these patients due to the Access Block.


Composite child feeding indices (CCFIs) developed from various relevant measures of dietary intake by infants and young children have several potential applications in nutritional epidemiological studies for the development and deployment of precise public health nutrition interventions against child undernutrition. The predictive utility of some CCFIs (computed from varying formulation components) for child nutritional status  were compared. The purpose of the study was to identify the most suitable among them for possible standardization, validation, and adoption by nutritional health researchers. Using cluster sampling, data from 581 mother–child pairs were collected. Multivariable regression analyses were applied to the data obtained through a community-based analytical cross-sectional survey design. Three of the CCFIs were found to be significantly associated with only wasting (WHZ) from the linear regression models after adjusting for potential confounders and/or correlates. None of the CCFIs  was consistently predictive of all three measures of child nutritional status, after controlling for potential confounders and/or correlates, irrespective of the choice of regression method. CCFI 5 was constructed using a dimension reduction technique—namely principal component analysis (PCA)—as the most optimal summary index in terms of predictiveness for child wasting status, validity, and reliability (Cronbach’s α = 0.80) that captured relevant dimensions of optimal child food intake. The dimension reduction approach that was used in constructing CCFI 5 is recommended for standardization, validation, and possible adoption for wider applicability across heterogeneous population settings as an optimum CCFI usable for nutritional epidemiological studies among children under five years. Child food intake and/or nutrition-related factors are estimated to be associated with about 45% of global mortality amongst pediatric populations under five years . The seeIYCF indicators are widely utilized within the nutritional epidemiological research (NER) community. They constitute some of the key indicators reported by nutritional epidemiologists, pediatricians, public health nutritionists, and researchers in global, national, regional, and community nutrition study reports. However, NER literature is replete, with study findings of inconsistencies in the predictive utility of the individual IYCF indicators for child nutritional status, contrary to the association theoretically postulated and espoused by the developers and users alike within the NER community ,12,13. FThe purpose of this study was to compare the predictive utility of some CCFIs (computed from varying formulation components) for child nutritional status  using a cross-sectional study data set obtained from a resource-constrained study setting in northern Ghana, a West African country in Sub-Saharan Africa (SSA).The northern region of Ghana has the country’s highest prevalence rate of stunting  according to the Ghana Demographic and Health Survey 2014 report  and the A community-based analytical cross-sectional design was used for this study conducted in June 2018. Together with their children (6–23 months), 634 mothers of reproductive age (15–49 years) were selected using a two-stage cluster sampling technique from stunting-endemic districts of the northern region of Ghana. There are several languages and dialects spoken in northern Ghana. However, the major languages spoken in the selected study districts are Dagbani (Dagombas), Gonja, and Nanumba. The study participants were drawn from 25 communities across five of the districts in the northern region with a relatively high prevalence of stunting (≥30%) amongst children under five years of age .n = 284. The required minimum sample size was estimated to be n = 568 based on the assumption of a correction factor of 2.0 due to the design effect for cluster sampling [The final sample size used for the statistical analyses of the study data was 581 and was determined from the standard formula for one-point sample estimation ,44. The sampling . The calsampling .A local field research team , recruited mostly from the northern region and provided with training prior to the pilot and definitive surveys, was led by the principal investigator to conduct an interviewer-administered survey of 634 mother–child pairs. The training exercise was to ensure high intra- and inter-rater reliability ,46. The Self-reported dietary intake indicators of child breastfeeding and complementary feeding status and/or practices were used to construct five CCFIs with varying components and scoring guides as summarized in Measures of child nutritional status were the outcome variables in this study. The heights/lengths and weights (anthropometric measurements) of the children and mothers were measured to determine nutritional status. The following measurements were used to calculate the anthropometric (bodily) indicators of underweight, stunting and wasting status, respectively: WAZ (weight-for-age), LAZ (length-for-age), and WLZ (weight-for-length: SD < −2) for the children and BMI (body mass index) for the mothers using the WHO Anthro Software Version 3. Computed Z-scores were based on the 2006 WHO growth standards, expressed as standard deviation units from the median value for the WHO growth reference groups . ImprobaThe independent variables of interest in this study were the CCFIs in the continuous and categorical forms, constructed from various indicators of infant and young child feeding practices. The determinants (independent variables) of undernutrition in the northern region of Ghana in this study were classified into proximal or immediate, intermediate, or underlying and distal or basic factors based on an adapted version of the UNICEF hierarchical conceptual framework  as descrThe child feeding practice indicators of this study were estimated from self-reported 24 h food recall (24HFR) ,7. Each Minimum acceptable diet (MAD) was defined as the proportion of children who received both the MMF and MDD for their age category, as classified by the WHO. Intake of micronutrient-rich foods (MRF) was also estimated for vitamin A and iron (Fe), using the 17 food groups as classified by the FAO . ChildreAppropriate complementary feeding (ACF) was a composite child feeding index (CCFI) constructed from TICF, MMF, and MDD as previously described ,30. ACF,n = 634) were coded, entered, and screened using IBM SPSS Software (Version 27). Cases with missing values and/or implausible Z-scores were deleted from the dataset. The cleaned data set (n = 581) were evaluated for compliance with the key assumptions underlying multivariable regression analyses. These diagnostics included sample size adequacy, missing values, univariate outliers, multivariate outliers (Cook’s distance), normal distribution of residuals (P-P plot), linearity (scatter plots), homoscedasticity , multicollinearity (variance inflation factor (VIF)), and independence of observations or residuals (Durbin–Watson statistic) [Responses from the interviewer-administered questionnaires n = 4 were coatistic) .t-test  and Pearson’s chi-square ((χ2) tests . The means and standard deviations (SD) and relative frequencies were reported for the continuous and categorical forms of the CCFI component variables, respectively. Bivariate analyses were conducted also to determine associations  between each categorical independent variable (IV) and the categorical form of the dependent variables (less than −2 SD for stunting and wasting) using Pearson’s chi-square ((χ2) tests at p < 0.05. Pearson correlation coefficient (r) and simple linear regression were used to measure the strength, direction, and significance of the relationships between the covariates  and the continuous form of the DVs at p < 0.05 [Descriptive analyses were performed to summarize the characteristics of the study participants, all the other covariates or factors (independent variables (IVs)), and prevalence of the dependent variables  using mean and standard deviation for the continuous variables, counts, and relative frequencies (percentages) for the categorical variables. Bivariate analyses were also performed to examine the distribution of each CCFI using ANOVA and p < 0.05 ,66.p < 0.05. However, explanatory variables that were considered to have clinical relevance from literature search and were also statistically significant at p < 0.10 were included in the multivariable regression models [A predictive statistical modelling approach was used to analyze the association between each CCFI and the measures of child nutritional status , accounting for the effects of potential confounders (relevant factors and/or covariates) in the model specifications ,68. Multn models ,69. The 2 for the logistic regression models. The coefficient of determination (R2) was used as a measure of goodness of fit and parsimony for the multiple linear regression models [The overall model performance  were assessed using the Hosmer–Lemeshow goodness of fit test and the Nagelkerke Rn models ,71. Two-Content and construct validity of the five CCFIs were assessed qualitatively by the authors based on consensus, cognizant of inferences from the previous studies . InternaSensitivity (what-if) analyses of the study results were conducted to assess the robustness of the final parsimonious models based on the form of the CFFI used  and the exclusion of breastfeeding status from CCFI 1 formulation ,76,77.In accordance with the requirements of the Helsinki Declaration, ethical clearance was obtained from the Ghana Health Service Ethics Review Committee (GHS-ERC: 011/11/17) in Accra, Ghana, and the Ethics Committee of Bielefeld University (EUB 2018-083) in Bielefeld, Germany. Community and household entry protocols for the study area were followed accordingly to gain access to the study participants. Written informed consent prior to enrolment was obtained from each mother by endorsement with a thumb print and/or signature on the consent forms provided after explaining the purpose and scope of the study to the participants in their native languages. Verbal consent was also obtained from the household heads in accordance with their cultural values and community normsCharacteristics of study participants and prevalence of child nutritional status are as follows:The majority of participating mothers (55.2%) were aged 25–34 years, farmers (55.6%), married (97.2%), and currently breastfeeding (96.4%). The majority of children (89.9%) weighed less than 2.5 kg at birth, with 32.2% being stunted .p < 0.05). Of the five CCFIs, the child age group of 9–11 months had the highest median score (50th percentile) for CCFI 1, all the three age groups had the same median score for CCFI 2, child age group of 12–23 months had the highest median score for CCFI 3, child age group of 9–11 months had the highest median score for CCFI 4, and child age group of 12–23 months had the highest median score for CCFI 5 , maternal age and height, child age group, usage of insect-treated nets (ITN), and the number of occupants per the child’s household, which were significantly associated with child stunting status in the bivariate analysis. Religion, tribe (ethnicity), marital status, maternal body mass index (BMI), child age group, child gender (sex), child health status (morbidity in the last two weeks and frequency of diarrhea in the last six months), child immunization status, frequency of prenatal care (PNC) services attended, and the source of power (energy) for household utility were significantly associated