Strategic Institutions Research Articles

Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK.

Studies report a strong impact of the COVID-19 pandemic and related stressors on the mental well-being of the general population. In this paper, we investigated whether COVID-19 related concerns and social adversity affected schizotypal traits, anxiety, and depression using structural equational modelling. In mediation analyses, we furthermore explored whether these associations were mediated by healthy (sleep and physical exercise) or unhealthy behaviours (drug and alcohol consumption, excessive media use). We assessed schizotypy, depression, and anxiety as well as healthy and unhealthy behaviours and a wide range of sociodemographic scores using online surveys from residents of Germany and the United Kingdom over 1 year during the COVID-19 pandemic. Four independent samples were collected (April/May 2020: N=781, September/October 2020: N=498, January/February 2021: N=544, May 2021: N=486). The degree of schizotypy was measured using the Schizotypal Personality Questionnaire (SPQ), anxiety, and depression symptoms were surveyed with the Symptom Checklist (SCL-27), and healthy and unhealthy behaviours were assessed with the Coronavirus Health Impact Survey (CRISIS). Structural equation models were used to consider the influence of COVID-19 related concerns and social adversity on depressive and anxiety-related symptoms and schizotypal traits in relation to certain healthy (sleep and exercise) and unhealthy behaviours (alcohol and drug consumption, excessive media use). The results revealed that COVID-19 related life concerns were significantly associated with schizotypy in the September/October 2020 and May 2021 surveys, with anxiety in the September/October 2020, January/February 2021, and May 2021 surveys, and with depressive symptoms in all surveys. Social adversity significantly affected the expression of schizotypal traits and depressive and anxiety symptoms in all four surveys. Importantly, we found that excessive media consumption (>4 hr per day) fully mediated the relationship between COVID-19 related life concerns and schizotypal traits in the January/February 2021 survey. Furthermore, several of the surveys showed that excessive media consumption was associated with increased depressive and anxiety-related symptoms in people burdened by COVID-19 related life. The ongoing uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being and especially the expression of schizotypal traits. The negative impact is further boosted by excessive media consumption, which is especially critical for people with high schizotypal traits. FK received funding from the European Union's Horizon 2020 (Grant number 754,462). SN received funding from the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health, Toronto, Canada and the Wellcome Trust Institutional Strategic Support Fund from the University of Cambridge.

The DCA Methodology To Institutional Strategic Planning

يسعى هذا البحث إلى دراسة العلاقة والأثر لمنهجية (DCA) على التخطيط الإستراتيجي المؤسسي كأداة من أدوات وأساليب التخطيط الإستراتيجي الحديثة وكيفية إستخدامها في رسم الخطط المستقبلية الفاعلة والمؤثرة للمنظمات في عالم الأعمال عموماً ومنظمات القطاع العام والمؤسسات الحكومية خصوصاً .
 استمد البحث مادته العلمية والعملية من إعداد خطة إستراتيجية بكامل عناصرها على أرض الواقع لأحدى المؤسسات الحكومية الخدمية (مديرية طرق وجسور كربلاء المقدسة) التي أعتمدها الباحثان كعينة بحثية ونموذج تطبيقي لإستخدام منهجية (DCA) للتخطيط الإستراتيجي المؤسسي ، يعتمد البحث المنهج الوصفي التحليلي ، أشتملت عينة البحث على كافة الموظفين والموظفات من حملة شهادة البكالوريوس فما فوق من العاملين في تلك المديرية في جميع الشُعب والوحدات الإدارية فيها والذين تم إستبيان رأيهم بواسطة أداة القياس (الإستبانة) التي تم إعدادها وتحكيمها للحصول على البيانات اللازمة لدراسة هذين المتغيرين بأبعادهما المتعددة .
 أستخدم البحث العديد من الأدوات والوسائل الإحصائية لتحليل البيانات للحصول على النتائج ، حيث تم إستخدام برنامج (SPSS V.24) وبرنامج (SmartPLS V.3.2.2) للقيام بوصف وتحليل البيانات التي تم الحصول عليها من العينة المبحوثة لقياس وتشخيص العلاقات ما بين متغيرات وأبعاد البحث والإختبارات الإحصائية اللازمة لإنجاز البحث .
 توصل البحث إلى عدة إستنتاجات أبرزها إن إستخدام المنهجيات الحديثة للتخطيط الإستراتيجي المؤسسي مثل منهجية (DCA) يساهم بشكل كبير وواضح وملموس في تطوير أداء المنظمات المختلفة كونها تتميز بقدرتها الفائقة على التشخيص وتحليل المعلومات التي يتم جمعها بطريقة تفاعلية مبتكرة ولما تستند إليه من تقنيات ومهارات ومفاهيم متنوعة وفاعلة وتَعدُدٍ في مُخرجاتِها جعلها تتميز عن غيرها من المنهجيات وأساليب التخطيط التقليدية الجامدة .
 أما أهم التوصيات فكانت مطالبة الإدارات العليا للمنظمات المختلفة بإستثمار الوسائل والأدوات الملائمة والعمل وفق المنهجيات الحديثة للتخطيط الإستراتيجي مثل منهجية (DCA) والإعتماد عليها في إعداد خططها الإستراتيجية .

