Finding the right dose of a novel treatment is one of the most important tasks in early drug development. However, there is often uncertainty about the form of the relationship between dose and patient response at the time that the dose-finding trials are designed. In this presentation we develop Bayesian adaptive designs for Phase II cross-over trials conducted to estimate the minimum effective dose (MED), that is, the dose corresponding to the minimum clinically relevant effect over placebo.We propose designs which stipulate that patients enter the trial in cohorts, and each cohort receives placebo and three active doses from a total of K active doses available for use. After each cohort of patients has been treated using a Williams square design an interim analysis is performed to identify which doses the next cohort of patients should receive. Bayesian model averaging is used to account for model uncertainty. Prior distributions will be based on pseudo data collected from experts by eliciting quantiles of the response distribution on placebo and a number of active doses to be used in the trial. A number of plausible models for the dose-response relationship are identified before the trial begins and accumulating evidence on the shape of this relationship is summarised by posterior model probabilities. Doses for the next cohort of patients are chosen adaptively to minimise the weighted average variance of the log(MED), averaging across all candidate models and weighting according to posterior model probabilities.


ObjectiveHypotonia is a common clinical entity well recognized in pediatric age group, which demands experienced clinical assessment and an extensive array of investigations to establish the underlying disease process. Neuroimaging comes as great help in diagnosing the disease process in rare cases of central hypotonia due to structural malformations of brain and metabolic disorders and should always be included as an important investigation in the assessment of a floppy child. In this article, we discuss the MRI features of eight cases of central and two cases of combined hypotonia and the importance of neuroimaging in understanding the underlying disease in a hypotonic child. Hypotonia is a constant clinical sign associated with a wide variety of cerebral as well as systemic diseases in newborns and older infants. Causes can be common such as hypoglycemia and hypoxic ischemic injuries that do not pose many difficulties in diagnosis and could be rare Inborn Errors of Metabolism; which are difficult to diagnose especially in resource limited Nations. A thorough clinical examination by an experienced pediatrician is usually the first step necessary to determine the anatomical origin of hypotonia i.e., whether in the central or peripheral nervous system . CarefulIn this article, MRI brain imaging details have been discussed retrospectively in eight patients of central and two cases of combined hypotonia referred to the Department of Radiology of Dr. Rml Hospital, a Tertiary Care Institute for neuroimaging in northern India. We have excluded the more common systemic or acquired causes like sepsis or hypoxic ischemic encephalopathy and those cases where MRI was essentially normal. MRI was performed on a 1.5 Tesla Siemens Magnetom Symphony scanner with 4 mm thick slices and 2 mm interslice gap. All standard sequences were included including post contrast sequences and MR Spectroscopy in special situations as and when required.MRI findings in structural anomaliesVariable degree of posterior fossa abnormalities were observed in the present cases: Jouberts Syndrome, Chiari I, WalkerWarbug Syndrome (WWS) and Fukuyama. Small posterior fossa and tonsillar herniation was seen in Chiari I malformation , VermianMRI findings in metabolic disordersWhite matter signal abnormalities were observed in most of the cases with metabolic disorders with symmetrical involvement being the most common type. While the white matter signal changes were confined to the white matter of cerebral hemispheres, corona radiata in adrenoleukodystrohy and metachromatic leukodystrohy diffuse signal changes with involvement of posterior fossa was seen in Canavan’s disease and in Maple syrup urine disease , 9. AmonMRI findings in combined hypotoniaIn Fukuyama disease, MRI revealed multiple subcortical small cysts in bilateral cerebellar hemisphere and polymicrogyric cortex with diffuse signal changes in white matter of brain . In WalkAdvances in neuroimaging have led to early recognition and diagnosis of rare congenital anomalies of brain and inborn metabolic disorders in floppy infants even before the full clinical manifestations of the disease sets in the later childhood. Present series was aimed at describing MRI features and its importance in the work up of floppy infants with congenital structural and metabolic basis of neurological disorders. Structural malformations and metabolic encepahalopathies produce profound hypotonia in infants and often in early months of life, this may be the sole manifestation of these rare diseases .These inIn Conclusion, Neurological evaluation of a floppy child is an extremely difficult and demanding task and the clinician may be clueless about the next correct investigation to choose among the wide array of highly specialized tests for the diagnosis of central hypotonia. Hence, neuroimaging should be considered for quick diagnosis and identification of potentially treatable cases.


