This Research Topic collects different contributions that highlight various aspects related to the deployment of MR devices for neuromorphic and AI applications. These contributions provide new insights toward utilizing emerging devices and approaches to mimic biological behavior of the brain.Poduval et al.), proposes a brain-inspired system that displays HDC memorization ability over a graph of relationships. The authors introduce GraphHD, hyper-dimensional memorization that displays graph-based information in high-dimensional space. This approach provides superior cognitive functions over the encoded memory graph, which allows the representation of complex graph-based data structure into high-dimensional space.The first article of this Topic  spiking model, and introduces memristive-based LIF (MLIF). The authors prove the superiority of MLIF over LIF via comparing the firing patterns of both models. It's shown that MLIF can efficiently mimic the firing behavior of biological neurons. Experimental results show that a single memristive cell can emulate the synapse and demonstrate the function of integration and filtering of both the dendrite and soma. Thus, this work could provide a basic building block for reproducing the behaviors of biological neurons and building neural networks.The contribution proposed by Fang, Duan et al.. The reported approach easily mimics the spiking and bursting patterns of distinct brain neurons. The MIZH neural network demonstrates both synchronous and asynchronous collective actions. The firing patterns of excitatory, inhibitory, and other neurons are also studied in this work using the MIZH model. Due to the inherent characteristics of memristor devices, MIZH will have a great impact on the design and implementation of artificial neural network models.As an alternative approach, a memristive-based Izhikevich (MIZH) spiking neuron model is proposed in Fang, Tan et al. propose replacing the resistor with a memristor in the Resistor-Capacitor (RC) neuron circuit, and name the new circuit as Memristor-Capacitor (MC) circuit. It's shown that the charging and discharging time has been reduced using the MC circuit. Thus, due to the key advantages of memristor devices through the non-linear and non-volatile switching, this work proves the potential of utilizing memristor-based circuit to reproduce the behaviors of the biological neurons.The authors in Garg et al. proposed a novel approach for brain-inspired unsupervised local learning. This study focuses on voltage-dependent-synaptic plasticity (VDSP). The authors show that the new methodology helps in reducing the number of updates compared to the standard spike timing dependent plasticity (STDP). Also, results prove that VDSP can be successfully deployed in pattern recognition applications.On a different study, the work reported in We hope this Research Topic will be a great asset for the reader to enrich the knowledge and understanding of utilizing the unique and promising properties of emerging memristor devices for neuromorphic and AI applications.The author confirms being the sole contributor of this work and has approved it for publication.


The use of smoking and smokeless tobacco causes pigmentation on the oral mucosal as mucosal pigmentation, which is one of the clinical features of tobacco-induced melanosis. Tobacco-induced pigmentation is seen on the tongue of the presented case . He had


We introduce the Astronomy New Talent collection, a collection of invited papers by tomorrow's leaders in astronomy and astrophysics. This collection showcases the strength of some of the research funded by the Royal Society. Comprising both research articles and review papers, this collection is a continuation of the series of commissioned New Talent collections which started with the Chemistry New Talent collection , which hThe authors published within this collection are recent awardees of a Royal Society University Research Fellowship (URF) , Newton We hope that readers of the journal will explore this collection and enjoy reading these pieces as much as we did. Royal Society URF Grant Kennedy, at the University of Warwick, investigates the origin and frequency of warm dust in the so-called ‘habitable-zones’ around stars . KatheriWe look forward to growing and expanding this collection from more contributors who are funded by the Royal Society. This collection highlights some of the exciting work from tomorrow's leaders in the field who are delving into the most pertinent questions within astronomy.https://royalsocietypublishing.org/topic/special-collections/astronomy-new-talent [These papers are all curated at w-talent .


The financial pressures associated with a gerontological education are significant given the rising costs associated with education. This fact is particularly relevant for economically vulnerable university students. One source of stress is the cost of textbooks and other required course materials. Indeed textbook prices have increased at a rate faster than other educational expenses. Additionally, the perspectives of diverse and underrepresented scholars are often not as readily available in some textbooks. In this presentation, our process of adapting an undergraduate Aging and Mental Health course to reduce cost and also showcase diverse perspectives is described in detail. The goals of this project were to: 1) adapt a preexisting course to include low- and no-cost content through the integration of open educational resources (OER); 2) provide the most up-to-date evidence based information for content and skills development in the area of aging and mental health; and 3) highlight the perspectives of diverse or traditionally underrepresented scholars in this field of study. We will also share the process of developing an interactive Pressbooks webbook from a strengths-based perspective wholistic perspective.


The long-term services and supports (LTSS) sector is a microcosm of systemic racism that exits in our society. Nationally, half of frontline professional caregivers are nonwhite, while mid- and executive-level managers and board members are predominately white. Research has identified this lack of diversity in management and leadership as a major contributor to turnover and recruitment challenges among frontline staff. We will summarize the findings from three applied research activities: 1) DEI survey of chief executive officers (CEOs) of multi-setting LTSS organizations; 2) interviews with chief diversity officers and CEOs on current workplace DEI efforts and the challenges; and 3) interviews with leaders of color who have had experience with the LTSS sector. Not-for-profit multisite organizations and life plan communities lack diversity among the senior leadership team and board members (12% are people of color). A DEI initiative is more likely to be successful if it has buy-in from the CEO and board members, aligns with the organization’s strategic plan and mission, is integrated into the organizational culture, and is assessed regularly to measure its impact and identify needed adjustments. Leaders of color in aging services acknowledge the barriers – lack of diversity among leaders and residents and the microaggressions that people of color experience - that make it challenging for people of color to work in the field. They recommend increasing diversity among senior leaders, investing in enhancing DEI, and spreading awareness of the LTSS field and its career opportunities to communities of color.


Scientific Reports 10.1038/s41598-022-18120-z, published online 02 September 2022Correction to: The original version of this Article contained an error in the Acknowledgments section.“We gratefully acknowledge the support and the funding sources that are provided by the University of Tabuk (Saudi Arabia). We are thankful to Professor Sergei Petrovskii  for careful reading of the manuscript.”now reads:“We gratefully acknowledge the support and the funding sources that are provided by the University of Tabuk (Saudi Arabia) and the Vice-Presidency for Graduate Studies and Scientific Research for the project number (0148-1442-S). We are thankful to Professor Sergei Petrovskii  for careful reading of the manuscript. ”The original Article has been corrected.


The diagnosis of pediatric cancer is a traumatic event that is considered to be one of the most adverse situations the child and his family can experience. The psychological impact of this diagnosis on the parents has triggered a great scientific attention in these recent years.Estimate the prevalence of depression and post-traumatic stress among parents of children with cancer.Our study was cross-sectional over a period of 1 month in the medical carcinology department at the Salah Azaeiz Institute. We used the Beck Depression Scale II and the Post Traumatic Stress Disorder Cheklist-Civilian assessements.Thirty parents participated in our study. Most of whom were mothers (73%). The educational level was primary in 63% of cases and socio-economic level was average in 60% of parents. 40% of parents were assessed within six months after diagnosis. Prevalence of depressive disorder and post-traumatic stress disorder were 73% and 57% respectively. The low educational level was correlated to the presence of these two disorders. Similarly, the low educational level was correlated to the presence of depressive disorders (p=0.008). The number of children in the family was also associated to the presence of post-traumatic stress disorder (p=0.029).The prevalence of depressive and post-traumatic stress disorders was high among parents of children diagnosed with cancer. The low socio-economic and educational level and the large number of children in the family are risk factors for psychological distress. Psychosocial support should be offered to parents of children with cancer to optimize the management of this disease.No significant relationships.


The COVID-19 pandemic and concomitant lockdown restrictions in South Africa pose critical challenges for adolescents living with HIV (ALHIV) and on ART, impacting their ability to remain engaged in care and adherent to antiretroviral therapy (ART). Not only has this pandemic directly impacted the health care that ALHIV receive, but it has also consequently had devastating effects on society and has negatively affected the mental health and well-being of ALHIV. The challenges associated with the impact of the COVID-19 pandemic on disadvantaged groups such as ALHIV on ART need to be further explored as it may offer hope to ALHIV and restore confidence in the health system. The COVID-19 pandemic brought about severe economic and social inequalities that continue to negatively impact the lives and experiences of already disadvantaged groups such as adolescents living with HIV (ALHIV) . This coSub-saharan Africa houses the largest population of ALHIV as 89% of the 1.6 million ALHIV globally reside here . It has Social and health service delivery restrictions caused by national responses to curb the spread of COVID-19 disrupted and hindered access to facility-based services such as medication pick-ups, adherence counselling and support groups . The losThe impact of the COVID-19 pandemic on the mental health of children can be noted in social isolation, the loss of loved ones, the disruption of school programmes as well as food insecurity all directly and in increased levels of stress in households . The resAdolescents are in the critical stages of biological, psychological, behavioural, cognitive and social development, and it is found that adolescents greatly benefit from and place great value on social interaction and in-person peer contact . However


His neurological examination results were normal, except for a visual field defect in the lower quadrant of the right eye. A slightly hyperintense appearance was observed in the cortical gyri of the occipital and frontal lobes on diffusion-weighted magnetic resonance imaging . Long-te