The 2019 Conference on Health and Active Transportation: Research Needs and Opportunities.

Active transportation (AT) is widely viewed as an important target for increasing participation in aerobic physical activity and improving health, while simultaneously addressing pollution and climate change through reductions in motor vehicular emissions. In recent years, progress in increasing AT has stalled in some countries and, furthermore, the coronavirus (COVID-19) pandemic has created new AT opportunities while also exposing the barriers and health inequities related to AT for some populations. This paper describes the results of the December 2019 Conference on Health and Active Transportation (CHAT) which brought together leaders from the transportation and health disciplines. Attendees charted a course for the future around three themes: Reflecting on Innovative Practices, Building Strategic Institutional Relationships, and Identifying Research Needs and Opportunities. This paper focuses on conclusions of the Research Needs and Opportunities theme. We present a conceptual model derived from the conference sessions that considers how economic and systems analysis, evaluation of emerging technologies and policies, efforts to address inclusivity, disparities and equity along with renewed attention to messaging and communication could contribute to overcoming barriers to development and use of AT infrastructure. Specific research gaps concerning these themes are presented. We further discuss the relevance of these themes considering the pandemic. Renewed efforts at research, dissemination and implementation are needed to achieve the potential health and environmental benefits of AT and to preserve positive changes associated with the pandemic while mitigating negative ones.

The 2021 National Eye Institute Strategic Plan—Relating Vision to Health and Quality of Life

The 2021 National Eye Institute Strategic Plan—Relating Vision to Health and Quality of Life

The 2021 National Eye Institute Strategic Plan: Fostering Collaboration in Vision Research and Clinical Care.

The 2021 National Eye Institute Strategic Plan: Fostering Collaboration in Vision Research and Clinical Care.

Child maltreatment and incident mental disorders in middle and older ages: a retrospective UK Biobank cohort study.

BackgroundUnderstanding the mental health consequences of child maltreatment at different life stages is important in accurately quantifying the burden of maltreatment. This study investigated the association between child maltreatment and incident mental disorders in middle and older age as well as the potential mediators and moderators.MethodsThis is a retrospective cohort study of 56,082 participants from UK Biobank. Child maltreatment was recalled using the Childhood Trauma Screener. Incident mental disorders, including depressive, anxiety and affective disorders, behavioural syndromes, post-traumatic stress disorder (PTSD), schizophrenia, substance abuse, and dementia, after baseline assessment were ascertained through linkage to primary care records.FindingsThere was a dose-response relationship between child maltreatment and mental disorder. Those who experienced three or more maltreatment types had the highest risk of all mental disorders (HR 1.85, 95% CI: 1.67-2.06) followed by those who experienced two (HR 1.48, 95% CI: 1.35-1.63) and then one (HR 1.26, 95% CI: 1.19-2.35). Child maltreatment was most strongly associated with PTSD (HR 1.59, 95% CI: 1.20-2.10 P=0.001). The excess risk was largely unexplained by the included mediators. The association between child maltreatment and all mental disorders were stronger among participants who binge drank (Pinteraction=0.003) or had few social visits (Pinteraction=0.003).InterpretationThe mental health consequence of child maltreatment could last decades, even among those who had no recorded mental disorders in early adulthood. In the absence of strong mediators, prevention of child maltreatment remains the priority.FundingWellcome Trust Institutional Strategic Support Fund

Infection-exposure in infancy is associated with reduced allergy-related disease in later childhood in a Ugandan cohort.