The brain-machine interface (BMI) used in neural prosthetics involves recording signals from neuron populations, decoding those signals using mathematical modeling algorithms, and translating the intended action into physical limb movement. Recently, somatosensory feedback has become the focus of many research groups given its ability in increased neural control by the patient and to provide a more natural sensation for the prosthetics. This process involves recording data from force sensitive locations on the prosthetics and encoding these signals to be sent to the brain in the form of electrical stimulation. Tactile sensation has been achieved through peripheral nerve stimulation and direct stimulation of the somatosensory cortex using intracortical microstimulation (ICMS). The initial focus of this paper is to review these principles and link them to modern day applications such as restoring limb use to those who lack such control. With regard to how far the research has come, a new perspective for the signal breakdown concludes the paper, offering ideas for more real somatosensory feedback using ICMS to stimulate particular sensations by differentiating touch sensors and filtering data based on unique frequencies. Limb loss and paralysis can have crippling consequences for those affected, severely hindering the ability of individuals to live normal lives. Work being done with prosthetics utilizing neural interfacing techniques for neural control may hold the answers to potentially restoring some of what these people have lost and significantly improving their overall quality of life , 2. WithRecently the importance of somatosensory feedback as a method for providing higher level cognitive control has become apparent –7. Ever This paper will review what is currently being done with prosthetics implementing BMI technology, focusing on the integration of proprioceptive and somatosensory feedback as a method to improve control. After delving into some of the basics behind BMI, the importance of sensory feedback and commencing with the review, a new perspective on methods for signal breakdown will be explored for the purpose of offering possible new insights and a unique perspective on what can be done moving forward in the field. Finally, the applications of neural prosthetics will be discussed.A brain-machine interface is a link between the mind and the physical world in which information can flow and allow the two to interact through an external device. The principals behind modern day prosthetic BMIs involve extracting motor control signals from pools of neurons and translating those signals into motor control of a device that control being fine-tuned through different feedback sources and assistance from computer algorithms . InformaDecoding is a huge component of being able to understand brain signals and translating them to the prosthetic device. Decoders use multiple mathematical functions to process a variety of neural signals recorded by electrodes into signal patterns that can be recognized and interpreted as relating to specific neural activity . The rigAlong with decoding, one of the most crucial challenges facing brain-machine interfacing is electrode design and lifespan. The electrode/electrolyte interface can cause unfavorable reactions, such as irreversible faradaic reactions, and chronic implantation in the central nervous system has been shown to elicit a typical response of electrode encapsulation by macrophages, microglia, and astrocytes, even in materials considered to be biocompatible . Less inDecoding signals from neural activity collected from these electrodes give rise to cognitive control. BMIs used in research involving monkeys have developed from giving them cognitive control of a cursor on a computer screen, in which they would perform tasks for a juice reward , to beinPatients suffering from paralysis and limb loss can theoretically benefit from two different types of prosthetics: motor-based prosthetics that read out information from motor cortical areas of the brain concerned with arm and movement and cognitive prosthetics that translate activity from various cortices related to sensory-motor integration involving higher level of cognitive processes that organize behavior , 20. EffThe idea of sending the information about the touch from the artificial hand to the brain is a new concept. It works by adding additional somatosensory feedback channel that can create tactile signals generated by real sensors placed in the robotic hand, directly to the somatosensory cortex. The goal of adding sensory signal makes the system closer to the real side and can also add a whole new experience of being able to feel the touch surface. BMI without somatosensory feedback only relies on visual feedback and thus could result in reduced quality of BMI-controlled movements , 5.Research has shown that integration of multiple sources of feedback significantly improves control when using BMIs, research that will be explored in the following animal study. Work done in 2010 by Suminski et al. using BMIs that incorporated feedback from multiple sensory modalities in monkeys found early on that using proprioception as a feedback mechanism aided in neural control [Two adult male rhesus macaques were trained to control a two-dimensional cursor using a robotic exoskeleton, moving the cursor to a series of random targets to receive a juice reward. The monkeys were then implanted with a 100-electrode microelectrode array in the primary motor cortex (MI) contralateral to the arm used for the task of controlling the cursor see , and mulThese results are the first to demonstrate the important implications of feedback modalities other than that provided by one's vision in cortically controlled brain-machine interface. The performance with proprioception also surpassed that reported in a clinical experiment involving two human patients with tetraplegia  and compSomatosensation, including proprioception, is an integral component of natural motor abilities. Losing proprioception will have significant detriments on the capacity to plan dynamic limb movements , and in Conveying somatosensory information via ICMS has also been shown to be viable in animal studies. Researchers at the University of California Berkeley tested whether rats could use artificial tactile percepts generated from ICMS to the barrel cortex to navigate around a virtual target . Rats weResearchers at the University of Chicago sought to convey information about sensory contact location on the hand and digits of a Macaque monkey by delivering ICMS to regions of S1 with particular receptive fields in the hand . Tabot aEarly experiments exploring sensory mapping along S1 via electrical stimulation by Penfield and Boldrey showed that S1 neurons organized into distinct columns, which represent regions of the body , and thaOne option being explored utilizes the brains ability to adapt, relying on its plasticity, instead of meeting the demands of complete biomimicry. By associating different stimulation patterns with various kinds of sensory information, it is hoped that patients will be able to learn the meaning behind each and use that information to operate better prosthetics. This method might also be warranted in the presence of cortical plasticity, or when the brain adapts unused areas to help control the functions used to compensate for that loss. Given time, areas not in use may have become completely devout to this other function, making new adoption out to be a more reliable option. The synergy between these adaptive methods and biomimicry may hold answers to improving patient control of cognitive neural prosthetics and BMIs that can integrate both afferent and efferent signals .BMI technology can aid tremendously in restoring function and patient rehabilitation in a clinical setting. Traditionally, the main forms of treatment for sensorimotor disorders involve pharmaceutical intervention for pain and clonus, and classic physiotherapy techniques focused on avoiding muscular hypotrophy by administration of passive movement sessions through manual interventions . HoweverThe idea of neural prosthetic control through functional electrical stimulation spans back from when one of the first FES systems employing implantable electrodes is inserted into muscular fibers to allow a hemiplegic patient to move a completely paralyzed limb again  to FES-BImplanted electrode arrays can produce excellent accuracy and complex motor routines; modern BMIs can detect and encode natural hand and finger motions performed by monkeys with the use of intracortical electrodes , 36. IntRaspopovic et al. at Ecole Polytechnique Federale de Lausanne set out to restore natural sensory feedback via stimulation of peripheral sensory nerves (median and ulnar nerves) through the use of transversal intrafascicular multichannel electrodes . They thFuture perspectives include incorporating the prosthesis into the body schema . Better brain-prosthetics integration must reduce the timing between motor information and sensory information, which has been found to be crucial for patient recognition and acceptance of the prosthetics . ExistinDealing with phantom limb pain as an application of ICMS offers a good example of the mechanisms and benefits of peripheral stimulation in the context of neural prosthetic replacement. Phantom limb pain is a mild to extreme pain whose seeming origin comes from a no longer existing extremity or which is felt from where a person's limb has been amputated , 42. ThiEven when a basic prosthetic device is attached to an upper limb injury the patient can still have these types of phantom pains because there is still no sensory information being sent to the primary somatosensory area of the brain. The sensory information received at the prosthetic device has shown a resultant decrease in the phantom pain experienced by these amputee patients , 44. RedAlthough most of the current research involves the use of ICMS to stimulate the somatosensory cortex; in future, the use of optogenetics might become more prevalent. Optogenetics is based on genetically modified ion channels that respond to light, and thus it could remove all the problems associated with the use of ICMS. It would also allow for finer control of spatial pattern of activation .The focus on improving control in this paper will be via proposing a stimulation method to provide full sensory information directly to the patient. The intent on conveying comprehensive somatosensory information will focus on providing information regarding multiple features of tactile perception rather than just one . Visual feedback has been predominantly used to modulate the output of BMI limbs, but this provides limited control of force and takes time for complicated spatial tasks . As mentCurrent ICMS techniques have demonstrated the capability to deliver localized activation of neurons . They caAs elucidated earlier, there has been much progress in the development of advanced decoding algorithms and research into the function and mapping of the motor cortex that has contributed to the capability of lending CNP arms to mimic much of the natural movement capabilities of a native arm. Given these developments and the demonstrable advantage of artificial sensory feedback , using tSince ICMS has been established as the preferred method of conveying somatosensory feedback, it is necessary to have a stimulation strategy that will successfully convey comprehensive somatosensory information. To accomplish this, the signals will first have to be acquired by the device and then converted into a form that can be conveyed via ICMS. The following proposed method of signal breakdown will only require information from one or two sensors preferably from a flexible array sensor with a high spatial resolution and small size accompanied by a larger normal force sensor to contrast related receptive fields in the hand. This combination of sensors is a possibility given previous applications in robotics .Next, the method of signal breakdown will be discussed. Since most of the information within contact events is contained within the event itself, we propose selecting certain features of the information out to be conveyed via existing somatosensory information streams in native arms. In the native arm, haptic information is conveyed via canonical mechanoreceptors of the skin and their slowly adapting (SA) and rapidly adapting (RA) afferent components . These mTo accomplish this, one approach would be to mimic the somatosensory afferents of the native arm. For providing comprehensive somatosensory information, this paper will focus on SA and RA information streams and their two subtypes. SA and RA refer to the response of the mechanoreceptor to a sustained stimulus; SA mechanoreceptor afferents maintain a high response throughout the stimulus duration, where RA mechanoreceptor afferents respond to changes in stimulus intensity. Furthermore, the SA and RA mechanoreceptors can be broken down into their respective subtypes based on their intrinsic response properties. The frequency range refers to the range of frequencies, to which the mechanoreceptor can respond. Sensitivity refers to the lowest amount of change in frequency that will cause a change in the firing of the mechanoreceptor, and the receptor field size refers to the area on the surface of the skin which one mechanoreceptor occupies , 13.  TaSensory information produced by the response to contact events could possibly be replicated by filtering out the appropriate information from the fewest amount of sensors needed to replicate tactile sensation in the fingers and hand. The electrical signals from these sensors could be filtered through appropriate frequency band selection via bandpass filters or low-pass filters , followed by the addition of processing to recreate the response properties of the native sensory afferent  according to their native physiological properties listed in The processed signals must be used to evoke sensory percepts via ICMS to their relevant regions of S1 .  FigureICMS pulse trains from the proposed method of signal processing could then be delivered to the respective areas of S1 for each receptive field of the hand and separated by their RA and/or SA stream components into the areas with these natural receptive fields. We hypothesize that using ICMS to deliver the same information processed by this method may improve the ability of a patient to interpret many details from elicited tactile percepts due to the existence of both RA and SA-like neurons in S1 .The goal of this perspective is to propose a technique that could convey multiple submodalities of somatosensory stimuli to a human patient operating a somatosensory BMI. This point of view could offer insight into the recovery of multiple submodalities of tactile information as well as a deeper insight into the relationship between natural cortical coding of somatosensory information and the somatosensory percepts that they elicit.Providing direct sensory feedback to amputees can be considered truly cutting edge research. A review of BMI and the superior control attained when incorporating somatosensory feedback into a device shows the possibility to restore natural function and the challenges that need to be addressed for this technology to reach a broad clinical setting. This paper offers a new perspective for improving tactile sensation in neural prosthetics with somatosensory feedback by separating the stimulus from the sensor into signals that resemble the sensory afferent sensation of a real hand. ICMS was discussed as a primary method for sending signals to the S1 in the postcentral gyrus of the brain. The applications of a feedback system range from reducing the cognitive burden of one sense to restoring vital sensations that are essential in allowing people the chance to interact with their surroundings and one another. The power that tactile sensation conveys is invaluable and completely necessary for restoring function. Moreover, it is certainly clear that research into creating prosthetic devices with sensory feedback will continue to evolve the scientific frontier, creating a new understanding of how the brain works and helping those suffering from the loss of limb use everywhere.


Newborns from multiple pregnancies demonstrate a higher perinatal morbidity and mortality compared to singletons. Prematurity is more frequent in twins and therefore birth weight is significantly lower compared to singletons . Thus, tCareful analysis of both twins for a pathological condition is mandatory to address the most appropriate management. Twin discordance for the presence of a severe pathological condition raises serious concern in terms of bioethical and psychological impact on the parents and medical staff. DiffereThe management of multiple pregnancies is a very complex task for medical staff and requires parental support with adequate counselling and psychological help .


Virtual communities are emerging in many aspects of health activities and widespread in health management. Online health communities offer a virtual system where people with common interest, specific health needs can exchange information and experiences with other people with the same condition as well as getting support from peer and professionals. The objective of this study is to develop an ICT platform enhancing community resident participation involving in the chronic disease prevention and physical activities. The aim of this platform is to promote physical activity of community residents for health promotion and disease prevention goal attainment. Health promotion goals for enhancing physical activity were set by health care professionals based on scientific evidence. Instead of individual plan to set the goal by themselves, the platform offered them tailored goal with their conditions and then suggested them to participate in group shared their physical activity goals. The platform encouraged the active participation of community residents though adherence physical activity of health communities in which they were members.The ICT platform provides a place where community residents with chronic conditions or even healthy people who want to promote their health be able to find an appropriate group for together prevent disease and enhancing physical activity. The platform in the study allowed community residents to develop their own communities and invite other members to participate with them. This online community intended to empower community residents to increase their involvement in their self-management and pushing the active participation in phycial activities. Function such as reminder of activity participating was added. Future study will be conducted to evaluate changes in health promotion self-efficacy, health goal fulfillment, health-related quality of life, and shared decision-making after using the Health Community Platform among community residents. Extensive research initiatives are needed to determine the impact of virtual health communities on patient outcome, the overall process as well as quality and access of care.


