This review aims to explore the intricate relationship between epigenetic mechanisms, stress, and affective disorders, focusing on how early life experiences and coping mechanisms contribute to susceptibility to mood disorders. Epigenetic factors play a crucial role in regulating gene expression without altering the DNA (deoxyribonucleic acid) sequence, and recent research has revealed associations between epigenetic changes and maladaptive responses to stress or psychiatric disorders. A scoping review of 33 studies employing the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Statement) guidelines investigates the role of stress-induced epigenetic mechanisms and coping strategies in affective disorders' occurrence, development, and progression. The analysis encompasses various stress factors, including childhood trauma, work-related stress, and dietary deficiencies, alongside epigenetic changes such as DNA methylation and altered gene expression. Findings indicate that specific stress-related genes frequently exhibit epigenetic changes associated with affective disorders. Moreover, the review examines coping mechanisms in patients with bipolar disorder and major depressive disorder, revealing mixed associations between coping strategies and symptom severity. While active coping is correlated with better outcomes, emotion-focused coping may exacerbate depressive or manic episodes. Overall, this review underscores the complex interplay between genetic predisposition, environmental stressors, coping mechanisms, and affective disorders. Understanding these interactions is essential for developing targeted interventions and personalized treatment strategies for individuals with mood disorders. However, further research is needed to elucidate specific genomic loci involved in affective disorders and the clinical implications of coping strategies in therapeutic settings.

Contrasting results have suggested that the prevalence and intensity of post abortion emotional distress (PAD) either diminishes rapidly or persists over time. Few studies have followed women for longer than five years. This study examines retrospective population data on 226 ever aborting U.S. women aged 41-45, at an average of 20 years following the abortion, with extensive measures of PAD. Most post abortive women (55.2%) experienced little or no distress from their abortion(s) and 74.6% were confident it had been the right decision, but 44.8% reported moderate (20.7%) to high (24.1%) distress related to their abortion(s), including 37.7% who reported negative emotions; 31.2% “frequent feelings of loss, grief or sadness;” 24.6% “frequent thoughts, dreams, or flashbacks;” 23.2% for whom thoughts and feelings about their abortion “negatively interfered with life, work, or relationships.” Time since the abortion (mean 20 years, range 0-31 years) was not correlated with PAD (r = -.02, p .71). For the minority of women who experienced it, PAD did not diminish but persisted for decades. An estimated 7.5 million U.S. women currently experience persistent high PAD. Further research to specify risk factors and possible interventions for postabortion distress would be of value for this group of women.

Affective computing has emerged as a prominent technology in recent years, driven by the increasing demand for machines capable of understanding and interpreting emotions. The COVID-19 pandemic has intensified this need by reducing physical interactions and increasing reliance on digital communication, which often involves complex emotional exchanges. To enhance social interactions by identifying and addressing negative emotions, an interactive emotion-perception system based on multi-sensing interfaces and affective computing has been proposed. Integration of gesture, voice, and brainwave sensors is employed to provide users with a rich sensory experience and immersive environment. Design principles and system development processes are derived from the affinity diagram method and prototype development approach. The proposed system was constructed, and experiments were conducted with 60 participants. Interpersonal interaction scenarios were explored to understand emotional transmission mechanisms, aiming to enhance user satisfaction and positive interpersonal experiences. Data were collected through indirect observation and questionnaires, followed by evaluation and statistical analysis. Findings include: (1) The emotion-perception system enhances positive interpersonal interactions by identifying 36 distinct emotions, with overall user emotions being positive but exhibiting notable individual variations; (2) The system effectively stimulates positive emotions and strengthens interpersonal interactions, with affective computing technology fostering enjoyable emotional resonance and high-quality relationships; (3) A positive correlation was observed between semantic analysis and brainwave metrics of relaxation and concentration, showing increased concentration and enhanced positive emotional interactions during message transitions; and (4) The multi-sensing and affective computing technology provides a pleasant and relaxing emotional journey, with interactions shifting from enthusiasm to comfort, demonstrating the system’s capacity for a satisfying and enjoyable experience.

Depression, anxiety, and pain are part of a common phenomenon that requires to be studied together when evaluating patients with chronic pain. The aim of the study was to examine the correlations between depression, anxiety and pain intensity in patients with chronic pain and how they change when a depressive episode was added. A sample of 120 patients with chronic pain (age: 51.90±11.94; 81.7% female; 18.3% male) was studied in two stages with a three-month period between them. Patients with a depressive episode (n=61) were treated with antidepressants and analgesics, while a patient without depression (n=59) was treated only with analgesics. The scales used to achieve the objectives were: HAM-D-17, Spielberger‘s STAI and VAS. Insignificant correlations were found between depression, state and trait anxiety, and pain intensity (p<0,05) in the group without depression, except for a significant one between depression and state anxiety (p<0,01) in the second stage. Significant correlations were identified between all indicators (p<0,01) in the group with depression at the two stages. Those in the second stage were stronger. The interrelations between sensory and affective aspects of pain were stronger when a depressive episode occurs, the severity of which determines their dynamics.

Videogames have been the focus of research since their widespread popularity, with particular emphasis on their effects on cognitive and affective abilities, especially in children and adolescents. Despite numerous correlational studies, robust evidence on the causal relationship between videogames and cognition remains scarce, hindered by the absence of a comprehensive assessment tool for gaming skills across various genres. This study aimed to develop and validate the Gaming Skill Questionnaire (GSQ) and to assess the impact of gaming skills in six different genres (Sport, First-Person Shooters, Role-Playing Games, Action-Adventure, Strategy, and Puzzle Games) on adolescents’ cognitive and affective abilities. The GSQ exhibited strong reliability and validity, highlighting its potential as a valuable tool. Gaming skills positively affected executive function, memory, overall cognition, cognitive flexibility, and emotion recognition, except for empathy. Various game genres had different effects on cognitive and affective abilities, with verbal fluency influenced mainly by sports, executive functions by action, strategy, and puzzle, and emotion recognition positively impacted by action and puzzle but negatively by sports and strategy games. Both age and gaming skills influenced cognitive flexibility, with gaming having a greater effect. These intriguing genre-specific effects on cognitive and affective functioning postulate further research with GSQ's contribution.

Role identity theory describes the purpose and meaning in life that comes, in part, from occupying social roles. While robustly linked to health and well-being, this may become, however, when an individual is unable to fulfil the perceived requirements of an especially salient role in the way that they believe they should. Amid high rates of mental illness among public safety personnel, we interviewed a purposely selected sample of 21 paramedics from a single service in Ontario, Canada to explore incongruence between an espoused and able-to-enact paramedic role identity. Situated in an interpretivist epistemology, and using successive rounds of thematic analysis, we developed a framework for role identity dissonance wherein chronic, identity-relevant disruptive events cause emotional and psychological distress. While some participants were able to recalibrate their sense of self and understanding of the role, for others, this dissonance was irreconcilable, contributing to disability and lost time from work. In addition to contributing a novel perspective on paramedic mental health and well-being, our work also offers a modest contribution to the theory in using the paramedic context as an example to consider identity disruption through chronic workplace stress.

Emotions or affective states recognition in farm animals is an underexplored research domain. Despite significant advances in the animal welfare research, the animal affective computing through the development and application of devices and platforms that can not only recognize but interpret and process the emotions, are in nascent stage. By capitalizing on the immense potential of biometric sensors, the artificial intelligence enabled big data methods substantially offers advancement of animal welfare standards and meet the urgent need of caretakers to respond effectively to maintain the wellbeing of their animals. Farm animals, numbering over 70 billion worldwide, are increasingly managed in large-scale, intensive farms. With both public awareness and scientific evidence growing that farm animals experience suffering, as well as affective states such as fear, frustration and distress, there is an urgent need to develop efficient and accurate methods for monitoring their welfare. At present, there are no scientifically validated ‘benchmarks’ for quantifying transient emotional (affective) states in farm animals, and no established measures of good welfare, only indicators of poor welfare, such as injury, pain and fear. Conventional approaches to monitoring livestock welfare are time consuming, interrupt farming processes and involve subjective judgments. Biometric sensors data enabled by Artificial Intelligence are an emerging smart solution to unobtrusively monitoring livestock, but their potential for quantifying affective states and groundbreaking solutions in their application are yet to be realized. This review provides innovative methods for collecting big data on farm animal emotions, which can be used to train artificial intelligence models to classify, quantify and predict affective states in individual pigs and cows. Extending this to the group level, social network analysis can be applied to model emotional dynamics and contagion among animals. Finally, ‘digital twins’ of animals capable of simulating and predicting their affective states and be-havior in real time are a near-term possibility.

Background: Since circa 1980, a model of neocortical interactions, Statistical Mechanics of Neocortical Interactions (SMNI) has been successful in calculating many experimental phenomena, including fits to electroencephalographic (EEG) data in attention tasks, using an importance-sampling code Adaptive Simulated Annealing (ASA). The SMNI model is developed in the context of classical path-integrals, which affords intuitive insights as well as direct numerical benefits, e.g., using the effective Action as a a cost/objective function for parameter fits to data. Objective: Previous authors have fit affective EEG data to neural-network models. This project seeks to use models based on physics and biology to fit this same data. Previous work showed improvements in fits to EEG for attention states; this project extends these methods to affective states. Method: Path integrals are used in both classical and quantum contexts. Classical path integrals are used to define a cost/objective function to fit data, and quantum path integrals are used to derive a closed-form analytic expression for Ca-ion waves in the presence of a magnetic vector potential which is generated by highly synchronous neuronal firings which give rise to EEG. ASA is used to fit EEG data. Results: The mathematical-physics and computer parts of the study are successful, in that cost/objective functions used to fit EEG data using these models are consistent with previous work published by other authors. However, since the SMNI model includes these quantum effects, this is another reason to continue examining these issues. The results here are consistent, not better, than previous work using neural-network models, albeit only one parameter was used here, instead of multiple filters and kernels used previously on such data. Conclusion: Although these quantum effects are highly speculative, explicit calculations have shown them to be consistent with experimental data, at least to date. The current supercomputer project extends this model to affective/emotion data. Results from several authors using neural-network approaches at individual electrode sites show some predictive capabilities; the results given here are consistent with these other results. However, since the SMNI model includes these quantum effects, this is another reason to continue examining these issues.

The road pavement condition affects safety and comfort, traffic and travel times, vehicles operating cost and emission levels. In order to optimize the road pavement management and guarantee satisfactory mobility conditions for all the road users, the Pavement Management System (PMS) is an effective tool for the road manager. An effective PMS requires the availability of pavement distress data, the possibility of data maintenance and updating, in order to evaluate the best maintenance program. In the last decade, many researches have been focused on pavement distress detection, using a huge variety of technological solutions for both data collection and information extraction and qualification. This paper presents a literature review of data collection systems and processing approach aimed at the pavement condition evaluation. Both commercial solutions and research approaches have been included. The main goal is to draw a framework of the actual existing solutions, considering them from a different point of view in order to identify the most suitable for further research and technical improvement, also considering the automated and semi-automated emerging technologies. An important attempt is to evaluate the aptness of the data collection and extraction to the type of distress, considering the distress detection, classification and quantification phases of the procedure.

Background. The possible interactions between anger and fear have not been widely explored in the psychological literature. Fear and anger are currently beginning to be studied by looking at their interrelationships, rather than seeing them as simply opposing emotions. Furthermore, there is a tendency to think that anger is more typical of men and fear of women. Our contribution proposes a particular perspective of affective neuroscience. The objectives of the study are: 1) To assess possible differences in affective systems, states, and traits of anger in relation to biological sex; 2) To assess correlations between ANGER, FEAR, and PANIC, state and trait anger in both a female and male sample; 3) To assess possible differences in basic affective systems in relation to different levels of ANGER, FEAR, and PANIC, state and trait anger, in sample of female and in sample of male. Methods. A non-clinical sample of 339 females and 99 males completed the ANPS 3.1 to assess basic affective states and the STAXI 2 to assess anger states and traits. Results. No significant differences were found for ANGER and FEAR scores and for state and trait scores between the male and female samples. Clear correlations emerged (p < .01) between FEAR. PANIC and FEAR in both the female and male samples. Among the differences that emerged in the affective systems, we emphasise that in the female group as FEAR increases, there are significant variations in systems of SEEKING, PLAY, and CARE. Furthermore, only in the female sample as PANIC increases, PLAY progressively decreases, and CARE shows an irregular trend. Discussion. Given the importance of the SEEKING and PLAY systems for well-being and gender equality the hypoactivation of these systems to increases in FEAR and PANIC highlights the need to monitor conditions that may trigger these affective systems.

Parasomnias are a group of sleep disorders characterized by abnormal and unpleasant motor, verbal or behavioral events that occur during sleep or during transitions between wake and sleep states. They disrupt sleep and can have a detrimental impact on the individual experiencing them. Our goal was to identify types of parasomnias and their prevalence in the post-secondary student population and to explore students' coping strategies for parasomnias they found distressing. Seventy-seven post-secondary students completed the 21-item Munich Parasomnia Screening (MUPS) frequency scale. They also rated, on a 10-point scale, how disturbing each parasomnia was. Not only did 92% percent of students report at least one parasomnia, but our results also indicate that the vast majority of students experienced more than one parasomnia. This led us to investigate the likelihood of the co-occurrence of different parasomnias. With respect to the level of subjectively experienced distress, the most prevalent parasomnias were not always the more disturbing ones. Coded open-ended responses about what students do about the disturbing parasomnias indicate that grounding strategies and physical manipulation of one’s body were the most common, although most participants indicated that in spite of distress, they do nothing to cope. In conclusion, our study found a strikingly high prevalence of parasomnias in this sample of young adults and a lack of knowledge about effective means of dealing with these.

Acute respiratory distress syndrome (ARDS) is caused by infectious insults, such as pneumonia from various pathogens or related to other noninfectious events. Clinical and histopathologic characteristics are similar across severely affected patients, suggesting that a common mode of immune reaction may be involved in the immunopathogenesis of ARDS. There may be etiologic substances that have an affinity for respiratory cells and induce lung cell injury in cases of ARDS. These substances originate not only from pathogens, but also from injured host cells. At the molecular level, these substances have various sizes and biochemical characteristics, classifying them as protein substances and non-protein substances. Immune cells and immune proteins may recognize and act on these substances, including pathogenic proteins and peptides, depending upon the size and biochemical properties of the substances (this theory is known as the protein-homeostasis-system hypothesis). The severity or chronicity of ARDS depends on the amount of etiologic substances with corresponding immune reactions, the duration of the appearance of specific immune cells, or the repertoire of specific immune cells that control the substances. Therefore, treatment with early systemic immune modulators (corticosteroids and/or intravenous immunoglobulin) as soon as possible may reduce aberrant immune responses in the potential stage of ARDS.