with child wasting status in the bivariate analysis. The district of residence, community, tribe, type of community , maternal BMI and height, child age group and gender, child health status (morbidity in the last two weeks), the source of power (energy) for household utility, and the number of people per room in the household were significantly associated with child underweight status in the bivariate analysis. Child gender, child’s recent morbidity status, and maternal BMI were consistently associated significantly with wasting status in the multivariable regression models, alongside with CCFI 1, 4, and 5.None of the CCFIs in the continuous form was consistently predictive of all three measures of child nutritional status  after controlling for potential confounders and/or correlates. The continuous forms of CCFI 1, 4, and 5 were significantly predictive of only wasting (WHZ) from the linear regression models after adjusting for potential confounders and/or correlates .The continuous form of the CCFIs were all not significantly predictive of child stunting (HAZ), wasting (WHZ), and underweight (WAZ) status in the bivariate regression models except CCFI 2 for stunting (logistic regression) and underweight status (linear regression); CCFI 3 for stunting (linear and logistic regression), wasting (linear regression), and underweight status (linear regression), CCFI 4 for wasting (linear regression) and underweight status (linear regression), and CCFI 5 for stunting (linear and logistic regression), wasting, and underweight status (linear regression). Only CCFI 3 and CCFI 5 were consistently associated with child nutritional status in the bivariate analyses irrespective of the type of regression method used except for the simple logistic regression analyses between CCFI 3 and wasting or underweight status and that between CCFI 5 and wasting status .There was consistency in the predictive outcomes of the continuous forms of the CCFIs irrespective of the choice of regression methods (linear or logistic) used except CCFI 1 for wasting (multivariable), CCFI 2 for stunting (bivariate) and underweight status (bivariate), CCFI 3 for wasting (bivariate) and underweight status (bivariate), CCFI 4 for wasting (multivariable and bivariate) and underweight status (bivariate), and CCFI 5 for wasting status (multivariable and bivariate) .There was consistency in the predictive outcomes of the continuous forms of the CCFIs for child nutritional status compared with the adjusted (multivariable) and unadjusted (bivariate) models except CCFI 1 for wasting (linear regression); CCFI 2 for stunting (logistic regression) and wasting status (linear regression); CCFI 3 for stunting (linear and logistic regression), wasting (linear regression), and underweight status (linear regression); CCFI 4 for underweight status (linear regression); and CCFI 5 for stunting (linear and logistic regression) and underweight status (linear and logistic regression). Only the continuous form of CCFI 1 exhibited Simpson’s paradox, that is, a spurious reversal of statistical significance, strength, and/or direction of association for the prediction of wasting (WHZ) in the linear regression model. The bivariate association between CCFI 1 and wasting was not statistically significant, but after controlling for the potential confounders and/or correlates, CCFI 1 became significantly associated with wasting .None of the CCFIs in the categorical form was consistently predictive of all three measures of child nutritional status , irrespective of the regression method (linear or logistic), after controlling for potential confounders and/or correlates .The categorical form of each CCFI was not significantly predictive of child stunting (HAZ), wasting (WHZ), and underweight (WAZ) status in the bivariate regression models except CCFI 1 for stunting (linear and logistic regression) and underweight status (linear and logistic regression); CCFI 2 for underweight status (linear regression); CCFI 3 for stunting (linear and logistic regression), wasting (linear regression), and underweight status (linear regression); CCFI 4 for stunting (linear and logistic regression) and underweight status (logistic regression); and CCFI 5 for stunting (linear and logistic regression), wasting, and underweight status (linear regression). None of the categorical forms of the CCFIs was consistently associated with all the three measures of child nutritional status in the bivariate analyses for both linear and logistic regression model specifications .There was consistency in the predictive outcomes of the categorical forms of the CCFIs irrespective of the choice of regression methods (linear or logistic) used except CCFI 2 for underweight status (bivariate), CCFI 3 for wasting (bivariate) and underweight status (bivariate), CCFI 4 for underweight status (bivariate), and CCFI 5 for wasting (bivariate) and underweight status (bivariate) .There was consistency in the predictive outcomes of the categorical form of the CCFIs for child nutritional status compared with the adjusted (multivariable) and unadjusted (bivariate) models except CCFI 1 for stunting (linear and logistic regression) and underweight status (linear and logistic regression); CCFI 2 for underweight status (linear regression); CCFI 3 for stunting (linear and logistic regression), wasting (linear regression), and underweight status (linear regression); CCFI 4 for stunting status (linear and logistic regression); and CCFI 5 for stunting (linear and logistic regression), wasting (linear regression), and underweight status (linear regression). None of the categorical forms of the CCFIs exhibited Simpson’s paradox .CCFI 1 and CCFI 5 had the lowest and highest Cronbach α values, respectively, in correspondence with the number and relevance of the test item components used in their construction . Breastf2) used to assess the trade-off between the goodness of fit and parsimony for the multiple linear regression models explained 6.7% of the variance in child wasting status for CCFI 1, 7.5% for CCFI 4, and 7.5% for CCFI 5  used in the modeling. The adjusted coefficient of determination (adjRr CCFI 5 .The purpose of this study was to compare the predictive utility of CCFIs (computed from varying formulation components) for child nutritional status . After controlling for potential confounders and/or correlates in the regression models, CCFI 5, which was constructed using a dimension reduction statistical technique, namely PCA, was found to have a relatively higher predictive utility for child wasting status compared to CCFI 1, which was constructed following the seminal formula of Ruel and Menon . It was In most of the studies that adopted the Ruel and Menon  approachTo the best of our knowledge, no study has adopted the PCA approach to construct CCFI. However, similar epidemiological and public health studies that used dimension reduction as a statistical technique to generate a summary index for predictive modeling purposes found it to be robust and clinically useful ,80,81.Acute undernutrition also referred to as wasting status (WHZ/WLZ) is one of the key nutritional health indicators used in the construction of the Global Food Security Index (GFSI) and Global Hunger Index (GHI) for the classification of populations prone to food insecurity, hunger, and/or malnutrition. The consistency and suitability of the CCFIs especially CCFI 5 for predicting wasting status can also therefore be useful as a public health tool to rapidly identify undernourished children under five years under acute food shortage or emergency situations.The measurement validity  of the CCFIs as constructed in this study were generally rated subjectively  as ranging between low and very good even though the test items of the sub-domains covered the relevant aspects of optimal child food intake, namely breastfeeding and complementary feeding ,74. CCFIThe Cronbach alpha values of CCFI 1, 4, and 5  were indicative of low to very good internal consistency as a measure of reliability (or homogeneity of the test items) of the construct representing optimal young child food intake ,82,83. TThe findings from the sensitivity analyses and model performance evaluations agree with studies that suggest that the choice of statistical method, form of the predictors in the regression models, and the selection criteria for inclusion or exclusion of one or more IVs in regression models could influence the inferences obtainable ,85. ThisThis study is the first attempt to compare the predictive utility of variously formulated composite child feeding indices (CCFIs) that reflect the multidimensionality of optimal child dietary intake for identifying infants and young children at risk of undernutrition . Even though the cross-sectional design used for this study precludes it from establishing causality, the reliability, validity, model performance, and sensitivity analyses conducted provides additional confidence in the study results. It also highlights some important conditions that potentially debunk or otherwise accentuate the robustness of the postulated association between CCFIs and child nutritional status measures.Some possibly unmeasured confounders and residual confounding coupled with potential reporting bias (under- or overestimation from 24 HDR) and probable covariate selection bias may have suppressed or otherwise potentiated the effects of the CCFIs on child nutritional status ,87. The No internal and external model validation analyses were conducted; thus, the practical utility and generalizability of the CCFIs identified to be predictive of wasting status (WHZ) of children under five years cannot be proffered from this study. No clinical utility or practical epidemiological significance evaluation of the predictive models were conducted because none of the CCFIs was consistently predictive of all the three measures of child nutritional status (undernutrition) in this study after adjusting for potential confounders. No interaction analyses were conducted to assess the moderation effects of covariates such as child age and gender on the association between CCFI and wasting.The predictive utility of CCFIs for child nutritional status is sensitive to the components and/or various measures of child feeding practices used in their formulation and construction. After adjusting for the potential confounders measured, CCFI 1, CCFI 4, and CCFI 5 were significant predictors of wasting status of children under five years.The dimension reduction approach (PCA), which was used in formulating and constructing CCFI 5, is recommended for internal and external validation and possible adoption for wider applicability across heterogeneous study settings as the potentially optimum composite child feeding index usable for nutritional epidemiological studies among children under five years. Just as the hunger index (HI) and global food security index (GFSI) are used for ranking the vulnerability to malnutrition across communities, countries, and geographical regions, CCFI 5 could be used for a similar purpose.More robust study designs  and validation methods should be considered for exploration to address some of the limitations widely known to be inherent in cross-sectional design studies and self-reported dietary intake measurement instruments during the validation of these study findings. A comparative study of the effects of the choice of various regression methods  on the predictive utility of CCFIs for undernutrition, with or without the dichotomization (or categorization) of continuous data, is also recommended as explored by Sauzet et al.  in an ob