The COVID-19 crisis requires an integrated effort from governments, institutions, organizations, and communities to attack this crisis. The COVID-19 pandemic has imparted several economic and financial shocks to society. We believe that the nature of work everywhere will be transformed in the aftermath of this global pandemic; for example, online working from home is increasingly adopted by companies wishing to reduce fixed costs and minimize organizational risk. Also, there should be significant changes in lifestyle and access to basic infrastructures, such as energy and transportation systems. Therefore, governments should promote green energy and transportation in the post-COVID-19 world. This issue can also change the pollution levels in the 2020s. Finally, the COVID-19 pandemic provided a significant inequality between developing and advanced economies. Decreasing inequality  should also be essential, especially in the United States and the United Kingdom's free-market economies.Given this background, this Research Topic aims to investigate the effects of the COVID-19 pandemic on leading economic and financial indicators in developing and developed economies. Each paper also aimed to discuss the potential implications for the post-COVID-19 era.This Research Topic covers 46 papers on COVID-19 and the post-COVID-19 era.Sun, Cai et al.). It is also shown that the COVID-19 pandemic has had a critical incentive effect on knowledge collaboration . It is indicated that Artificial intelligence technology can alleviate the plights of firms in the post-pandemic era . Investors' uncertainty sentiment is negatively related to the Chinese stock return from 2 March 2020 to 2 March 2021 . Another paper discusses how governments should evaluate their pandemic policies to determine their effectiveness . The paper also measured China's market power in medical product exports, including the COVID-19 era, from 1992 to 2020 . It is observed that the negative impact of the COVID-19 pandemic on Corporate Social Responsibility efficiency from 2012 to 2020 in China . A significant convergence of the vaccination rates in seven clubs across 30 Organization for Economic Co-operation and Development countries . It is shown the significant role of China's monetary policy implementation on the industrial structure during the COVID-19 pandemic . It is stated that the significant impact of the COVID-19 pandemic on consumer behavior in China's stock market . Another paper discussed the role of lockdowns on economic losses during the COVID-19 pandemic . It is shown that the digital economy significantly positively affects economic growth in the Chinese regions, and this may be a valuable finding for digital transformation during the COVID-19 pandemic . It is observed that pandemics-related uncertainty decreased fertility rates in the panel dataset of 126 countries from 1996 to 2019 . It is found that the COVID-19 pandemic enhanced the congestion effect of tourism industry agglomeration on total factor productivity in China (Wang and Ma). It is stated that the COVID-19 pandemic has promoted job opportunities in the healthcare sector . It is discussed that China's carbon Emissions Trading System would be necessary for carbon reductions after the post-pandemic era .The first paper finds that pandemic uncertainty decreases human capital in the panel dataset of 122 countries from 1996 to 2019 . It is shown that digital finance promoted economic development in the Chinese regions from 2013 to 2020 . It is observed that the market mechanism motivates enterprises' green technology innovation during pandemics (Gong and Dai). It is found that the COVID-19-related uncertainty increased the corporate tax rates in the panel dataset of 113 countries from 2020 to 2021 . It is indicated that listed private firms in China became more valuable with the “black swan” events, such as the COVID-19 pandemic . It is observed that public health emergencies hurt insurance companies' stock returns .Furthermore, it is found that bilateral investment agreements improved the efficiency of the contract execution panel data of 73 developing countries from 2005 to 2019 (Jin). It demonstrated the negative impact of the COVID-19 pandemic on Chinese cross-border retail enterprises. It is found that the COVID-19 pandemic significantly negatively affects the stock market returns of cultural industries . It is indicated that the COVID-19 pandemic has negatively affected economic performance in panel data of 14 prefecture-level cities in Hunan from 2015 to 2020 . It is also discussed the policies related to the COVID-19 pandemic crisis management of the Spanish healthcare sector . It is found that global pandemics sentiment positively affects the returns of the global art market (Wang). It is stated that green finance is the key to the Chinese economy from the recovery from the COVID-19 pandemic . It is indicated that the industrial sector would be more critical during the post-COVID-19 pandemic era to enhance global economic activity . It is observed that the COVID-19 pandemic decreased financial flexibility and firm performance in the listed hotel firms on Taiwan Stock Exchange .On the other hand, the escalating impact of the COVID-19 pandemic on China's stock price volatility was found in the daily data from July 2020 to October 2021 . It is shown that policy uncertainty in China increases the fluctuation of exports in the country from January 2002 to April 2021 (Hu andLiu). Another paper discussed the role of supply chain distortions in the COVID-19 pandemic by focusing on the case of China . It is found that the digital economy increased China's cultural tourism integration during the COVID-19 pandemic . It also stated the negative impact of pandemics on Chinese firms' corporate innovation behavior . It is indicated that stringency measures are negatively related to the COVID-19 pandemic outcomes in the United States from 11 March 2020 to 13 August 2021 . It is also observed that the digital economy increased economic development in the regions of China, and the data included the COVID-19 pandemic era . Another paper used the data in China from January 2015 to April 2021 and found the significant role of the COVID-19 pandemic on the effectiveness of the monetary policy . Another paper discussed the impact of the COVID-19 pandemic on working conditions using the case of survey data for dentists . It provided the negative impact of the COVID-19 pandemic on life insurers in the United States . It is found that the effects of the COVID-19 pandemic are permanent in Indonesia and the Philippines but temporary in Malaysia . It is observed that the COVID-19 pandemic significantly affected revenues and openings of small leisure and hospitality firms in the United States . It is also stated that the COVID-19 pandemic harmed the international trade volume between Australia and China . It is suggested that isolation and quarantine policies as the most cost-effective intervention during the COVID-19 pandemic . It is also shown that the COVID-19 pandemic negatively affected Malaysia's economic indicators .Meanwhile, It was found that foreign direct investments and international trade increased income inequality in China, and the data included the COVID-19 pandemic era (In conclusion, this Research Topic shows the significant effects of the COVID-19 pandemic on various economic and financial indicators in different countries, regions and markets. It also discusses the potential implications for the post-COVID-19 era.GG and CL: writing the editorial. All authors contributed to the article and approved the submitted version.