Subjective aging is interpersonal, it embodies processes of thinking about the self in relationship to others. We utilize data from the 100-day microlongitudinal Personal Understanding of Life and Social Experiences Project  to explore how self-perceptions of aging differentiate the processes by which older adults shape interactions with close social ties to support progress toward a meaningful health goal in everyday life. Those with more positive self-perceptions of aging identified more friends among their closest social ties and reported a higher levels of goal progress and support toward that goal during the study period. Further, multilevel random coefficient models showed that goal progress on a given day was more sensitive to received support on that day among those with more positive self-perceptions of aging. The implications for adult development and shared experiences of aging within friendship networks is discussed.


Parker  The authors regret that the incorrect middle initial was given for Samantha Y. Chong in the original article. The corrected author list is as shown above.The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.


Impaired cognition is often overlooked in the clinical management of depression, despite its association with poor psychosocial functioning and reduced clinical engagement. There is an outstanding need for new treatments to address this unmet clinical need, highlighted by our consultations with individuals with lived experience of depression. Here we consider the evidence to support different pharmacological approaches for the treatment of impaired cognition in individuals with depression, including treatments that influence primary neurotransmission directly as well as novel targets such as neurosteroid modulation. We also consider potential methodological challenges in establishing a strong evidence base in this area, including the need to disentangle direct effects of treatment on cognition from more generalised symptomatic improvement and the identification of sensitive, reliable and objective measures of cognition.


Pathogens initiated this Special Issue. Epidemiology is a field that combines specialist knowledge of many disciplines, considered a facilitator of communication and various diverse skills.One Health is a popular headline for an all-inclusive concept of our scientific work. It is not a new concept, but one along that we have been researching for many decades, if not centuries. Nevertheless, the term has become a keyword used worldwide for an inclusive approach to investigating issues such as pathogens in our various environments and host species. It was with this intention that We are very pleased with to present ten original publications covering the molecular properties, distribution and surveillance of pathogens and vectors. A few examples:A sampling methodology for the surveillance of mosquitos and arboviruses in Florida was more efficient when stratified by a vertical gradient;Genotyping parvoviruses of dogs and cats in Sri Lanka allowed identification of cats as possible source of the virus for dogs;A hitherto unknown zoonotic risk emerged from a study of illegally traded companion animals in Italy and Austria;A study in Barbados resulted in the identification of the seasonal and occupational distribution of human orthohantavirus infections among febrile patients;We now know that the majority of genotypes of equine herpes virus 5 from Poland clustered within two main groups and similar viruses circulated in geographically distinct locations without any apparent age predisposition;An investigation of re-emerging rabies virus in Southeast Asia demonstrated a need for collecting data in remote locations for detecting drivers of emergence.Leptospira spp., about virulence factors of the avian-pathogenic Escherichia coli (APEC) to inform antibiotic therapy, vaccine development and virulence inhibitors, and about the economic loss of the zoonotic Ross River virus (RRV) transmitted from horses to humans. A more confined investigation described an outbreak of canine distemper in a rescue centre.In addition, three reviews detail the merits and limitations of diagnostic assays for describing the diversity of This Special Issue intended to provide ‘insights into the ecological behaviour of pathogens and their impact on human and animal populations and environments’. We believe the ten publications have significantly contributed to achieving this goal. We would like to thank our colleagues and authors who collaborated and crafted articles describing their scientific thinking and outcomes.


There is considerable interest by many stakeholder groups in developing new therapies in Alzheimer’s disease (AD). Increasing interest in the treatment of pre-clinical disease and measurement of associated long term outcomes using RWD is being explored as the use of RCTs in this context can be limited. Many challenges exist in generating RWE to support regulatory submissions in this disease population including lack of important clinical variables such as disease severity and progression in existing data sources. We will discuss the AD RWD landscape with a focus on challenges and future directions for the use of RWD to generate RWE supportive of regulatory submissions for pharmaceutical products.


The progressively lowered stress threshold model suggests that due to impairments in coping, persons living with dementia have a reduced threshold for stress and respond with more behavioral symptoms of dementia as stress accumulates throughout the day. While the propositions of the model have not been evaluated, this model serves as the basis of non-pharmacological interventions for behavioral symptom management aimed at modifying the environment to reduce stressors. These interventions have mixed success, which may be due to traditional longitudinal measurement models that don’t account for the dynamic temporal nature of behavioral symptoms. This paper evaluates the progressively lowered stress threshold conceptual model as an explanation for behavioral symptoms of dementia and tests several of its hypothesized propositions using an intensive longitudinal design. A sample of N=165 family caregivers completed brief daily diary surveys for 21 days (n=2841) reporting on behavioral symptoms of their care recipients. Dynamic structural equation modeling was used as the analytic technique to examine the impact of caregiver and care recipient environmental stressors on the diversity of behavioral symptoms of dementia (number of different symptoms) to account for the nested data structure and autoregressive relationships. Results show direct relationships between environmental stressors and diversity of behavioral symptoms of dementia that same day and the following day. Findings provide support for the progressively lowered stress threshold model. Further, findings suggest an extension to the conceptual model is warranted given evidence of an exposure/recovery trajectory and the lagged effects of stress exposure on behavioral symptoms of dementia presentation.


Older adults experiencing cognitive decline, including those with Alzheimer’s disease and related dementias, are at-risk for social isolation and participation restrictions, especially given the COVID-19 pandemic. Previously examined research has primarily focused on reducing problematic behaviors and remediating cognition for individuals with cognitive impairments. In this symposium, we will discuss novel intervention approaches and under-studied aspects of lifestyle behaviors that minimize social isolation and maximize participation for older adults with Alzheimer’s disease and related dementias. Information presented in this symposium is intended to inform future intervention research to achieve an optimal quality of life for those with cognitive impairments. The first presentation will describe an analysis of lifestyle behaviors and cognition in an older population. The second presentation will discuss the development of an intergenerational, active music intervention that is delivered virtually to individuals with dementia and their caregivers. The third presentation will describe the effects of an adaptive horseback riding program that is becoming increasingly prevalent and improves the quality of life of persons living with Alzheimer’s disease and related dementia.


Sleep quality has been considered as one of the most important parameters of good sleep health. A recent study  conducteThe strength of the study lies in the inclusion of various ethnicities and groups across the country. Similar studies with regional modifications need to be performed in other countries to find out the modifiable factors that can help in improving quality of sleep as well as overall health of the population. Inclusion of sleep medicine specialists at district/county-level hospitals would further enhance the health indices significantly in the coming years.The recent advancements in artificial intelligence based trackers and diagnostics bring a lot of hope for affordable sleep health improvement applications . Ethical


Funding statement. The corrected statement appears below and replaces the Acknowledgments.In the original article, there were errors in the “The authors extend their appreciation to the Deputyship for Research & Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number: IFP22UQU4331317DSR174.”The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Recent years have provided unprecedented opportunities to advance translational science in obstetric and pediatric pharmacology. With our Insights 2021 Research Topic presented herein we also appreciate that there is still much to do. Previous works have pointed out some of the challenges in our domain; many of these relate to the still conservative nature of clinical research in obstetric and pediatric populations and sub-populations  but alsoKoch et al. remind us that there are opportunities for these newer quantitative approaches to be applied in perinatology, providing an excellent application in the treatment of jaundice in preterm and term neonates.An encouraging theme among these papers is that they not only that they address the aforementioned knowledge gaps, but they all represent building blocks by which future preclinical and clinical investigations in obstetric and pediatric pharmacology can proceed. DBS assays have been around for a long time with many illustrating the benefit in the clinical conduct in obstetric and pediatric clinical trials and still there is a reluctance to invest in the approach prospectively to support new drug research and development due to concerns about transitivity and cross-validation with traditional analytical methodologies and regulatory acceptance . LikewisTherapeutic proteins still represent a gap as a modality for pediatrics and pregnant women though new promising agents in this class provide an opportunity to fill these gaps in addition to benefit patients.Meibohm paper highlights the knowledge gaps and prioritizes efforts to reduce them for the purpose of accelerating new TP development in these at-risk populations.Their development however typically requires some manner of bridging from small molecule experience in these populations. Cell and gene therapy for obstetric and pediatric pharmacology populations continues to be an important therapeutic modality requiring additional study. Several critical therapeutic areas including cancer, ischemia, and several rare diseases  all reprThese papers are both timely and clinically relevant in their own right, but they are also likely to be foundational for future work to come. Obstacles remain for obstetric and pediatric pharmacology investigation.