This study examines how the design of museum archaeological boxes and the overall museum image affect behavioral intention. This research used partial least squares-structural equation modeling, indicating a relationship between aesthetics, symbolism, affective museum image, perceived value, and behavioral intention. This study found that symbolism predicted behavioral intention. Moreover, aesthetics, symbolism, and affective museum image affected perceived value, in turn triggering behavioral intention. This indicates theoretical and practical implications for museum products.

The main objective of this investigation was to study the effect of organizational competencies development practices on turnover intentions and whether affective commitment explains this relationship. Another of the study's objectives was to test whether these relationships vary ac-cording to the generation to which the participant belongs. The study sample consisted of 2123 participants working in Portuguese organizations. The results indicate that organizational com-petencies development practices (training, individualized support, and functional rotation) nega-tively and significantly affect turnover intentions and that affective commitment mediates this re-lationship. However, these relationships vary according to the participant's generation. For Gen-eration Y and Generation X, this mediating effect is found in all dimensions of organizational competencies development practices. For the baby boomer generation, there is only a mediating effect of affective commitment in the relationship between individualized support and turnover intentions. These results indicate that human resources should consider the generation to which the participant belongs when implementing competencies development practices.

The process of international migration causes a situation of vulnerability in people's health and greater difficulty in coping with disease. Furthermore, the adversities suffered during migration can trigger reactive signs of stress and cause anxious, depressive, confusional and somatic symptoms. This article studies the relationships between psychosocial risk, psychological distress and somatization in immigrants from 4 communities: Maghrebis, Sub-Saharans, South Americans and South Asian. A cross-sectional study was carried out with questionnaires on 602 immigrants who were surveyed in the Primary Care Centres of an urban area of Catalonia. The instruments used were the Demographic Psychosocial Inventory (DPSI), the Brief Symptom Inventory (BSI) and the Somatic Symptom Inventory (SSI). The average psychosocial risk obtained was 0.35, with the highest values in the sub-Saharan community. Psychological distress showed a mean value of 0.66, with the sub-Saharan community scoring the lowest in all dimensions except depression. The average somatization values were 1.65, with the sub-Saharan community scoring the least. The female gender is a risk factor for somatization and psychological distress. Perceived psychosocial risk is a predictor of psychological distress, but not somatization, suggesting that the use of more adaptive coping strategies could minimize the effect of the migration process on somatizations.

This study investigates the effect of perceived discrimination on the mental health of Afghan refugees, and secondly, tests the distress moderating effects of pre-migration traumatic experiences and post-resettlement adjustment factors. In a cross-sectional design, 259 Afghans completed surveys assessing perceived discrimination and a number of other factors using scales developed through inductive techniques. Multivariate analyses consisted of a series of hierarchical regressions testing the effect of perceived discrimination on distress, followed by a sequential analysis of moderator variables. Perceived discrimination was significantly associated with higher distress, and this relationship was stronger among those with a strong intra-ethnic identity, high civic engagement, and high pre-resettlement traumatic experiences. Discrimination is a significant source of stress for Afghan refugees, which may exacerbate stresses associated with other post-migration stressors. Future research is needed to tailor interventions that can help mitigate the stress associated with discrimination among this highly vulnerable group.

Recent studies have emphasized the influence of resettlement factors on the mental health of refugees resettling in developed countries. However, little research has addressed gender differences in the nature and influence of resettlement stressors and sources of resilience. We address this gap in knowledge by investigating how gender moderates and mediates the influence of several sources of distress and resilience among 259 Afghan refugees residing in northern California. Gender moderated the effects of four factors on levels of distress. Intimate and extended family ties have little correlation with men’s distress levels, but are strongly associated with lower distress for women. English ability is positively associated with lower distress for women, but not men. In terms of gender ideology, traditionally oriented women and egalitarian men have lower levels of distress. And experiencing greater dissonant acculturation increases distress for men, but not women. The influence of gender interaction terms is substantial and patterns may reflect difficulty adapting to a different gender order. Future studies of similar populations should investigate gender differences in sources of distress and resilience, and efforts to assist new arrivals might inform them of changes in gender roles they may experience, and facilitate opportunities to renegotiate gender roles.

A single paragraph of about 200 words maximum. For research articles, abstracts should give a pertinent overview of the work. We strongly encourage authors to use the following style of structured abstracts, but without headings: (1) Background: Place the question addressed in a broad context and highlight the purpose of the study; (2) Methods: briefly describe the main methods or treatments applied; (3) Results: summarize the article’s main findings; (4) Conclusions: indicate the main conclusions or interpretations. The abstract should be an objective representation of the article and it must not contain results that are not presented and substantiated in the main text and should not exaggerate the main conclusions. This study presents a comprehensive literature review on the convergence of affective computing, interactive installation art, multi-dimensional sensory stimulation, and artificial intelligence (AI) in measuring emotional responses. It addresses the problem of understanding emotional response and measurement in the context of interactive installation art under artificial intelligence (AI). The study aims to fill the existing research gaps by examining three key aspects: sensory stimulation, multi-dimensional interactions, and engagement, which have been identified as significant contributors to profound emotional responses in interactive installation art. The study proposed approach involves conducting a process analysis of emotional responses to interactive installation art, aiming to develop a conceptual framework that explores the variables influencing emotional responses. The study will formulate hypotheses that make specific predictions about the relationships between sensory stimulation, multi-dimensional interactions, engagement, and emotional responses. By employing the ASSURE model combined with experimental design, the research methodology ensures a systematic and comprehensive study implementation. The implications of this project lie in advancing the understanding of emotional experiences in interactive installation art under AI, providing insights into the underlying mechanisms that drive these experiences. The contributions of this research include bridging the identified research gaps, refining theoretical frameworks, and guiding the design of more impactful and emotionally resonant interactive artworks. Ultimately, this research aims to contribute to the broader field of human-computer interaction and enhance the development of immersive and emotionally engaging interactive installations.

This study presents a modest attempt to interpret, formulate, and manipulate emotion of robots within the precepts of quantum mechanics. Our proposed framework encodes the emotion information as a superposition state whilst unitary operators are used to manipulate the transition of the emotion states which are recovered via appropriate quantum measurement operations. The framework described provides essential steps towards exploiting the potency of quantum mechanics in a quantum affective computing paradigm. Further, the emotions of multi-robots in a specified communication scenario are fused using quantum entanglement thereby reducing the number of qubits required to capture the emotion states of all the robots in the environment, and fewer quantum gates are needed to transform the emotion of all or part of the robots from one state to another. In addition to the mathematical rigours expected of the proposed framework, we present a few simulation-based demonstrations to illustrate its feasibility and effectiveness. This exposition is an important step in the transition of formulations of emotional intelligence to the quantum era.

A capacity to reflect on experience and learn through it (reflective and reflexive practice) is deemed an essential part of ethical practice and research. Challenging traditional research approaches this arts-based, inter-disciplinary, Ph.D. project explores artistic practice as a research methodology, and how learning through experiences of ‘making’ things may enhance and amplify our understanding of the more affective aspects of human situations and experience. Grounded in the author’s artistic practice and learning through experiences of ‘making’, the author assembles and adapts frames from psychoanalysis, art (psycho)therapy, and the arts with/through which to observe and document their experience of an organisational situation. Describing the development of their method in three phases, analysis takes place through returning to revisit and rework artistic material produced, and engaging in conversation with the emergent material and others in response. Results take the form of artworks and artistic projects, including documentation of process. Emergent threads draw attention to the speculative, entangled, and affective nature of the research process, the reflexivity generated through moving and handling material, and the reflexive work of undergoing, foregrounding an ethics of responsibility, attention, and care for/of the body. As a space for imaginative encounter and performative enactment, and a site for reflexivity through which one may be pressed to notice and feel more acutely, the author argues that the research value resides in the capacity of this method to embrace complex relationalities, and engage our affective, ethical sensibilities in ways that may not emerge through more traditional approaches to reflective/reflexive practice(s). This has implications for both art therapy practice and research, amplifying the learning opportunities afforded by moving, modifying, and assembling things differently, the embodied ‘work’ of art as a method of enquiry, the cultural sensitivity of documentary fragments captured in/through various media and voices, and the value of collaborative endeavours where meaning is co-constructed in conversation.

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy 5-months-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β=-0.22, p<0.05) and SIgA (β=-0.29, p<0.01), while social support was positively associated with milk IgG (β=0.25, p<0.05). Neither anxiety nor social support was related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological well-being and social support may affect milk immune properties.

Background: Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC. Methods: A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis. Results: Nearly 20% of participants exhibited high suicide risk. There was a moderate to high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors. Conclusions: These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

Some COVID-19 patients develop interstitial pneumonia that can evolve into Acute Respiratory Distress Syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. SarS-CoV has proteins capable of promoting cytokine storm, especially in patients with comorbidities, including obesity. Since there is currently no resolutive therapy for ARDS and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Adenosine through its receptors is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier and reduce the damage due to an overactivation of the immune system, such as in cytokine storms. These features are known in ischemia / reperfusion models and could also be exploited in acute lung injury, with hypoxia. In light of these hypotheses, for compassionate use, a COVID-19 patient, with unresponsive respiratory failure, was treated with adenosine. The results showed a rapid and clear improvement in clinical conditions, with the negative effect of detection of SarS-CoV2.

Developmental, clinical, and epidemiological research have demonstrated the salience of perceived racial discrimination (PRD) as a contributor to negative mental health outcomes in adolescence. This article summarizes secondary analyses of cross-sectional data from a large-scale youth survey within a predominantly rural state to estimate the prevalence and strength of association between PRD and serious psychological distress, suicidal ideation, and prior suicidal attempts. Data from 93,812 students enrolled in Grades 6, 8, 10, and 12 within 129 school districts across Kentucky were examined to determine prevalence rates for subgroups within the cohort. Logistic regression analyses assessed differences and established comparative strength of association among these variables for racial/ethnic subgroups. PRD was self-reported at high rates across several demographic subgroups and was most evident among Black (24.5%) and Asian (22.1%) students. Multiracial students experienced the highest rates of both SPD and suicidality. Both for the entire cohort and for each racial/ethnic subgroup, PRD was significantly associated with increased likelihood of negative mental health outcomes, although the strength of these associations varied across subgroups and developmental levels. Implications for early intervention and prevention are discussed.

Purpose: The impact of ethical leadership on employee emotional exhaustion has been widely analyzed. However, the effect of the leader's moral intensity on the employee's emotional state has gone unnoticed. This research seeks to show that ethical management by the leader affects employees' emotional exhaustion in accordance with the scope of the leader's moral standards. Their relationship is not necessarily linear but adopts a curvilinear pattern as a function of the leader's ethical intensity, and affective commitment acts as a mediating mechanism. Methods: A simple mediation model is used. The sample consists of 448 professionals in six organizations in the Colombian electrical sector who responded to an online questionnaire. The sampling is probabilistic by conglomerates. Findings: This research revealed that ethical behavior is voluntary in nature and develops in an environment of trust. When the ethical leader surpasses specific moral turning points, the follower's learning becomes an obligation, preventing affective fluidity. A search for acceptance implies constant consumption of resources that weakens the follower's capacity for self-regulation until it is exhausted. Furthermore, when the leader's expectations are difficult to achieve, affective commitment causes emotional ambiguity in followers, intensifying the stress associated with their role and increasing the likelihood of burnout. Originality: This research challenges conventional wisdom about the positive, linear effect of ethical leadership on employees' emotional state. It broadens the understanding of this management style and fills a crucial knowledge gap by introducing a new perspective. Practical Implications: A horizontal, balanced, and accessible leader can quickly convey a convincing ethical discourse. Emphasizing the vulnerability and importance of human beings can help prevent moral anguish and ethical distances. This, in turn, provides followers with resources to mitigate exhaustion and strengthen commitment.

A simple bounded stochastic motion is employed for modelling equity price dynamics under shocks, where the prices are constrained to lie between two positive bounds. While the stochastic process has an inaccessible boundary, the other boundary is quasi-bounded, implying that the boundary can be breached if the probability leakage condition is met. The quasi-boundedness of the process at the boundary can thus provide an indicator of possible risk of equities under price shocks. Empirical calibration of model parameters of the proposed process for equities can be performed easily due to the availability of an analytically tractable probability density function which generates fat-tailed distributions consistent with empirical observations. The volatility and mean-reversion of the S&P500 dynamics calibrated by the process is positively and negatively co-integrated respectively with the VIX index representing the level of market distress. The process captures the high likelihood of Hertz’s default about two months earlier, using only information until that point, and before the firm filed for Chapter 11 bankruptcy in May 2020 as a result of the Covid-19 pandemic. Empirical calibration of the process for GameStop’s stock price shows that the short squeeze of the stock occurred when the condition for breaching an upper boundary was met on 14 January 2021, i.e., about two weeks before major short sellers closed out their positions with significant losses. The trading volume of the stock was positively co-integrated with the probability leakage ratio.

Mass crises are disruptive to people's mental health. The study aimed to explore mental distress during COVID-19 quarantine in a sample of university workers in Brazil. The survey included sets of questions about demographics, health, and support, an open question about major concerns, and the Clinical Outcome Routine Evaluation (CORE-OM), a measure of mental distress. 407 professionals participated in the study: mean age of 40 years (SD = 11.2), mostly female (67.8%), married (64.8%) and fulfilling social distancing to avoid COVID-19 infection (99%). Using the Consensual Qualitative Research for simple qualitative data (CQR-M) the main areas of concern were grouped into six domains, as follows: Work, Health, Isolation, Personal life and routine, Social environment, and Future. Many responses were multiple. They form categories indicating specific concerns within these domains. Quantitative data were analyzed by identifying the simple effects of potential predictors of mental distress. The results indicated medium effects of help with household chores, psychiatric treatment, age and physical exercise. Having someone available to listen was the only variable with a large effect in reducing mental suffering. The hybrid approach showed that the psychological experience during the pandemic is quite multifaceted and complex pointing new clues for public mental health.

Purpose: To assess the clinical safety and possible effectiveness of Vasoactive Intestinal Peptide in the treatment of Acute Respiratory Distress Syndrome (ARDS) related to sepsis. Methods: Under FDA Investigational New Drug clearance, 8 patients with ARDS related to sepsis were treated with 50 pmole/kg/hr – 100 pmole/kg/hr of Vasoactive Intestinal Peptide by intravenous infusion for 12 hours. All patients were on mechanical ventilation and full telemetery. Results: No drug-related serious adverse events were seen. Hypotension was seen in association with two infusions and diarrhea in association with one, but did not necessitate cessation of therapy. Bigeminy was seen in association with one infusion without sequelae. Seven of eight patients demonstrated a successful course during intensive care and were successfully removed from mechanical ventilation and discharged from intensive care. The eighth patient succumbed to purulent secretions in the lungs. Of those who were discharged from the ICU, six demonstrated successful 30 day survival. The seventh died from a cerebral infract at day 30, deemed unrelated to treatment with VIP. Serum levels of Tumor Necrosis Factor α were obtained in 6 patients at baseline and 24 hours and were seen to decrease with treatment in five patients. Conclusions: Initial clinical results of treatment with VIP in patients with ARDS demonstrated a safety profile consistent with previous studies in normal volunteers. The successful clinical course seen in 7 of 8 patients in the setting of an expected 50% survival may suggest that VIP shows promise in the treatment of other infectious conditions that damage the pulmonary epithelium, particularly COVID-19.