Lack of early infection-exposure has been associated with increased allergy-related disease (ARD) susceptibility. In tropical Africa, little is known about which infections contribute to development of ARDs, and at which time. We used latent class analysis to characterise the early infection-exposure of participants in a Ugandan birth cohort and assessed ARDs in later childhood. Of 2345 live births, 2115 children (90%) had data on infections within the first year of life while 1179 (50%) had outcome data at 9 years. We identified two latent classes of children based on first-year infection-exposure. Class 1 (32% membership), characterised by higher probabilities for malaria (80%), diarrhoea (76%), and lower respiratory tract infections (LRTI) (22%), was associated with lower prevalence of wheeze, eczema, rhinitis, and Dermatophagoides skin prick test (SPT) positivity at 9 years. Based on 5-year cumulative infection experience, class 1 (31% membership), characterised by higher probabilities for helminths (92%), malaria (79%), and LRTI (45%), was associated with lower probabilities of SPT positivity at 9 years. In this Ugandan birth cohort, early childhood infection-exposure, notably to malaria, helminths, LRTI, and diarrhoea, is associated with lower prevalence of atopy and ARDs in later childhood. This work was supported by several funding sources. The Entebbe Mother and Baby Study (EMaBS) was supported by the Wellcome Trust, UK, senior fellowships for AME (grant numbers 064693, 079110, 95778) with additional support from the UK Medical Research Council. LL is supported by a PhD fellowship through the DELTAS Africa Initiative SSACAB (grant number 107754). ELW received funding from MRC Grant Reference MR/K012126/1. SAL was supported by the PANDORA-ID-NET Consortium (EDCTP Reg/Grant RIA2016E-1609). HM was supported by the Wellcome's Institutional Strategic Support Fund (grant number 204928/Z/16/Z).

Penulisan Transkrip Konsultasi Syariah sebagai Upaya Pengarsipan Tertulis Dewan Syariah Wahdah Islamiyah

The Sharia Council of Wahdah Islamiyah is one of the strategic institutions in the structure of Wahdah Islamiyah Organization that has many visual recordings related to sharia consultations delivered by citizens. Therefore, in order to obtain broader benefits, the Sharia Council of Wahdah Islamiyah considers it important to do a transcript on the sharia consultation video. This process is done by copying the data through the recorded visual video. During one month of transcript process, 23 transcript files of Sharia Consultation were collected which were divided into five commissions, namely: General Commission, Worship Commission, Usrah Commission, Akidah Commission and Muamalah Commission. The results of this transcript were sent to the official email of the Sharia Council of Wahdah Islamiyah as an archive. The archive of transcripts of Wahdah Islamiyah Sharia Consultation that has been typed, can be one of the references of the Sharia Council which contains a collection of Questions and Answers (Q&A) of the Sharia Council of Wahdah Islamiyah and can be printed into a book for wider benefit.

Is attachment style in early childhood associated with mental health difficulties in late adolescence?