This is the second of two guidance articles produced by the British Infection Association (BIA), the Healthcare Infection Society (HIS), the Infection Prevention Society (IPS) and the Royal College of Pathologists (RCPath). Both articles refer to the pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using evidence that emerged during the first wave of the pandemic, the articles summarise aspects of the transmission dynamics of SARS-CoV-2 and provide guidance on how to reduce the risk of transmission. This article focuses on the risks of presymptomatic, asymptomatic and post-symptomatic SARS-CoV-2 transmission, allowing healthcare workers and the public to understand how transmission occurs and to take action to protect themselves and others. The guidance recognises further waves of the pandemic, the possibility of reinfection, the emergence of new variants of the virus and ongoing immunisation programmes.confirmedpresymptomatic transmission  is probable.asymptomatic transmission (meaning that an index case never develops symptoms or signs of infection) is Having considered the evidence, the COVID-19 Rapid Guidance Working Party concluded that:The Working Party was unable to assess the likelihood of post-symptomatic transmission  because of an absence of evidence.The Working Party formulated recommendations for practice taking account of the evidence reviewed. The recommendations were developed for acute healthcare settings , but they might be useful in other health and care settings such as dental practices and care homes. The Working Party also identified areas for future research.people without noticeable symptoms may transmit the SARS-CoV-2 virus to other peopletransmission of SARS-CoV-2 from people without symptoms may occur in all settings in which people are in close proximityhowever, it is likely that the risk of transmission of SARS-CoV-2 is greater from people who have symptoms compared with those who do not.Be aware that:Even in the absence of symptoms, adhere to legislation and guidance regarding measures to reduce the risk of transmission of SARS-CoV-2 .nature of further waves or outbreaks of COVID-19emergence and circulation of SARS-CoV-2 variants of concernpotential for people who have had COVID-19 previously to be reinfectedeffectiveness of available vaccines, including the longevity of immunity they confer.Be aware that the future transmissibility of SARS-CoV-2 from people carrying the virus without symptoms might depend on the:Be aware that it is not yet known to what extent or for how long people recovering from acute infection can transmit the SARS-CoV-2 virus to other people.Covid-19 is a worldwide problem, and we are learning not just how to treat and vaccinate (immunise) people, but also how and when the infection is spread from person to person. Unlike some infections, you cannot necessarily see who is likely to infect another person; this is because sometimes the infection is transmitted before (pre) someone develops symptoms. It is also the case that some people have the infection and can transmit it but never develop symptoms themselves; this we call asymptomatic transmission.This guidance document is one of a pair which have reviewed the scientific evidence on how Covid-19 is spread. This part of the guide provides recommendations on how to help stop the spread of infection before someone becomes obviously ill (presymptomatic) and for those who never become ill themselves (asymptomatic). We did not find evidence for post symptomatic transmission (someone transmitting Covid-19 after they have recovered).The recommendations based on the evidence we have reviewed give confidence that the things we are all doing such as social distancing, hand washing, wearing face coverings and keeping rooms well ventilated by opening windows are the things that we should be doing to prevent people getting infected with Covid-19. We hope that this guide will help everyone try and prevent spreading Covid-19.Coronavirus disease 2019 (COVID-19) was first detected in Wuhan, Hubei province, China; it spread around the world as a pandemic and by November 2021 had affected more than 260 million people [As an emerging and pandemic disease, COVID-19 attracted worldwide attention and interest in understanding the dynamics of SARS-CoV-2 transmission and treatment options for COVID-19 patients. This Working Party Report is the second of two guidance articles developed using evidence published during the first wave of the pandemic to summarise aspects of the transmission dynamics of SARS-CoV-2 and advise on measures to reduce the risk of transmission in health and care settings. The article examines the risks of presymptomatic, asymptomatic and post-symptomatic SARS-CoV-2 transmission. Understanding the risk of transmission according to the index case’s symptom status at the time of exposure of  their close contacts is important to allow healthcare workers and the public to take action to protect themselves and others. The guidance acknowledges the possibility of reinfection, the emergence of new variants of the virus (particularly variants of concern), and ongoing immunisation programmes.Key technical terms used in this guidance article are explained in the accompanying glossary  Guidelines Committee for reviewing this document.The authors received no specific funding for this work. Financial support for time required to identify and synthesise the evidence and to write the manuscript was provided by the authors’ respective employing institutions.No authors reported any conflicts of interest , HIS, the Infection Prevention Society (IPS) and the Royal College of Pathologists (RCPath) commissioned the authors to develop the Working Party Report. The authors are members of the participating organisations and together comprise the COVID-19 Rapid Guidance Working Party convened to develop the guidance. MAM and AB are employed by HIS as guideline developers. Further information is provided in Additional file The views expressed in this publication are those of the authors and have been endorsed by BIA, HIS, IPS and RCPath following rapid consultation.This report is the second in a pair of guidance documents covering key aspects in the prevention of SARS-CoV-2 transmission in health and care settings. The guidance also reviews the evidence for SARS-CoV-2 transmission dynamics in broader settings. The diagnosis and management of COVID-19 in general is outside the remit of this guidance.The Working Party recommendations have been developed systematically through multidisciplinary discussions based on currently available evidence from published, preprint and grey literature sources. They should be used in the development of local protocols for relevant health and care settings such as hospitals, nursing/care homes, primary care and dental practices.The first wave of the COVID-19 pandemic occurred amid uncertainty as to how it could be prevented and controlled. Concern still exists about further waves and new outbreaks occurring. Evidence that emerged during the first wave provides an opportunity to develop evidence-based guidance for preventing and controlling future waves/outbreaks, acknowledging the possibility of reinfection, the context of newly emerging variants of SARS-CoV-2, and ongoing immunisation programmes.The main purpose of the recommendations is to inform clinicians, managers and policy makers about SARS-CoV-2 transmission dynamics and to provide evidence-based guidance to prevent and control the spread of SARS-CoV-2 in health and care settings. The report highlights current gaps in knowledge, which will help to direct future areas of research.The scope of the guidance is to provide advice for the optimal provision of effective and safe health and care services during the period in which COVID-19 remains a health threat. The guidance was developed for acute healthcare settings, but it might be useful in other health and care settings such as dental practices and care homes.Topics for this guidance were derived from initial discussions of the Working Party and specific review questions were developed in accordance with the population–exposure–comparator–outcome (PECO) framework for investigating the likelihood of developing a certain condition after an exposure event. To prepare the recommendations, the Working Party collectively reviewed relevant evidence from published, preprint and grey literature sources. The processes and methods used were in accordance with the National Institute for Health and Care Excellence (NICE) manual for developing guidelines  . The proThe Working Party included infectious diseases, microbiology and virology clinicians, academic infection prevention and control experts, systematic reviewers, and a lay representative.Any healthcare practitioner, manager or policy maker may use this guidance and adapt it for their use. It is anticipated that most users will be clinical staff and infection prevention and control teams. Some aspects of this guidance might also be beneficial to patients, their families/carers, and the public.To provide advice rapidly, the guidance is being produced as two separate articles, each addressing a different review question. Each article will comprise an introduction, a summary of the evidence, and recommendations graded according to the available evidence.The guidance will be considered for update within 1 year of publication to determine whether new evidence exists that would require a change in the recommendations.The aim of the guidance is to evaluate evidence for presymptomatic, asymptomatic and post-symptomatic transmission of SARS-CoV-2 with the intention of preventing transmission in hospitals and other health and care settings.As noted above, the processes and methods used to produce this Working Party Report were aligned with those described in the first Working Party Report . Topics Two electronic databases (MEDLINE and Embase) were searched for articles published between 1 January and 29 May 2020. Search terms were constructed using medical subject headings (MeSH) and free-text terms  or asymptomatic transmission (in which the index case never developed symptoms or signs of infection) was undertaken to aid presentation and interpretation of the evidence.Many of the cluster/outbreak investigations permitted only a categorical  assessment of the credibility of transmission by presymptomatic or asymptomatic people . Other cluster/outbreak investigations allowed calculation of an attack rate  and an associated confidence interval (CI). Stratification of the evidence from cluster/outbreak studies according to the time at which contacts were exposed to SARS-CoV-2 relative to the index case acquiring the virus  was also undertaken.Where cluster/outbreak studies reported the use of personal protective equipment (PPE) this was noted to aid interpretation of the evidence.The possibility of identifying comparative epidemiological studies relevant to the review question had not been anticipated because the pandemic was associated with a novel disease and was still in its early stages when the evidence review was initiated. However, several such studies were identified and included as noted above. For these epidemiological studies  that reported  a measure of transmission risk according to the index case’s symptom status at the time of exposure of their close contacts, the convention of expressing risks based on exposure to people with fewer symptoms compared to risks based on exposure to people with more symptoms was applied where possible.Mathematical modelling studies were included in the review only where they distinguished between transmission risks according to the index case’s symptom status during exposure of their close contacts.Included epidemiological studies were appraised for quality using checklists recommended in the NICE guidelines manual . Criticahttps://www.gradeworkinggroup.org/ for details). The resulting GRADE tables are presented in Additional file .Feedback on the draft guidance was received from the HIS Guidelines Committee and through rapid consultation with relevant stakeholders. The draft report was placed on the HIS website for 10 working days along with the HIS standard response form, including a conflict-of-interest disclosure form. The availability of the draft guidance was communicated via email and social media. Stakeholders were invited to comment on format, content, local applicability, patient acceptability and recommendations. The Working Party reviewed stakeholder comments, and collectively agreed revisions in response to the comments  , 26, 41 The reported cluster/outbreak investigations focused on potential transmission of SARS-CoV-2 in both community and nosocomial settings  is reflected in the evidence tables for the cluster/outbreak studies  , 35, andThree of the mathematical modelling studies included in the review used adaptations of the susceptible–exposed–infected–recovered (SEIR) compartmental modelling framework to model transmission dynamics in hypothetical populations , 29, 45.For each type of study for which it was possible to produce an overall GRADE rating of the quality of the evidence the rating applied was very low  and imprecision associated with no CIs or other measures of precision being reported . Among those cluster/outbreak investigations that evaluated the risk of asymptomatic transmission, several had evidence downgraded for indirectness because the definition of an asymptomatic infection included having mild symptoms (such as a pre-existing cough that might or might not have been associated with or exacerbated by SARS-CoV-2 infection), or signs of infection on a computerised tomography (CT) scan of the chest. See Additional file Another aspect of the evidence from the cluster/outbreak investigations was the use of PPE as recorded in the evidence tables for these studies  relative measures of transmissibility according to the index case’s symptom status during exposure of their close contacts, a frequently occurring reason for downgrading the quality of the evidence was risk of bias associated with potential confounding factors  not being accounted for in the design or analysis of the study. Another common reason for downgrading the quality of evidence from such studies was that CIs for estimated effects crossed default thresholds for defining imprecision according to the GRADE approach. See Additional file The quality of the evidence from the mathematical modelling studies included in the review was downgraded for indirectness in several cases because relative measures of transmissibility according to the index case’s symptom status during exposure of their close contacts were not wholly aligned with the symptom statuses of interest to the Working Party . In one such study, asymptomatic infections and mildly symptomatic infections were grouped together . AnotherThere was strong evidence from 36 cluster/outbreak investigations  , 57, 58 There was moderate evidence from seven cluster/outbreak investigations , 42, 55 There was weak evidence from two further cluster/outbreak investigations , 37 regaThere was moderate evidence from four epidemiological studies reported across six articles , 52, 56 There was inconsistent evidence from four mathematical modelling studies , 29, 45 There was weak evidence from one mathematical modelling study  regardinNo evidence was identified regarding the possibility of SARS-CoV-2 being transmitted by post-symptomatic people.The Working Party’s interest focused on whether transmission occurs as a result of presymptomatic, asymptomatic or post-symptomatic SARS-CoV-2 infection. For the most part, this was evaluated through consideration of absolute risks of transmission. At the start of the evidence review process, it was not anticipated that relative risks of transmission based on the symptom status of an index case would have been examined (because the pandemic was in its early stages and research was just starting to be published). However, it became evident when sifting the results of the systematic literature searches that some studies had investigated relative risks of transmission and this evidence was eligible for inclusion according to the review protocol.The evidence from the cluster/outbreak investigations and epidemiological studies providing estimates of relative risks of transmission based on an index case’s symptom status during exposure of their close contacts was assessed for quality using the GRADE framework. All of the evidence from these studies was classified as being of very low quality. Recurring reasons for downgrading the evidence included: risk of bias  not being accounted for in the case of epidemiological studies providing relative risks of transmission based on the index case’s symptom status during exposure of close contacts); imprecision due to CIs for effect estimates crossing predefined thresholds or being unavailable; and indirectness . The overall assessment of the evidence as being of very low quality did not, however, prevent the Working Party reaching conclusions about characteristics of SARS-CoV-2 transmission and making recommendations for practice (see below).The evidence from the mathematical modelling studies included in the review could not be fully assessed using the GRADE framework, but some GRADE domains were applicable, for example, inconsistency and indirectness. A recurring reason for downgrading the evidence from these studies was indirectness due to relative measures of transmissibility according to an index case’s symptom status during exposure of close contacts not being fully aligned with symptom statuses of interest to the Working Party .confirmedpresymptomatic transmission  is probable.asymptomatic transmission (meaning that an index case never develops symptoms or signs of infection) is Having considered the evidence, the Working Party concluded that:There was uncertainty regarding the evidence related to asymptomatic transmission, with the Working Party noting that a lack of awareness of symptoms or suppressed symptoms  could not be distinguished from a complete absence of symptoms in the reported investigations. The Working Party recognised the potential for subclinical or pauci-symptomatic infection while emphasising that truly asymptomatic infection or carriage of SARS-CoV-2 occurs and transmission is to be expected .The Working Party recognised that the list of symptoms suggesting COVID-19 had expanded during the pandemic, reflecting growing knowledge of the condition. The evidence review and synthesis involved extracting any information about symptoms reported by the study investigators, although it was acknowledged that people’s perceptions of symptoms differ and this could influence the types of symptoms reported. The Working Party emphasised the importance of clarity in defining and reporting symptoms in future research related to COVID-19.The settings in which presymptomatic or asymptomatic transmission was demonstrated mirrored those reported in the first of the pair of guidance articles in which routes of transmission, regardless of the symptom status of the index case, were explored . In partThe Working Party agreed that from the perspective of preventing transmission by people without symptoms, it is immaterial whether they later develop symptoms. The recommendations were therefore phrased in terms of people without symptoms rather than using the terms presymptomatic and asymptomatic. The Working Party anticipated that this phrasing would also make the recommendations more meaningful to the public.The benefits of preventing transmission of SARS-CoV-2 by people without symptoms include the prevention of ill health due to COVID-19 among their close contacts and the prevention of onward transmission to ever greater numbers of people. Possible harms associated with actions intended to prevent transmission of SARS-CoV-2  arise through restriction of personal freedoms and a need to modify behaviours with potential adverse consequences in terms of, for example, mental health and wellbeing. These benefits and harms apply to healthcare workers, patients and their families/carers, and the public. On balance, the Working Party recognised that since anyone might carry the virus without knowing it, or be infected without having noticeable symptoms, the recommendations should reinforce the importance of adhering to existing legislation and guidance intended to reduce the risk of transmission of SARS-CoV-2 in the general population.The Working Party noted that the evidence regarding relative risks of transmission according to symptom status suggested that presymptomatic infections are less transmissible than are symptomatic infections, and that asymptomatic infections are less transmissible than are presymptomatic infections. The Working Party was aware that the viral load associated with asymptomatic and pauci-symptomatic infections is typically lower than that associated with symptomatic infection , lendingAlthough the evidence from the mathematical modelling studies was regarded as indirect, the Working Party noted the reported differences in asymptomatic transmission rates in indoor environments under different ventilation scenarios. This prompted the Working Party to emphasise the importance of ventilation in enclosed spaces in the recommendations.The Working Party was acutely aware that the development of the guidance was occurring during an evolving pandemic. When formulating the recommendations, the Working Party recognised the possibility of reinfection in people who previously had COVID-19 , the emeThe likelihood of post-symptomatic transmission  could not be assessed because of an absence of evidence. The Working Party agreed that post-symptomatic transmission should be prioritised as an area for further research.The Working Party did not undertake a detailed economic analysis because the recommendations focused on raising awareness of the possibility of presymptomatic and asymptomatic transmission of SARS-CoV-2 and reinforcing existing legislation and guidance aimed at preventing transmission. However, the Working Party considered costs and resource use from the perspective of health and care systems and identified that costs associated with transmission that is not prevented include the costs of managing COVID-19 in infected patients and the costs of needing additional resources such as PPE. Considerations related to the value of time as a resource included the time taken to don and doff PPE and time away from work for healthcare workers who are unwell or required to self-isolate. Taken together, these considerations emphasise increased pressure on healthcare systems when COVID-19 is prevalent. The Working Party recognised potential inconvenience and possible adverse consequences  of implementing measures such as social distancing and using PPE. The Working Party also recognised that the cost effectiveness of preventing transmission would be greater in aspects of healthcare focusing on people more vulnerable to COVID-19.when a person who has acquired SARS-CoV-2 becomes infectious andhow long infectivity lasts in the absence of symptoms.As outlined above, the Working Party highlighted several areas for future research. These included consideration of:While the evidence available to the Working Party demonstrated presymptomatic transmission within 7 days of an index case acquiring the virus, later transmission could not be ruled out. Moreover, the available evidence did not permit a detailed analysis of infectivity during the first 7 days since acquiring the virus, which was of interest to the Working Party and could form part of future research. The Working Party also highlighted potential seasonality in transmission rates, and indoor versus outdoor transmission, as areas to explore in future research.The Working Party discussed the relevance and possible consequences of lung damage revealed by CT scans in people who did not report symptoms. The Working Party questioned whether such features might have longer-term consequences for a person who although infected has no noticeable symptoms and recommended this as an area for future research.The Working Party made several observations regarding the quality of the evidence identified in the review. While the importance of rapid evaluation during a pandemic caused by a novel disease such as COVID-19 was appreciated, the value in ensuring robust and efficient research activity was also recognised. The Working Party agreed that this value could be promoted by avoiding duplication and repetition in data collection, analysis, and reporting, and acknowledged the time needed to ensure high quality research outputs. The Working Party highlighted the desirability of concerted global action to coordinate research activity and formalised data gathering and sharing in the event of future pandemics caused by novel diseases. The Working Party acknowledged that some of the areas recommended for future research might already have been addressed in primary studies or systematic reviews published after the searches for the evidence review had been completed. Although the Working Party had considered updating the review to take account of more recently published evidence, the rate at which additional evidence was being published prohibited such an approach. For example, rerunning the MEDLINE and Embase searches in April 2021 indicated that approximately 20,000 further articles would need to be considered; it was, therefore, not feasible to undertake a timely and systematic update of the review using the original search terms. The Working Party emphasised that the research recommendations were intended to build on the evidence review and allow the guidance to be refined or extended, preferably with reference to evidence of higher quality and allowing more focused or nuanced consideration of SARS-CoV-2 transmission dynamics. By November 2021, rerunning the MEDLINE and Embase searches resulted in an additional 30,000 articles, which when filtered to select records containing the phrase ‘systematic review’ in the title, abstract or keywords identified nearly 600 articles. Among these systematic reviews, a handful investigated relative transmissibility of presymptomatic, asymptomatic and symptomatic infections –69; howeThe Working Party noted that evidence included in the review suggested that using PPE (such as face masks or coverings) reduced the risk of transmission of SARS-CoV-2 by people with presymptomatic or asymptomatic infection. The current evidence review was not designed to explore this systematically, whereas the first of the pair of guidance articles  includespeople without noticeable symptoms may transmit the SARS-CoV-2 virus to other peopletransmission of SARS-CoV-2 from people without symptoms may occur in all settings in which people are in close proximityhowever, it is likely that the risk of transmission of SARS-CoV-2 is greater from people who have symptoms compared with those who do not.Even in the absence of symptoms, adhere to legislation and guidance regarding measures to reduce the risk of transmission of SARS-CoV-2 .Be aware that the future transmissibility of SARS-CoV-2 from people carrying the virus without symptoms might depend on the:nature of further waves or outbreaks of COVID-19emergence and circulation of SARS-CoV-2 variants of concernpotential for people who have had COVID-19 previously to be reinfectedeffectiveness of available vaccines, including the longevity of immunity they confer.Be aware that:Be aware that it is not yet known to what extent or for how long people recovering from acute infection can transmit the SARS-CoV-2 virus to other people.Based on the evidence review, which included research published to the end of May 2020, the Working Party considered presymptomatic transmission of SARS-CoV-2 to be confirmed, and asymptomatic transmission to be probable. The evidence for these forms of transmission was sufficient for the Working Party to formulate several strong recommendations with the intention of raising awareness in health and care settings of the potential for transmission in the absence of symptoms. The recommendations were intended to reinforce existing legislation and guidance specifying measures for reducing the risk of transmission from people who have no noticeable symptoms. The Working Party formulated recommendations for future research to address areas of uncertainty, such as the relative transmissibility of presymptomatic, asymptomatic and symptomatic infections, the period of infectivity in people without symptoms, and the possibility of transmission in the post-symptomatic period. The Working Party emphasised the importance of good quality design, analysis and reporting of research studies even in pandemic situations. The Working Party also highlighted the desirability of concerted action to coordinate research activity and share outputs effectively.The rationale for the following research recommendations is presented in "What is the relative transmissibility of SARS-CoV-2 from people with presymptomatic, asymptomatic and symptomatic infection, and how does transmission correlate with quantification of viral shedding?How long after acquiring SARS-CoV-2 do people without symptoms become infectious and how long does infectivity last?To what extent or for how long can people who have acquired SARS-CoV-2 and are post-symptomatic transmit the virus to other people?What are the long-term consequences of lung damage associated with SARS-CoV-2 infection in people who do not report symptoms?What impact do reinfection, variants of concern, and immunisation programmes have on transmission of SARS-CoV-2?Additional file 1. Working Party Report appendices.