Objective: To examine the associations between menstruation features and symptoms and hormone-immune-metabolic biomarkers. Methods: Forty-one women completed questionnaires assessing characteristic menstruation symptoms, duration of menstrual cycle and number of pads used/day and completed the Daily Record of Severity of Problems (DRSP) during the consecutive days of their menstrual cycle. Menses-related symptoms (MsRS) were computed from the sum of 10 pre- and post-menses symptoms and the menstruation blood and duration index (MBDI) was computed based on the daily number of pads and duration of menses. We assayed serum levels of various biomarkers at days 7, 14, 21, and 28 of the subjects’ menstrual cycle. Results: MBDI was significantly associated with a) MsRS including low abdominal cramps, and gastro-intestinal (GI) and pain symptoms (positively); b) plasma levels of haptoglobin (Hp), CCL5, insulin growth factor (IGF)-1, and plasminogen activator inhibitor (PAI)1 (all positively); and c) estradiol and paraoxonase (PON)1 arylesterase activity (both inversely). MsRS were significantly predicted by CCL5 and IGF-1 (both positively) and progesterone (inversely). Low-abdominal cramps, and gastro-intestinal and pain symptoms were associated with lower progesterone levels. The MBDI+MsRS score was significantly predicted by the cumulative effects of (in descending order of importance): Hp, IGF-1, PON1 arylesterase, estradiol and PAI. Conclusion: Menstruation-related features including estimated blood loss, duration of menses, cramps, pain and GI symptoms are associated with hormone-immune-metabolic biomarkers, which mechanistically may explain those features. Women with an increased MBDI+MsRS index ≥ 0.666 percentile may be considered to have menstruation-related distress, including dysmenorrhea symptoms.

Affective prosody is an indispensable cognitive cue that moderates social activities, and has become a prevailing research topic in psychology-related disciplines. The present study conducts the first bibliometrics-based visualization analysis concerning affective prosody to evaluate the influential cases, including countries/regions, institutions, publication venues, academic articles, and disciplinary contributions, and the diachronic changes of publication trends and research hotspots. With the combination of statistical results and a qualitative literature inspection, limitations of extant studies and promising research directions were also proposed. The present study extracted the bibliographic data of 1,624 articles retrieved from the Web of Science Core Collection, which were published over the past 25 years (1997-2021). Statistical results revealed four leading powers (the U.S., Germany, England, and Canada) and four emerging fronts (China, France, Netherlands, and Switzerland), and identified three primary research themes in this field, including clinical implication, measurable index, and modality-specific issues. Literature inspection demonstrated current limitations in individual characteristics control and experiment-related influential factors, and proposed two prosperous research directions. Findings of the present study could facilitate academic retrieval of affective prosody research, help concerned researchers identify thematic hotspots and seek appropriate collaboration, and provide convenience for research policy and management in this field.

Pandemic restrictions and reduced social opportunities led to increased loneliness throughout affected countries. Considering that stressful situations activate the attachment system and engage various coping strategies, the present study explored the role of attachment dimensions and coping styles in perceived social isolation and the subsequent effect on emotional distress. Data was collected using an online survey between the third and fourth waves in Romania during the second year of the pandemic. Correlational analyses presented significant relationships between all variables measured. Regression analysis showed that attachment insecurity could predict up to half of the variance in loneliness and one-third of emotional distress. Coping styles that predicted both loneliness and emotional distress were problem-focused and socially supported coping, though the effect was minimal. Emotion-focused coping presented a protective role against loneliness. Finally, moderation analysis revealed how loneliness fully mediated the relationship between insecure attachment styles and emotional distress. Further implications for research on loneliness, and pandemic resilience are discussed.

Syncope and presyncope occurring during work can affect safety and impair occupational performance. Few data are available regarding the prevalence of these events among workers. The possible role of sleep quality, mental stress and metabolic disorders in promoting syncope, presyncope and falls in workers is unknown. In the present study, 741 workers (male 35.4%; mean age 47±11 years), employed in different companies, underwent clinical evaluation and blood tests and completed questionnaires to assess sleep quality, occupational distress and mental disorders. The occurrence of syncope, presyncope and unexplained falls during their working life was assessed by an ad hoc interview. The prevalence of syncope, presyncope and falls of unknown origin was 13.9%, 27.0%, and 10.3%, respectively. The occurrence of syncope was associated with an increased risk of occupational distress (adjusted Odds Ratio aOR: 1.62, Confidence Intervals at 95%: 1.05-2.52), low sleep quality (aOR: 1.79 CI 95%: 1.16-2.77) and poor mental health (aOR: 2.43 CI 95%: 1.52-3.87). Presyncope was strongly associated with occupational distress (aOR: 1.77 CI 95%: 1.25-2.49), low sleep quality (aOR: 2.95 CI 95%: 2.08-4.18) and poor mental health (aOR: 2.61 CI 95%: 1.78-3.84), while no significant relationship was found between syncope or presyncope and metabolic syndrome. These results suggest that occupational health promotion interventions aimed at improving sleep quality, reducing stressors and increasing worker resilience might reduce syncope and presyncope events in the working population.

Objectives To delineate the features of ischemic stroke patients and their caregivers that may predict distress, depression, and anxiety symptoms in the caregivers. Methods The Hospital Anxiety and Depression Score (HADS), Zarit Burden Interview (22 item-ZBI), and Perceived Stress Scale (PSS-10) were used to assess caregivers' burden, stress, depressive, and anxiety symptoms. We performed partial least square-structural equation modeling (PLS-SEM) in order to delineate a multi-step mediation model.Results In this study, 97 stroke patients and their caregivers were included. Multiple regression analysis revealed that ZBI-personal strain and stroke of other determined etiology explained 15.0 percent of the variance in the HADS depression score (p=0.001). We discovered that the caregiver's underlying disease and the National Institute Stroke Score (NIHSS) of the patients explained 13.6 percent of the variance in the total ZBI score of the caregivers (p=0.001). The total ZBI score, the presence of lacunar circulation infarction in the patients, and the caregiver's underlying disease explained 40.9 percent of the variance in the total PSS score of the caregivers (p <0.001). Moreover, PLS analysis showed that the NIHSS and the caregiver's underlying disease had significant indirect effects on the HADS score which were mediated by the ZBI score. Conclusions A large part of the variance in stress and depressive scores in caregivers of ischemic stroke patients is determined by the patient's disability, dependency, cognition, and stroke phenotypes, as well as the caregiver's health status and burden. Screening for the aforementioned factors in ischemic stroke caregivers is critical.

Entrepreneurship education has become increasingly relevant. For some years now, the business environment for starting a new company in the Dominican Republic has been considered very propitious. This has generated that many universities have incorporated training in entrepreneurship in their study plans. This study aims to analyse whether the cognitive and affective components, the country's business environment, university training in entrepreneurship and attitudes towards entrepreneurship are antecedents of the entrepreneurial intention of university students. It also seeks to investigate the relationship between entrepreneurial intention and entrepreneurial behaviour of students. Data were collected through a structured questionnaire from a sample of 523 students who had taken courses on entrepreneurship. The data have been analysed through the SPSS and Smart-PLS programs. The results of this research highlight the importance of the affective component and attitudes towards entrepreneurship in the formation of students' entrepreneurial intentions. This reinforces the importance of cultivating positive attitudes through educational interventions. These results contribute to the understanding of the factors that drive entrepreneurial intentions among university students and provide a foundation for future research.

Autosselecionar a intensidade do treinamento aeróbico é uma perspectiva que permite aos praticantes desenvolver autonomia (escolha do ritmo), melhorar a aptidão física e alcançar a perda de peso. Comparar o efeito de quatro protocolos de treinamento aeróbico nas respostas cardiometabólicas e psicofisiológicas em homens e mulheres adultos fisicamente inativos. A amostra foi composta por 11 indivíduos com idade entre 56 ± 10 anos e IMC 29,2 ± 2,4 kg/m2 que realizaram quatro diferentes protocolos de treinamento aeróbio em esteira, sendo: 1-indivíduo com intensidade autosselecionada (ISS), 2-indivíduo com intensidade prescrita (IPI) (64-76% da FC máx), grupo 3 pequeno com autosseleção. intensidade selecionada (SGS) e intensidade prescrita em 4 pequenos grupos (SGP) (64-76% da FC máx). Foram analisados ​​frequência cardíaca, lactato, percepção subjetiva de esforço, resposta afetiva, escala de ativação, prazer, intenção de repetir a sessão, velocidade da esteira e distância total do protocolo. A análise estatística utilizou ANOVA com teste post hoc de Tukey (p<0,05). As análises de frequência cardíaca, lactato, percepção subjetiva de esforço, escala de ativação, prazer, velocidade média e distância total não apresentaram diferenças significativas entre os protocolos. A resposta afetiva apresentou menor declínio no protocolo ISS (p<0,05), e a intenção de repetir a sessão de treinamento foi maior no protocolo ISS (p<0,05). Conclusão: Os dados permitem concluir que o protocolo de treino ISS produziu resultados superiores na resposta afetiva e na intenção de repetir a sessão.

The purpose of this study was to explore the role of moral distress on physician burnout during COVID-19. Physicians in the US were interviewed between February and March 2021; 479 responded to our survey. Results indicated that moral distress was a key mediator in explaining the relationship between perceived organizational support, medical specialization, emotional labor, and coping on burnout. There was no support for increased burnout among female physicians, and contracting COVID-19 likewise did not play a role in burnout. Our findings suggest that physician burnout can be mitigated by increasing perceived organizational support; likewise, physicians who engaged in deep emotional labor and problem-focused coping tended to fare better when it came to feelings of moral distress and subsequent burnout.

Background: Psychological sufferings are observed among dental students during their academic years, which had been intensified during the COVID-19 pandemic. Objectives: This study assessed the levels and identified factors associated with psychological distress, fear and coping experienced by dental undergraduate students in Bangladesh. Methods: A cross sectional online survey was conducted during October-November, 2021. The Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale (FCV-19S) and Brief Resilient Coping Scale (BRCS) were used in order to assess psychological distress, fear and coping strategies respectively. Results: A total of 327 students participated; the majority (72%) were 19-23 years old and females (75%). One in five participants were infected with COVID-19 and 15% reported contact with COVID-19 cases. Negative financial impact (AOR 3.72, 95%CIs 1.28-10.8), recent or past COVID-19 infection, contact with COVID-19 cases were associated with higher levels of psychological distress; but being a 3rd year student (0.14, 0.04-0.55) and being satisfied about current social life (0.11, 0.03-0.33) were associated with lower levels of psychological distress. Being a 3rd year (0.17, 0.08-0.39) and a 4th year student (0.29, 0.12-0.71) were associated with lower levels of fear. Health care service use and feeling positive about life were associated with medium to high resilience coping. Conclusions: This study iden-tified dental students in Bangladesh who were at higher risk of psychological distress, fear and coping during the ongoing pandemic. Development of mental health support system within dental institution should be considered in addition to the academic and clinical teaching.

Background. The novel coronavirus (SARS-COV-2) and related syndrome (COVID-19) has required a worldwide measure of quarantine with severe consequences for millions of people. Methods. Since psychopathological consequences related to social restrictions have been reported, a systematic review according to Cochrane Collaboration guidelines and the PRISMA Statement was performed to quantify the effects of quarantine on mental health of adults. Major databases - Pubmed, Scopus, Embase, PsycInfo, and Web of Science- were researched for observational studies with data on mental health indexes related to quarantine or isolation for epidemic infections. Results. Twenty-one independent studies were included for 82,312 subjects. Conclusions. The results showed that at least 20% of people exposed to these conditions reported a psychological distress, with a prevalence of PTSD, depression and, less often, generalized anxiety. Important methodological bias weakens the conclusion of most studies, opening to the need of further research on mental health after quarantine and related risk/buffering factors.

The belief in online news has become a hot topic. Previous studies have shown the role of emotion in susceptibility to believing fake news. However, Few studies have explored the effect of empathy on belief in online news. This study investigated the relationships between trait empathy, state empathy, the belief in online news, and the potential moderating effect of the news type. One hundred and forty undergraduates evaluated 50 online news pieces (25 real, 25 fake) regarding their believability, state empathy, valence, arousal, and familiarity. Trait empathy data were collected using the Chinese version of the Interpersonal Reactivity Index. State empathy was positively correlated with affective empathy in trait empathy and believability, and affective empathy was positively correlated with believability. The influence of affective empathy on news belief was partially mediated by state empathy, regulated by the news type (fake, real). We discussed the influence of empathy on the belief in online news and its internal processes. This study explains some unique insights for researchers, practitioners, social media users, and social media platform providers.

Purpose: Understanding how older adults perceive and interpret emotional cues in speech prosody contributes to our knowledge of cognitive aging. This study provides a systematic review with meta-analysis to investigate the extent of the decline in affective prosody recognition (APR) among older adults in terms of overall and emotion-specific performance and explore potential moderators that may cause between-study heterogeneity. Method: Incorporated into the literature search were six electronic databases, with a specific emphasis on studies comparing the APR performance of older adults with that of younger adults. This comparison was focused on basic emotions. Meta-regression analyses were executed to pinpoint potential moderators related to demographic and methodological characteristics. Results: A total of 19 studies were included in the meta-analysis, involving 560 older adults with a mean age of 69.15 years. The findings indicated a substantial negative effect size (g = －1.21). Furthermore, the magnitude of aggregated effect sizes showed a distinct valence-related recognition pattern with positive prosody exhibiting smaller effect sizes. Years of education were found to moderate the overall performance effect estimate while age and gender significantly influenced the effect estimate of happiness. Conclusions: The results confirmed a significant decline in APR ability among older adults, but this decline was unbalanced across basic emotions. Educational level emerged as a significant factor influencing APR ability. Moreover, participants with a higher mean age exhibited notably poorer performance in recognizing happy prosody. These findings underscore the need to further investigate the neurobiological mechanisms for APR decline associated with aging.

Background: Affective states play a role in dietary behaviors. Yet, little research has studied within-subjects associations between affect and diet during pregnancy. We examined the acute bidirectional relationships between affect and food intake and moderation by pre-pregnancy body mass index (BMI) in low-income, Hispanic pregnant women using ecological momentary assessment (EMA). Methods: Women (N=57) completed four days of EMA during their first trimester. Women responded to five random prompts per day about their current affect and past two-hour food intake. Results: Higher positive affect (PA) or lower negative affect (NA) predicted greater likelihood of fruit/vegetable consumption in the next two hours in women with lower pre-pregnancy BMI and lower likelihood in women with higher pre-pregnancy BMI. Higher PA predicted less likelihood of fast food consumption in the next two hours in women with lower pre-pregnancy BMI and slightly higher likelihood in women with higher pre-pregnancy BMI. Women with lower pre-pregnancy BMI had higher PA when they reported consuming chips/fries in the past two hours, and women with higher pre-pregnancy BMI had lower PA when they reported consumption of chips/fries in the past two hours. Conclusions: Results showed differential relationships between affect and food intake as a function of pre-pregnancy BMI.