AimsIdentifying factors that contribute to mental health difficulties in young people as early in life as possible are needed to inform prevention strategies. One area of interest is attachment. Although existing research has suggested an association between insecure attachment styles and mental health difficulties, these studies often have small sample sizes, use cross-sectional designs, and measure attachment as a discrete variable at a single point or use romantic relationship attachment as a proxy for childhood attachment. It is also unclear whether these associations persist into late adolescence. In this large prospective study we aimed to determine whether an insecure attachment style measured at repeated points in early childhood, is associated with depression and self-harm at 18 years.MethodWe used data from the Avon Longitudinal Study of Parents and Children cohort. Mothers completed attachment related questionnaires when their child was 18, 30, and 42 months old. Offspring depression and lifetime self-harm was assessed at 18 years in clinic using the Clinical Interview Schedule-Revised. Attachment was derived as a continuous latent variable in a structural equation modelling framework. Logistic regression was performed on participants with complete attachment data (n = 7032) to examine the association between attachment style and depression and self-harm, with adjustment for potential confounders. Differential dropout was accounted for using multiple imputation.ResultWe found some evidence for an association between a more insecure attachment style in childhood, and a diagnosis of depression and life-time self-harm at age 18. In the fully adjusted imputed model, a one standard deviation increase in insecure attachment was associated with a 13% increase in the odds of depression (OR = 1.13; 95%CI = 1.00 to 1.27) and a 14% increase in the odds of self-harm at age 18 (OR = 1.14; 95%CI = 1.02 to 1.25), for children who had more insecure attachment in early childhood, compared with children who had more secure attachment.ConclusionThis is the largest longitudinal study to examine the prospective association between childhood attachment and depression and self-harm in late adolescence. Our findings strengthen the evidence suggesting that a childhood insecure attachment style is associated with mental health difficulties in late adolescence. Policies and interventions to support parenting behaviours that foster the development of secure attachment styles, or attachment-based therapies to improve attachment quality, could help reduce depression and self-harm in adolescence/young adulthood.Philippa Clery is supported by the Elizabeth Blackwell Institute for Health Research at the University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.

Analytical centers of the East

The article reviews the strategic institutions and brain centers of individual Eastern countries in terms of their national analytical traditions and branched multi-tiered self-awareness. The East is characterized by a variety of religious and philosophical analytical traditions, respectively, in Asian countries, the activities of think tanks take different forms. The specifics of the work of brain centers in Islamic countries, as well as Chinese and Jewish analytical traditions are considered in detail.
 According to the analysis of the formation and functioning of the brain centers of the East, the development of analytical structures is one of the priority problems of state information policy. The activity of these structures determines how fully the authorities will be informed and will be able to provide the public with objective information about their decisions and actions, current events in the country and abroad.

ELEVATING INSTITUTION PERFORMANCE OF SPECIAL SCHOOLS THROUGH STRATEGIC PLANNING

In the current pandemic period, some activities of the work program cannot be carried out properly, there are even some activities cannot be carried out. Special school institutions as a forum for education services for children with special needs, need to make changes and improve work programs. The institution work program needs to improve to achieve an institution's vision and mission. It is necessary to change the work program through a more focused program planning. This research aims to formulate a strategic plan contained in the work program of special schools. This study uses a qualitative method with SWOT analysis. This research essential the current condition of private special school X, namely by compiling strengths, weaknesses, opportunities, and threats. To obtain current condition information from the institution, involving school supervisors, principals, teachers, and school committees by teleconference. Before analysing the current condition data of strengths, weaknesses, opportunities, and threats conducted the validity and reliability test by using Smart-structural equation modelling. From the classification results, the institution's position quadrant will be identified to obtain the institution's strategic planning work program will be obtained from this quadrant. The research results state the institution's position was in the 3rd quadrant that means institutions must develop strategic planning institutions by minimizing weaknesses to reduce threats to the institution. Special school headmasters can arrange programs based on strategic planning with horizontal and vertical coordination to achieve their goals on time according to the work program plan.
 
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Respon Nahdlatul Ulama terhadap Gempuran Aliran Fundamental; Telaah Kritis Radikalisme Intoleran dan Pudarnya Moderatisme Islam

Islam that is displayed by mainstream groups is now getting great onslaguht from non-mainstream from transnational circles with diverse faces, this second group is more violent and has a more structured and massive regeneration system and tends to dominate strategic institutions in Indonesia, with a fiercer appearance. and openly, even carrying the caliphate system in government, and trying to enter the national political arena as a strategic vehicle. On the other hand, the mainstream group began to feel and received strong pressure from the non-mainstream so that it began to step aside, even though it had long colored the nation and state of Indonesia, the other side of the non-mainstream group began to take center stage. However, it turns out that there is still hope that educated mainstream groups will begin to show their potential even though they have not been properly consolidated in facing non-mainstream groups. Islam that is displayed by mainstream groups has actually got a place from many circles in this world, because their life always adheres to the principles of tasamuh, tawassud, tawazzun, al'adl, and amar ma'ruf nahi munkar consistently, even in the global era it can also adapt to the life of time.