The Author Replies:We appreciate the interest from Hakroush and Tampe in our manuscript describing compassionate use of avacopan in 8 difficult-to-treat patients with antineutrophil cytoplasmic autoantibody-associated vasculitis (AAV).The disease course of the patient described by the authors is in line with the disease course of 6 refractory AAV patients we previously described.,In the era of big data analyses, it is important to appreciate that case-reports and case-series remain pivotal as hypothesis-generating clinical observations. In contrast to the pivotal randomized ADVOCATE trial that produced evidence for a steroid-free treatment strategy for active AAV patients,In summary, the unique and beneficial clinical observation described in the case by Hakroush and Tampe should prompt clinicians to collaborate in collecting and describing the real-world experience of treating in a low-prevalent AAV patients with a novel complement-targeting drug avacopan.


Worldwide agriculture faces enormous challenges. Global warming, a growing world population with a constantly growing need for high-quality food, increasing demand for animal welfare, and reducing the ecological footprint represent the greatest challenges for the present and the near future.Florez et al. generated the first KISS1-edited large animal using CRISPR/Cas9-ribonucleoproteins and single-stranded donor oligonucleotides. Though follow-on research will be necessary to evaluate the efficacy of this approach, this proof-of-principle study gives a good example of how genetic engineering could be employed to address urgent problems in livestock production. The knockout of Myostatin (MSTN), a negative regulator of muscle growth, is accompanied by a significant increase in skeletal muscle mass and has been discussed to increase the meat yield from livestock species (Pei et al. provide the first evidence that MSTN-KO pigs show no significant difference in the size and average weight or length of visceral organs in adult pigs. These findings are important for the further application of this technology.Deciphering the function of the CRISPR-Cas9 system and adapting it for genome editing of the mammalian genome has revolutionized the genetic engineering of farm animals and offers novel opportunities to address these challenges . Besides species . SeveralDavies et al. that generated a unique type I Interferon Receptor knockout sheep model for viral immunology and reproductive signaling. The mini-review by Greising et al. reviews the recent developments and options for the treatment of volumetric muscle loss in gene-edited pigs, while Ruan et al. provide a comprehensive opinion on the recent developments in altering the pig genome.The importance of genetically engineered livestock is further displayed in the article by Wu et al. employed transcriptional sequencing and proteomics to investigate the differences between the uteruses of laying hens with high- and low-breaking eggshells. They identified the KRT14 gene which may promote calcium metabolism and the deposition of calcium carbonate in eggshells.The establishment and culture of PGCs enabled the targeted genetic modification of the chicken genome to address productive traits such as eggshell strength and thickness which are critical factors in reducing egg breaking and preventing economic losses . To idenSince its advent, CRISPR-Cas9 has proven its disruptive potential for animal breeding. A multiverse of different CRISPR variants has been developed in the last 10 years increasing the efficiency of precisely altering the genome of livestock species and reducing the number of unwanted mutations . Except


The Therapeutic Engagement Questionnaire (TEQ) has been developed and validated in partnership with service users (SUs), registered mental health nurses (RMHNs) and nurse academics in the UK in accordance with psychometric theory. The TEQ is highly relevant and useful to clinical practice. The TEQ measures therapeutic engagement (TE) in two contexts - 1-1 interactions between SUs and RMHNs, as well as the overall environment and atmosphere of the units - from the perspective of both SUs and RMHNs. The TEQ has been translated into Finnish by two expert panels and was pre-tested and validated in ten adult acute psychiatric in-patient units in two hospitals in Finland.To measure TE in Finnish adult acute in-patient psychiatric settings from the perspectives of both SUs and RMHNs.The Finnish version of the TEQ (Hoidollinen yhteistyö) will be completed by RMHNs and SUs in 15 adult acute psychiatric in-patient units. Nine of the units are within the University Hospital and six in a municipal psychiatric hospital. The data will be collected within a 3-month period (October - December 2020). The coordinating nurse of each unit will organise the operational side of the study including obtaining consent from SUs. The nurses will participate in the survey via Webropol which includes nurses’ consent. Sociodemographic information will be collected from the SUs and nurses.The results of the measurement study will be reported at the 29th European Congress of Psychiatry.The conclusions of the measurement study will be reported at the 29th European Congress of Psychiatry.This study is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London).


In this session we will present results from the English Longitudinal Study of Ageing (ELSA) Covid-19 substudy. Data were collected during the pandemic at two separate occasions to capture the experiences of older people and to compare them to pre-covid periods. The session will include results among people with cognitive impairment, people who contracted infections and explore the consequences on their mental health, well-being and health in general


Teaching Point: When performing ultrasound examination of a cephalhematoma, the occurrence of a mirror-image artifact can mimic the presence of an epidural hematoma. A 3-day-old neonate was referred to the radiology department for ultrasonographic evaluation of a parieto-occipital cephalhematoma. The neonate was born through spontaneous vaginal delivery and no forceps nor suction cup was used. There were no clinical problems other than the presence of the cephalhematoma, and neurologic findings were normal.Figure 1) showed the presence of an anechoic biconvex structure (dotted line A) resembling an epidural hematoma in the parietal region underlying the cephalhematoma (dotted line B). This was a curious finding because the delivery hadn’t been traumatic and there were no neurological symptoms present.Coronal grayscale ultrasound image  at the same level as the ultrasound image in Figure 1 shows the cephalhematoma without underlying intracranial abnormalities.Because angulation of the probe could not clearly eliminate the possible presence of an epidural hematoma, in consultation with the treating paediatrician it was opted to further evaluate the infant through non-contrast-enhanced computed tomography (NECT) of the brain. Coronal NECT image  [Mirror-image artifacts occur when the primary beam encounters an obliquely oriented highly reflective surface and is reflected by this surface but encounters another structure in its path before being reflected to the transducer. The transducer interprets the delayed echo as being reflected from a structure deeper down and this creates the mirror-image artifact on the other side of the reflective surface (igure 3) .In this case the ultrasound beam is reflected by the skull bone and a mirror-image artifact of the cephalhematoma is created on the opposite side, mimicking an epidural hematoma.Other common examples of mirror-image artifacts include reflection of ascites across the diaphragm mimicking pleural effusion and reflection of the gestational sac mimicking heterotopic pregnancy.The mirror-image artifact may closely resemble the original structure, but it may also appear weaker, distort the image of the original structure, or appear on images that do not simultaneously show the original structure. It is important to recognize such mirror-image artifacts and not mistake them for pathology so that unnecessary additional examinations and anxiety in patients can be avoided.The occurrence of a mirror-image artifact can be evaluated by changing the angle of the primary beam or in case of a cephalhematoma applying graded compression, which shows simultaneous compression of the true image and the false mirror image. Doppler ultrasound may also be used, showing the presence of normal cerebral blood flow within the false mirror image .


The world has given serious thought to epidemics, disasters and crises. One of the most important mental disorders that can be caused by epidemics, disasters and crises is the Post-Traumatic Stress Disorder (PTSD). The Coronavirus (COVID-19) pandemic is one of the most serious global health crises.We deal with the appearance of symptoms of PTSD among Bahraini society as a consequence to COVID-19 pandemic. We aim to investigate two main aspects: PTSD and the correlation between the pandemic COVID-19 and the appearance of PTSD symptoms in the Bahraini society.This research was conducted based on the Davidson Trauma Scale (DTS), developed by Jonathan Davidson in 1995, according to the DSM-IV criteria.The findings of our research concluded that the percentage of PTSD among a group of Bahraini society members following the outbreak of COVID-19 was 11.1%.conducting awareness campaigns as part of the media plan to combat COVID-19. Designing and applying treatment programs for PTSD for those in need. Allocating mental institutions from the public and private sectors to be used as rehabilitation centers for PTSD patients.No significant relationships.