This talk will explore: 1) the conceptual importance of select interpersonal factors inherent to Black culture and bereavement, and 2) the impact of these factors on grief in a Black bereaved sample. 103 Black adults aged 45+ were administered items assessing cultural  and bereavement-specific  factors. Using linear regressions, closeness (p<.001), suddenness (p=.020), anger (p<.001), and communalism (p<.001) predicted reported levels of grief. This study identifies factors which substantially dictate the experienced levels of grief of bereaved Black adults in the latter half of life. With cultural factors notably impacting the Black bereavement experience, individuals seeking to work with this population must adopt strategies to keep bereaved Black adults connected to their communities throughout their loss. Resources to support Black adults in maintaining healthy continuing bonds with the deceased through abrupt or unsettling losses also appear paramount.


Reminiscence therapy (RT) is a multi-sensory treatment that uses a combination of sight, touch, taste, smell and sound to help persons with dementia (PWD) remember events, people and places from their past lives. Currently, digital technologies such as mobile applications and immersive solutions including virtual and augmented reality, are gaining momentum as supplementary tools for RT. This paper presents a usability study of a web-based and virtual reality application to understand the limitations and opportunities of digital platforms for facilitating engaging experiences for PWD towards recalling memories, while easing the therapy process for the caregivers. A total of ten healthcare caregivers were recruited from the Geriatric Dementia Unit and Geriatric Transitional Unit in Ontario Shores Center for Mental Health Sciences, Ontario Canada. Usability feedback from the caregivers were collected from the interviews after the completion of the System Usability Scale (SUS) questionnaire. Institutional caregivers found both web-based and virtual reality (VRRT) usable with SUS score above average (68/100), but required improvements related to the onboarding training of caregivers. The interview revealed four overarching themes related to the VRRT: (1) Ease of use; (2) Positive impact on caregiving; (3) Potential of reduction in responsive behaviors; (4) Feasibility for promoting social connection during COVID-19 pandemic. Next steps will focus on improving the user experience and expanding the application for immersive VR supporting head-mounted displays, hand tracking, and physiological measures, as well as conducting an usability study with PWD to expand our understanding of using RT digital tools with various levels of immersion.


This case series describes the kinetics of humoral deficiency in patients with relapsed refractory multiple myeloma treated with bispecific antibodies, the infectious complications, and response to COVID-19 immunization. We report on the kinetics of humoral deficiency among patients with RRMM treated with bsAb, the infectious complications, and response to COVID-19 immunization.Bispecific antibodies (bsAb) targeting novel antigens are a promising class of therapeutics for relapsed refractory multiple myeloma (RRMM).6 and antibiotic prophylaxis was prescribed per current institutional guidelines. Statistical analysis details are provided in the eMethods in the In this case series, we included patients with RRMM treated in early phase 1 and 2 clinical trials of bsAb at our institution between January 1, 2019, and December 31, 2021. Patients self-reported their sex and race and ethnicity; the latter data were collected due to the high incidence of multiple myeloma among racial and ethnic minority groups. Serial immunoglobulin levels and infections confirmed by clinical, imaging, microbiologic, or histopathologic evidence were captured retrospectively from the start of therapy until last follow-up or 3 months after study exit. Cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome were graded per American Society for Transplantation and Cellular Therapy criteria,reporting guideline for case series.The Medical College of Wisconsin Institutional Review Board approved this study and waived the need for informed consent owing to its retrospective design. This study followed the Forty-two patients contributing 49 treatment periods (7 patients were counted twice) were included in our analysis . The The overall cumulative risk of infections increased with increasing duration of therapy with risk at 3 months of 41%; at 6 months, 57%; at 9 months, 64%; at 12 months, 67%; and at 15 months, 70%. The most common infections were bacterial (44 of 81 [54%]), followed by viral (33 of 81 [41%]) and fungal (4 of 81 [5%]) infections. Respiratory tract infections accounted for 41 of 81 infections (51%). Four deaths were attributed to infections, including 2 patients who died within 90 days of treatment . On multThe findings of this case series highlight the prolonged hypogammaglobulinemia and increased risk of infectious complications with a 70% cumulative infection risk in patients with RRMM treated with bsAb therapy. The risk of infection was associated with the degree of hypogammaglobulinemia and increased with treatment. We also noted an increasing rate of seroconversion with COVID-19 booster vaccination series. Our study is limited by the small sample size and heterogenous patient population treated with differing dose escalations and combinations with other myeloma therapies; nevertheless, our findings underscore the changing continuum of humoral immunodeficiency and infection risk with this growing class of therapeutics in RRMM.