FORMATION OF THE CONCEPT OF CRITICAL INFRASTRUCTURE OBJECTS TAKING INTO ACCOUNT THE FEATURES OF POTENTIALLY DANGEROUS OBJECTS OF UKRAINE

Olena Afanasieva, Oleksii Basmanov, Serhii Novikov FORMATION OF THE CONCEPT OF CRITICAL INFRASTRUCTURE OBJECTS TAKING INTO ACCOUNT THE FEATURES OF POTENTIALLY DANGEROUS OBJECTS OF UKRAINE The paper identifies the main provisions of the methodological apparatus of civil protection in relation to the paradigm - the object of critical infrastructure, taking into account the characteristics of potentially dangerous objects and the regulatory framework of Ukraine. The nature of the origin of the paradigm "object of critical infrastructure" is considered. Global trends in the formation of the paradigm of "critical infrastructure object" in the context of solving problems of civil protection are identified. The existing domestic legislative basis for the formation of a modern type of paradigm "critical infrastructure object" in the context of solving problems of civil protection is analyzed. The latter made it possible to determine the following - to date, and in the European Union has formed a definition of critical infrastructure, which includes physical objects, resources, services and information technology, networks and other infrastructure assets, violation or destruction of which leads to serious consequences for the health, safety and economic well-being of citizens and to the disruption of the effective functioning of government. Ukraine has passed and is in force laws that to some extent provide for measures to prevent emergencies caused by accidents and catastrophes at protected potentially dangerous facilities, the consequences of which can lead to infection, disease and death. Therefore, as a definition of critical infrastructure in the work, it is proposed to identify a set of enterprises, networks, systems, failure or disruption of which can cause loss of management and cause serious damage at the national, regional or local level. It includes nuclear and hydroelectric power plants, chemical and petrochemical plants, metallurgical plants and many other state-owned enterprises and private strategic institutions, which are not only protected, but also have special organizational and technical systems of physical protection. At the next stage of the work, the authors plan to join the development of the State system of critical infrastructure protection, which should include: creation of a state system of critical infrastructure protection; to determine the state structure responsible for the coordination of activities for the protection of critical infrastructure; to form the basis of public-private partnership and resource provision in the field of critical infrastructure protection; to promote the development of international cooperation in the field of critical infrastructure protection. Key words: emergency situation, object of critical infrastructure, civil protection, normative-legal basis

Structural Changes in Agricultural Cooperatives Following Bulgaria’s European Union Integration

The article aims to analyze the structural changes in agricultural cooperatives in Bulgaria, in terms of the Common Agricultural Policy (CAP) of the European Union (EU) and, on this basis, outline the main trends in their development. The analysis is based on official statistical information from the Ministry of Agriculture and Food and Forestry (MAF) “Agrostatistics”, primary data “Agricultural and Accounting Information System” (FADN) National Strategic Institute (NSI). The trend of changing the following indicators is investigated: number of agricultural cooperatives in Bulgaria, changes in the utilized agricultural area (UAA,); changes in arable land, average size of UAA, labor force, dynamics of the production structure (crop and livestock) for the 2007-2016 period. The results show that, as a consequence of the implementation of the CAP for the 2007-2016 period, structural changes in agricultural cooperatives are reported. They are expressed in the lasting tendency to decrease both their number and the land they manage. The analysis shows that the incentives under the various CAP support schemes have positive effects on the diversification of crop production. In general, the areas with cereals and oilseeds have decreased over the years. In 2016, there was an increase in the production of fresh fruits and vegetables as a result of the implementation of CAP measures resulting from coupled payments. Despite the CAP subsidies to support the livestock sector, including the support of farms included in selection control schemes, at the end of the period the number of cooperatives developing cattle breeding was almost halved. Despite the negative results in general, at the level of the production unit the result is in the consolidation of production.

O lugar da universidade pública: referência social ou fator de desenvolvimento das forças produtivas?