Versus Arthritis (UK) and ReumaNederland (The Netherlands) have made a particular contribution at the project proposal stage and invited founding PC members. Ingrid Lether participated in the MRI test and re-test study , together with two co-authors of this paper. Merck KGaA kindly allowed the authors to utilize drawings from its 350th anniversary research day ; the artist was Andreas Gaertner from die-zeichner.de. The authors would also like to acknowledge two former PC members from Germany and Spain, respectively; when still active members of the PC, their contribution and experience was highly valued. The authors would like to thank specifically the IMI reviewers and expert panels who encouraged the involvement of patients from the inception of this project.The correct Acknowledgements section should read:Leonie Hussaarts (Lygature) was the PC coordinator from the start of the APPROACH project; in this role she initiated and managed a number of trivial PC activities . Ingrid Lether participated in the MRI test and re-test study , together with two co-authors of this paper. Merck KGaA kindly allowed the authors to utilize drawings from its 350th anniversary research day ; the artist was Andreas Gaertner from die-zeichner.de. The authors would also like to acknowledge two former PC members from Germany and Spain, respectively; when still active members of the PC, their contribution and experience was highly valued. The authors would like to thank specifically the IMI reviewers and expert panels who encouraged the involvement of patients from the inception of this project.The authors would like to thank all partners of the APPROACH consortium for their continued collaboration and support of the PC. Versus Arthritis (UK) and ReumaNederland (The Netherlands) have made a particular contribution at the project proposal stage and invited founding PC members. All the changes requested are implemented in this correction and the original article  has been


Population level changes in physical activity (PA) may benefit from policy intervention. In response to the UN Sustainable Development Goals, Wales introduced legislation  Act 2015) to holistically improve health and well-being, including the translation of national policy into practice. This audit provides a case study approach that could be replicated by researchers in other countries to appraise the role of PA actions in national and sub-national policies.An audit of policies published by national and sub-national public bodies between 2015 and 2020 was conducted. The list of identified policies was reviewed by an external panel to act as a ?critical friend? to verify its inclusiveness. Content of the policies were extracted and synthesised to determine: (i) how many policies included a PA action; (ii) what the drivers of those policies were; (iii) the content of the PA actions; and (iv) how the PA actions aligned with the Well-being of Future Generations  Act 2015.A final list of 73 policies was obtained. Only 16 national-level documents had a PA action, which had been published by 4/13 public bodies (who are bound by the Act). Of the 19 sub-national well-being policies, 15 included PA actions. Most policies were considered reactive and varied in terms of the clarity and specificity of the actions, the assignment roles/responsibilities, and the setting of targets; all overarching principles which can be used to strengthen national and sub-national policy in the future. The most common theme of action across the national-level documents was the broad action of PA promotion, which was identified in nine of the 16 documents. The actions within the national-level documents were reflected in the sub-national well-being plans.This research used a novel approach to assess alignment of policies related to PA and the Sustainable Development Goals (SDGs) in Wales. It provides an overview of the current status of policy related to PA in Wales, which can be used in manifestos and frameworks to shape the subsequent actions of public bodies.This case study provides a valuable example of how to utilise PA to address broader health and wellbeing agendas, and specifically the SDGs. It also demonstrates an approach to achieving stronger connections between national and sub-national policy to support the translation of policies into practice.


Anorexia nervosa (AN) is one of the most common chronic disorders in adolescence with still high mortality rates. Knowledge on gut-brain interaction might help to develop new treatments, as severe starvation-induced changes of the microbiome in AN-patients have been demonstrated, which do not alleviate with weight gain. In our own pilot study alpha-diversity was increased in patients with AN after short-term weight recovery, while beta diversity showed clear group differences with healthy controls before and after weight gain. A reduction of taxa belonging to Enterobacteriaceae at admission and discharge and an increase in taxa belonging to Lachnospiraceae at discharge were typically found in patients with AN. The work plan of our European project comprises an observational study and two phase II RCTs with the application of omega-3-PUFA and a multistrain psychobiotic to both, humans and rodents. With the help of a well-established animal model for AN , the effect of stool transplants from patients to rodents will be analysed. Longitudinal MRI will be conducted in rodents together with cellular and molecular brain analyses. In addition, immune response and circulating antibodies associated with the presence of certain bacterial strains and interaction with hunger and satiety hormones will be explored. We hope that by this translational research we may systematically investigate the role of an altered microbiome for the course of AN and to identify new therapeutic tools.This project is funded by ERA-NET of the European Union.


An error was present in the published article in the final sentence of the Abstract. The correct sentence should read as follows:Additionally, the methodological capability of PFG NMR for measuring self-diffusion coefficients of long-chain hydrocarbons (up to C19) confined to narrow mesopores of catalytically active materials is demonstrated for the first time.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.


The presentation is dedicated to employees who care for others in addition to their work. The starting point is the representative cohort study on mental health at work (S-MGA), which covered both care at home and care outside the home in the second wave of the survey. In this regard, cross sectional associations with exhaustion and work-life balance as indicators of mental health were examined taking into account full-time and part-time employment.The sampling frame consisted of all German employees being subject to social security contributions and born between 1951 and 1980. The baseline sample consisted of 4511 survey participants of whom 1279 males and 1358 females were asked for informal care at the follow-up interview. Employment conditions as well as work-life balance were obtained by personal interview; exhaustion was obtained in a paper and pencil questionnaire. Statistical analysis was conducted descriptively and in linear and logistic regressions stratified by gender and controlled for age.Informal care at home was reported by n = 74 individuals (2.8%) and care outside of their home by n = 236 (8.9%). The association between both types of care with exhaustion was below the level for significance. There was an increase of work-life-imbalance for females caring at home but not for those who were caring outside. For males there were no effects of both types of care. Including the part-time/full-time distinction indicator within the regression models showed that women who cared at home had lower exhaustion scores and lower work-life imbalance when they were employed part-time.The results show that caring at home for females leads to work-life imbalance and that part-time employment mitigates the negative effects on work-life imbalance and exhaustion. However, there are strong limitations by the sample size and the number of observations at the second wave of assessment.The results show that caring at home among females seems to lead to work-life imbalance.Part-time employment seems to mitigate the negative effects on work-life imbalance and exhaustion.


Societies can be confronted with disasters and major incidents that form a serious threat to population well-being, safety and health. The Covid-19 pandemic challenged governments at different levels in many countries across the world for over two years to address a variety of public health risks. This also applies to the Netherlands, a densely populated high income country in Europe with approximately 17 million citizens. Experience with previous crises - such as the Bijlmermeer Airplane Disaster in Amsterdam (1992), the Q fever outbreak (2007-2011), the MH17 airplane disaster in Ukraine (2014) and gas-mining induced earthquake problems in the north of the Netherlands (ongoing) - shaped the current Dutch public health response structure and knowledge base, designed to assist local and national authorities to anticipate disaster-related population health risks. During the Covid-19 pandemic this structure was used as a starting point to develop and implement a five-year monitoring program: the integrated GOR-Covid-19 health monitor; GOR stands for “Gezondheidsonderzoek bij rampen” . The main objective of the GOR-Covid-19 monitor is to collect and promote the uptake of reliable and timely monitoring information for the benefit of regional and national public health decision-making in the Netherlands, focusing on the public health impact of the Covid-19 crisis (virus infections and mitigation measures) among children and adolescents, adults and public mental health care, a potentially vulnerable group including homeless and former drug addicts. The monitor is carried out under coordination of the “Network GOR”, comprised of the National Institute for Public Health and the Environment, GGD GHOR Netherlands , Nivel, and ARQ National Psychotrauma Centre. The current workshop consists of five presentations by members of Network GOR. The first contribution gives an overview of the research objectives and the outline of the study protocol of the monitoring program. The other contributions focus on particular study components, that are shaped and aligned during the timeline of the monitor. One presenter will share the findings from the first series of systematic literature reviews. Two contributions are based on a combination of surveys in representative samples and an analysis of primary care registry data: one with an emphasis on quarterly results (short-cycle monitoring), the other on (bi-)annual reports, which zoom in on long-term developments and differences between subgroups based on vulnerability factors and geography (long-cycle monitoring). The fifth contribution details the participatory stakeholder-engagement process designed and implemented to promote that monitor findings are used for local and national public health sense-making and decision-making.• The workshop describes the background and design of a national longitudinal monitoring program to track the public health impact of the Covid-19 pandemic in the Netherlands.• An overview is given of the first findings on the health impact of the pandemic for different populations and related vulnerability factors as well as the stakeholder engagement process.


The more preterm they are, the greater the riskPoor neonatal care increases the risk, even in less premature babiesHigh quality neonatal care. If there is not enough equipment to safely deliver and monitor oxygen, this must be strongly advocated forScreening: All babies at risk must be screened before 30 days after birthTreatment: Laser treatment should be given urgently, with confluent spotsFollow-up: All children born preterm are at risk of visual impairment and must be followed up by an ophthalmologist and/or optometristInvolve parents in the day-to-day care of the baby and encourage kangaroo careKeep parents informed of the need for screening and the results of screening, and the need for urgent treatment, if requiredEnsure parents understand the need for follow-up visits


The COVID-19 pandemic had a significant impact on economic development, lifestyles and health systems in all countries. Due to the lack of medical interventions, many countries adopted restrictive measures to slow the spread of the virus and reduce the burden on the healthcare system. Quarantine measures have had an impact on the transmission of SARS-CoV-2. However, the unintended consequences of such drastic measures were inevitable. In developing countries, there have been adverse effects of disruptions in health services, including the provision of timely medical services in detecting cases of tuberculosis in the population. The aim of this study was to study the influence of COVID-19 pandemic on the tuberculosis incidence in the Republic of Kazakhstan.We analyzed national data on the reported tuberculosis cases and screening results of tuberculosis in Kazakhstan for 2019-2020. The primary data were collected from regular reporting of cases through surveillance.The number of registered patients identified during screening activities in 2020 were 2,854 cases compared to 4,288 cases in 2019 before COVID-19 era. The proportion of cases with antibiotic-resistant  forms of tuberculosis increased up to 6.7% in 2020 in comparison with 2019.There is a need to conduct an analysis of the reasons for the increase in cases of multidrug-resistant and extensively drug-resistant tuberculosis. The working process should be adapted to epidemics and emergencies to ensure the availability of medical services, as well as to improve the system of preventive examinations and screening for the early detection of TB cases.The abstract was submitted under the ‘CATINCA - Capacities and infrastructures for health policy development’ project which is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.The detection of tuberculosis during preventive examinations and screenings significantly decreased in 2020 compared to 2019.In recent years, there has been a significant increase in the number of cases with poly-, multi- and superantibiotic-resistant forms of tuberculosis.