There is strong and consistent evidence that leisure-time physical activity (LTPA) improves cardiovascular health and reduces the risk of all-cause and cardiovascular mortality. Less is known about health effects of occupational physical activity (OPA), and results are not in favor of a beneficial effect on cardiovascular health. Several large-scale prospective studies have found that high occupational physical activity (OPA) is associated with detrimental or no effects on cardiovascular health and mortality. These contrasting associations with cardiovascular morbidity and mortality for LTPA and OPA have coined ‘The Physical activity health paradox'. Although the underlying physiological mechanisms are not established, a theoretical framework was proposed by Holtermann and colleagues (2018). This framework suggests that due to the nature of OPA , it may not result in healthy adaptation to the same extent as LTPA, or even lead to unhealthy responses, such as elevated 24-hour heart rate and blood pressure and increased inflammation. Drawing on theoretical models and empirical findings, the aim is to summarize the literature regarding potential physiological mediators of the physical activity health paradox. This also includes a brief summary of our own research based on accelerometer measurements of physical activity with cardiovascular regulation assessed by heart rate and blood pressure in workers with low occupational class and manual work.


This study aims to assess the impact of the relationship quality between parents and children on parents’ cognitive function in later life, with an additional focus on variation by parents’ gender. We analyze data from a nationally representative longitudinal panel survey of participants age 50 and older. We employ latent growth curve models (LGCM) to estimate how changes in parent-child relationship quality are related to cognitive trajectories over time. Maintaining frequent contact with children and receiving more support from children are associated with a slower rate of cognitive decline for older parents whereas experiencing relationship strain with children is associated with a faster rate of cognitive decline for older parents. These associations are stronger for mothers than fathers. This study highlights the importance of the “linked lives” of aging parents and their children. The findings have implications for the development of interventions and strategies to protect cognitive function in later life.


It has been suggested that liberal values such as lack of autonomy and burden discourses shape the public’s relation toward people with health problems. However, previous research on the role of such values on one’s recovery and well-being is scarce.We investigated whether perceived autonomy mediates the impact of stigma and negative social experiences on life satisfaction and recovery.Our sample, drawn from a subsample of the Swiss Household Panel survey, consisted of 326 individuals reporting a mental health problem  and 354 individuals reporting a physical health issue . We tested a model where perceived autonomy, measured with four items drawn from the Acceptance of Illness Scale (AIS), mediates the impact of experienced stigma and negative social experiences on health satisfaction and self-reported recovery.Our analysis of direct and indirect paths confirmed our hypothesis. Our model showed a good fit to the data for persons with a mental health problem  and an adequate fit for persons with a physical health problem .Our results provide empirical evidence for the potentially self-stigmatizing role of the autonomy ideal for people with health problems and invite for the development of further research and practice regarding this role.No significant relationships.


Multidisciplinary management of breast cancer patients has become standard of care. It has been shown that patients managed by multidisciplinary teams have better disease outcome and better quality of life. In a large retrospective cohort study analyzing outcome data of 13,722 breast cancer patients diagnosed between 1990 and 2000 at an NHS Hospital in Scotland, it was shown that after the introduction of multidisciplinary care, breast cancer mortality was 18% lower compared to hospitals performing traditional care  and first president of the Central and Eastern European Academy of Oncology (CEEAO).The development of the final version of the texts published in this Issue of Pathology & Oncology Research followed a methodology similar to the formulation of the Hungarian Consensus Documents; i.e., the Hungarian documents –7 were tThe set of documents published in this issue of Pathology & Oncology Research –13 comprIn the first document , standarThe second document on pathology workup and reporting  includesThe third text  includesThe fourth document  summarizThe fifth document on medical oncology  describeThe sixth document gives guidance for follow up, rehabilitation and psycho-oncology  and is a


This research focuses on a current social welfare problem: unemployment and the loss of employer-based health insurance among non-elderly adults aged 18 to 64. The literature covers this social problem in terms of health status, access to medical care, employed versus unemployed working-age adults, mitigating the risks of unemployment, and loss of health insurance via the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). As good as the findings are, they are methodologically limited by looking at only half the story. This research asks a different question: how might the humanities and arts-based perspective address the social problem? It aims at answering why the employment status is related to health and health insurance. Chinese poetry has a long rich tradition of expressing insights about the inner life since antiquity to the present. These reflections include practice wisdom and keen observations on aging. This poster presents case findings on the use of Chinese poetics to inform aging care in the West. Each case provides discussions on why social welfare system comes up short to solve the problem and how the social welfare system can be effectively changed. Researchers use survey data to compliment Chinese poetic insights about employment status and insurance status to illustrate the correlation between respondents’ health status with versus without employment. Findings are hoped to interpret the role of family as a social unit where it consists in social welfare along with the speculative inquiry of poetry.


Psychiatric disorders may be one of considerable contributing factors for dry eye symptoms and the severity of subjective symptoms of dry eye are often related to psychological factors.The aim of this research was to determine which of two chosen questionnaires for subjective symptoms of dry eye (Ocular Surface Disease Index and Schein questionnaire) is more reliable in the assessment of dry eye in patients with schizophrenia.Our research included 80 patients of both sexes with schizophrenia ranging between the age of 25 and 55 who have been taking antipsychotics  for five years and were in remission. All participants were required to satisfy all included and excluded criteria. They all filled out the Schein and OSDI questionnaires for assessment of subjective symptoms. Tear break-up time test (TBUT) for objective evaluation of tear film stability was also performed. In order to determine the correlation between two subjective and objective tests we calculated Spearmans correlation coefficients.A analysis shows that there are no statistically significant differences between the correlations. Both subjective questionnaires are statistically significantly and negatively related to the TBUT test, showing that an increase in the results on the OSDI and Schein’s questionnaires led to the decreases in the results on the TBUT test.In patients with schizophrenia the OSDI and Schein questionnaires are equally reliable in the assessment of subjective symptoms of Dry eye disease. Considering that, OSDI is more common in clinical practice, it is recommended for use in patients with schizophrenia.No significant relationships.


This paper first introduces major aspects of the Japanese Act on the Prevention of Elder Abuse, including trends in substantiated elder abuse cases in both institutional and domestic settings, definitions of elder abuse, and abusers and reporting systems. It then introduces the recent amendment of operational standards in institutional settings made by ministerial ordinance. The amendment includes a requirement to develop a committee to prevent occurrence and recurrence of elder abuse and to appoint a designated individual to establish guidelines and implement training. It is hoped to further prevent elder abuse in Japan.


Currently anxiety and depression are the fourth leading cause of morbidity. Anxiety is the most common mental disorder from which 20% of the adult population suffer worldwide and has become a significant research area in the field of psychopharmacology . AnxietyMajor depressive disorder (MDD) is also one of the most common psychiatric disorders, posing serious public health problem . AccordiIn the last few decades have seen a significant rise in the use of natural remedies to treat various ailments including depression and anxiety. These products are perceived as safer alternatives to pharmacotherapy, with lower risk of adverse effects or withdrawal. Considerable efforts have been made in recent years to discover substances from natural sources particularly plants which can help prevent these serious mental disorders. Natural products are small molecules present in divergent natural sources. They are considered to possess one of the most coveted positions in the treatment of all human disorders including anxiety and depression. They are considered to be the most important source of novel drug leads . The impvia different mechanisms that may provide quick onset of action for relieving anxiety and depression symptomatology. Furthermore the newer agents may prevent the aforementioned adverse effects and provide effective treatment to the non-responsive patients to the conventional drugs.In view of the above, there is a dire need for the discovery and development of novel antidepressant agents acting This Research Topic focuses on original contributions for natural products being useful in various mental disorders particularly anxiety and their possible mechanisms of action.


Good metadata, local ownership and fair reuse of genomic and outcome data can be sustained in partnership among well‐resourced and well‐peopled regions of the world.“A Perspective in this issue recounts the endeavors of the collaborative Virus Outbreak Data Access Network (VODAN)—AfricaGenome data is cheap, plentiful, and concentrated in a few wealthy places, even relative to the information web, where less than 1% of the world's servers serve over 99% of the web content.In contrast to genome data, personal experiences including exposures and clinical records are distributed across institutions, homes, families, and individuals. Lifelong trust that sharing this information brings better outcomes for the donors is essential if we are to use this living biobank of diverse experience to make sense of variation in both viral and human genomes. Information from affected and unaffected individuals is needed to understand the importance of even point mutations in small viral genomes—such as the SARS‐CoV‐2 variants that continue to cause so much disruption and disease worldwide. Yet this data has not been gathered from places where the disruption is occurring, largely because we do not yet have collection networks with the trust and capacity to sustainably return results within the region of study.There are now several related functional technologies for linked data to deliver the aspirational goals laid out in the principles of FAIR data and services. These working together would amount to a mercantile revolution in the global data trade rather than the gold rush metaphor of the Perspective.The VODAN project has contributed to capacity building through its active interdisciplinary cooperation informatics training plan and has greatly promoted the cause of equitable autonomous and secure data ownership. However, it may be some time before the participating sites will be able both to innovate and interoperate fully on the same network in a distributed fashion as the project was originally conceived. Problems inherent in the stability of each local datastore's query protocol service and the potential for inadvertent divergence in implementation led to a tactical decision instead to use centrally provided metadata templates and mirrored storage at a secure central site (CEDAR). This redesign shows that central providers may gain sufficient trust, and partner through secure hosting and open commitment to the storage, organization and ownership of data by the participating local informatics communities across the network. The dream of building distributed capacity together across data rich and resource rich regions remains alive and compelling as ever.Myles Axton: Writing‐original draft; writing‐review & editing.