Background: There is a strong comorbidity between mood disorders and metabolic syndrome (MetS). Increased levels of reactive oxygen and nitrogen species (RONS) and nitro-oxidative stress toxicity (NOSTOX) partially underpin this comorbidity.Aims: To examine the associations of RONS/NOSTOX biomarkers with MetS after adjusting for the significant effects of mood disorders (major depression, and bipolar type 1 and 2), generalized anxiety disorder (GAD), tobacco use disorder (TUD), and male sex.Methods: The study included subjects with (n=65) and without (n=107) MetS and measured levels of superoxide dismutase 1 (SOD1), lipid hydroperoxides (LOOH), nitric oxide metabolites (NOx), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) and computed z unit-weighted composite scores which reflect RONS/NOSTOX. The study included 105 patients with mood disorders, 46 with GAD, and 95 with TUD.Results: MetS was associated with increased levels of MDA and AOPP, independently from mood disorders, TUD, sex and GAD. Atherogenicity and insulin resistance (IR) were significantly associated with a NOSTOX composite score. Mood disorders, TUD, GAD, male sex and MetS independently contribute to increased RONS/NOSTOX. The RONS/NOSTOX profile of MetS was different from that of GAD, which showed increased SOD1 and NOx levels. TUD was accompanied by increased SOD1, LOOH and MDA, and male sex by increased LOOH and AOPP.Conclusions: MetS is characterized by increased lipid peroxidation with aldehyde formation and chlorinative stress, and atherogenicity and IR are strongly mediated by RONS/NOSTOX. Partially shared RONS/NOSTOX pathways underpin the comorbidity of MetS with mood disorders, GAD, and TUD.

Introduction: Adolescence is a critical period for the development of affectivity and sexual-ity. Adolescents begin to explore their sexual identity, form intimate relationships, and learn to manage their emotions in new and complex contexts. This study aims to analyze the prevalence of habits and behaviors related to the affective-sexual health of adolescents in the 4th year of ESO, identifying risk factors, comparing behaviors and risks, monitoring these behaviors, analyzing pornography consumption, and evaluating the use of the in-ternet as a source of sexual information. Method: Descriptive cross-sectional study using questionnaires. Participants are 4th-year ESO students from a school in the Baix Llobregat province (Catalonia) aged between 14 and 18 years. Descriptive and bivariate statistical analyses were conducted using the Chi-square test and p-value calculations with R Project software. Frequency and percentage analyses were also used to describe the health behav-iors of the participants. Results: The study reveals that girls have better knowledge of the contraceptive pill and male condom than boys. Sexual initiation and condom use man-agement vary between genders, with girls being more capable of persuading their partners to use them. Pornography consumption also shows significant differences in age of initia-tion and frequency between boys and girls. Conclusions: The study on adolescent affectiv-ity and sexuality reveals knowledge about contraceptives, early sexual initiation, and high pornography consumption, highlighting the need for early and diverse affective-sexual education, youth empowerment, and media misinformation management to promote safer and healthier behaviors in municipal public health.

Studies at the juncture of development economics and public health host considerable responsibility in addressing inequality and related mental health distress. Mental health care in economically marginalized populations requires depicting the linkages between socioeconomic status and psychological distress. In the present work, a sequential mixed-methods design was used to study 190 people in such communities in India. Gender-dependent psychological distress was found according to Kessler Psychological Distress Scale (K-10) with moderate distress in women (M= 26.30, SD= 9.15) and mild distress in men (M= 21.04, SD= 8.35). Regression analysis indicated that gender significantly predicted psychological distress, followed by age, marital status, and education of the head of the family. The Interpretative Phenomenological Analysis of semi-structured interviews to six women who scored the highest on the distress scale unveiled three master themes: (1) Manifestation of Psychological Distress, (2) Contextual Challenges, and (3) Sources of Strength and Resilience. Overall, participants reported lack of resources, community violence, gender discrimination, and widespread substance use as major contributors to the ongoing distress. These findings can pave the way for future studies to expand beyond independent economic indicators and curate clinical interventions for culturally competent mental health care.

Although extracorporeal membrane ventilation offers the possibility for low frequency ventilation, protocols commonly used in patients with acute respiratory distress syndrome (ARDS) and treated with extracorporeal membrane oxygenation (ECMO) vary largely. Whether strict adherence to low frequency ventilation offers benefit on important outcome measures is poorly understood. Background/Objectives: This pilot clinical study investigated the efficacy of low frequency ventilation on ventilator free days (VFDs) in patients suffering from ARDS treated with ECMO therapy. Methods: In this single-center randomized controlled trial, 44 (70% male) successive ARDS patients treated with ECMO (aged 56 ± 12 years, SAPS III 64 (SD ± 14)) were randomly assigned 1:1 to control group (conventional ventilation) or treatment group (low fre-quency ventilation during first 72 hours on ECMO: respiratory rate 4-5/min; PEEP 14-16cm H2O; plateau pressure 23-25 cm H2O, tidal volume: < 4mL/kg). The primary endpoint was VFDs at day 28 of ECMO start. The major secondary endpoint was ICU mortality, 28-day and 90-day mortality. Results Twenty-three (52%) patients could be successfully weaned from ECMO and were discharged from intensive care unit (ICU). Twelve patients in the treatment group and five patients in the control group showed more than one VFD at day 28 after ECMO. VFDs were 3.0 (SD ± 5.5) days in the control group and 5.4 (SD ± 6) days in the treatment group (P = 0.117). Until day 28 after ECMO initiation, patients in the treatment group could be more often successfully weaned from ventilator (OR of 0.164 of 0 VFDs at day 28 after ECMO start; 95% CI 0.036-0.758; P = 0.021). ICU mortality did not differ significantly (36% in treatment group and 59% in control group; P = 0.227). Conclusions: Low frequency ventilation is comparable to conventional protec-tive ventilation in patients with ARDS treated with ECMO. However, low frequency ventilation may support weaning from invasive mechanical ventilation in patients suffering from ARDS treated with ECMO therapy.

Background. Moral distress (MD) and Burnout of Health Care Personnel (HCP) were extensively studied during the pandemic. However, little information is available about their prevalence after its decline. This study assesses the prevalence of MD, and burnout after the decline of the pandemic. Methods. The British Medical Association questionnaire referring to MD and the Maslach Burnout questionnaire were addressed to the hospital’s personnel. Results. 516 valid questionnaires were included in the study. Nurses’ participation rate was 67% and doctors 41%. MD was identical among doctors and nurses 73,8%, and in decremental order factors contributing to MD are insufficient staff, mental fatigue, and physical fatigue. Participants believe that more staff, less bureaucracy, and greater emotional support would alleviate MD. Doctors score higher than nurses for lack of time to give sufficient support to patients and public health decisions affecting communities. To alleviate MD, doctors ask for more ethical and legal support, more funding and working fewer hours. Nurses score high on emotional exhaustion and depersonalization. Conclusions. MD and burnout persist among HCP after the decline of the pandemic. Participants believe that institutional and public health decisions would help alleviate MD. Leaders and institutions must provide more supportive environments to moderate MD.

Background Research on the mental health of students in health disciplines mainly focuses on psychological distress and nursing and medical students. This study aimed to investigate the psychological well-being and distress and related factors among undergraduate students training in eight different health-related tracks in Geneva, Switzerland. Methods This cross-sectional study used established self-filled scales for anxiety, depression, stress, psychological well-being, and study satisfaction. Descriptive statistics and hierarchical regression analyses were applied. Results In October 2019, out of 2835 invited students, 915 (32%) completed the survey. Lower academic satisfaction scores were strongly associated with depression (β=-.26, p<.001), anxiety (β=-.27, p<.001), and stress (β=-.70, p<.001), while higher scores with psychological well-being (β=.70, p<.001). Being female was strongly associated with anxiety and stress but not with depression or psychological well-being. Increased age was associated with enhanced psychological well-being. The nature of the academic training had a lesser impact on mental health and the academic year none. Conclusion Academic satisfaction strongly predicts depression, anxiety, stress, and psychological well-being. Training institutions should address the underlying factors that can improve students’ satisfaction with their studies while ensuring that they have access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.

Abstract: Objective: The aim of this study is to evaluate the effectiveness of an affective-sexual education programme among 14-15 year-old adolescents and its impact on their perception of their health. Design: This is a quantitative, descriptive and prospective quasi-experimental study, employing various cross-sections throughout the school year. It constitutes an educational promotion intervention where a health blog serves as a supplementary component to the "Health and School" programme. This phase is assessed using specific tools designed to evaluate scales. The study aims to assess the programme's effectiveness in the areas of knowledge and attitudes related to sexuality, sexually transmitted diseases, and affectivity. Additionally, it aims to evaluate the intervention's impact on 292 secondary school students, divided into a control group (N=144) and an intervention group (N=148). Both groups belong to the same population and have undergone affective-sexual education interventions focusing on gender and sexual diversity perspectives. The assessment considers perceptions and behaviours related to knowledge about HIV and other STDs/STIs, attitudes towards HIV, health anxiety, and AIDS phobia. Cross-sectional comparisons between the control and intervention groups are conducted at three points during the school year: longitudinal study, baseline, at month 4, and at month 9 post-intervention. Methods: Median and interquartile range, Wilcoxon test for numerical variables and Fisher's test for categorical variables were calculated according to intervention group. Results: 53% of the students reported a very good perception of health, compared to 45% with a good perception. Boys reported a good perception of health (85%) and had perceptions of their physical appearance and health (p=0.023) and (p<0.001) in the intervention group. Differences were found between perceptions of physical appearance in the control group, which was close to normal (p=0.429). In terms of level of knowledge about HIV and other STDs/STIs, the most significant difference was found in knowledge about HIV transmission, which varied between groups. Conclusions: Early affective-sex education sessions have an impact on health perception and behaviours related to knowledge about HIV and other STDs/STIs, leading to reduced anxiety in adolescents. School nurses should focus on health promotion, prevention of sex-related diseases, healthy attitudes from a gender perspective and integrated affective relationships in all their dimensions.

Cancer patients may experience significant distress. The “Emotion Thermometers” (ETs) are a short visual analogue scale used to screen patients for psychosocial risk. This study aimed to assess emotional distress in a large sample of cancer patients attending psychological services at an NGO, and to explore factors that may contribute to it. The ETs were answered by 899 cancer patients. They were, on average, 59.9 years old, the majority were female, had breast cancer, were under treatment or were disease-free survivors, and reported high levels of emotional distress, above the cut-off (≥5). A Generalized Linear Model was used to measure the association between the level of Distress and 33 items of the problem list. Four items - sadness, depression, sleep and breathing - were found to be significantly related to a higher level of Distress. Additionally, women and those who were in the palliative phase also had significantly higher levels of Distress. Conclusions: The results confirm the need for early emotional screening in cancer patients, as well as the relevance of attending to the characteristics of each patient. Additionally, they highlight the utility of the ETs for the clinical practice, allowing to optimize the referral to specialized psy-chosocial services.

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child’s overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated antenatal depression and COVID-19 related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted antenatal depression, B = 1.46, p &lt; .001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

Background: Parkinson’s Disease (PD) is a long-term condition, which is more common among people aged 65 years or more. People with Parkinson (PwP) tend to lose motor functions and find themselves in more fatigue and pain, sometimes leading to anxiety, distress and in extreme cases, even depression. So far, there is no cure for PD and they need support from family members, healthcare professionals and carers, as the disease progresses. A large proportion of carers for PwP are their spouses. Progression of PD can result in loss of employment, reduced work hours or premature retirement, for both PwP and their carers. This poses a huge financial burden as income reduces on one hand, and expenses increase on the other. There is a lack of evidence on the societal costs of Parkinson's disease, and this study tries to fill that gap. Objectives: To examine the impact of financial distress on quality of life (QoL) and wellbeing of PwP and their carers in the UK. Methods: A mix of online and postal, cross-sectional survey was administered, which received responses from 853 respondents, out of which 776 were PwP and 546 were carers. The survey sought data on management of the socioeconomic, health and living conditions of PwP and their carers. Net effect of financial distress (cost of healthcare use, non-health expenditure, societal costs and other direct / indirect cost components) on QoL (and VAS scores) as well as wellbeing scores (life satisfaction and happiness scores) of PwP and their primary carers are estimated using simple linear regression models. Results: Financial burden of treatment increase whereas quality of life and wellbeing of PwP decrease with progression of PD. Similar association but of a milder magnitude is observed on quality of life of their primary carers. A strong negative association is found between quality of life of PwP, with financial burden, while holding for demographic and socioeconomic factors, and for disease progression and treatment. The QoL of carers increase up to a financial burden threshold, before it starts declining. This could be because of the increased expenditure in initial phases is associated with improved activities of daily living and lesser reliance on carers. Financial distress is more pronounced among PwP having annual income below £20,000. Despite a small representation of persons from ethnic minority (5 per cent representation), it is observed that the impact of financial distress could be more pronounced on PwPs from other ethnicities. Also, it would be more on women than on men, irrespective of ethnicity. Conclusion and Policy Implications: Cost of care cuts both ways, reduced or lost employment as well as increased expenses on healthcare. This results into a considerable financial distress and deterioration in quality of life and wellbeing of both PwP and carers. Most carers are spouses of PwPs, thus their physical and psychological health and wellbeing is found to deteriorate with the progression of PD due to increased burden of care. Therefore, informal / family carers should get support in the form of respite care. This can help revitalise their energy and psychological wellbeing. Financial distress indicators need to be explored further.

Objective: The study aimed to evaluate the effects of monoclonal antibodies (mAbs) acting on the calcitonin gene-related peptide (CGRP) or its receptor (anti-CGRP/R mAbs) on comorbid symptoms of depression, anxiety, and fatigue in migraine patients resistant to traditional prophylaxis. Methods: The study was an open-label prospective study assessing comorbidities in patients with high frequency (HFEM) and chronic migraine (CM), medication overuse headache (MOH), and resistance to traditional prophylaxis treated with anti-CGRP/R mAbs for 3 months. Results: 77 patients were enrolled with either HFEM (21%) or CM (79%) with or without MOH (56% and 44% respectively). We identified 21 non-responders (27%) and 56 responders (73%), defined on the reduction ≥ 50% of headache frequency. The two groups were highly homogeneous for investigated comorbidities. Disease severity in terms of headache frequency, migraine-related disability, and affective comorbid symptoms were reduced in both groups with different thresholds; allodynia and fatigue were ameliorated only in responders. Conclusion: anti-CGRP/R antibodies improve pain together with affection, fatigue, and sensory sensitization in migraine patients.