Breast cancer (BC) is one of the leading causes of cancer death worldwide. The problem of mental health and quality of life of patients is currently particularly relevant. Most patients with breast cancer in the process of adapting to the disease experience certain mental disorders: depressive, anxiety-phobic and psychosomatic disorders.To study the severity of anxiety-depressive disorders in the clinical picture in patients with breast cancer and evaluate the effectiveness of specialized pharmacotherapy using antidepressants in combination with antitumor therapy.The study included 30 patients with a first established diagnosis of breast cancer and 52 patients with a follow-up history of 3-17 years. The main method of work was the clinical, psychopathological, and statistical research methods .To assess the severity in the clinical picture of anxiety-depressive tendencies and the effectiveness of treatment, special scales were used: hospital scale of anxiety and depression (HADS); general clinical impression scale (CGI) for assessing disease severity (CGI-S “severity”) and improvement (CGI-I “improvement”). High antidepressant therapy efficacy indicators were obtained in combination with benzodiazepine drugs and hypnotics in a group of patients with anxiety-depressive nosogenia , in the group with chronic hypochondriac dysthymia and cyclotymic endoform depression.The data obtained in the study confirm the effectiveness of psychopharmacotherapy with antidepressants in breast cancer patients with identified disorders of the anxiety-depressive spectrum.No significant relationships.


Errors were present in the published article in terms of corresponding authors and e-mail addresses; Chen Yu is the sole corresponding author, extra e-mail addresses have been deleted, and the correct version is shown here.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.


A forecasting model for prevalence and mortality based on a trend partitioning approach which models trends in age-adjusted prevalence and incidence-based mortality in terms of changes in interpretable epidemiologic quantities such as disease incidence and survival, is developed and applied to generate forecasts of Alzheimer’s disease (AD) and related dementia (ADRD) prevalence and mortality up to 2035 using health data drawn from a 5% sample of the total Medicare population. Forecasts are generated for entire AD population and for unique subgroups characterized by age groups and the presence of high-impact health conditions  prior to AD diagnosis. Then methodology using B-splines in key time points allows is used to analyze scenarios of possible interventions focused on the prevention and treatment of AD/ADRD. Prevalence of AD/ADRD is predicted to be stable between 2017 and 2035 primarily due to a decline in prevalence of pre-AD/ADRD-diagnosis stroke. Mortality, on the other hand, is predicted to increase. In all cases the resulting patterns come from a trade-off of two disadvantageous processes: increased incidence and disimproving survival. The projections are constructed with the assumption that future trends represent a superposition of historic trends in different time periods taken with weights. Sensitivity to assumptions on choice of specific weights are studied, and the approach to choose an optimal combination of weights and therefore, to minimize uncertainties of future forecasts of AD/ADRD prevalence and mortality is suggested and discussed.


Parental reflective function is the ability of a parent to attribute mental states to their child and to themselves. The Parental Reflective Functioning Questionnaire is widely used for the measurement of this construct, the adolescent version of which can be used by parents of children aged 12-18.The aim of our research was to adapt the adolescent version of The Parental Reflective Functioning Questionnaire to the Hungarian language.In our study 240 mothers completed the adolescent version of The Parental Reflective Functioning Questionnaire (PRFQ-A), and the Reflective Function Questionnaire (RFQ).Confirmatory factor analysis did not confirm the original three-factor structure. The principal component analysis resulted in a two-factor structure. Factors corresponded to the original questionnaire’s certainty in mental states (Alpha = .81) and interest and curiosity subscales (Alpha = .70). When analyzing the relationship between parental reflective function and reflective function, the subscales of the parental reflective function questionnaire were examined with two types of median coding in addition to polar coding. During the first median coding, the frequency of scores in the middle of the scales reflected optimal mentalization, while the frequency of extreme values on the scales corresponded to less favorable reflective functioning. With the second median coding, hypermentalization and hypomentalization subscales were also created. The second median transcoding proved to be the most suitable for capturing the relationship between RFQ and PRFQ-A.The questionnaire proved to be a reliable measure on the Hungarian sample and we recommend using the additional subscales.No significant relationships.


The relevance of studying of self-regulation styles of young people who face various difficulties at a stage of vocational training has increased in the situation of a pandemic.The purpose of our work is to describe the functional states of students at different stages of education, characterized by different degrees of satisfaction with educational and professional activities and different levels of self-regulation, to substantiate programs of psychological support for students during the formation of their professional identity.The sample consisted of 153 students enrolled in 1 and 3 courses in Moscow higher educational institutions. They were asked to fill out a package of methods aimed at diagnosing self-regulation styles , the severity of states of reduced performance .Indicators of reduced working capacity among third-year students are statistically significantly higher (p≤0.05) and are in a critical range of severity than among freshmen. Despite a similar level of satisfaction, third-year students demonstrate a whole palette of states of reduced performance, characterized by the experience of monotony of activity with high tension associated with the requirements of the educational situation. The absence of significant differences in the diagnostic indicators of self-regulation obtained in these two groups does not give grounds to assert that the general self-regulation of senior students is higher than that of first-year students.The data obtained confirm the “painfulness” of the crisis of the “middle” of education and necessarily raise the question of developing a targeted program for mastering the means of conscious self-regulation by students.No significant relationships.


Sleep is essential for life, but its measurement has a brief history in evolutionary terms. The most widely accepted way of measuring sleep is via sleep stages derived from analysis of the electroencephalogram (EEG) which was first introduced by Loomis et al.  in 1937.To standardize recording and scoring techniques and increase the equivalence of results between laboratories, the manual of Rechtschaffen and Kales (R&K) was introduced in 1968 . In the To address some of these criticisms and improve the interscorer agreement, the American Academy of Sleep Medicine (AASM) manual was released in 2007 . The AASPartially due to the historical development of sleep analysis and because there is no true gold standard for sleep analysis, epoch-based manual sleep scoring is the current standard. Manual scoring can be performed by an individual scorer or a panel of scorers with the assumption that a panel of scorers is more consistent than a single scorer. Many studies have looked at the overall agreement between scorers. A very recent meta-analysis of 11 eligible studies  selectedConsiderable progress has been made with machine-based sleep stage scoring and current evidence suggests that the performance of machine-based scoring is comparable to human scoring. A review of the state-of-the-art machine-based scorers in 2019 revealed that the overall agreement of machine-based sleeping staging against individual scorers was a kappa value in the range 0.73–0.86 [The development of machine-based scoring sleep systems requires a training stage whereby sleep stages from human scorers along with PSG signals are provided to machine learning algorithms and the system uses these manually labeled sleep stages to learn associations between the signals and the sleep stages. Given that human and machine scoring achieve comparable agreement the obvious question arises as to whether machines can provide better performance than they currently do. In this issue of Sleep, van Gorp et al.  provide One path forward may be through the wider use of panel-based scoring but, given the high workload for panel-based scoring, our field must test the assumption that panel-based scoring is actually more consistent than individual scoring. Another approach is to consider observing sleep as a continuous, non-discrete dynamic phenomenon. These definitions of “continuous sleep” have been recently proposed using both machine learning, with the description of hypnodensity  as well


Burden of disease (BoD) studies are an established method of quantifying health loss across - and within - a population. They aim to combine the impact of living with, and dying from, various health conditions to allow for comparability of conditions in an equitable manner. A key component of this is the calculation of the loss of years of life arising from premature death (Years of Life Lost (YLL)). Most high-income nations have robust death registration systems which ensure that deaths are routinely recorded, the causes are medically certified and the age at death is accurate. However, even in these situations the recording of ill-defined death (IDD) causes remains widespread and to some extent unavoidable, in that it is not always appropriate to undertake extensive investigation to establish an exact cause of death or the cause of death recorded does not map directly to disease groupings used routinely in BoD studies. The Scottish Burden of Disease (SBoD) uses cause of death data from the National Records of Scotland. These patient-level records include one underlying cause of death and up to 10 supplementary causes of death, all coded using ICD classifications. Around 12% of these deaths do not map directly to a BoD cause group and could therefore be considered ill-defined. The SBoD study have developed a 9-step hierarchical methodology for the redistribution of ill-defined deaths, utilising uses a mix of fixed and proportional redistribution and focusses on exploiting the data recorded on the death certificate at both an individual and population level. In this presentation we will describe the methodology used to redistribute ill-defined deaths in the Scottish study - the development, the application and the strengths and weaknesses of our approach. We will also discuss the example of COVID-19 and how competition between the underlying cause of death is likely to impact how we need to approach IDDs in the future.


Barker’s fetal origins hypothesis and the critical period theory suggest that early life events have long-term health effects. However, evidence of the famine exposure in early life and its effects on health in later life is scarce and inconsistent. To explore the effects of early-life exposure to the Chinese famine of 1959-1961 on later-life multimorbidity, we performed Poisson growth curve models using CHARLS Life History 2014 and CHARLS 2011-2018 . Our analyses revealed two findings. First, there was an overall detrimental effect of the early-life famine exposure on multimorbidity, although there was no effect of severity of famine exposure. Second, there was no overall interaction between famine exposure and life stages, although a more parsimonious model suggested that the detrimental effect of famine exposure was more pronounced in earlier life stages than in later life stages. Findings suggest that early life is a critical period in the life course and provides developmental origins of health and disease in later life.