There is a critical need to grow and strengthen the pipeline of physician scientists who have expertise in sociomedical and behavioral research and are dedicated to addressing the nation's challenges posed by Alzheimer's disease and related dementias (ADRD). In 2021 The Indiana ADRD Medical Scientist Training Program (IADRD MSTP) was designed to meet this need and is built on the infrastructure of a robust portfolio of ADRD research, graduate training programs in medical neurosciences and sociology, and our existing MD-PhD program at Indiana University School of Medicine. The Aims of the IADRD MSTP are: 1) To recruit and train a competitive pool of diverse students who have an interest and commitment to social and behavioral research and patient care focused on ADRD; 2) To engage MD-PhD students early in mentored sociomedical and behavioral research that integrates IUs systems-based medical training curriculum with our cutting edge ADRD research that reinforces commitment and minimizes attrition of physician-scientists ADRD; and 3) To graduate students with dual MD-PhD degrees with strong methodological training in social and behavioral science and experts in ADRD who will be successful independent investigators at the best academic medical centers nationwide. The program includes rigorous didactic training in social, behavioral, and clinical research methods, with flexibility to allow students to focus their effort on one methodological area of interest; early initiation of ADRD research experiences with multidisciplinary teams of mentors and advisors; and the provision of educational experiences that enhance students' abilities to become independent researchers.


A physicians work is closely related to patients and the understanding of their problems. The use of psychotherapeutic methods is a factor for successful care . At the same time burnout is a syndrome that can affect the health of doctors themselves thus reflecting on the quality of care they can provide .To investigate the use of psychotherapeutic methods in family physicians work in Latvia and the association between burnout rates and the use of these methods in practice as well as different demographic and work-related factors.A cross sectional study was carried out. An anonymous online form that contained questions about the demographic data, psychotherapeutic methods/techniques mastering and usage and questions from the Maslach Burnout Inventory was sent out to the publicly available email addresses of family physicians in Latvia. The collected data was analyzed using Microsoft Excel and IBM SPSS software.Together 54 responses were received from all regions of Latvia. The analysis found association between work hours per week, patients seen per week, usage of psychotherapeutic methods and burnout. More hours per week was associated with higher rates of depersonalization  and burnout . More patients per week was associated with higher rates of burnout . Being unsure if they were using any psychotherapeutic methods was associated with higher rates of depersonalization .The data obtained allows a better insight in to the usage of psychotherapeutic methods, everyday work and the association with burnout rates in family physicians.


This article has been retracted: Aging has completed its investigation of this paper. We found overlap between some transwell assay images used for Figures 3G and 6E and data previously published by different authors. The authors confirmed the overlap and also raised a concern that the statistical methods used for some analyses were inappropriate. As a result, all of the listed authors agreed that the article should be retracted.The Administration of the First Affiliated Hospital of Xinxiang Medical University was notified about the retraction by Aging Journal. The Ethics Committee of The First Affiliated Hospital of Xinxiang Medical University agreed that this paper should be retracted because the errors in the statistical methods led to an insufficiently rigorous analysis of the results and because of the improper use of several pictures included in this manuscript. The authors deeply regret any inconvenience this publication has caused for the scientific community.


Pogostemon cablin Benth) using a microwave air-hydrodistillation method as a new green technique’ by Heri Septya Kusuma et al., RSC Adv., 2017, 7, 1336–1347.Expression of concern for ‘The extraction of essential oils from patchouli leaves ( RSC Advances is publishing this expression of concern in order to alert our readers that we are presently unsure of the reliability of the data reported in the article.Periodica Polytechnica Chemical Engineering, 2017, 61, 82–92), which has not been cited in this RSC Advances paper. The reproducibility seen between the GCMS data in these two papers is very unlikely. The authors have been unable to provide raw GCMS data for the measurements presented in the RSC Advances article.The Royal Society of Chemistry has been provided with credible information suggesting that the GCMS results presented in the paper may not be reliable. The majority of the microwave hydrodistillation (MHD) GCMS data presented in Table 5 has been reproduced from a previously published paper by the authors (The Royal Society of Chemistry is currently seeking support from the affiliated institution in order to investigate this matter and establish whether the reported results are reliable. An expression of concern will continue to be associated with this manuscript until we receive information from the institution on this matter.Andrew Shore19th November 2018RSC AdvancesExecutive Editor,


Older adults living with chronic illnesses, such as diabetes, cancer and heart disease, have an increased risk of poor mental health outcomes. While a link between living with chronic illness and depression have been examined in previous studies, relatively little is known about factors that increase and decrease the risk of suicidal ideation among older adults living with chronic illness. Using data from the third wave of the Midlife in the United States (MIDUS) database, we examined the relationship between living with a chronic illness were more likely to endorse thinking about death in the previous two weeks . The analysis also revealed that the likelihood of suicidal ideation in the previous two weeks increased with the number of chronic conditions reported by participants . The results of this study are consistent with previous studies suggesting a relationship between older adults living with a chronic condition are at a higher risk of suicidal ideation. Findings from this study can help inform intervention development to support mental health of older adults living with chronic illness. Future studies are needed to examine additional psychosocial factors that may mediate the relationship between living with a chronic illness and suicidal ideation among older adults.


Alzheimer’s Disease and Related Dementias (ADRD) affect one in nine adults aged 65 and over. Past research has demonstrated the need for services that improve quality of care for those with ADRD and their caregivers. Those with ADRD are at a greater risk for negative health outcomes. Therefore, it is crucial that those with ADRD receive care consistent with their preferences. However, more research is needed to shed light on effective tools available and patterns of advance care planning (ACP) when it comes to those with ADRD and their caregivers. This symposium highlights the landscape of ACP communication among those with ADRD and their caregivers. The session begins with a study that explored experiences of apathy and preferences for dyadic-communication via mobile health  among adults with mild cognitive impairment and their care-partners. The second presentation demonstrates the feasibility and effectiveness of a palliative care education in assisted living program for nurses and administrators on increasing ACP discussions with family caregivers of residents with dementia. The third presentation investigates ACP among African Americans with ADRD and their caregivers and the critical role the community can play in facilitating communication. The final presentation explores how ACP differs by race, ethnicity and ADRD status using data from the 2018 Wave of the Health and Retirement Study. Future directions for implementation of these innovations for improving ACP communication among caregivers and persons with ADRD will be discussed.


To continue to monitor trends in detentions under the Mental Health Act based on race, age, gender, and sexuality during the COVID-19 Pandemic to consider if there were any specific areas that would need to be addressed.We investigated available mental health detention documents stored in mental health legislative office, Birmingham and Solihull mental health foundation NHS Trust.We found that detentions under Section 3 of the Mental Health Act have increased very gradually over the last three years (2018 to2021). However, there has been gradual reduction in detentions under Section 3 within the white population beginning in 2019 and continuing with a marked acceleration in reduction during the two peaks of the pandemic. This is marked in the 66yrs plus age group. As the pandemic has eased this reduction has stopped and reversed with increased section 3 admissions in last few months in this population. The detentions in the black and Asian population have followed a reverse pattern, with marked increase during the pandemic peaks in 2020/2021 and a marked fall as the pandemic has eased.Mental health act detention data during the Pandemic shows that the pandemic has disproportionality impacted black and Asian population of all ages and Elderly white population.During the pandemic there has been a marked increase in detentions under Section 3 of the Mental Health Act (for treatment) in the Black and Asian population with a marked reduction in the white population. This difference is stark in the working age population.The need for a well-functioning community based health and social care offer to reduce detentions in the black and Asian population.Return of admissions under the mental health act of white elderly post vaccination (which are vast majority white) shows a reversal of the trend of this group not accessing inpatient treatment fully during the pandemic.This highlights:Community Treatment Order (CTO) detentions in the Black and Asian population continue to increase through the pandemic disproportionatelyThere is no material change during the pandemic, in short term detentions ) or other inpatient detentions under the Mental health actThere are no significant trend changes noted based on gender or sexuality or age during the pandemic in BSMHFT .


Cross-border health data sharing is essential to facilitate vital health research into new treatments and to improve patient care and safety across Europe. The flagship European Health Data Space (EHDS) aims to promote better exchange and access to health data through the creation of a European-wide infrastructure. However, significant barriers to cross-border data sharing must first be resolved in order to fully ensure the successful functioning of the Data Space. To this end, the European Commission established a Joint Action (TEHDAS), as the policy development tool for the development of the EHDS. This presentation will be based around the findings of the recent TEHDAS report ‘Barriers to cross-border sharing of health data for secondary use and options to overcome them.’ The report draws on the results of a dedicated literature review, 133 case studies from across 23 countries and expert interviews to identify the primary barriers to cross-border data sharing and options to overcome these from the perspective of European data users (research and policymakers). The session will start with a concise presentation of the report methodology. The research team will then deliver an interactive presentation, in which they succinctly outline each barrier and policy option and ask participants to vote for their preferred policy option to overcome each barrier identified. EUPHA participants votes will inform the final TEHDAS recommendations on mitigations and solutions for barriers to cross-border data sharing which will be submitted to the European Commission for incorporation in the European Health Data Space legislative proposal.