Acute respiratory distress syndrome (ARDS) and the serious complications are the most frequent causes of death of SARS-CoV-2 infection. We bring out a hypothesis that early low-flow oxygen inhalation would maintain the hypoxic pulmonary vasoconstriction (an essential protection mechanism of the lung that optimize gas exchange) and accelerate the re-absorption of pulmonary edema fluid. The optimal time for oxygen therapy was analyzed and four comments are proposed: (1) Finger SpO₂ should be measured at home simultaneously with the first-time nucleic acid test. (2) If the patient's SpO₂ was lower than the reference value by 2% or more, it is suggested to be hospitalized immediately for standard low-flow oxygen inhalation. (3) If it was not possible to be admitted to hospital immediately, the patient is recommended to take oxygen in the home. (4) The Patients with low SpO₂ are advised to use prone position as much as possible.

Earnings management and financial distress are two critical facets of financial management in corporations that have lately been the focus of thorough research from both scholars and practitioners. The purpose of the research is to evaluate the influence of financial distress on the earnings management of companies listed at the NSE during the pre- and post-COVID eras. Multiple linear regression was applied in this study to examine the causal association between earnings management and financial distress. To assess the effect of financial distress on earnings management, the study analyzed data from 37 listed companies during the pre-COVID and post-COVID periods. The methodology also takes into account control factors like firm size, GDP, and inflation. The pre-COVID research indicates a significant positive correlation between financial strain and earnings management. In contrast, the correlation between financial distress and earnings management is not statistically significant in the post-COVID analysis. However, research shows that firm size has a statistically significant negative influence on managing earnings. The results of this study show that smaller firms are more inclined to engage in earnings management during the post-COVID era than bigger ones.

Coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has reached a global epidemic across the world after first reported in Wuhan, China’s Hubei province in December 2019. The pandemic is also associated with acute respiratory distress syndrome (ARDS) characterized by excess inflammation, progressive arterial hypoxemia and dyspnea. Mesenchymal stem/ stromal cells (MSCs) have been investigated as treatment for ARDS due to immunomodulatory property. Exosomes derived from MSCs play an important role in paracrine signaling of MSCs, thereby contributed to immunomodulation of the immune microenvironment. Exosomes are emerged as potential alternative to MSC cell therapy with superiority of safety. In this review, we will introduce MSC-derived exosomes and briefly discuss current progress on MSCs and exosomes in ARDS, which may have clinical implications in pathogenesis and treatment of COVID-19.

Psychological distress (PD) may be common among adolescents. The study aimed to estimate population-based rates of PD among adolescents in South Africa. National cross-sectional data were analysed from 2,240 adolescents (17 years median age) that participated in a community-based population survey, the “2012 South African National Health and Nutrition Examination Survey (SANHANES-1).” Results indicated that 16.0% of the adolescents had PD, 13.1% among boys and 18.5% among girls. In adjusted logistic regression analysis, increasing age, girls, belonging to the Black African population group, having experienced two or more traumatic life events, poor self-rated health status, having activity limitations, perceived body overweight, fast food and snack consumption were associated with PD. Almost one in six adolescents in South Africa reported PD and several associated factors were identified.

The goal of the study was to estimate the prevalence and correlates of psychological distress (=PD) among adolescent school children in Bhutan. Nationally representative cross-sectional data were analysed from 7,576 adolescents (16 years median age) that took part in the “2016 Bhutan Global School-Based Student Health Survey (GSHS).” PD was assessed with a 2-item screening measure (BMC Psychiatry. DOI: 10.1186/s12888-020-02888-3). Results indicate that the prevalence of PD was 15.8%, 12.8% among males and 18.4% among females. In adjusted logistic regression analysis, female sex, having no close friends, older age, bullying victimization, infrequently physically attacked, parental emotional neglect, parents never check home work, passive smoking trouble from alcohol use, ever had sex, high sedentary behaviour and having sustained a single or multiple serious injuries (past year) were associated with PD. In addition, adequate fruit and vegetable consumptions was protective against PD. Almost one in six students reported PD and several associated factors were identified which can aid prevention and control strategies.

Background: Coronavirus disease 2019 (COVID-19) is an ongoing pandemic and life-threatening highly infectious disease. The people of Bangladesh are at high risk of COVID-19 and have already experienced various socio-economic, health and psychological (mental) consequences. Particularly, mental health problems are dominantly reported in the literature and should be controlled. The main objective of this epidemiological study is to assess the mental distress and identify its determinants using online-based survey. Such information is urgently needed to develop feasible strategies for Bangladesh. Methods: An online survey was conducted for this study from May 01 to May 05, 2020. A total of 240 respondents provided self-reported online responses. Respondent’s mental distress was measured by the General Health Questionnaire 12 (GHQ-12) and by the self-rated mental health (SRMH) question. Various kinds of statistical analyses ranging from simple to multivariable logistic recession were performed using SPSS 23.0. Results: About 31.3% and 48.3% of respondents were mentally distressed by GHQ-12 and SRMH question, respectively. Logistic regression analysis revealed that mental distress was significantly higher among those respondents, whose usual activity was affected by the coronavirus (OR = 6.40, 95% CI: 1.87 - 21.90, p<0.001) and whose financial stress was increased due to lockdown (OR = 2.12, 95% CI: 1.01 – 4.46, p<0.05) on GHQ-12. Female sex (OR = 1.97, 95% CI: 1.03 – 3.75, p<0.05) and respondents with poor mental health before the outbreak (OR = 3.38, 95% CI: 1.18 – 9.72, p<0.05) were also significantly affected by mental distress on SRMH. Conclusions: At least thirty percent of the respondents were found to be mentally distressed. Some of the study findings, particularly significant determinants, should be considered while developing strategies to reduce the burden of mental distress among study respondents or similar group in Bangladesh.

Post-stroke depressive disorders (PSD) and post-stroke cognitive impairments (PCI) are frequent consequences of ischemic stroke (IS). The study was focused on exploring possible associations between relative volumes of cortical and limbic brain structures during the acute period of IS, and changes in biochemical indices of hypothalamic-pituitary-adrenal, sympathoadrenal medullary and inflammatory systems, with the development of PSD or PCI after mild or moderate IS. Patients developing PSD later on had significantly smaller relative volumes of the hippocampus, entorhinal cortex, and temporal pole versus patients without depressive symptoms. PCI development was associated with significantly smaller volumes of temporal pole and supramarginal gyrus versus patients without cognitive changes. Multiple logistic regression analysis showed higher likelihood of developing PSD in patients with smaller temporal pole volume (β0=10.9; β=-4.27; p=0.04) and increased salivary α-amylase activity (β0=-3.55; β=2.68e-05; p=0.02,). PCI likelihood was higher in patients with smaller supramarginal gyrus volume (β0=3.41; β=-0.99; p=0.047), smaller temporal pole volume (β0=3.41; β=-3.12; p=0. 06), and increased hair cortisol concentration at admission (index of accumulated stress load within a month before IS; β0=3.41; β=-0.05; p=0.08). The data support the hypothesis suggesting predisposition to PSD and PCI and multi hit scenarios of their pathogenesis with IS providing a final hit.

The COVID-19 has dramatically affected mental health and work environment of many labor sectors, including the educational sector. Our primary aim was to investigate preschool teachers’ psychological distress and work engagement during the early stages of the COVID-19 outbreak, while examining the possible protective role of participating in mindfulness-based intervention (C2C-IT) and emotion regulation. Emotional distress, work engagement and COVID-19 concerns’ prevalence were evaluated among 165 preschool teachers in the early stages of the COVID-19 outbreak in Israel, using self-report questionnaires. Findings show that preschool teachers have experienced increased emotional distress. Teachers who had participated in the C2C-IT intervention six month before the pandemic outbreak (N=41) reported lower emotional distress, higher use of adaptive emotion regulation strategies and higher work engagement, compared to their counterparts that had not participated in the mindfulness training (N = 124). Emotion regulation strategies mediated the link between participating in the CTC-IT intervention and emotional distress and work engagement. Teaching is a highly demanding occupation, especially during a pandemic, therefore it is important to invest resources in empowering this population. According to the findings of the current study, implementation of mindfulness-based intervention during the school year, may benefit teachers’ well-being, even during stressful events such as the COVID-19 pandemic.

Covid-19 pandemic has captivated scientists to investigate if this new disease can affect the central nervous system (CNS). The most challenging symptoms of Covid-19 are related to respiratory distress, and most patients admitted in intensive care units cannot breathe by their own. Therefore, a crucial question is if respiratory distress can be partially explained by the CNS affection. SARS-Cov-2 is a beta-coronavirus that shares high similarities with SARS-CoV. The infection of SARS‐CoV has been reported in the brains from both patients and experimental animals, where the brainstem was heavily infected. Those coronaviruses have been able to invade the brainstem via a synapse‐connected route to the medullary respiratory center, where the infected regions included the nucleus of the solitary tract and nucleus ambiguous. The vagal afferent nerves from receptors in the lung communicate with the medulla and pons respiratory control centers to coordinate inspiration and expiration. This suggests that neuroinvasion of SARS‐CoV‐2 might play a role in the acute respiratory failure of Covid-19. Therefore, acute respiratory distress in Covid-19 can be partially explained by brainstem dysfunction, suggesting the needs of more specific and aggressive treatments with the direct participation of neurologists and neurointensivists.

Psychiatric patients are particularly vulnerable to strong weather stimuli, such as foehn, a hot wind that occurs in the alps. However, there is a dearth of research regarding its impact on mental health. This study investigated the impact of foehn wind among patients of a psychiatric hospital located in a foehn area in the Swiss Alps. Analysis was based on anonymized datasets obtained from routine records on admission and discharge, including the Brief Symptom Checklist (BSCL) questionnaire, as well as sociodemographic parameters (age, sex, and diagnosis). Between 2013 and 2020 a total of 10,456 admission days and 10,575 discharge days were recorded. All meteorological data were extracted from the database of the Federal Office of Meteorology and Climatology of Switzerland. We estimated the effect of foehn on the BSCL items using a distributed lag model. Significant differences were found between foehn and non-foehn admissions in obsession-compulsion, Interpersonal Sensitivity, depression, Anxiety, Phobic Anxiety, Paranoid Ideation, and General Severity Index (GSI) (p &lt;.05). Our findings suggest that foehn wind events may negatively affect specific mental health parameters in patients. More research is needed to fully understand the impact of foehn’s events on mental health.

Previously we have shown that the combination of radiotherapy with human-umbilical-cord-derived mesenchymal stem-cell therapy significantly reduces the size of the xenotumours in mice, both in the directly irradiated tumour and in the distant non-irradiated tumour or in its metastasis. We have also shown that exosomes secreted from mesenchymal stem-cells pre-irradiated with 2 Gy are quantitatively, functionally and qualitatively different from the exosomes secreted from non-irradiated mesenchymal cells and also that proteins, exosomes and microvesicles secreted by mesenchymal cells suffer a dramatic change when cells are activated or non-activated, with the amount of protein present in the exosomes of the pre-irradiated cells being 1.5-fold times greater compared to those from non-irradiated cells. This finding correlates with a dramatic increase in the anti-tumour activity of the exosomes secreted by pre-irradiated mesenchymal-cells. After the proteomic analysis of the load of the exosomes released from both irradiated and non-irradiated cells, we conclude that annexin A1 is the most important and significant difference between the exosomes released by the cells in either status. Knowing the role of annexin A1 in the control of hypoxia and inflammation which is characteristic of acute-distress-respiratory syndrome, we have designed a hypothetical therapeutic strategy, based on the transplantation of mesenchymal stem cells stimulated with radiation, to alleviate the symptoms of patients who, due to pneumonia caused by COVID-19, require the care of an intensive care unit for patients with life-threatening conditions. With this hypothesis, we would seek to improve the patients’ respiratory capacity and increase the expectations of their cure.

Background: Survival and outcome of extremely preterm (EP) infants have improved due to changes in the management of stabilization at birth and respiratory distress syndrome. Methods: In a retrospective study conducted at an academic perinatal level III center in Romania, we compared the effects of different protocols on the early outcomes of EP infants of two different periods (2008-2012 vs. 2018 vs. 2022). Two subgroups were studied in each period, based on gestational age (GA), 22-25 weeks, and 26-28 weeks, excluding those with significant congenital anomalies or missing data. Results: 270 EP infants were included in the study (121/149), with a mean GA 26.1±1.6/26.7±1.1 weeks. Significant improvements were found during period II regarding initial FiO2 (40% vs. 100%; &lt;0.001), nCPAP (55.7% vs. 19.0%; p&lt;0.001) at birth, early rescue surfactant administration (65.8% vs. 34.7%; p&lt;0.001), need of mechanical ventilation (58.4% vs. 98.3%; p&lt;0.001). Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26-28 weeks subgroup (63.8% to 83%). The frequency of severe IVH decreased in period II from 30.6% to 14.1%, while the rates of BPD were lower in period II (23.4% vs. 36.6%; p=0.045), in the 26-28 weeks subgroup. We found improvements but no significant differences in NEC, sepsis, PVL, ROP, or PDA frequencies. Conclusions: Using updated guidelines and protocols is crucial for improving outcomes.

Objectives: There are limited data regarding the efficacy of methylprednisolone in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation. We aimed to determine whether methylprednisolone increases the number of ventilator-free days (VFDs) among these patients. Design: Retrospective single-center study Setting: Intensive care unit Patients: All patients with ARDS due to confirmed SARS-CoV-2 infection and requiring invasive mechanical ventilation between 1 March and 29 May 2020 were included Interventions: None Measurements and Main Results: The primary outcome was ventilator-free days (VFDs) during the first 28 days, defined as being alive and free from mechanical ventilation. The primary outcome was analyzed with competing-risks regression based on Fine and Gray’s proportional subhazards model. Death before day 28 was considered to be the competing event. A total of 77 patients met the inclusion criteria. Thirty-two patients (41.6%) received methylprednisolone. The median dose was 1 mg.kg-1 (IQR: 1-1.3 mg.kg-1) and median duration of 5 days (IQR:5-7 days). Patients who received methylprednisolone had a mean 18.8 VFDs (95% CI, 16.6-20.9) during the first 28 days vs. 14.2 VFDs (95% CI, 12.6-16.7) in patients who did not receive methylprednisolone (difference, 4.61; 95% CI, 1.10-8.12; P = 0.001). In the multivariable competing-risks regression analysis and after adjusting for potential confounders (ventilator settings, prone position, organ failure support, severity of the disease, tocilizumab, and inflammatory markers), methylprednisolone was independently associated with a higher number of VFDs (subhazards ratio: 0.10, 95%CI: 0.02-0.45; p=0.003). Hospital mortality did not differ between the two groups (31.2% vs. 28.9%, p=0.82). Hospital length of stay was significantly shorter in the methylprednisolone group (24 days [IQR:15-41 days] vs. 37 days [IQR:23-52 days], p=0.046). The incidence of positive blood cultures was higher in patients who received methylprednisolone (37.5% vs. 17.8%, p=0.052). However, 91% of patients who received methylprednisolone also received tocilizumab. The number of days with hyperglycemia was similar in the two groups. Conclusions: Methylprednisolone was independently associated with increased VFDs and shortened hospital length of stay. The combination of methylprednisolone and tocilizumab was associated with a higher rate of positive blood cultures. Further trials are needed to evaluate the benefits and safety of methylprednisolone in moderate or severe COVID-19 ARDS.