HIV rapid testing services is one among key interventions in the controlling of HIV/AIDS. Despite availability of quality standards, the quality of HIV rapid testing services remains questionable since non-laboratory testers are allowed to conduct testing while they are not specialized in providing testing services.To evaluate the compliance to the quality standards of HIV rapid testing services provided by non-laboratory testers in Makete District, TanzaniaAn explanatory descriptive study employing quantitative approach of data collection was used. An observation of 23 non-laboratory testers performing HIV rapid tests, observation of HIV testing points and documents review was done in 23 testing points to collect data. Data were analyzed using a programmed excel sheet and a three-point scale was used to determine the level of compliance to quality standards.Analysis shows that out of 23 testing points visited, the level of compliance to quality standards was lower for 22 (95.6%) testing points and moderate in 1 (4.4%) testing point. None of the testing point was highly complied to quality standards for HIV rapid testing services.The quality of HIV rapid testing services provided by non-laboratory testers is below the established quality standards for HIV rapid testing services. HIV rapid testing services is among key interventions in the controlling of HIV/AIDS since it provides chances to access HIV care, treatment, prevention, and support services.5Several studies have been conducted to evaluate the quality of HIV rapid testing services. An auditing study conducted in Caribbean and African countries, which involved 968 HIV testing points demonstrated that 20% of the testing points scored level 0; 46% of the testing points scored level 1; 31% of the testing points scored level 2; while 3% of the testing points scored level 3 and none of the testing point that had high level of compliance to quality standards such that none of the testing points scored level 4.6Furthermore a study conducted in 102 private health facilities in Kampala Uganda to evaluate the quality of HIV rapid testing services demonstrated that the quality of HIV rapid testing services is below the recommended quality standards.7Tanzania has also adopted the WHO quality standards for the implementation of HIV rapid testing services.The study was conducted at Makete District Council in Njombe Region, Southern Tanzania. HIV Records for 2016/2017 show that Njombe Region has the highest HIV prevalence (11.4%) in Tanzania.Purposive sampling technique was used to select both public and private health facilities where by all HIV rapid testing points were studied and non-laboratory testers who provided services on the day of the study were observed when performing actual HIV rapid tests.An on-site checklist for document review and observation adopted from WHO by the Tanzania Ministry of Health was used to collect quantitative data. The main areas of observations included: personnel training and certification; physical facility; safety; pretesting phase; testing phase; documentation and records as well as external quality assessment.Ethical clearance to conduct this study was obtained from Research and Ethics Committee (REC) of Muhimbili University of Health and Allied Sciences (MUHAS). Permission to conduct the study was requested from the District Medical Officer of Makete District and officer in charges of the respective health facilities. Study participants were informed about the purpose of the study, procedures, risk and benefits for them to participate in the study. Informed written consent was obtained from each study participant after agreeing to participate in the study.Data were collected manually and entered into excel sheets and they were cleaned and validated. All descriptive data were analyzed using programmed excel sheets and data were presented in frequency tables of numbers, percentages  and level of compliance to quality standards for HIV rapid testing service. Summation of each response of the open ended question in each quality standard was used to determine the average compliance for each quality standard. A three-point scae  was used to determine the level of compliance to all quality standards for HIV rapid testing services for each testing points whereas testing points scored level 4 (score of 90% or higher) were defined as highly complied to quality standards; level 3 (score of 80% – 89%) were defined as moderately complied to quality standards; level 2 (60% – 79%), level 1 (40% – 59%) and level 0 (less than 40%) were defined as lower complied to quality standards.Most of the HIV testers (34.8%) worked on wards, Reproductive and Child Health section (21.7%) and Care and Treatment Centre (13%). The majority of the testers (52%) were from the district level health facilities while about 22% of them were from dispensaries. Majority of the testers (78%) worked in the government health facilities and the remaining 22% worked in private health facilities. Most of testers were women (78.3%) while 21.7% were men. All testers (100%) had ordinary level of secondary education whereas among them 69.6% testers had certificate level of education and 30.4% had diploma level of education. Only one study participant (4.4%) was clinical officer, 30.4% were enrolled nurses and 34.8% were Medical attendants while 30.4% were assistant nursing officers.Evaluation results show that out of 23 testing points visited, the level of compliance to the quality standard was lower for 22 (95.6%) testing points. Two (2) testing points (8.7%) scored level zero, 13 (56.5%) testing points scored level one and 7 (30.4%) scored level two. The level of compliance to HIV rapid testing quality standards was moderate in 1 (4.4%) testing point. None of the testing point had high level of compliance to the HIV rapid testing quality standards, meaning that no testing point attained level four. Average compliance for each quality standard was also determined by observing how non-laboratory testers and testing points operations comply with such standards. These standards include: personnel training and certification; physical facility, safety, pretesting phase, testing phase, documentation and records as well as external quality assessment. The average compliance to personnel training and certification quality standards was 15% whereas: only 9 (39%) out of 23 non laboratory testers that provided HIV rapid testing services on the day of the study received comprehensive training on HIV rapid testing using the nationally approved curriculum; only 2 (9%) non-laboratory testers were trained on external quality assessment (EQA)/proficiency testing (PT) process; only 5 (22%) non-laboratory testers were trained on safety and waste management procedures and practices. No any non - laboratory tester has been certified or licensed through a national certification program to perform HIV rapid testing services.Average compliance to physical facility quality standards was 65% whereas: 16 (66%) testing points have designated area for providing HIV rapid testing services; 11 (48%) testing points were clean and organized for testing; 22 (96%) of testing points had sufficient lighting; none of the testing points store test kits in temperature-controlled environment and there was no device to monitor temperature in all visited testing points and 18 (78%) testing points had sufficient and secure storage space for test kits and other testing consumables.Average compliance to safety standards was 56% whereas: only 2 (9%) testing points had SOPs to manage spills of blood and other body fluids; only 4 (17%) testing points had SOPs to address accidental exposure to potentially infectious body fluids through a needle stick injury, splash or other sharps injury; all 23 (100%) testing points had personal protective equipment (PPE) and testers properly used PPEs through the testing process; 13 (57%) testing points had hand-washing facilities such as water and liquid soap. Only 6 (26%) testing points handled properly waste materials such as sharps, infectious and non-infectious waste and only 13 (56%) testing points disinfect working area with the appropriate disinfectant such as chlorine.The average compliance to pre testing phase standards was 63% whereas: only 9 (39%) testing points had national guidelines for HIV testing services; all 23 (100%) testing points use national algorithm and approved HIV rapid kits; expired HIV rapid test kits such as uni-gold were available in 9 (39.1%) testing points; only 4 (17%) testing points had a standard process for stock management; only 4 (17%) testing points had posted job aides on client sample collection; 19 (82%) testing points had sufficient supplies for client sample collection and in only 9 (39%) testing points, client's identifiers were recorded in the HIV testing register and on test devices as per national guidelinesThe average compliance for testing phase standards was 53% whereas: only 5 (54%) testing points had SOPs on HIV testing procedures and posted at the testing area; timers were available and used routinely in only 1 (4.3%) testing point; sample collection devices such as capillary tube, loop, disposable and pipettes were used accurately in 22 (95%); testing procedures such as correct use of buffer and reading of results on time were adequately followed in 16 (70%) testing points and positive and negative quality control specimens were routinely used in 13 (57%) testing points. Retest for verification was done in 4 (67%) health facilities out of 6 health facilities visited.Average compliance to documentation and records standards was 92% whereas: 20 (87%) testing points had standardized register for documentation, which contain key elements in the registers such as client demographics, kit names, lot numbers, expiration dates and tester name. The final HIV results were recorded correctly in 16 (70%) testing points; client documents and records were securely kept throughout all phases of the testing process in 22 (95%) testing points.Average compliance to External Quality Assessment was 40% whereas: 11 (48%) testing points were enrolled in Proficiency Testing (PT) program; out of 11 testing points enrolled into PT program, only 4 (36%) testing points implement corrective action in case of unsatisfactory PT results; 21 (91%) testing points received periodic supervisory visit and written supervision report was available in only 1 (5%) testing point.This study has shown that the level of compliance to the quality standards for HIV rapid testing is below the recommended standards. Majority of observed HIV testing points scored level one and none of the testing point was highly complied to quality standards, meaning that no testing points scored level four. The results of this study are similar with the study conducted in Kampala Uganda to assess the quality of HIV counseling and testing services, which demonstrated that the quality of HIV testing services is below the recommended standards.13In this study, the highest average compliance score was seen on documentation and records followed by physical facility that included availability of conducive designated areas for provision of HIV rapid testing services and the lowest average compliance score was seen on personnel training and certification, followed by External Quality Assessment, testing phase, safety and pre testing phase. In addition, this study revealed that availability of new National HIV register that require all key elements to be documented in one register has contributed to improved documentation and record keeping for different data hence results into higher score for documentation and records quality standards. Furthermore, this study shows that most of the non-laboratory testers did not receive comprehensive training to perform HIV rapid testing services and none of them were certified/licensed to perform HIV rapid test through the National Certification Program. This situation has resulted into the lower score for the personnel training and certification quality standards, which was below the recommended quality standards for HIV rapid testing services, which requires that services should be provided by testers who received comprehensive training as well as evaluated for their competence and certified to provide testing services.7In this study we observed low compliance to the quality standards for External Quality Assessment (EQA) and about half of the testing points were enrolled into proficiency testing program and most of the testers were not trained to perform samples for proficiency testing. A study conducted in South Africa to evaluate the quality management system for HIV rapid testing services reported similar findings indicating that the compliance to EQA standards was low and only two clinics out of eleven clinics were enrolled into proficiency testing program. 6In this study, non-adherence to testing procedures including the use of small volume of buffer and non-adherence on time to read result whereby timers were not used during testing were observed. Similar findings were reported in a study conducted in Zambia National Reference Hospital in which the use of inadequate volume of specimen and use of incorrect volume of buffer leading into poor quality of test results was reported.11Our study has shown that a few testing points had guidelines for HIV testing services and Standard Operating Procedures (SOPs). These guidelines and SOPs are important documents for providing guidance and procedures needed to be followed during testing hence lack of guidelines and SOPs compromises the quality of HIV rapid testing services.19Some of the testing points were temporarily closed during data collection period due to lack of trained testers to provide service, and probably such testing points could have useful information regarding the practice of implementation of HIV rapid testing services in studied facilities. Furthermore, due to resource constrains only six facilities were studied, which might have limited the data collected. However, we believe that this study provides valuable insights regarding the quality of HIV rapid testing services provided by non-laboratory testers in the rural setting district in Tanzania.The quality of HIV rapid testing services provided by non-laboratory testers in Makete District is below the established quality standards set for provision of HIV rapid testing services. Most of the non-laboratory testers were not trained, evaluated for their competencies and were not certified or licensed to provide HIV rapid testing services. Some of HIV rapid testing points do not have Guidelines and SOPs that guide provision of HIV rapid testing services, which compromises the quality of HIV testing services. The Ministry of Health and Management of the health facilities should invest more efforts in training and strengthening of certification of non-laboratory testers, increasing enrolment of testing points into proficiency testing and strengthening supervision of testing points in order to improve compliance to quality standards.