As a part of continuous destigmatization of mental illness and paople with mental disorders significant importance has media reporting, especially in modern times.Media reports about mental health (MH) are still an issue of a great discussion concerning their content especially in ethical matters. Many initiatives in different countries resulted in various changes in attitudes and influenced on this topic. But the image of mental illness as well as psychiatry in general are still burdened with the shadow of stigma.To show development of one of initiatives in Bosnia and Herzegovina (BH) supported by policy makers through the creation and broad distribution of recommendations for ethical media reporting about mental disorders.In 2019 Task Force appointed by both entities’ ministries of health in BH developed an publication with recommendation for ethical reporting about mental health topics with special highlights on specific mental disorders . It was widely distributed to media and health institutions in the country and was officially adopted as the recommendation of the national Regulatory Agency for Media. Trough five rounds of educational workshops in 2019 and 2021 more than 150 media and mental health professionals were introduced with the publication as well as practical implementation of this recommendations (as is exercises of giving statement).In BH is developed very useful tool for more quality media reporting about MH topics as one of important ways for reducing the stigma and discrimination of people with mental disorders as well as promotion of good mental healthNo significant relationships.


There has been an increasing focus on the importance of national policy to address population levels of physical inactivity. It has been suggested that the four ?cornerstones' of policy comprise: 1) national guidelines on physical activity levels; 2) setting population goals and targets; 3) surveillance or health monitoring systems; and 4) public education. The aim of the current paper was to analyse the policy actions which have addressed each of these elements for children and youth in England and to identify areas of progress and remaining challenges.A literature search was undertaken to identify past and present documents relevant to physical activity policy for children and youth in England. Each document was analysed to identify content relevant to the four ?cornerstones' of policy.Physical activity guidelines for children and youth have been in place since 1998 and reviewed periodically to ensure they reflect the latest scientific evidence. The setting of physical activity targets has focused on the provision of opportunities for physical activity, particularly through physical education (PE) in schools, rather than in relation to the proportion of children meeting recommended physical activity levels. There has been much surveillance of children's physical activity but this has been undertaken infrequently over time, by a wide range of organisations, and with varying inclusion of different domains of activity such as school PE, leisure time activity and active travel. There has only been one campaign in England targeted at children and their intermediaries (Change4Life), which was an obesity campaign focussing on dietary behaviour in combination with physical activity. Most recently an infographic supporting the physical activity guidelines for children and young people was developed, but details of its dissemination and usage are unknown.There have been many developments in physical activity policy in England targeted at children and youth. The area of greatest progress is national physical activity guidelines. Establishing prevalence targets, streamlining surveillance systems, and investing in public education would strengthen national policy efforts to reduce physical inactivity.


Digital infrastructure and connectivity is layered and requires a number of defined viewpoints in order for safe data flow and use to occur. To address context specific challenges to support communication in health and social care, health informatics standards supporting interoperability are key. In this skills building seminar we will introduce participants to a standards based roadmap for interoperability. We will provide examples of projects and resources detailing the process of engagement to optimise system design for sustainability through a use case based approach.


Intergenerational relationships have been present features in texts from the American literary canon that often problematizes the intersections of age and gender. This paper investigates how representations of intergenerationality provide the opportunity to explore the concepts of relationality and intersectionality through a feminist lens. Maierhofer’s concept of anocriticism was used in in the analysis of Julia Alvarez’ In the Time of the Butterflies (1994) and Yaa Gyasi’s novel Homegoing (2016) to validate individual experiences of gendered ageing. This paper presents ways in which this particular intersection can be viewed as a potential site of resistance towards what it means to grow old as a woman. Placing literature in a cultural, social, and political context, traditional paradigms can be reconstructed and heteronormative assumptions of age and gender can be deconstructed by focusing on the individual narratives and their potential for resistance.


Owens  In order to avoid misleading readers, the sentence on page 35448 “The same clean disposable plastic nozzles have previously been used by Babel and Rudolph,The Royal Society of Chemistry apologises for these errors and any consequent inconvenience to authors and readers.


Cell cycle checkpoints are surveillance mechanisms in eukaryotic cells that monitor the condition of the cell, repair cellular damages, and allow the cell to progress through the various phases of the cell cycle when conditions become favorable. Recent advances in stem cell biology highlight a mitochondrial metabolic checkpoint that is essential for stem cells to return to the quiescent state. As quiescent stem cells enter the cell cycle, mitochondrial biogenesis is induced and mitochondrial stress is increased. Mitochondrial unfolded protein response and mitochondrial oxidative stress response are activated to alleviate stresses and allow stem cells to exit the cell cycle and return to quiescence. These processes are critically regulated by several sirtuin family members, which are NAD+-dependent deacetylases. Because loss of stem cell quiescence results in the depletion of the stem cell pool and compromised tissue regeneration, deciphering the molecular mechanisms that regulate the mitochondrial metabolic checkpoint in stem cells will increase our understanding of tissue homeostasis and how it becomes dysregulated under pathological conditions and during aging. More broadly, this knowledge is instrumental for understanding the maintenance of cells that convert between quiescence and proliferation to support their physiological functions.


For the study, the animals were observed exclusively by video cameras and no manipulations of the animals were necessary. Therefore, ethical approval for animal experimentation by an institutional animal care and use committee was not considered necessary in our jurisdiction.”The animal ethics statement on page 218 should be revised as follows (addition in bold): “This study was conducted on a commercial Austrian dairy farm in May 2019. The farmer gave his informed consent to the use of the accelerometer data and video recordings of his animals.


A thread common to all disasters is the effect on human health that results when the health care infrastructure and delivery of health services are disrupted. This view has reinforced the importance of an all “all-hazards approach” to preparedness, whereby disaster response planning incorporates principles common to all events and can be adapted to specific contingencies. Preparing for and responding to a disaster in long-term care (LTC) requires a broad view of multiple events that can disrupt daily life and needed services for LTC residents . This symposium will examine the effects of varied emergency events on older adults residing in nursing homes (NHs) and assisted living communities (ALCs) using quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Harvey (Texas). The second is an investigation of NH direct care staffing during the recent Winter Storm Uri (Texas). The third presentation qualitatively explores the challenges of providing care to residents living with dementia during the COVID-19 pandemic, based on interviews with Florida NH and ALC administrators. The fourth quantitatively and qualitatively explores issues related to resident-to-resident contact restrictions in Florida ALCs. Finally, we will discuss the application of the 4Ms Age Friendly framework  to disaster preparedness in LTC. This symposium will provide information that can be used to develop or revise public policies to improve preparedness for and response to a range of emergency events in NHs and ALCs.


Cultural barriers and prejudices of mental healthcare professionals may promote inequalities in the provision of care to immigrant population and have a negative impact in provided service quality.To identify barriers and facilitators of immigrants’ accessibility to mental health services.A literature review has been made through PubMed database.Immigrants’ accessibility to mental health services may be related to social insurance problems, inadequate knowledge about their health rights, inadequate knowledge of the local language, as well as the bureaucracy of Greek State which may complicate mental health examination and treatment. The challenges faced by mental healthcare professionals in terms of diagnosis and treatment of migrants include communication difficulties due to linguistic and cultural differences as far as verbal presentation of symptoms and illness behavior is concerned. Culturally competent mental health professionals should work to erase racism and prejudice, to be familiar with cultural issues and have adequate knowledge related to cultural groups, to learn the life story of each patient separately and encourage patients to explain how their illness affects their lives, promoting a trustful communication environment in the context of healthcare provision.Exploring the specific needs of migrants as well as assessing the degree of satisfaction from their access to healthcare services are essential to providing integrated mental health care for people from different culture.No significant relationships.


The authors have provided the original correct data for 0.03 MPa.The Royal Society of Chemistry has asked the affiliated institution (Tianjin University) to investigate this matter and confirm the integrity and reliability of the new data and figures provided.An expression of concern will continue to be associated with this manuscript until we receive information from the institution on this matter.Laura Fisher10th November 2022RSC AdvancesExecutive Editor,


This presentation gives a real world and compelling picture of the abuse of older adults, with authors representing three different World Health Regions  each locating the problem within an area’s historic and present societal treatment of older persons. An actual and emblematic case study of the abuse of an older adult will frame each presentation. Presenters will synthesize empirical data and research on the problem, explaining its usefulness and limitations as well as guiding frameworks utilized to address the problem, highlighting efforts of leading figures in each area or region who are addressing the problem and explaining existing policies and future initiatives to address the abuse of older adults. Dr. Eniola Cadmus will present perspectives on elder abuse in Nigeria. Drs. Noriko Tskudada and Asako Katsumata and will present perspectives from Japan. Drs. Farida Ejaz and Mala Shankardass will present perspectives from India. Dr. Georgia Anezberger will tie together the differences and commonalities within each region drawing upon a holistic and person-centered picture of the issue and problem of elder abuse.