Background and aims Loneliness and a low sense of mastery have been associated with excessive gambling, but the underlying processes of these relationships remain unstudied. Because psychological distress can increase vulnerability to excessive gambling, we investigated its mediating role in these relationships among young people. To meet the need for cross-country research, we also observed how these relationships occur in four countries with different cultures. Design, setting and participants Demographically balanced cross-sectional survey data were collected for 15–25-year-olds in Finland (n=1200; 50% male), the United States (n=1212; 49.8% male), South Korea (n=1192; 49.6% male) and Spain (n=1212; 51.2% male). Measurements Excessive gambling was measured with the South Oaks Gambling Screen, psychological distress was assessed with the 12-Item General Health Questionnaire, loneliness was measured with the Three-Item Loneliness Scale and low sense of mastery was assessed with the Pearlin Mastery Scale. Associations were examined first using zero-inflated negative binomial regression analyses with excessive gambling as the outcome. In addition, path analyses were performed to study how loneliness and low sense of mastery relate to excessive gambling, with psychological distress as the mediating variable. Findings Loneliness and low sense of mastery were associated indirectly with excessive gambling via psychological distress in all country samples. Low sense of mastery was also directly associated with excessive gambling. There was a direct association between loneliness and excessive gambling only in samples from South Korea and Spain. Conclusions Psychological distress is an important factor in understanding how loneliness and sense of mastery relate to gambling.

Although, staging models gained momentum to stage define affective disorders, no attempts were made to construct mathematical staging models using clinical and biomarker data in patients with major depression and bipolar disorder.The aims of this study were to use clinical and biomarker data to construct statistically-derived staging models, which are associated with early lifetime traumata (ELTs), affective phenomenology and biomarkers.In the current study, 172 subjects participated, 105 with affective disorders (both bipolar and unipolar) and 67 controls. Staging scores were computed by extracting latent vectors (LVs) from clinical data including ELTs, recurring flare ups and suicidal behaviors, outcome data such as disabilities and health-related quality of life (HR-QoL), and paraoxonase (PON)1 actvities and nitro-oxidative stress biomarkers.Recurrence of episodes and suicidal behaviors could reliably be combined into a LV with adequate composite reliability (the “recurrence LV”), which was associated with female sex, the combined effects of multiple ELTs, disabilities, HR-QoL and impairments in cognitive tests. All those factors could be combined into a reliable “ELT-staging LV” which was significantly associated with nitro-oxidative stress biomarkers. A reliable LV could be extracted from serum PON1 activities, recurrent flare ups, disabilities and HR-QoL.Our ELT-staging index scores the severity of a relevant affective dimension, shared by both major depression and bipolar disorder, namely the trajectory from ELTs, a relapsing course and suicidal behaviors to progressive disabilities. Patients were classified into three stages, namely an early stage; a relapse-regression stage; and a suicidal-regression stage. Lowered lipid-associated antioxidant defenses may be a drug target to prevent the transition from the early to the later regression stages.

Current diagnoses of mood disorders are not cross validated. The aim of the current paper is to explain how machine learning techniques can be used to a) construct a model which ensembles risk/resilience (R/R), adverse outcome pathways (AOPs), staging, and the phenome of mood disorders, and b) disclose new classes based on these feature sets. This study was conducted using data of 67 healthy controls and 105 mood disordered patients. The R/R ratio, assessed as a combination of the paraoxonase 1 (PON1) gene, PON1 enzymatic activity, and early life time trauma (ELT), predicted the high-density lipoprotein cholesterol – paraoxonase 1 complex (HDL-PON1), reactive oxygen and nitrogen species (RONS), nitro-oxidative stress toxicity (NOSTOX), staging (number of depression and hypomanic episodes and suicidal attempts), and phenome (the Hamilton Depression and Anxiety scores and the Clinical Global Impression; current suicidal ideation; quality of life and disability measurements) scores. Partial Least Squares pathway analysis showed that 44.2% of the variance in the phenome was explained by ELT, RONS/NOSTOX, and staging scores. Cluster analysis conducted on all those feature sets discovered two distinct patient clusters, namely 69.5% of the patients were allocated to a class with high R/R, RONS/NOSTOX, staging, and phenome scores, and 30.5% to a class with increased staging and phenome scores. This classification cut across the bipolar (BP1/BP2) and major depression disorder classification and was more distinctive than the latter classifications. We constructed a nomothetic network model which reunited all features of mood disorders into a mechanistically transdiagnostic model.

While the global COVID-19 pandemic has been widely acknowledged to affect the mental health of health care workers (HCWs), attention to measures that protect those on the front lines of health outbreak response has been limited. In this cross-sectional study, we examine workplace contextual factors associated with how psychological distress was experienced in a South African setting where a severe first wave was being experienced with an objective of identifying factors that can protect against HCWs experiencing negative impacts. Consistent with mounting literature on mental health effects, we found a high degree of psychological distress (57.4% above General Health Questionnaire cut-off value) and a strong association between perceived risks associated with the presence of COVID-19 in the healthcare workplace and psychological distress (adjusted OR = 2.35, p <.01). Our research indicates that both training (adjusted OR 0.41, 95% CI 0.21 – 0.81) and the reported presence of supportive workplace relationships (adjusted OR 0.52, 95% CI 0.27 – 0.97) were associated with positive outcomes. This evidence that workplace resilience can be reinforced to better prepare for the onset of similar outbreaks in the future suggests that pursuit of further research into specific interventions to improve resilience is well merited.

Previous research has already examined the relationship between Future Anxiety, a construct recently introduced in Italy, and mental health in young adults, although possible mediating variables in this relationship have so far never been investigated. The present study attempts to fill this gap by exploring the incidence of Future Anxiety on psychological distress in a group of 302 young Italian adults (18 - 30 years; M = 21.9; SD = 2.6), presenting and evaluating the simultaneous mediating effect of Intolerance of Uncertainty and Non-Pathological Worry.Findings highlighted how Future Anxiety had a positive and significant direct effect on Stress and Depression, but not on Anxiety. In the three serial mediation models proposed, Intolerance of Uncertainty and Non-Pathological Worry mediated the relationship between Future Anxiety and mental health outcomes. The results also confirmed the hypothesized serial mediation effect by highlighting how young adults with greater Future Anxiety experienced more Intolerance of Uncertainty, which positively affected Non-Pathological Worry levels and, in turn, exacerbated psychological distress. Finally, results indicated that female participants experienced more Stress, Anxiety, and Depression in relation to Future Anxiety compared to males. Starting from the review of main references on this subject, the results discussed provide new insights for understanding youth psychological distress. Finally, practical implications for the design of supportive interventions for this study’s target group are proposed.

This research addresses the respiratory distress syndrome (RDS) in preterm newborns, caused by insufficient surfactant synthesis, which can lead to serious complications, including pneumothorax, pulmonary hypertension, and pulmonary hemorrhage, increasing the risk of a fatal outcome. By analyzing chest radiographs and blood gases, we specifically focus on the significant contributions of these parameters to the diagnosis and analysis of the recovery of patients with RDS. The study involved 32 preterm newborns, and the analysis of gas parameters before and after the administration of surfactants and inhalation corticosteroid therapy revealed statistically significant changes in values of parameters such as FiO2, pH, pCO2, HCO3 and BE (Sig.&lt;0.05), ehile the pO2 parameter showed a potential change (Sig.=0.061). Parallel to this, the research emphasizes the development of a lung segmentation algorithm implemented in the MATLAB programming environment. The key steps of the algorithm include preprocessing, segmentation, and visualization for a more detailed understanding of the recovery dynamics after RDS. These algorithms have achieved promising results, with a global accuracy of 0.93±0.06, precision 0.81±0.16 and an F-score of 0.82±0.14. These results highlight the potential application of algorithms in the analysis and monitoring of recovery in newborns with RDS, also underscoring the need for further development of software solutions in medicine, particularly in neonatology, to enhance the diagnosis and treatment of preterm newborns with respiratory distress syndrome.

Objective: to analyze the relationships between sociodemographic variables, intolerance to uncertainty (INT), social support and psychological distress (i.e., indicators of Common Mental Disorders [CMDs] and perceived stress [PS]) in Brazilian men during the COVID-19 pandemic. Methods: a cross-sectional study with national coverage, of the web survey type, and conducted with 1,006 Brazilian men during the period of social circulation restriction imposed by the health authorities in Brazil, for suppression of the coronavirus and control of the pandemic. Structural equation modeling analysis was performed. Results: Statistically significant direct effects of race/skin color (λ=0.268; p-value<0.001), socioeconomic status (SES) (λ=0.306; p-value<0.001), household composition (λ=0.281; p-value<0.001), PS (λ=0.513; p-value<0.001) and INT (λ=0.421; p-value<0.001) were evidenced in the occurrence of CMDs. Black-skinned men, with higher SES, living alone and with higher PS and INT levels presented higher prevalence values of CMDs. Conclusions: high levels of PS and INT were the factors that presented the strongest associations with the occurrence of CMDs among the men. It is necessary to implement actions to reduce the stress-generating sources, as well as to promote an increase in resilience and the development of intrinsic reinforcements to deal with uncertain threats.

Background: Sudden changes in clinical practice and the altered ability to care for patients due to the COVID-19 pandemic have been associated with moral distress and mental health concerns in healthcare workers internationally. This study aimed to investigate the severity, prevalence, and predictors of moral distress experienced by Australian healthcare workers during the COVID-19 pandemic. Methods: A nationwide, voluntary, anonymous, single time-point, online survey of self-identified frontline healthcare workers was conducted between 27th August and 23rd October 2020. Participants were recruited through health organisations, professional associations or colleges, universities, government contacts, and national media. Results: 7846 complete responses were received from nurses (39.4%), doctors (31.1%), allied health staff (16.7%) or other roles (6.7%). Many participants reported moral distress related to resource scarcity (58.3%), wearing PPE (31.7%) limiting their ability to care for patients, exclusion of family going against their values (60.2%), and fear of letting co-workers down if they were infected (55.0%). Many personal and workplace predictors of moral distress were identified, with those working in certain frontline areas, metropolitan locations, and with prior mental health diagnoses at particular risk of distress. Moral distress was associated with an increased risk of adverse mental health outcomes. Feeling appreciated by the community mitigated this risk in healthcare workers. Conclusions: Safeguarding healthcare workforces during crises is important for both patient safety and workforce longevity. Targeted interventions are required to prevent or minimise moral distress and associated mental health concerns in healthcare workers during COVID-19 and other crises.

During the pandemic, assisted reproductive treatments suffered from major disruptions in their terms due to the restrictions imposed. The objective of this study is to evaluate the level of anxiety of women whose treatments were either suspended or delayed. Methods: Descriptive cross-sectional study conducted between April and May 2020. The State-Trait Anxiety Inventory was applied in a Spanish adapted version. The research also included social, personal, and work aspects which may be involved in the challenging situation. Results: A total of 115 patients participated in the study (73.7%). Women showed a mean in trait anxiety of 17.79 (SD = 8.80) and a mean in state anxiety of 19.95 (SD = 9.08). Neither the type of treatment nor the time of infertility are predictors of trait anxiety or state anxiety. More age pressure and more worry were associated with more trait and state anxiety (p&lt;0.001). The most common emotional reactions to discontinuation of fertility treatments were sadness and anxiety. Conclusions: Discontinuation of fertility treatments due to confinement restrictions had a negative impact on the mental health of women who were following a process of assisted reproduction treatment, increasing their levels of emotional distress and anxiety.

Introduction: The exponential growth of the SARS-CoV-2 virus transmission during the first months of 2020 has placed substantial pressure on health systems worldwide. The complications derived from the novel coronavirus disease (COVID-19) vary in due to comorbidities, sex and age, with more than 50% of the patients who require some level of intensive care developing acute respiratory distress syndrome (ARDS). Areas covered: Various complications caused by SARS-CoV-2 infection have been identified, the most lethal being the acute respiratory distress syndrome, caused most likely by the presence of severe immune cell response and the concomitant alveolus inflammation. The authors carried out an extensive and comprehensive literature review on SARS-CoV-2 infection, the clinical, pathological and radiological presentation as well as the current treatment strategies. Expert Opinion Elevation of inflammatory biomarkers is a common trend among seriously ill patients. The information available strongly suggests that in COVID-19 patients, their altered immune response, including a massive cytokine storm, is responsible for the further damage evidenced among ARDS patients. The increasingly high number of scientific articles and evidence available can only suggest that the individualization of each case is the norm, not all patients with acute respiratory failure due to COVID-19 meet the Berlin definition and therefore ARDS should be considered as a heterogeneous disease, with a wide range in the expression of its severity and clinical manifestations.

Confidence in intermodal transport has not yet been defined. There are many different approaches to the concept of trust. However, the authors embedded them in the light of the challenges of sustainability, linking with the shift paradigm. The objective of the article is to indicate the directions and criteria for the implementation of the shift paradigm, inscribed in the idea of sustainable transport. The auxiliary objective is to predict which countries in a given year will have the TRUST status, i.e. implement the shift paradigm, and which will not implement it (DISTRESS). The article uses taxonometric techniques and built a model using General Discriminant Analysis. On their basis, the utility function was approximated, including the directions of implementation of the shift paradigm depending on the scale of the environmental load of transport. In the course of the research, an original and innovative econometric model was constructed, pointing to three variables, which had the greatest impact on trust. Thanks to the cognitive value of the model, it is possible to identify individuals who deserve the trust, i.e. it will implement the shift paradigm, with 93% probability. In the future, it is worth expanding the research by models for each country.

Background University students’ psychological health is linked to their academic satisfaction. This study aimed to investigate students’ psychological health and academic satisfaction in the context of COVID-19 and academic year-end stress. Methods Standardized self-filled scales for anxiety, depression, stress, psychological well-being, and an ad-hoc COVID-19 stress scale were used in this cross-sectional study. Participants were first- to third-year students of eight different health-related tracks in Geneva, Switzerland. Descriptive statistics and hierarchical regression analyses were applied. Results In June 2020, out of 2835 invited students, 433 (15%) completed the survey. Academic satisfaction was a stronger mental health predictor than COVID-19, which mainly predicted stress and anxiety. Lower academic satisfaction scores were significantly associated with stress (β = -.53, p < .001), depression (β = -.26, p < .001), anxiety (β = -.20, p < .001), while higher scores with psychological well-being (β = .48, p < .001). Being female was strongly associated with anxiety and stress but not with depression or psychological well-being. Lower age was associated with stress only. The nature of the academic training had a lesser impact on mental health and the academic year none. Compared to students starting the academic year, year-end students reported significantly lower academic satisfaction, higher depression, and particularly higher anxiety and stress. There was, however, no difference in psychological well-being. Conclusion Students suffer more from anxiety, stress, depression, and lower satisfaction with studies at the end of the academic year than at the beginning. Academic satisfaction plays a more substantial role than COVID-19 in predicting students’ overall mental health status. Training institutions should address the underlying factors that can enhance students’ academic satisfaction, especially during the COVID-19 period, in addition to ensuring that they have a continuous and adequate learning experience, as well as access to psychosocial services that help them cope with mental distress and enhance their psychological well-being.