Self-isolation regime is an effective measure to contain the pandemic , but the psychological factors predicting compliance with stay-at-home recommendations (CSHR) are understudied. We hypothesized that 1) defensive optimism and constructive optimism will have opposite effects on CSHR, 2) the effect of defensive optimism will be mediated through a decrease of anxiety (fear of infection).. The purpose of this study was to assess the direct and indirect (through the fear of infection) effects of defensive optimism (belief that coronavirus problem is exaggerated) and constructive optimism (belief that people’s efforts help to prevent infection and spread of the virus) on CSHR, controlling for dispositional optimism.. A longitudinal study (from 10/4/2020 till 2/6/2020) was conducted on a sample of 306 university students  using a single-item measure of CSHR, LOT-R , the scales of defensive and constructive optimism , and anxiety in a pandemic situation questionnaire .. During seven-week interval CSHR has decreased dramatically  while the other variables remained stable. Using SEM we have showed that CSHR at the end of study (T2) is predicted by the CSHR (T1) and through it by the defensive optimism  and constructive optimism . Negative effect of defensive optimism on CSHR is also mediated by the fear of infection (T2), reducing it. Dispositional optimism is associated only with constructive optimism.. Defensive and constructive optimism/ pessimism are essential in explaining health-related behavior.No significant relationships.


Age-friendly community initiatives (AFCIs) have become key policy efforts aimed at improving quality of life for older residents, but there is limited evidence about the process. This mixed methods study draws on survey and demographic data from 350 municipalities in Massachusetts to characterize communities by these categories: 1) not interested in AFCIs (n=109); 2) interested in learning more about AFCIs (n=84); 3) planning for age-friendly action (n=71); and 4) maintaining an AFCI (n=86). Interview data from key-informants contextualize the process of developing an AFCI. Thematic analyses suggest that progression through AFCIs is self-defined by the accumulation of momentum. Communities committed to AFCIs have higher proportions of vulnerable residents . Municipal resources  correlate with more advanced stages of AFCIs. Implications of the variability across AFCIs, including the effort required for moving from concept to execution of AFCIs, will be discussed.


Vaccination is one of the main mitigation strategies to protect people from COVID19 mortality. People incarcerated in jails experienced disparate rates of COVID19 infection compared to people in the community, thus operationalization of COVID19 vaccine delivery in jails was prioritized in several states, including Massachusetts (MA). The goal of this project was to track COVID19 vaccine ordering in MA jails and compare numbers and types of COVID19 vaccines ordered by MA jails to those in the MA community, with specific attention to the Centers for Disease Control and Prevention’s (CDC) guidelines for COVID19 vaccines.MA jails received COVID19 vaccines free of charge through the MA Department of Public Health. We requested de-identified, facility-level data from the MA DPH including: number of vaccines ordered by each jail, type of vaccine, and date of the vaccine order from December 2020 - January 2022. We obtained COVID19 vaccines distribution data for the MA general population from the CDC.Vaccine orders were available for 13/14 MA jails. A total of 23,060 vaccines were ordered from the MA DPH between December 2020 - January 2022. January 2021 marked the highest number of vaccine orders by the jails, and all other months were orders < 33% of the January 2021 order. Moderna COVID vaccines were most frequently ordered by the MA jails (88%), followed by Janssen (11%) then Pfizer (1%). In the general population, Pfizer was the most frequently distributed vaccine type (59%), followed by Moderna (37%), then Janssen (4%).Prioritization of jails in MA led to a strong initial push for vaccine distribution which then waned. Potential reasons for the drop in orders include: the initial vaccine orders in January 2021 may have lasted several months, people entering jail after spring 2021 may have received vaccines in the community, and clinical and administrative fatigue may have limited continued robust vaccine protocols. Tracking COVID-19 vaccine orders by jails is a way to assess equitable vaccine operationalization. As recommendations for vaccination evolve, public health and carceral leaders should collaborate to ensure consistent low-barrier COVID19 vaccine access in jailsAll Authors: No reported disclosures.