Medical educators and representatives of medical student associations in Australia and New Zealand are collaborating on an initiative on climate change and health in medical educationClimate change and environmental degradation are harming the health of Australians and New Zealanders and pose a serious challenge to our health care systems.Australia and New Zealand have accreditation standards for the education of the regulated health professions. For the medical profession in Australia and New Zealand, standards are maintained by the Australian Medical Council (AMC), including for the 23 university medical schools offering medical programs.A Working Group on Climate Change and Health was formed when medical educators from several Australian medical schools submitted a proposal to the Medical Deans Australia and New Zealand Medical Education Collaborative Committee that it explore the development of model learning objectives and learning resources regarding the impact of climate change on health.▪the evidence for anthropogenic climate change and how this relates to the environmental determinants of health;▪the impact of climate change on health;▪the impact of climate change on the health system;▪the environmental impact of the health sector and the elements of environmentally sustainable health care; and▪creating change, both intra‐ and inter‐sectorally, through practice, advocacy and leadership.To examine current environmentally sustainable health care education, the Working Group searched the literature, reviewed teaching experience, and benchmarked against relevant courses developed for medical students, including those developed by students for their peers.The current 2012 AMC graduate outcome statements were mapped against these five areas to determine whether they were sufficient or whether amendments or new statements were required. A minimal change approach was adopted, mirroring changes to the accreditation standards adopted in 2018 by the United Kingdom General Medical Council.The Working Group considered that, by focusing on the environment as a determinant of health, climate change would be addressed. As sustainable health care in Australia usually refers to financial sustainability, to avoid confusion, the term environmental sustainability is used. The amendments proposed by the Working Group also introduce the concept that decisions taken today in the care of patients and populations should not compromise the health of future generations.The proposed amendments to the graduate outcome statements represent modest changes to the existing statements. Fourteen statements were identified: ten were modified to be aligned and four did not require amendment. Statements have been identified in all four AMC domains of practice. The Box 1Learning objectives regarding climate change and health in medical and health professional education that support each statement have been identified from recently published literature.The proposed graduate outcome statements and learning objectives were circulated to the Deans of all medical schools in August 2018 for further consideration and as a potential curriculum resource when considering curriculum review. Resourcing changes to curricula is a major hurdle to the successful implementation of change.https://www.amc.org.au/review‐of‐accreditation‐standards‐for‐primary‐medical‐programs‐medical‐schools/). A submission has been provided to the consultation by the authors.However, the suggested amendments will only be sustained and embedded into practice across Australia and New Zealand if they are adopted by the AMC and become part of the Standards for Assessment and Accreditation of Primary Medical Programs. A review by the AMC of the accreditation standards for primary medical programs opened in 2021 and the consultation process for this review continues in 2022 (MJA–Lancet Countdown report aims to report an indicator describing progress on the inclusion of environmental sustainability and the health impacts of climate change in medical curricula in Australia.From 2023, the annual Medical educators internationally and other health professions in Australia have shown strong interest in this collaborative approach to aligning the education of health professional graduates with environmentally sustainable health care.Through this initiative, the collaboration of medical educators and medical student associations in Australasia has shared with all medical schools an approach to incorporating the health effects of climate change and the environmental impact of health care within medical curricula. The work is stimulating a dialogue within faculties and among medical students. The process recognises the essential contribution of the AMC Standards to secure and drive these changes to prepare medical graduates to practise environmentally sustainable health care. Amending the AMC graduate outcome statements to frame curricula change, and working through the network of medical schools, enables system level change in medical curricula. New patterns of disease are already emerging and medical practice is evolving as health care systems are challenged to become more environmentally sustainable; doctors and other health professionals are increasingly using their influence to help society transition to an environmentally sustainable future. Health educators have an essential part to play in preparing future doctors for these roles.The statements or opinions expressed in this article reflect the views of the authors and do not represent the opinion or policies of Medical Deans Australia and New Zealand Inc.No relevant disclosures.Commissioned; externally peer reviewed.


Dementia is one of the major age-related societal challenges and causes enormous demands for persons living with dementia (PlwD) and their families. We do not understand the origins of this multifactorial syndrome and there is still no cure for dementia. New thinking by the exploration of paradigms has scope to improve knowledge about this complex condition. Social health can be understood as a driver for stimulating the use of cognitive reserve through active facilitation and utilization of the individual’s capacities. It allows to slow cognitive impairment or to maintain cognitive functioning in old age and therefore seems to be a promising approach to a better understanding of the developmental mechanism of dementia.In this international symposium we therefore aim to explore the role of social health in the onset and progress of dementia. The first presentation will present a new framework on understanding social health in dementia. The second presentation will describe convoys of care in a family based culturally sensitive ADRD caregiving intervention reducing care burden and family conflicts. The third presentation reports on the role of immune system and neurodegeneration markers in the association between social health and cognitive brain aging in older adults. The final presentation presents newly derived results from a mixed research synthesis on underlying mechanisms of the interrelation of social health and cognitive functioning, elaborated by the international SHARED-consortium. Our discussant will synthesize the research findings and lead a discussion of future directions for research and practice to successfully fight challenges in dementia care.


Implantable hemodynamic monitoring may be considered a milestone in the management of patients supported by LVAD because monitoring may dramatically improve the prognosis of these patients.18.See Article page Heart failure is an advanced disease with an increasing influence on patient quality life, and the health system. These patients become increasingly frail and hemodynamically more unstable.These factors are major causes of repeat hospitalizations and influence a patient's life by being associated with poor prognosis, poor quality of life, and reduced life expectancy. In advanced and extreme conditions (Intermacs stage 2 or 3), these patients no longer respond to medical therapy and are often kept hospitalized to undergo intensive medical treatment with intravenous inotropic drugs while waiting to undergo heart transplantation or left ventricular assist device (LVAD) implant. During the past decade, more and more attention has been paid to the use of continuous remote implantable hemodynamic monitor (IHM) to prevent both rapid deterioration of the hemodynamic parameters of patients with heart failure (HF) and to monitor continuously the course of patients assisted with LVADs. There is an increasing interest in the use of a wireless IHM  in these patients because the CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients randomized trial demonstrated an advantage of this device in reducing significantly the rate of readmission compared with patients without a device .,CardioMEMS is positioned in 1 pulmonary artery branch during right heart catheterization and measures the pulmonary artery pressure and the filling pressures. It works according to the hypothesis that filling pressures will increase before other signs of decompensated HF occur. In addition, the usefulness of CardioMEMS is also likely to be found in patients with an LVAD. A decrease in filling pressures recorded by the device is frequent in situations such as hypovolemia and hemorrhage, whereas an increase in filling pressures is often associated with increased pulmonary congestion  and in case of cardiac tamponade. Moreover, patients with fixed pulmonary hypertension before LVAD implant can be carefully monitored to verify the trend of pulmonary pressure during LVAD therapy to consider the patient eligible for heart transplant.Lampert and TeutebergCardioMEMS represents a promising tool and should be considered a cornerstone in the continuous monitoring of patients with HF and those assisted with an LVAD, especially because it could improve their prognosis.


As people age, they find themselves living similar lives to those around them. This concept is often referred to as linked lives. Linked lives explains that individual lives are often interdependent. This is due to various elements such as social and historical influences. These influences can imprint networks of shared relationships. Researchers have found that the first point of socialization as humans are social relationships with family and friends. However, while the connections of linked lives are often attributed to early life course trajectories, little research has evaluated the interdependency that is created with disabilities in later life. Life course disability research is a key factor of gerontology because a majority of older adults encounter disabilities within later life. This attributed disability can often forge bound and interdependence within people and their own social networks. This paper theoretically examines different perspectives of disabilities research and how it relates to the fundamental principles of linked lives. This paper highlights the gap in the current gerontological understanding of the later life links among older adults with disabilities. This theory paper provides the needed information for gerontologist focusing on older people with disabilities to be able to evaluate allocations needed for providing adequate social support and services tailored towards the needs of these interdependent lives.