Classical light sources emit a randomly-timed stream of individual photons, the spatial distribution of which can be detected with a camera to form an image. Quantum light sources, based on parametric down conversion, emit photons as correlated photon-pairs. The spatial correlations between the photons enables imaging systems where the preferential selection of photon-pairs allows for enhancements in the noise performance over what is possible using classical light sources. However, until now the technical challenge of measuring, and correlating both photons has led to system complexity. Here we show that a camera capable of resolving the number of individual photons in each pixel of the detector array can be used to record an image formed from these photon-pair events and hence achieve a greater contrast than possible using a classical light source. We achieve an enhancement in the ratio of two-photon events compared to one-photon events using spatially correlated SPDC light compared to uncorrelated illumination by a LED. These results indicate the potential advantages of using photon counting cameras in quantum imaging schemes and these advantages will further increase as the technology is developed. Operating in photon sparse regimes such systems have potential applications in low-light microscopy and covert imaging. The ability to observe these correlations at the single photon level is afforded by low noise detector technologies that are sensitive to single photons. These quantum enhancements can be extracted from correlations between pairs of single photon detection events, however, photon-pairs that arrive within the same pixel and/or time bin may not be easily distinguished from a single photon event due to limitations of detector technology. The inability to make this distinction prevents the full extent of the correlations between photon-pairs from being utilised in some imaging contexts. The capacity to distinguish between a two-photon event and a one-photon event would enable an increased amount of information to be extracted from experimental data thereby improving the efficiency of quantum imaging systems. Such improvements will allow quantum imaging techniques such as quantum enhanced microscopy to be implemented in real-world applications.Quantum imaging utilises correlations between entangled photon-pairs to achieve enhancements beyond classically achievable limits8. Such measurements can be made due to the capability of single photon sensitive detectors to distinguish a single photon from the absence of a photon by the setting of an appropriate threshold and/or by time-gating the detector. However, due to the stochastic nature of the gain process within Electron Multiplying CCD detectors (EMCCD) and Intensified CCD detectors (ICCD) it is not possible to accurately resolve the actual numbers of photons in each pixel in a frame and as a result it is not possible to simply identify the two-photon events10. This is a disadvantage because in the case of the detector being positioned in the image plane of the downconversion source the most strongly correlated photon-pairs will arrive within the same pixel and time bin.A common source of entangled photon-pairs that are used in many quantum enhanced imaging experiments is spontaneous parametric down-conversion (SPDC) within a non-linear crystal. In SPDC, a photon-pair is created by the spontaneous parametric downconversion of a single pump photon and due to conservation laws the downconverted photon-pairs are strongly correlated in their position and anti-correlated in their transverse momentum. With a spatially resolving detector array it is possible to image and measure the correlations between photon-pairs realising a large number of entangled states12, ghost imaging16, imaging through scattering media17, interaction-free ghost imaging18, and sub-shot-noise imaging21. Further to these applications, quantum illumination schemes that are resilient to the effects of noise and losses have been demonstrated27.To date the inability to distinguish two-photon events from one-photon events has not prevented the development of quantum enhanced imaging systems using entangled photon-pair sources and single-photon-sensitive array detector technologies. Enhancements have been realised in terms of image resolutionIn this work we utilise a photon number resolving array detector that is based on CMOS technology which allows us to report a simpler method for the detection of correlated photon-pairs. The capability to distinguish two-photon events from one-photon events presents an advantage over the preceding technologies in imaging using SPDC photon-pairs because the photon-pairs can be detected in the same pixel in the same frame. Selecting these events allows the construction of an image consisting of two-photon events. We demonstrate an advantage in the ratio of two-photon events to one-photon events for images obtained under SPDC illumination when compared to images obtained under illumination from a LED source. This advantage is shown to be present across a range of illumination levels. In the context of quantum imaging the ability to identify two-photon events will allow the full extent of the correlations between photon-pairs to be utilised by image-plane applications in which the photon-pair events occur in the same pixel at the detector. Whilst we acknowledge the limited performance of our experiment, the method that we present method will improve efficiency with which data is collected and increase the rate at which images are populated with events, thereby increasing the opportunity for quantum imaging technologies to transition into real-world applications.The experimental setup used is shown in Fig. L is the length of the crystal, 28. For the system presented here, with a camera with a pixel size of We choose the de-magnification and crystal length of our system such that the number of pairs detected in the same pixel is maximised. The correlation strength The ability to distinguish the number of photon events occurring in a pixel is crucial to our experiment. The signal output of the camera is digitised into ADU , from which a histogram of events can be built up in order to set thresholds corresponding to the number of photon events. For a histogram constructed over events on all pixels in the region of interest a series of global thresholds can be determined. An example of a global histogram constructed using all pixels in the region of interest over 100,000 frames can be seen in Fig. The offset of each pixel is determined as its average value under dark conditions. The gain of the sensor is determined by measuring the mean and variance in pixel output for series of images acquired under different intensities of poisson distributed light. For the camera used in this experiment the relation between ADU and electrons for the complete sensor was determined to be 1 ADU equals The probability of the output of a specific pixel depends on the input photon statistics as well as on the readout noise of that specific pixel. While the readout noise is typically a continuous gaussian distribution (which is digitised in a later step), the photon distribution is discrete in nature and depends on the source. The total output probability function will be a convolution of the photon statistics with the readout noise of the specific pixel. This method needs as input parameters the readout noise of the pixels and the photon distribution. The readout noise is derived from dark frames, while the photon distribution is estimated empirically from 10 pixels with a below average noise value (around Such a scenario is indicated in Fig. With the ability to distinguish the number of events in each pixel per frame images consisting of only one-photon events or two-photon events were obtained. One-photon and two-photon event images of a binary star target obtained over 10,000 frames may be seen in Fig. 29.To compare the performance of the imaging system at selecting correlated photon-pairs two-photon event images for the downconversion source are compared with a LED source. These comparison images for increasing illumination levels can be seen in Fig. The improved two-photon to one-photon event ratio provides an increased contrast in images where the object was illuminated by the SPDC source compared to the LED. This can be seen from the corresponding cross section image intensity plots in Fig. The key performance parameter in our experiment is the ratio between the number of pixels containing a one-photon event, whether it be signal or noise, and the number of pixels containing two-photon events for the LED and SPDC photon-pair source respectively. Considering first the limit of zero detector noise, and assuming a low illumination level with the number of events per pixel per frame Replacing the LED with the SPDC photon-pair source at the same illumination intensity, and assuming that the position correlation between the pair of photons is small compared to the pixel size, then the increase in the two event to one event ratio depends upon the efficiency of detecting both photons in a pair, the heralding efficiency, The camera noise of the detector is gaussian in nature and does not hold the above relation in that the number of events corresponding to two-photon events It follows that the largest difference in the two-photon and one-photon event ratios between the LED source and SPDC photon-pair source will be obtained when operating at a low number of total events per pixel per frame, We have reported a new method for the detection of spatially correlated photon-pairs from a SPDC source with a photon number resolving camera. With this imaging system images an improved ratio of two-photon events to one-photon events are obtained with a quantum SPDC photon-pair source when compared with a LED source across a range of illumination levels. Resulting images consisting only of two-photon events show a maximum improvement in the two-photon event to one-photon event ratio for the SPDC source compared to the LED source when operating at a low illumination level so as to minimise the contribution of accidental event-pairs. The presence of an enhancement in the 2/1 ratio for the quantum photon-pair source demonstrates the validity of the concept and is encouraging for the application of photon counting cameras in future quantum imaging applications.Quantum enhanced imaging experiments that require the detection of both photons in a photon-pair to realise an enhancement could benefit from the ability to distinguish one-photon events from two-photon events using the technology and methods described here. In an experimental configuration that places the detector in the image plane of the downconversion crystal the most tightly correlated photon-pairs arrive in the same pixel and this information is not easily recovered in the case of using a conventional CCD or CMOS detector technology for which it is difficult to distinguish between one-photon events and two-photon events. The ability to distinguish the number of photon events allows an increased amount of information to be recovered on a per frame basis thereby allowing increased efficiency and reduced acquisition times.Further improvements in the performance are set by the efficiency of photon-pair detection and camera readout noise, we expect improvements to these factors to yield more dramatic enhancements in the contrast of images. Higher detection efficiency could be achieved for example by creating down-converted photon-pairs at a shorter wavelength where the quantum efficiency of the sensor is higher. Furthermore, advancements in CMOS camera technology should result in lower sensor readout noises. With more dramatic contrast enhancements it is expected that images could be acquired on fewer frames where it is only possible to reveal the object with a quantum pair source. Such an experiment approaching real time imaging could point to applications in low light level microscopy or covert target detection systems.The pump beam source used here was a JDSU xCyte CY-355-150 Nd:YAG laser with quasicontinuous output at


All authors of the Cell Death and Disease article appeared as authors of the Molecular Therapy - Nucleic Acids article. Image analysis performed by the editorial office confirmed findings of image duplication in Figure 4B of the Molecular Therapy - Nucleic Acids article. This reuse (and in part misrepresentation) of data without appropriate attribution represents a severe abuse of the scientific publishing system.This article has been retracted at the request of the editor-in-chief. Similarities were found between images in this article and an article in