Since the Global Polio Eradication Initiative (GPEI) was established in 1988, the number of reported poliomyelitis cases worldwide has declined by approximately 99.99%. By the end of 2021, wild poliovirus (WPV) remained endemic in only two countries (Pakistan and Afghanistan). However, a WPV type 1 (WPV1) case with paralysis onset in 2021, was reported by Malawi a year after the World Health Organization (WHO) African Region (AFR) was certified as WPV-free and circulating vaccine-derived poliovirus (cVDPV) cases were reported from 31 countries during 2020–2021  the nonpolio AFP (NPAFP) rate,African Region. Among 28 priority countries in AFR, 50% met both national surveillance indicator targets in 2020 and 79% met the targets in 2021 . Subnational surveillance performance also improved in AFR; both surveillance indicator targets were met in 52% of first subnational administrative level areas in 2020 and 75% in 2021 , eight met both national surveillance indicator targets in 2020 and all but one (Djibouti with stool adequacy of 75%) met both targets in 2021. Most EMR countries performed well at the subnational level, but gaps were apparent in Djibouti. In 2020, a total of 140 WPV1 cases were detected in EMR countries (56 in Afghanistan and 84 in Pakistan), compared with five in 2021 (four in Afghanistan and one in Pakistan). Cases of cVDPV2 in EMR countries declined from 516 in 2020 to 68 in 2021, and cVDPV1 cases declined from 31 in 2020 to three in 2021 .European Region. In the WHO European Region (EUR), surveillance performance was assessed in Tajikistan and Ukraine. In 2020 and 2021, Tajikistan met both national indicators, whereas Ukraine met only the stool adequacy target. In Tajikistan, the proportion of the population living in areas that met both indicators increased significantly from 2020 to 2021.South-East Asia Region. Surveillance performance was assessed in the WHO South-East Asia Region (SEAR), country of Burma (Myanmar),Western Pacific Region. In the WHO Western Pacific Region (WPR), surveillance performance was assessed in Papua New Guinea and the Philippines. In 2020 and 2021, the Philippines met the NPAFP rate indicator, and Papua New Guinea did not meet either of the surveillance indicators. None of the subnational areas in Papua New Guinea met the indicator targets in either year; in the Philippines, 20.5% of the population lived in subnational areas in which both surveillance indicators were met in 2021  in 22 countries in 2021.Poliovirus environmental surveillance is the systematic collection and testing of sewage specimens to identify poliovirus circulation. Because paralysis occurs in <1% of poliovirus infections, environmental surveillance can detect poliovirus circulation even in the absence of confirmed paralytic polio cases  to 75 across 30 sites in 2021 (53% from Afghanistan). During 2020–2021, 27 cVDPV emergence groups (24 cVDPV2 and three cVDPV1) were detected in sewage samples collected in 32 countries, including 22 (69%) from AFR, seven (22%) from EMR, two (6%) from WPR, and one (3%) from EUR.In Afghanistan, WPV1 was isolated from only one environmental surveillance sample in 2021 compared with 35 samples from 15 sites in 2020  comprises 145 quality-assured poliovirus laboratories in the six WHO regions. GPLN laboratories implement standardized protocols to 1) isolate polioviruses ; 2) conduct intratypic differentiation (ITD) to distinguish between WPV, Sabin  virus, and VDPV (134 laboratories); and 3) conduct genomic sequencing (28 laboratories). Poliovirus transmission pathways are monitored through sequence analysis of the viral protein 1 (VP1) capsid protein from virus isolates. The accuracy and quality of testing at GPLN laboratories are monitored through a comprehensive standardized quality assurance program of onsite reviews and proficiency testing  accounted for 18 of 140 (13%) WPV1 isolates from AFP patients in 2020 and two of six (33%) in 2021.All priority countries faced setbacks in surveillance performance in 2020 because of the COVID-19 pandemic and associated risk mitigation measures  surveillance, the primary means of tracking poliovirus transmission, is supplemented by environmental surveillance of sewage samples. The COVID-19 pandemic negatively affected polio surveillance.Analysis of 2020–2021 AFP surveillance data from 43 priority countries experiencing or at high risk for poliovirus transmission found that national AFP surveillance performance improved from 2020 to 2021 in many priority countries, particularly in the World Health Organization’s African Region; however, substantial national and subnational gaps persist.Surveillance gaps need to be identified and addressed to ensure timely detection of poliovirus circulation and achieve eventual eradication.


This study assesses the extent to which changes in mental health among older adults from pre- to during the pandemic varied by cognitive functioning and the role that decreases in social resources played in this association. We use data from the National Social Life, Health, and Aging Project (NSHAP)—a population-based panel study of older U.S. adults that has surveyed respondents every 5 years since 2005—and the NSHAP COVID-19 supplement, conducted between September 2020 and January 2021 . Results from linear regression models suggest that (1) higher cognitive functioning in 2015 was associated with greater loneliness  during the pandemic; (2) this association is explained in part by a decrease in emotional support during COVID-19 ; and (3) cognitive status did not moderate links between social resources with happiness nor loneliness. Results emphasize the importance of social resources for older adults’ mental health, regardless of cognitive ability.


The nursing home population is vulnerable and medically complex, yet little is known about models of medical service provision and associated quality outcomes. The goal of this study is to examine the association between physician (MD) and nurse practitioner (NP) accessibility and practice sensitive outcomes. This project used data from the Translating Research in Elder Care (TREC) longitudinal study and the routinely collected Resident Assessment Instrument – Minimum Data Set version 2.0 (RAI-MDS 2.0) to test the association between the availability of MDs and NPs in nursing homes (NH) and clinically-relevant resident outcomes of antipsychotic medication (APM) use without indication of psychosis, physical restraint use, hospitalization and emergency department (ED) transfers, and polypharmacy. Eight models were created using logistic regression to test the association between the access measures of daily presence of MD or NP on unit and MDs being involved in care planning and each of the four resident outcomes. The sample consisted of 10,888 residents across 320 units in 92 facilities. Staff from 277 (86%) units reported an MD or NP visited daily and 318 (99%) units reported that the MD or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no associations between either measure of access and any of the resident outcomes. Although we did not find any associations between our measures of access and resident outcomes, additional research which more directly measures physician and NP activities in the NH is required.


Improving the quality and timely access of home health care is a new quality measure and particularly crucial in high-risk ADRD adults following hospitalization. However, a significant portion of older patients waits longer than 2 days to receive home healthcare. In this study, we examine how the quality of home health agency and race are associated with the delay in care among ADRD patients receiving home healthcare and how this delay mitigates the risk of rehospitalization. We find that Black patients in low rated home health agencies have 28% higher odds of delay in care compared to White patients in high rated home health agencies (Odds ratio (95% CI) =1.28 (1.21 - 1.36)). Timely initiation of home health care also reduces the risk of rehospitalization in minority older adults with ADRD.