Highlighting the intersectionalities between different markers of diversity and health inequities encourages the reconsideration of normativities in public health (PH). We developed an open access collection of syllabi on the relevance of intersectionality and diversity in PH together with the Association of Schools of Public Health in the European Region (ASPHER).We developed the syllabi in a participatory, iterative process guided by transformative teaching pedagogy. We reflect on this process and how this can inform the enhancement of the syllabi themselves, as well as future curriculum development.We recruited a core group of 9 PH researchers, teachers and professionals from all career levels from participants of introductory session presentations in different settings . The core group met once a month for one year online, and each meeting took the form of co-working sessions in breakout rooms to develop the syllabi based on interest and expertise. We designed a qualitative online survey to evaluate and ensure the scientific rigor and pedagogical value of the syllabi. We invited critical and constructive input from ASPHER member school professionals with expertise in intersectionality, diversity or curriculum development in PH in terms of content and pedagogy.Drawing from the expertise of the PH community we combined diverse professional and cultural backgrounds, experiences from different career levels and PH education systems, as well as specialisation in the PH field. The transformative pedagogical approach was considered particularly valuable in strengthening competences such as reflexive strategies and self-, social- and global awareness which are key to teaching on diversity and intersectionality issues. The peer-review structure supports the uptake in PH education and a sustainable implementation. The collection will also allow PH faculty to diversify their pedagogical approaches.• Inclusion of health inequities, diversity and social injustice issues is crucial in public health curricula, since an intersectional perspective is increasingly acknowledged in public health research.• The syllabi collection will equip public health teachers of all career levels to develop their own course material on social identities and their significance for public health.


Social isolation is an important predictor of mortality and morbidity in older persons. The increase in social isolation is often a result of major life events such as retirement, leading to the loss of social connections. The effects of the pandemic have exacerbated the loss of social connectedness. Measures to ensure social distancing have made technologies like voice and video calling, text messaging, and other phone mediated communication important resources for connecting people. Measuring social isolation often requires periodic administration of a paper survey instrument, like the Lubben Social Network Scale (LSNS). The approach was taken by Lubben for predicting a person’s social isolation level typically involves looking at their general frequency of interactions with family and friends along with the specific frequencies of private, tentative discussions happening during those interactions. This paper explores the process used to develop a tool to measure social isolation continuously and automatically by using an older person’s frequency and tone of telephonic conversations. We categorized a person’s family and friends into three sub-categories based on the self-reported level of closeness shared with them. We then analyzed the person’s conversation (content and tones). Lastly, we trained the deep learning model (Watson) using these captured tone values to determine the social isolation index of the individual. Our preliminary results indicate that we are able to correctly predict their degree of social isolation as judged by Lubben’s scale using their phone conversations. This technology may be promising for the assessment and intervention of social isolation.


To analyse the linked dataset between England and Wales 2021 Census/Census Coverage Survey and the Demographic Index (DI), would provide insights on quality and coverage, enabling improvements of using admin data to form population/ household estimates for future linkages and to evidence additional admin sources needed to capture the population.The DI is a composite dataset made up of several linked admin sources. Therefore, the linked output is complex, made up of clusters where individual sources within the clusters have been linked to the Census using the different available information across sources. To carry out the analysis, a flagging strategy has been designed to enable analysts to form cuts of the linked dataset that are specific to their research needs. High level research questions have been designed to provide fast paced analysis to inform the National Statistician’s 2023 recommendation on the need for a future Census.Providing insight into how to improve the current linkage methodology of the DIHow we use the DI to construct Statistical Population Datasets Identifying the extent of over and under coverage in the Statistical Population Datasets, allowing development of an appropriate estimation strategy to more accurately estimate the populationThe results will also inform how we utilise linked composite data sources in the future, as we can share the lessons learnt in how we planned to use the data, including our flagging strategy verses the reality faced when undertaking the analysis.This analysis will inform approaches to using linked composite data in the future but also provide a wealth of knowledge including: informing linkage methods, defining the population estimation challenge and providing insights into how we deliver admin based population estimates.


Middleton reflects on ASPHER’s achievements related to ensuring a vibrant multidisciplinary public health workforce now that he is reaching the end of his term as President for that organization. Finally, Barnhoorn and Busse describe the plenary programme of the European Public Health Conference that will take place 9–12 November 2022 in Berlin. Topics range from financial protection and the European Health Data Space to health system performance assessment and health promotion.In this edition of European Public Health News, we will reflect on past achievements and how we build on those for upcoming activities. In my first EUPHA office column I describe the busy yet exciting autumn the EUPHA team has ahead of them and highlight some of our main plans. Kluge


Covid-19 pandemic has affected early career psychiatrists (ECP) and psychiatric trainees significantly. Child and Adolescent Psychiatry (CAP) specialists and trainees have a particular position in the pandemic as redeployments to adult units are possibly more disorientating for these psychiatrists normally working in paediatric settings. Redeployments and abrupt but potentially permanent changes to the delivery of service and training are explored via the Covid-19 and Early Career Psychiatrists survey which was prepared and disseminated by the EPA ECP Committee and the European Federation of Psychiatric Trainees (EFPT). The CAP related data from the survey will be discussed in this presentation and the implications on the future of CAP will be considered with particular emphasis on training.No significant relationships.


A considerable percentage of Health Care Workers (HCW) have experienced psychological distress during the COVID-19 pandemic. Data from previous pandemics suggest that HCW might develop psychiatric disorders. Psychosocial and workplace measures can improve mental wellbeing of the MHW. As part of the program of the Hospital to give support to the HCW, five support weekly open dynamic groups have been carried out with HCW from the COVID Areas of our Hospital including the ICUIdentify recurrent contents in the group that express areas ofconcern Identify HCW in risk of develop a psuchiatric disorder and refer them to their apropiate level oThe sessions were carried out in a freely open group and the contents expressed in the sessions were recorded and analyzed ina narrative way. Special attention was given to the the more stresfull activities identified, to Signs of overload and to the ability to seek relief, as well as signs of disruption of personal life outside of work. Four sessions of 90 minutes, with staff of the same area were established and after these four sessions booster sessions was offered through continuity groups to members with need of more long term care as well as individual care.The recurrent areas identified were Concern about inadequite Personal Protective Equipment Concern about spreading the infection in their own families Need for relief and avoid double turn Uncertainty about the course of the illness Exposure to patients suffering and dyingHCW need nor only psychological support but also pragmatic measuresNo significant relationships.


Caring for an individual with dementia may result in caregiver stress and burden , which can lead to detrimental health outcomes if not managed with effective coping skills and support . Access to support and psychoeducation is limited in rural and frontier communities, and solutions are needed to reach caregivers across sparsely populated regions. Project ECHO  is an evidence-based model designed to improve patient outcomes through healthcare provider education. The Wyoming Dementia Together Caregiver Network is the first of its kind to adapt the ECHO model for family caregivers of persons with dementia. This presentation details evaluation results of 24 session across 52 weeks (n=162). Results suggest that adaptation of Project ECHO for family caregivers is feasible and palatable. In addition, the adapted program shows promise for improving caregiver outcomes such as depressive symptoms and caregiver burden.


Schizophrenia (SCH) and bipolar affective disorder (BP) are complex disorders that overlapping both in their clinical symptoms and certain familiar characteristics. They share some common characteristcs but there are also key differences. The frequency of overlapping symptoms between these diseases could give us more information about the current validity of the diagnosis based on existing diagnostic criteria. Similarities within and between these two disorders in the future, can possibly redefine greater reliability of diagnosis.The aim of the study was to investigate the frequency of overlapping symptoms between BP and SCH.The sample included 159 patients diagnosed with SCH and 61 with BP who were followed over a two year period. The research was conducted at the UCCS Psychiatric Clinic. Assessment of clinical symptoms and diagnosis were performed using a structured clinical interview (SCID I), a list of operationalized criteria (OPSCRIT), a scale for the assessment of positive and negative symptoms (PANSS), a scale for the assessment of manic symptoms (YMRS).The overall PANSS score was significantly higher in patients with SCH compared to patients with BP, but on the general psychopatology there are no significant differences betwen SCH and BP. Symptoms of mania are significantly more pronounced in patients with BP compared to those with SCH.Our results of overlapping of individual symptoms between SCH and BP can speak infavor of the theory of disease continuum. And can also help us in understanding symptoms and guide us to develop optimal treatment strategies.No significant relationships.


Due to the increasing costs of Medicaid and Medicare and concerns about how these two programs fail to work together to deliver quality care, there has been a growing enthusiasm for integrated care programs. The Financial Alignment Initiatives (FAI), implemented by the Centers for Medicare and Medicaid Services (CMS) in 2011 and tested in 13 states were designed to test the impacts of a program that offers Medicare and Medicaid services under one organization to individuals who are dually eligible for both programs. Previous studies of the expansion of managed long-term services have generated considerable interest over the last two decades however, research results have been mixed. There is also limited information about the implementation of these efforts, as demonstrations have served varying target populations with very different intervention strategies. The lack of conclusive results means that states, now faced with decisions about continued implementation of these initiatives do not have good information to make sound policy decisions. The national evaluation of the FAI states did not include Medicaid costs. Our study is designed to gain a better understanding of Ohio’s FAI MyCare Demonstration. This symposium provides data from a comprehensive impact analysis that examined both Medicaid and Medicare claims data using a difference- in- differences treatment and comparison analysis  and an in-depth process evaluation (using interviews with 487 participants) to gain an understanding of program effects. After reviewing results the symposium will discuss the future of these and other reform efforts to integrate Medicaid and Medicare services.