Este ensaio analisa se o lugar da avaliação concreta da universidade pública brasileira se dá em relação à sua referência social ou por ser uma instituição estratégica no desenvolvimento das forças produtivas. Por um lado, há um movimento para que as universidades públicas democratizem o acesso e respondam às demandas sociais. Por outro, há a defesa da formação técnica/profissional e avanço da ciência e tecnologia para a produção e reprodução do capital. A expansão da pesquisa e dos cursos de pós-graduação stricto sensu no Brasil estabeleceu critérios produtivistas de avaliação, os quais passaram a ser um parâmetro para a própria universidade. Esse processo leva à destruição do projeto de universidade socialmente referenciada, substituindo-o por um projeto que expressa a ideologia neoliberal.

Puberty timing and adiposity change across childhood and adolescence: disentangling cause and consequence.

STUDY QUESTIONIs earlier puberty more likely a result of adiposity gain in childhood than a cause of adiposity gain in adulthood?SUMMARY ANSWERPre-pubertal fat mass is associated with earlier puberty timing but puberty timing is not associated with post-pubertal fat mass change.WHAT IS KNOWN ALREADYAge at puberty onset has decreased substantially in the last several decades. Whether reducing childhood adiposity prevents earlier puberty and if early puberty prevention itself also has additional independent benefits for prevention of adult adiposity is not well understood.STUDY DESIGN, SIZE, DURATIONProspective birth cohort study of 4176 participants born in 1991/1992 with 18 232 repeated measures of fat mass from age 9 to 18 years.PARTICIPANTS/MATERIALS, SETTING, METHODSWe used repeated measures of height from 5 to 20 years to identify puberty timing (age at peak height velocity, aPHV) and repeated measures of directly measured fat mass from age 9 to 18 years, from a contemporary UK birth cohort study to model fat mass trajectories by chronological age and by time before and after puberty onset. We then examined associations of these trajectories with puberty timing separately in females and males.MAIN RESULTS AND THE ROLE OF CHANCEIn models by chronological age, a 1-year later aPHV was associated with 20.5% (95% confidence interval (CI): 18.6–22.4%) and 23.4% (95% (CI): 21.3–25.5%) lower fat mass in females and males, respectively, at 9 years. These differences were smaller at age 18 years: 7.8% (95% (CI): 5.9–9.6%) and 12.4% (95% (CI): 9.6–15.2%) lower fat mass in females and males per year later aPHV. Trajectories of fat mass by time before and after puberty provided strong evidence for an association of pre-pubertal fat mass with puberty timing, and little evidence of an association of puberty timing with post-pubertal fat mass change. The role of chance is likely to be small in this study given the large sample sizes available.LIMITATIONS, REASONS FOR CAUTIONParticipants included in our analyses were more socially advantaged than those excluded. The findings of this work may not apply to non-White populations and further work examining associations of puberty timing and fat mass in other ethnicities is required.WIDER IMPLICATIONS OF THE FINDINGSPrevious research has relied on self-reported measures of puberty timing such as age of voice breaking in males, has lacked data on pre-and post-pubertal adiposity together and relied predominantly on indirect measures of adiposity such as BMI. This has led to conflicting results on the nature and direction of the association between puberty timing and adiposity in females and males. Our work provides important clarity on this, suggesting that prevention of adiposity in childhood is key for prevention of early puberty, adult adiposity and associated cardiovascular risk. In contrast, our findings suggest that prevention of early puberty without prevention of childhood adiposity would have little impact on prevention of adult adiposity.STUDY FUNDING/COMPETING INTEREST(S)The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for Avon Longitudinal Study of Parents and Children (ALSPAC). L.M.O.K. is supported by a UK Medical Research Council Population Health Scientist fellowship (MR/M014509/1) and a Health Research Board (HRB) of Ireland Emerging Investigator Award (EIA-FA-2019-007 SCaRLeT). J.A.B. is supported by the Elizabeth Blackwell Institute for Health Research, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund (204813/Z/16/Z). L.D.H. and A.F. are supported by Career Development Awards from the UK Medical Research Council (grants MR/M020894/1 and MR/M009351/1, respectively). All authors work in a unit that receives funds from the UK Medical Research Council (grant MC_UU_00011/3, MC_UU_00011/6). No competing interests to declare.TRIAL REGISTRATION NUMBERN/A.