There is evidence that maternal perinatal depression is associated with adverse neurodevelopmental and mental health outcomes in children. No study has yet examined the association between maternal depressive symptoms during pregnancy and the postpartum period and the risk of oppositional-defiant disorder (ODD) in children and adolescents.This study aimed to investigate whether there is an association between perinatal depressive symptoms and the risk of ODD in offspring from age 7 to 15 years.We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective birth cohort study in the UK. Offspring ODD at the age of 7, 10, 13 and 15 years were assessed by using parental reports the Development and Well-Being Assessment (DAWBA). We applied Generalized Estimating Equation (GEE) modelling to examine associations across the four time points.adjusted OR = 3.59 (1.98-6.52).Maternal postnatal depressive symptoms were associated with more a two-fold increased risk of ODD overall. Third trimester depressive symptoms (measured at 32 weeks of gestation) increased risk of ODD by 72%. Offspring of mothers who had depressive symptoms both during pregnancy and in the first year of postpartum period have a four-fold increased risk of ODD over time (Offspring of mothers with perinatal depressive symptoms are at an increased risk of developing behavioural disorders.


Long-acting injectable antipsychotics (LAIs) can reduce relapse and hospitalization risk but they are not widely used in first psychotic episode (FEP) patientes.To examine the effcacy of two of the most used second generation LAI antipsychotics  to reduce hospitalization rates.We evaluated in a naturalistic study a sample of patients (n=277) with a FEP. We carried out a mirror-design study to compare the number of hospitalizations and days in hospital before and after the introduction of LAI paliperidone (3 monthly) or LAI aripiprazol. In our Early Intervention Services (Lehenak) antipsychotic treatment is not protocolized and is established for each patient according to the psychiatrist criteria.We review the oucome of 277 FEP treated in our Early Intervention Service “Lehenak” with LAI paliperidone 3 monthly (n=156) or LAI Aripiprazol (n=121)Both LAI paliperidone 3 monthly and LAI aripiprazol had a postive impact on hospitalIzation rate, decreasing them significantly after their introduction. These data also support a more extensive use of LAI paliperidone 3 monthly in FEP.Presenting author has received honouraria for lectures or advisory boards from Janssen, Otsuka, Lundbeck and Angelini in the last five years


Obsessive-compulsive disorder (OCD) is associated to a wide range of symptomatic expression and treatment response variability [1]. Sensory perception has been identified as an emerging factor in this process [2]. Sensory vulnerability and atypical sensory experience were identified as risk factors for the development of OCD [3] and a sensory subtype of the disease was proposed in which there is a positive correlation with early onset sensory symptoms, male gender and family background [4]. Adding to the atypical sensory profile, obsessions are frequently experienced as partially perceptual.Our main goals are to characterize the sensory perception in OCD patients; assess the prevalence and intensity of the sensory properties of the obsessive thoughts and explore the how sensory perception, obsessive thoughts and obsessive dimensions/clusters are interrelated.Patients with OCD diagnosis, aged 18 to 65 years and no comorbid mental disorder (except depression) will be recruited. The study battery will include participant form with demographical and clinical features, assessment of depressive and anxiety symptoms (HAM-A and HAM-D) evaluation of clinical outcome measures and obsessive dimensions/clusters  and Obsessive Beliefs Questionnaire-44 (OBQ-44)), assessment of sensory perception and sensory properties of obsessive thoughts (Sensory Perception Quotient (SPQ 21) and Sensory Properties of Obsessive Thoughts Questionnaire (SPOQ)).The results will help us understand the interaction between perceptual and cognitive processes in OCD.Better definition of OCD psychopathology and the establishment of a sensory subtype may indicate the need of specific therapeutic indications or a different escalation of treatment measures.No significant relationships.


Tobacco use intersects with the COVID-19 pandemic not only in terms of health consequences, but also on public health systems, economies, and the environment.The global tobacco supply contributes significantly to environmental pollution of the natural ecosystems. The damage is compounded by tobacco consumption and its resultant waste, which leaves a significant carbon footprint on the environment, undermining the planet’s ecological stability and intensifying climate change. Furthermore, tobacco use exacerbates inequalities and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic.he pandemic has provided a chance to combat tobacco use and accelerate efforts to alleviate these challenges and accelerate progress toward Sustainable Development Goals (SDGs). The MPOWER measures from the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) can play an integral part to boost sustainable and equitable COVID-19 recovery — Monitor tobacco use (article 20); Protection from tobacco smoke (article 8); Offer help for tobacco cessation (article 14); Warn about the dangers of tobacco (article 11); Enforcing bans on tobacco advertising, promotion, and sponsorship (TAPS) (article13); and Raise tobacco taxes (article 6).To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and policy actions to emphasise tobacco control across equity, public health, climate actions, and counteract against the tobacco industry during and beyond COVID-19 as global authorities pledge to achieve the SDGs.• Global authorities must create better synergies on policies with a prime focus on reinforcing tobacco control to recover from the pandemic.• The WHO FCTC MPOWER measures can play an integral part in COVID-19 recovery to fight tobacco use and accelerate progress toward SDGs.


Eradication is an all-or-nothing affair. The aspirational goal set by the World Health Assembly in 1988 of eradicating poliomyelitis by 2000 was not achieved.It is thus tempting to consider eradication of poliomyelitis two-thirds complete, with wild poliovirus type 1 in Pakistan and Afghanistan being the final hurdle to finishing the ‘polio end-game’. But this is sadly not the case. The protracted eradication efforts and perpetually underperforming vaccination programmes using oral live attenuated Sabin poliovirus vaccine (OPV) have birthed calamitous outbreaks of types 1, 2 and 3 circulating vaccine-derived poliovirus (cVDPV) in countries in every World Health Organization region since the first recorded cVDPV outbreak in Haiti in 2020.6 The unprecedented surge in reported confirmed human infections and increasing number of countries with cVDPV detections, either human infections or through environmental surveillance, is cause for great concern  to bivalent oral polio vaccine , while introducing at least one dose of inactivated poliovirus vaccine (IPV) for every child, was necessary to reduce the ongoing risk of cVDPV2 outbreaks. Unfortunately the tardy rollout of IPV and outbreak response campaigns using monovalent OPV type 2 have increased the risk of cVDPV outbreaks.We must not bury our heads in the sand. Novel, genetically more stable oral polio vaccines used under emergency authorisation for cVDPV2 outbreak response provide a glimmer of hope, but this alone is not enough.


The aim of the present study was to investigate emotional regulation and attachment in adolescents with anorexia nervosa (AN).Anorexia Nervosa (AN) is an eating disorder (ED) characterized by self-starvation driving by weight, shape, and eating concerns and extreme dread of food, eating, and normal body weight. Dysfunctional emotional processing and regulation play an important role in the development and maintenance of eating disorders (EDs). Difficulties with emotional awareness and regulation in EDs are hypothesized to have their origins in childhood attachment.The study population (N=20) consists of two research groups of patients with AN (group A) and general population controls (group B), matched for gender and age. The age of patients was 12-18 years. All adolescents were female. This study examined the attachment states of mind, assessed by the Adult Attachment Interview (AAI), and emotion regulation difficulties, measured by the Difficulties in Emotion Regulation Scale (DERS).Group A reported significantly higher attachment insecurity (82% vs 50%) than group B. Group A show higher DERS total  than group B.Study results show a crucial role of attachment insecurity and emotional dysregulation in the development and maintenance of AN. Developing interventions to improve emotional management skills in the treatment of patients with AN can be an important component in improving treatment outcomes.