The Sars-Cov-2 pandemic led to several needed containing measures that conditioned the onset of depressive, anxiety and post-traumatic stress symptoms in population. These symptoms, espe-cially if not diagnosed and treated, can also occur in patients undergoing surgery with high im-pact on people’s lives, like hysterectomy. To evaluate the post-surgical distress and anx-ious-depressive symptoms following hysterectomy for benign disease focusing on the impact of COVID-19 pandemic. The prospective observational cohort study included patients undergoing hysterectomy for benign disease. Psychologic evaluation through social-demographic question-naires was obtained before surgery (T1), postoperatively (T2), and 3 months after surgery (T3). The HADS (Hospital Anxiety and Depression Scale) was used to evaluate anxious-depressive symptoms and the PCL-5 (Post-traumatic Stress Disorder Checklist for DSM-5) compared the on-set of post-surgical distress and anxiety and depressive symptoms. The pre-COVID-19 pan-demic period was compared to the post-COVID-19 pandemic phase. Patients treated after COVID-19 pandemic showed higher depressive symptoms rate compared to those treated before (p-value=0.02); conversely, pre-COVID-19 patients were more prone to develop a PTSD (p-value=0.04). A significative association between the occurrence PTSD and anxiety-depressive symptoms registered at T2 a (p-value=0.007) and T3 (p-value

It is unclear whether delayed access to treatment/health assessment impacted psychological distress for these populations. This study aimed to fill this literature gap by using a cross-sectional survey, which aimed to evaluate the impact of COVID-19 pandemic on Chinese immigrants in North America during the second wave of the pandemic. The study focused on Chinese immigrants aged 16 or older in Canada. Covariates included sociodemographic variables, delayed access to treatment/health assessment, and other COVID-19 related variables. We used logistic LASSO regression for model selection and multivariate logistic regression models to evaluate the association between delayed access to treatment/health assessment and psychological distress outcome. Missing data were handled using multiple imputation. Our study included 746 respondents, with 47.18% normal CPDI group and 36.82% mild to severe CPDI group. Most respondents were originally from Mainland China and residing in Ontario. Over half have stayed in Canada for at least 15 years. The multivariate logistic regression models unveiled a significantly positive association between psychological distress and delayed access to treatment/health assessment (OR=1.362, 95% CI: 1.078–1.720, p= 0.0095), fear of COVID-19 (OR=1.604, 95% CI: 1.293–1.989, p<.0001), social loneliness (OR=1.408, 95%CI: 1.314–1.508, p<.0001). Sociodemographic variables and other COVID-19 related-variates did not significantly impact the study’s outcome. Reliable health information, mental health supports, and virtual care tailored to immigrants should be considered to mitigate this impact and optimize overall health and well-being.

Many parents have difficulty managing childhood asthma. In Hong Kong (HK), while medication is the primary form of treatment, traditional Chinese medicine is another favored option. In addition, HK follows a dual-track healthcare system, which may pose unique experiences for Chinese parents in childhood asthma management. This qualitative descriptive study aimed to explore the experiences of HK Chinese parents in caring for their children with asthma. Methods: Fourteen HK Chinese mothers of children (aged 3-10) suffering from asthma were purposively sampled to participate in individual, semi-structured interviews. A realist approach following conventional content analysis was used to interpret the interviews. Results: The mothers expressed feelings of uncertainty, fear of asthma crises, and searching for ways to cope. These feelings triggered various strategies to control their child’s asthma. As long as the child’s asthma symptoms recurred, the mothers’ distress continued. Their distress was sometimes exacerbated by self-doubt and worries about whether they would receive adequate support from their family and healthcare professionals. Conclusion: Helping parents to understand their limits may help them be more open to varied aspects of their caregiving experiences, and thus to cope better. Psychological interventions together traditional educational training may help to alleviate parents’ psychological difficulties.

This study aimed evaluating 7 years’ outcome in 118 very preterm newborn (VPN, gestational age=26±1.4wks) involved in a randomized controlled trial. They presented neonatal respiratory distress (RDS) requiring ventilation for 14±2 days post-natal age (PNA). Repeated instillation of 200mg/kg Poractant alfa (SURF) did not improve early bronchopulmonary dysplasia, but SURF infants needed less re-hospitalization than controls for respiratory problem at 1- and 2-years PNA. There was no growth difference at 7.1±0.3 years for 41 SURF vs. 36 controls (80% eligible children); 7.9% SURF vs. 28.6% controls presented asthma (p=0.021). Children underwent cogni-tive assessment (WISC IV) and pulmonary function testing (PFT) measuring spirometry, lung volumes and airway resistance. Spirometry showed differences (p<0.05) between SURF and con-trols (mean±standard deviation (median z-score)) for FEV1 (L/s) (1.188±0.690(-0.803) vs. 1.080±0.243(-1.446)); FEV1 after betamimetics (1.244±0.183(-0.525) vs. 1.091±0.209(-1.342)); FVC (L) (1.402±0.217 (-0.406) vs. 1.265±0.267(-1.141)), and FVC after betamimetics 1.452±0.237 (-0.241) vs. 1.279±0.264(-1.020)). PFT showed no difference in volumes or airway resistance. Global IQ median [Inter-quartile Range] was 89[82:99] vs. 89[76:98] with 61% children >85 in both groups. Former VPN presenting severe neonatal RDS treated with repeated Surfactant have improved lung function and less asthma at 7 years PNA. There were no differences in neurodevelopmental outcome

Abstract: (1) Background: We hypothesized measuring the extent of brain overwork can extrapolate the burden of mental distress. This study aimed to develop a scale that measures mental distress and validate it in the general population. (2) Methods: In this population-based cross-sectional study, we recruited a total of 739 adults aged 16-65 years from 64 sampling centers of a clinical cohort across Mongolia to validate a 10-item self-report questionnaire. Internal consistency was measured using the McDonald’s ω. Test-retest reliability was analyzed using intraclass correlation coefficients. Construct and convergent validities were examined using the principal component analysis (PCA) and confirmatory factor analysis (CFA). Hospital Anxiety and Depression Scale (HADS) and the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) were used to evaluate the criterion validity. (3) Results: Among the participants, 70.9% were women, 22% held a bachelor's degree or higher, 38.8% were employed, and 66% were married. The overall McDonald’s ω coefficient was 0.861 demonstrating evidence of excellent internal consistency. The total intraclass correlation coefficient of the test-retest analysis was 0.75, indicating moderate external reliability. PCA and CFA established a three-domain structure that provided an excellent fit to the data (RMSEA=0.033, TLI=0.984, CFI=0.989, χ2=58, p=0.003). This 10-item scale, the Brain Overwork Scale (BOS-10), determines mental distress in three dimensions: Excessive Thinking, Hypersensitivity, and Restless Behavior. All items had higher item-total correlations with their corresponding domain than the other domains, and correlations between the domain scores ranged from 0.547–0.615. The BOS-10 correlated with the HADS, whereas it was inversely correlated with the WHOQOL-BREF. (4) Conclusions: The results suggest that the BOS-10 is a valid and reliable instrument for assessing mental distress in the general population. The current findings also demonstrate that the BOS-10 is quantitative, simple, and applicable for large-group testing.

In a globalised economy, metropolises seem to have an ‘extra gear’ compared to other urban centres: they attract the most skilled businesses, drive innovation in many fields and can count on material and immaterial assets that foster greater resilience to adverse events of various kinds. Against this backdrop, what lies ahead for medium-sized cities (MSCs)? This paper focuses on the case of Northern Italy and explores employment trends between 2012 and 2020 in 189 MSCs with a population of between 20,000 and 200,000 inhabitants. Using a descriptive approach, we investigate the evolutionary trajectories of these cities and their varying specialisations, over a period marked by a moderate recovery of the Italian economy following the Great Recession and by a further setback caused by the COVID-19 pandemic. In general, in terms of employment performance, the 189 cities in question were less dynamic than the metropolises, but it is nevertheless necessary to look at their individual circumstances in detail. Furthermore, the work shows significant differences between the MSCSs of the North-West and North-East in evolutionary trajectories and specialisation profiles. The most problematic situations also relate to cities with hub status in the wider context and are not focused only where there is a production structure linked to industry.

We report a case of an adult patient with newly diagnosed human immunodeficiency virus (HIV) infection, Acquired Immune Deficiency Syndrome (AIDS), and acute respiratory distress syndrome (ARDS) secondary to pneumocystis and cytomegalovirus pneumonia present on presentation that was successfully managed with veno-venous extracorporeal membrane oxygenation (VV-ECMO). A 40-year-old female with a past medical history of asthma was admitted to a local hospital due to dyspnea, cough, and wheezing where she was diagnosed with HIV infection, ARDS, and combined pneumocystis and cytomegalovirus pneumonia. Her pulmonary function quickly declined neces-sitating mechanical ventilation (MV). After she failed all conventional therapies, she was trans-ferred to a tertiary medical center for VV-ECMO therapy. Patient was successfully treated with antiretroviral therapy (ART), antibiotics, antivirals, steroids, and 48 days of VV-ECMO support, with complete resolution of her respiratory symptoms. She was discharged on hospital day 82. HIV positive patients with ARDS complicated by opportunistic pulmonary infections can be successfully managed with ART, appropriate anti-infective therapies, and VV-ECMO.

The severe respiratory distress syndrome (SRDS) has been a significant clinical issue in modern respiratory medicine. Its role in COVID-19 pandemic is not well defined. Outside-the-hospital SRDS is usually community-acquired septic pneumonia; however, in-hospitals incidences are complicated by co-infections. While SRDS is genetically selected in European and African origins, these are not clear in Middle East, particularly in COVID-19 backgrounds. There is a severe paucity in high quality data on correlations between COVID-19, ARDS, co-infectome, and patient demographics. We have conducted a comprehensive investigation on 298 patients for associations of SRDS, coinfections, and patient demographics on COVID-19 patients’ outcomes. Of these, 9.4% (n=28) had SRDS, and the rest (90.6%) had not. 54% of those with SRDS died while 84% survived; SRDS fatality was highly significant (Chi-square test P-value = 0.00000246). Irrespective of gender, the age of patients was significantly associated with SRDS (72.9 +/-8.9) compared to those without it (56.2 +/-15.1). However, there was no significant difference neither in the age of admitted patients before COVID-19 (58.5 +/-15.3) and during COVID-19 (57.2 +/-15.5) nor in the gender and COVID-19 fatality (Fisher Exact test 2-sided 1.000, 1-sided .546) ruling out that SRDS age-specificity were selected by virus susceptibility. A 100% of SRDS patients without bacterial co-infections survived while only 25% of those with co- infectome did not; this association was highly significant (P value= 0.00041). Co-infections alone without underlying SRDS was also associated with high fatality among patients (P value= 0.00000000076). Almost all COVID-19 patients without co-infectome (99.2%) survived while 28% of those with bacterial co-infection died. The major bacterial pathogens that potentially predisposed to SRDS, were Acinetobacter baumannii, and Escherichia coli either alone or in a mixed infection with Klebsiella pneumoniae were predominant species identified during SRDS attack. Thus, Gram-negative co-infectome potentially induced fatal SRDS aggravating COVID-19 outcome. These findings have significant clinical implications in specific differential diagnosis of SRDS syndromes for subsequent empiric therapy and patient management strategies. Future vertical investigation for similar mechanisms of cytokine-induced SRDS by Gram negative pathogens is imperative since hypervirulent strains are rapidly circulating in the region. The study is limited by a single center study confined to Ha’il hospitals; large scale investigation in major national hospitals would gain more insights.

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), (Failed Back Surgery Syndrome), dramatically impacts on patient quality of life, as evidenced by Health-Related Quality of Life (HRQoL) assessment tools. However, the importance of functioning, pain perception and psychological status in HRQoL can substantially vary between subjects. Our goal was to extract patient profiles based on HRQoL dimensions in a sample of PSPS-T2 patients and to identify factors associated with these profiles. Two classes were clearly identified using a mixture of mixed effect models from a clinical data set of 200 patients enrolled in “PREDIBACK”, a multicenter observational prospective study including PSPS-T2 patients with 1-year follow-up. We observed that HRQoL was more impacted by functional disability for first class patients (n=136) and by pain perception for second class patients (n=62). Males that perceive their work as physical were more impacted by disability than pain intensity. Lower education level, lack of adaptive coping strategies and higher pain intensity were significantly associated with HRQoL being more impacted by pain perception. The identification of such classes allows for a better understanding of HRQoL dimensions and opens the gate towards optimized health-related quality of life evaluation and personalized pain management.

Background: Early diagnosis of postoperative complications is an urgent task, allowing timely prescribing of appropriate therapy and reducing the cost of patient treatment. Prognostic models based on various data could help in the early diagnosis of postoperative complications after cardiac surgery. Objectives: The purpose of the study was to determine whether an integrated approach based on clinical data along with metabolites and biomarkers had greater predictive value than the models built on less data. Methods: The study included patients (n=62) admitted for planned cardiac surgery (coronary artery bypass grafting with cardiopulmonary bypass), who were retrospectively divided into two groups depending on the presence (n=26) or absence (n=36) of postoperative complications of all types. Clinical and laboratory data on the first day after surgery were analyzed. Additionally, patients' blood samples were collected before and on the first day after surgery to determine biomarkers (interleukin-6, procalcitonin, NT-proBNP, high-sensitivity troponin T) and metabolites (8 aromatic and 2 dicarboxylic acids were detected using gas chromatography-mass spectrometry). Results: Patients before surgery, compared with healthy donors, differed in the concentration of metabolites (p &lt; 0.05), and had concentrations of a number of biomarkers exceeding the corresponding reference values. Multivariate PLS-DA models, predicting the presence or absence of postoperative complications, were built using clinical data (ROC-AUC=0.71), concentrations of metabolites and biomarkers (ROC-AUC=0.60), and the entire data set (ROC-AUC=0.75). For comparison we built univariate models using the EuroScore2 (ROC-AUC=0.59) and SOFA (ROC-AUC=0.76) scales; concentrations of lactate (ROC-AUC=0.71), the dynamic changes of 4-hydroxyphenyllactic acid (ROC-AUC=0.69), and the sum of three sepsis-associated metabolites (ROC-AUC=0.70). The proposed complex model using entire data set was comparable to the SOFA scale, which confirms the expediency of searching for new predictive models based on a variety of factors.