Plasma extracellular vesicles modulate immune cell gene expression following myocardial infarction

Abstract Background Myocardial infarction (MI) induces activation of immune cells and alters their gene expression en route to the injured myocardium but the underlying mechanisms coordinating immune cell programming following MI remain unknown. Plasma extracellular vesicle (EV) numbers are elevated in MI, correlate with the extent of myocardial injury and mobilises immune cells from the splenic reserve to peripheral blood. Here, we describe the role of plasma EV-microRNAs (miRs) in the modulation of peripheral blood mononuclear cell (PBMC) transcriptomes post-MI. Methods PBMCs were exposed to plasma EVs followed by whole transcriptome RNA-sequencing. Plasma EVs were isolated by size-exclusion chromatography and ultra-centrifugation (2 hours at 120,000 x g) from patients presenting with ST-segment elevation MI (STEMI) (N=9) and non-STEMI (NSTEMI) (N=11) control patients. Plasma EVs were characterised by western blot and Nanoview for EV markers CD9 and CD63, transmission electron microscopy (TEM) for morphology and Nanoparticle Tracking Analysis for size and concentration. High sensitive C-reactive protein (hs-CRP) and PCSK9 were determined in plasma by ELISA and compared to plasma EV number using Pearson's correlation. Plasma EV-miRs were measured by Agilent microarray and miR-mRNA putative targets assessed by TargetScanHuman. Results Plasma EVs were positive for EV markers CD9 and CD63, displayed typical EV morphology by TEM and had a heterogeneous size and concentration distribution profile as determined by Nanoparticle Tracking Analysis. Plasma EV number correlated significantly with hs-CRP at presentation (R2= 0.20 and P<0.05). miRNA array analysis revealed STEMI plasma-EVs contained significantly more miR-4487 (P<0.001), miR-6511b-5p (P<0.001), miR-4508 (P<0.001) vs NSTEMI control plasma-EVs at the time of injury. STEMI-plasma-EVs induced differential gene expression in PBMCs vs. NSTEMI-control-plasma-EVs. Gene set enrichment analysis (GSEA) showed STEMI-plasma-EVs upregulated pro-inflammatory pathways including: interferon-α (IFN-α) (P<0.01), IFN-γ (P<0.01), tumour necrosis factor-α (TNF-α) (P<0.01) and interleukin-6 (IL-6)-STAT3 signalling of the acute phase response (P<0.05). miR-4487 (P<0.001) and miR-6511-5p (P<0.05) predicted mRNA targets were significantly enriched in PBMC transcriptomes following treatment with STEMI plasma-EVs. Conclusions Plasma EVs mediating immune cell transcriptional programming following MI by promoting inflammatory pathways in PBMCs is a novel finding. Targeting PBMCs with EVs may allow modulation of the immune response following myocardial injury, to perturb inflammatory immune mediated damage following ischaemic injury. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation Centre of Research Excellence Awards, British Heart Foundation Project Grant, Novo Nordisk Fonden the Tripartite Immunometabolism Consortium and Wellcome Institutional Strategic Support Fund (ISSF)

The temporal association of introducing and lifting non-pharmaceutical interventions with the time-varying reproduction number (R) of SARS-CoV-2: a modelling study across 131 countries