When the Global Polio Eradication Initiative (GPEI) was established in 1988, an estimated 350,000 poliomyelitis cases were reported worldwide. In 2020, 140 wild poliovirus (WPV) cases were confirmed, representing a 99.99% reduction since 1988. WPV type 1 transmission remains endemic in only two countries (Pakistan and Afghanistan), but outbreaks of circulating vaccine-derived poliovirus (cVDPV) occurred in 33 countries during 2019–2020  rateSurveillance performance in 42 priority countries that had recent WPV or cVDPV transmission or that were deemed at high risk for poliovirus transmission were reviewed. In the World Health Organization (WHO) African Region (AFR), the percentage of priority countries that met targets for both national NPAFP rate and stool adequacy indicators was 67% in 2019 and 48% in 2020 . Both suAll 10 of the assessed priority WHO Eastern Mediterranean Region (EMR) countries met targets for both indicators in 2019, and all but one  did so in 2020. Subnational surveillance performance remained high in most EMR countries, but gaps were apparent in Yemen and Libya, where 44% and 53% of the population, respectively, lived in areas that met both surveillance indicator targets in 2020 . From 20In the WHO European Region (EUR), surveillance performance was assessed in the two priority countries of Tajikistan and Uzbekistan. In 2019 and 2020, only Tajikistan met both surveillance indicator targets at the national level. In both years, Uzbekistan met only the stool adequacy indicator target. Subnational surveillance performance was poor in both countries in 2020 ; in UzbeSurveillance performance was assessed in Burma (Myanmar),In the WHO Western Pacific Region (WPR), surveillance performance was assessed in Malaysia and Philippines. Both countries met the NPAFP indicator target in 2019 and 2020, and neither met the stool adequacy indicator in 2019; however, Malaysia did meet the stool adequacy indicator in 2020. During 2019–2020, approximately one quarter of Malaysia’s population and <3% of Philippines’ population lived in areas that met both indicator targets ; cVDPV1 Genomic sequence analysis identified 41 cVDPV emergences from AFP cases (39 type 2 cVDPV emergences) in 18 countries in 2019 and 34 cVDPV emergences (32 type 2 cVDPV emergences) in 25 countries in 2020. More than one half (22 of 41) of cVDPV emergences detected in 2019 continued to be detected during 2020.Environmental surveillance is the systematic testing of sewage samples to identify populations shedding polioviruses; environmental surveillance in some locations, might be more sensitive to detection of poliovirus transmission than AFP surveillance, given that paralysis occurs in <1% of poliovirus infections  to 599 isolates (57% in Afghanistan) resulting from two 2019 cVDPV2 emergences and seven additional new cVDPV2 emergences in 2020.In 2019, 10 WPV1 genetic clusters (isolates with ≥95% genetic relatedness) were detected in environmental sites from four provinces in Afghanistan and four provinces in Pakistan  is an essential component of poliovirus surveillance. It comprises 145 quality-assured poliovirus laboratories in the six WHO regions. GPLN laboratories implement standardized protocols to 1) isolate polioviruses ; 2) conduct intratypic differentiation to identify WPV, Sabin  polioviruses, and VDPV (134 laboratories); and 3) conduct genomic sequencing (28 laboratories). Poliovirus transmission pathways are monitored through sequence analysis of the capsid protein (VP1) coding region from isolates. The accuracy and quality of testing at GPLN laboratories are monitored through an annual accreditation program of on-site reviews and proficiency testing  was detected in Afghanistan and Pakistan in 2019 (176 cases) and 2020 (140 cases). Orphan isolates  indicate possible gaps in AFP surveillance; in 2019, orphan isolates accounted for five of 176 (3%) WPV1 isolates from AFP patients (two in Afghanistan and three in Pakistan) and in 2020 for 18 of 140 (13%) (11 in Afghanistan and seven in Pakistan).From 2019 to 2020, national NPAFP rates and stool adequacy declined overall in priority countries; subnational surveillance performance declined overall except for WPR countries. Although the total number of WPV1 cases decreased globally from 2019 to 2020, the increase in orphan WPV1 isolates between 2019 and 2020 in both countries suggests gaps in AFP surveillance. The COVID-19 pandemic substantially affected polio eradication activities in 2020  surveillance supplemented by environmental surveillance of sewage samples.Analysis of 2019–2020 AFP surveillance data from 42 countries at high risk for poliovirus transmission indicated that national and subnational nonpolio AFP rates and stool specimen adequacy declined in many priority countries.The findings provided in this report can help guide improvement efforts to restore timely and sensitive field surveillance activities, which were adversely affected by the COVID-19 pandemic.


Medications with anticholinergic properties are commonly used by older adults despite being associated with dementia.The anticholinergic total standardized daily dose (TSDD) is a continuous measure of exposure that has been associated with an increased risk of dementia at values >1095 over ten years in epidemiologic studies. We sought to determine a cumulative (cTSDD) and annualized (aTSDD) in a sample of community-dwelling older adults enrolled in the ongoing Reducing Risk of Dementia Through Deprescribing (R2D2) trial (NCT04270474). Participants were 65 years or older without dementia, attended at least one primary care visit within 12 months prior to enrollment, and were current users of strong anticholinergics according to the 2012 Anticholinergic Cognitive Burden Scale. Prescribed and over-the-counter medication details were collected during the baseline visit through self-report and included strength, frequency, units/dose and duration. The aTSDD was calculated for each participant assuming continuous use patterns throughout the year. The cTSDD was calculated by summing the aTSDD across the number of years since initiation. Of 66 participants, the median cTSDD was 2425 (IQR 5131), and 48 (72%) exceeded the threshold of dementia risk (>1095). Additionally, the aTSDD had a median of 730 (IQR 547), with 60 (90%) exceeding the threshold of dementia risk  while 11 (17%) exceeded dementia risk threshold of 1095 considering 1 year of exposure. Both measures identified the majority of anticholinergic users exceeding dementia risk thresholds despite some disagreement between the two approaches. However, both methods have potential for research and clinical applications.


In 2020, the Los Angeles County Department of Public Health launched Healthy Brain LA (HBLA). HBLA is a multi-pronged project designed to promote cognitive health, reduce the risk of dementia, and help develop a dementia-focused strategic plan for Los Angeles County (LAC) that prioritizes the needs of those impacted by dementia and cognitive impairment and their caregivers. To support this effort, the HBLA team analyzed weighted data from the 2019 and 2020 California Health Interview Survey (CHIS) to better understand the profile of adult caregivers of individuals with dementia and cognitive impairment. CHIS is a publicly available, population-based, web and telephone survey that asks California residents about a wide range of health topics, yielding representative data on all 58 counties in the state. In 2019-2020, an estimated 1.6 million adults provided care to individuals aged 18 years or older in LAC. About 322,880 of those caregivers provided care for individuals with dementia and cognitive impairment, representing 2% of LAC’s adult population. Many of these caregivers were female (59%), Latino/Hispanic (44%), and between 50-64 years of age (32%). Most of them experienced challenges, such as financial stress (61%), physical/mental health problems (18%), or a change in job status (27%), due to caregiving. These data provide the first local estimate of dementia and cognitive impairment caregiving in nearly 15 years. Results offer critical information about this population that will be used by the HBLA team and its partners to guide efforts to effectively meet the needs of caregivers in LAC.


Developing a level 1 accredited geriatric emergency department during the pandemic was challenging. The greater challenge has been to support rural critical access hospitals on their journey of becoming level 2 accredited geriatric emergency departments. This has been accomplished through a novel collaborative approach between the level 1 accredited emergency department, a newly established Geriatric Center of Excellence at Dartmouth-Hitchcock Health and a HRSA funded Geriatric Workforce Enhancement Program. This talk will focus on bringing together system partners and funders who have a history of success through: (a) development, testing and dissemination of tool kits and implementation guides; (b) boot camp training that includes interprofessional team training, QI and specific geriatric content training; (c) implementation support and coaching using data and QI methodology through learning collaboratives; (d) scaling successful models of evidence based geriatric care; (e) expertise in implementation science; (f) expertise in evaluation and (g) disseminating findings to achieve our goals.