Milk serves as a crucial source of natural bioactive compounds essential for human nutrition and health. The gastrointestinal digestion of milk proteins releases various biologically active peptides that positively impact human health and enhance physiological performance. With the growing production of cheese, Greek yogurt, and other dairy products, the volume of unutilized acid whey is significantly increasing. Acid whey, containing almost all whey proteins and approximately one-quarter of casein, presents a valuable raw material for generating peptides with potential health benefits. These peptides exhibit properties such as antioxidant, antimicrobial, anti-inflammatory, anticarcinogenic, antihypertensive, antithrombotic, opioid, mineral-binding, and growth-stimulating activities, contributing to improved human immunity and the treatment of chronic diseases. Enzymatic hydrolysis of milk proteins has been developed as a method to produce these peptides, facilitating their use in food fortification. To incorporate whey into functional beverages, it undergoes fermentation by lactic acid bacteria with proteolytic activity. To specifically enrich these beverages with peptides exhibiting targeted bioactivities, it is essential to select lactic acid bacteria strains possessing the requisite protease profiles. Additionally, the sensory properties of the final product can be enhanced using starter cultures with diverse metabolic capabilities, even in the absence of added flavoring agents. Given the imperative to develop waste-free technologies and enhance the profitability of the dairy industry, there is a growing need to efficiently utilize and transform acid whey into a broad spectrum of valuable products and food additives. This approach is justified not only by the nutritional benefits of the bioactive components in whey but also by the commercial potential of safe and health-enhancing products.

The paper focuses on the application of a multilevel, integrative and territorial approach to the protection of cultural heritage through planning instruments in Serbia. It points out the problems of the sectoral approach and discusses international recommendations that can be integrated into the planning methodology. The case study is the area of Djerdap National Park, which has an already established international and national importance. The research suggests that the cultural heritage in the area, with the exception of the Roman limes, is still recognized at the level of individual localities. The study emphasizes the importance of aligning all levels of governance to safeguard the whole spatial entity rather than focusing solely on its particular areas. The interna-tional and national importance of the planning area contributes to the strengthening of awareness of heritage and its institutional protection. However, the vitality of the area, which is key to its sustainable development, comes from the local level. Planning documents contribute to the inte-gration of local values and local communities into development programs and projects.

The impact of interaction SS with MJO on rainfall along Java Island to East Nusa Tenggara has been studied using daily rainfall observation data from 2140 weather observation stations, which are also equipped with GSMaP, OLR, and ERA5 data. There were 61 SS events found, 17 during active MJO and 44 in inactive MJO. Rainfall increases more in the western study area when the active MJO and more in the eastern study area when the inactive MJO is due to SS. SS reduces rainfall in the Jakarta region, regardless of the activity or inactivity of the MJO. SS causes extreme rainfall to only occur in a small part of certain areas, so it tends to significantly reduce the possibility of extreme rainfall. In the southern part of the IMC, SS predominates over MJO in supporting increased water vapor transport. Large-scale synoptic circulations like the monsoon, SS, and MJO can interact with local land-sea wind circulation to produce spatiotemporal variability in rainfall on Java Island. Rainfall mostly increases in the afternoon and decreases in the morning when SS occurs, whether there is MJO or not. Convective instability analysis indicates that SS increases precipitation, most likely by lowering CIN and raising VIMFC.

In order to shorten the detection time and improve the average precision on embedded devices, A lightweight and high accuracy model is proposed for passion fruit in complex environments (backlight, occlusion, overlap, sunny, cloudy, rainy). Firstly, replacing the backbone network of YOLOv5 with a lightweight GhostNet model reduces the number of parameters and computation while improving detection speed. Secondly, a new feature branch is added to the GhostNet network, and the feature fusion layer in the neck network is reconstructed to effectively combine the lower-level and higher-level features, which not only improves the accuracy of the model but also maintains its lightweight. Finally, the knowledge distillation methods are used to transfer the knowledge from the more capable teacher model to the less capable student model, which significantly improving the detection accuracy. The improved model is denoted as G-YOLO-NK. The average accuracy of the G-YOLO-NK network is 96.00%, which is 1.00% higher than the original YOLOv5s model. Furthermore, the improved model size is 7.14MB, reduced to half of the original model, and the real-time detection frame rate is 11.25 FPS on the Jetson Nano. Compared to the state-of-the-art model, the proposed model outperforms them in terms of average precision and detection performance. The present work provides an effective model for real-time detection of passion fruits in complex orchard scenes, which can provide valuable technical support for the development of orchard picking robots and greatly improve the intelligence level of orchards.

The Simultaneous Localization And Mapping (SLAM) scanner is an easy and portable Light Detection And Ranging (LiDAR) data acquisition device. Its main output is a 3D point cloud covering the scanned scene. Regarding the importance of accuracy in the survey domain, this paper aims to assess the accuracy of two SLAM scanners: the NavVis VLX and the BLK2GO Scanner. This assessment is conducted for both outdoor and indoor environments. In this context, two types of reference data are used: the Total Station (TS) and the static scanner Z+F Imager 5016. To carry out the assessment, four comparisons are tested: cloud to cloud, cloud to mesh, mesh to mesh, and edge detection board assessment. However, the results of the assessments confirm that the accuracy of indoor SLAM scanner measurements (5 mm) is greater than that of outdoor ones (between 10 mm and 60 mm). Moreover, the comparison of cloud to cloud provides the best accuracy regarding direct accuracy measurement without manipulations. Finally, based on the high accuracy, scanning speed, flexibility, and the accuracy differences between tested cases, it is confirmed that SLAM scanners are effective tools for data acquisition.

In recent years, electroencephalogram (EEG) emotion recognition has emerged as a research hotspot in the field of artificial intelligence (AI). Despite advancements in EEG-based emotion recognition, room for enhancing performance persists due to EEG signal redundancy and limitations in feature extraction, leading to inefficient models and emotional information loss. To fully utilize EEG's emotional information and improve recognition accuracy while reducing computational costs, this paper proposes a Convolutional-Recurrent Hybrid Network with a dual-stream adaptive approach and an attention mechanism (CSA-SA-CRTNN). Firstly, the model utilizes a CSAM module to assign corresponding weights to EEG channels. Then, an adaptive dual-stream convolutional-recurrent network (SA-CRNN and MHSA-CRNN) is applied to extract local spatial-temporal features. After that, the extracted local features are concatenated and fed into a temporal convolutional network with a multi-head self-attention mechanism (MHSA-TCN) to capture global information. Finally, the extracted EEG information is used for emotion classification. We conducted binary and ternary classification experiments on the DEAP dataset, achieving 99.26% and 99.15% accuracy for arousal and valence in binary classification, and 97.69% and 98.05% in ternary classification, surpassing relevant algorithms. Additionally, the model's efficiency is significantly higher than other models, achieving better accuracy with lower resource consumption.

Glycosidic linkage analysis was conducted on the unfractionated polysaccharides in the alcohol-insoluble residues (AIRs) prepared from six red seaweeds (Gracilariopsis sp., Prionitis sp., Mastocarpus papillatus, Callophyllis sp., Mazzaella splendens, and Palmaria palmata) using GC-MS/FID analysis of partially methylated alditol acetates (PMAAs). The cell walls of P. palmata primarily contained mixed-linkage xylans and small amounts of sulfated galactans and cellulose. In contrast, the unfractionated polysaccharides of the other five species were rich in galactans displaying diverse 3,6-anhydro-galactose and galactose linkages with varied sulfation patterns. Different levels of cellulose were also observed. This glycosidic linkage method offers advantages for cellulose analysis over traditional monosaccharide analysis that is known for underrepresenting glucose in crystalline cellulose. Relative linkage compositions calculated from GC-MS and GC-FID measurements showed that anhydro sugar linkages generated more response in the latter detection method. This improved linkage workflow presents a useful tool for studying polysaccharide structural variations across red seaweed species. Furthermore, for the first time, relative linkage compositions from GC-MS and GC-FID measurements, along with normalized FID and total ion current (TIC) chromatograms without peak assignments, were analyzed using principal component analysis (PCA) as a proof-of-concept demonstration of the technique's potential to differentiate various red seaweed species.

Background: Educating college students about the importance of good sleep habits could lead to the adoption of healthier sleep routines, including sufficient sleep duration and sleep quality. The current pre-post study examines the impact of completing a sleep education program called “Sleep 101” on (1) sleep hygiene practices, (2) sleep quality, and (3) weekday and weekend sleep behaviors among college students. “Sleep 101” is an interactive online course developed to educate college students about the importance of sleep by addressing basic sleep physiology, the impact of sleep on mood, academic and physical performance, the interactions between sleep and various substances, and common sleep disorders. Methods: 338 college students were recruited from a midsized public university in the US and invited to participate in “Sleep 101”, of which 25 participants completed the baseline and post-intervention questionnaire. The Sleep Hygiene Index (SHI) was utilized to evaluate sleep hygiene practices, while standard questions were employed to assess weekday and weekend sleep behaviors and overall sleep quality. Results: Those who completed the study demonstrated a significant increase in weekday sleep duration and were less likely to engage in negative prior bedtime activities. In addition, 40% of those who completed baseline and post-intervention assessments noticed improvements in their sleep quality. Conclusion: These findings suggest that a brief online program is beneficial in improving sleep behaviors among college and could be a scalable approach to addressing current sleep issues and preventing future sleep problems in college students.

The profile of secondary metabolites occurring in apple cuticular layer is not only characteristic for particular apple cultivar, but also dynamically reflects various external factors in growing environment. In this study, the possibility to authenticate apple samples based on analysis of their cuticular layer extracts was investigated. Ultra-high-performance liquid chromatography coupled to high resolution tandem mass spectrometry (UHPLC-HRMS/MS) was employed for obtaining metabolomic fingerprints. In total, 274 authentic apple samples, four cultivars harvested within the seasons 2020 to 2022 in the Czech Republic and Poland were analysed. The generated complex data processed by univariate and multivariate statistical methods enabled to build classification models for discrimination of apple cultivars as well as their geographical origin. The models showed very good performance in differentiation of Czech and Polish samples for three of four cultivars: ‘Gala’, ‘Golden Delicious’ and ‘Idared’, moreover, the validity of the models was verified over harvest seasons. The diagnostic markers, besides metabolites of triterpene biosynthetic pathway, mainly represented wax esters. ‘Jonagold’, which is known to be susceptible to mutations, was the only cultivar for which the unambiguous classification of geographical origin was not possible.

Superior fiber quality is one of the most important objectives in cotton breeding. To detect the genetic basis underlying fiber quality, an F2 population containing 413 plants was constructed by crossing Jifeng 914 and Jifeng 173, both of which have superior fiber quality, with Jifeng 173 being better. Five fiber quality traits were investigated in the F2, F2:3, F2:4, and F2:5 populations. Quantitative trait loci (QTL) mapping was conducted based on a high-density genetic map containing 11,488 single nucleotide polymorphisms (SNPs) and spanning 4,202.12 cM in length. Transgressive segregation patterns and complex correlations in the five tested traits were observed. A total of 108 QTLs were found, including 27 for fiber length (FL), 16 for fiber strength (FS), 24 for micronaire (MC), 17 for fiber uniformity (FU), and 24 for fiber elongation rate (FE). Chromosome A7 contained 12 QTL, ranking the first. No QTL was found on chromosome D1 and D11. Each QTL contributed 1.98%–21.45% to the phenotypic variation (PV), including 13 major effect QTLs that contributed more than 10% toward PV. Two QTLs could be repeatedly detected in three populations, including qFL-D3-2 in F2, F2:4, and F2:5 with 9.18%–21.45% of PV, qFS-A11-1 in F2:3, F2:4 and F2:5 with 6.05%–10.41% of PV. Another seven stable QTLs could be detected in two populations, including four major effect QTLs: qFL-A12-3, qFS-D10-2, qMC-D6-2, and qMC-D8-1. Fourteen QTL-overlapping regions were found, which might explain the complex correlations among the five phenotypic traits. Four regions on chromosome A11, D3, D6, and D10 covered by both stable and major effect QTLs are promising for further fine mapping. The genomic regions of the two QTLs detected in three populations and the four major effect QTLs contain 810 genes. Gene functional analysis revealed that the annotated genes are mainly involved in protein binding and metabolic pathways. Fifteen candidate genes in the qFL-D3-2 region are highly expressed in fiber or ovules during fiber initiation, elongation, secondary cell wall thickening, or maturation stages. qRT-PCR revealed that Ghir_D03G005440.1 and Ghir_D03G011310.1 may play a role in promoting fiber initiation, Ghir_D03G006470.1 may be beneficial for promoting fiber elongation. This study provides more information for revealing the molecular genetic basis underlying cotton fiber quality.

Currently there are fewer depth models applied to pepper picking detection, while the existing generalized neural networks have problems such as large model parameters, long training time, and low model accuracy.In order to solve the above problems, this paper proposes a Yolo-chili target detection algorithm for chili pepper detection. First, the classical target detection algorithm yolov5 is used as a benchmark model, and an adaptive spatial feature pyramid structure combining the attention mechanism and the idea of multi-scale prediction is introduced to improve the model's detection effect on occluded peppers and small target peppers. Secondly, a three-channel attention mechanism module is introduced to improve the algorithm's long-distance recognition ability and reduce the interference of redundant testers. Finally, the quantized pruning method is used to reduce the model parameters and realize the lightweight processing of the model. Applying the method to the homemade chili pepper dataset, the AP value of chili pepper reaches 93.11%; the accuracy rate is 93.51% and the recall rate is 92.55%.The experimental results show that yolo-chili is able to achieve accurate and real-time pepper detection under complex orchards.

The temporary immersion system bioreactor named GreenTray®[2], [3]presents advantages over the existing ones. Firstly, there is no need to use forceps to move the shoots or plantlets in or out of the recipient, neither the use of scalpel to divide them. Secondly, the basis of the shoot can remain in the GreenTray® and can sprout again in several cycles of growth. These two characteristics reduce the costs in the process of micropropagation. Besides, shoots or plantlets development is enhanced by the aeration of the recipient, thus enriching with CO2 the recipient atmosphere. The chapter describes and provides images and values of interest in (1) the micropropagation process of some commercial Prunus or Pyrus rootstocks; (2) the plantlet growth under autotrophic conditions; and (2) the inoculation of plants with pathogens that reproduce in vitro the symptoms observed in vivo, using the GreenTray® bioreactor.

The aim of this retrospective study was to compare the clinical outcomes of treating isolated surgical neck fractures of the humerus using either the intramedullary nail or the MIROS (Minimally Invasive Reduction and Osteosynthesis System®) system. The study included 42 patients who underwent surgical treatment at the Polyclinic from January 2014 to June 2020. The results indicated that both treatments were effective; however, the MIROS system exhibited a higher complication rate. Intramedullary nailing was more reliable, thus recommended as the primary treatment method. This study underscores the importance of selecting the appropriate fixation technique to minimize complications and enhance patient outcomes.