BackgroundNon-pharmaceutical interventions (NPIs) were implemented by many countries to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of COVID-19. A resurgence in COVID-19 cases has been reported in some countries that lifted some of these NPIs. We aimed to understand the association of introducing and lifting NPIs with the level of transmission of SARS-CoV-2, as measured by the time-varying reproduction number (R), from a broad perspective across 131 countries.MethodsIn this modelling study, we linked data on daily country-level estimates of R from the London School of Hygiene & Tropical Medicine (London, UK) with data on country-specific policies on NPIs from the Oxford COVID-19 Government Response Tracker, available between Jan 1 and July 20, 2020. We defined a phase as a time period when all NPIs remained the same, and we divided the timeline of each country into individual phases based on the status of NPIs. We calculated the R ratio as the ratio between the daily R of each phase and the R from the last day of the previous phase (ie, before the NPI status changed) as a measure of the association between NPI status and transmission of SARS-CoV-2. We then modelled the R ratio using a log-linear regression with introduction and relaxation of each NPI as independent variables for each day of the first 28 days after the change in the corresponding NPI. In an ad-hoc analysis, we estimated the effect of reintroducing multiple NPIs with the greatest effects, and in the observed sequence, to tackle the possible resurgence of SARS-CoV-2.Findings790 phases from 131 countries were included in the analysis. A decreasing trend over time in the R ratio was found following the introduction of school closure, workplace closure, public events ban, requirements to stay at home, and internal movement limits; the reduction in R ranged from 3% to 24% on day 28 following the introduction compared with the last day before introduction, although the reduction was significant only for public events ban (R ratio 0·76, 95% CI 0·58–1·00); for all other NPIs, the upper bound of the 95% CI was above 1. An increasing trend over time in the R ratio was found following the relaxation of school closure, bans on public events, bans on public gatherings of more than ten people, requirements to stay at home, and internal movement limits; the increase in R ranged from 11% to 25% on day 28 following the relaxation compared with the last day before relaxation, although the increase was significant only for school reopening (R ratio 1·24, 95% CI 1·00–1·52) and lifting bans on public gatherings of more than ten people (1·25, 1·03–1·51); for all other NPIs, the lower bound of the 95% CI was below 1. It took a median of 8 days (IQR 6–9) following the introduction of an NPI to observe 60% of the maximum reduction in R and even longer (17 days [14–20]) following relaxation to observe 60% of the maximum increase in R. In response to a possible resurgence of COVID-19, a control strategy of banning public events and public gatherings of more than ten people was estimated to reduce R, with an R ratio of 0·71 (95% CI 0·55–0·93) on day 28, decreasing to 0·62 (0·47–0·82) on day 28 if measures to close workplaces were added, 0·58 (0·41–0·81) if measures to close workplaces and internal movement restrictions were added, and 0·48 (0·32–0·71) if measures to close workplaces, internal movement restrictions, and requirements to stay at home were added.InterpretationIndividual NPIs, including school closure, workplace closure, public events ban, ban on gatherings of more than ten people, requirements to stay at home, and internal movement limits, are associated with reduced transmission of SARS-CoV-2, but the effect of introducing and lifting these NPIs is delayed by 1–3 weeks, with this delay being longer when lifting NPIs. These findings provide additional evidence that can inform policy-maker decisions on the timing of introducing and lifting different NPIs, although R should be interpreted in the context of its known limitations.FundingWellcome Trust Institutional Strategic Support Fund and Data-Driven Innovation initiative.

What Is the Evidence for Transmission of COVID-19 by Children in Schools? A Living Systematic Review

Summary: It is of paramount importance to understand the transmission of SARS-CoV-2 in schools, which could support the decision-making about educational facilities closure or re-opening with effective prevention and control measures in place. We conducted a systematic review and meta-analysis to investigate the extent of SARS-CoV-2 transmission in schools. We performed risk of bias evaluation of all included studies using the Newcastle-Ottawa Scale (NOS). 2,178 articles were retrieved and 11 studies were included. Five cohort studies reported a combined 22 student and 21 staff index cases that exposed 3,345 contacts with 18 transmissions [overall infection attack rate (IAR): 0·08% (95% CI: 0·00%-0·86%)]. IARs for students and school staff were 0·15% (95% CI: 0·00%-0·93%) and 0·70% (95% CI: 0·00%-3·56%) respectively. Six cross-sectional studies reported 639 SARS-CoV-2 positive cases in 6,682 study participants tested [overall SARS-CoV-2 positivity rate: 8·00% (95% CI: 2·17%-16·95%)]. SARS-CoV-2 positivity rate was estimated to be 8·74% (95% CI: 2·34%-18·53%) among students, compared to 13·68% (95% CI: 1·68%-33·89%) among school staff. Gender differences were not found for secondary infection (OR: 1·44, 95% CI: 0·50-4·14, P= 0·49) and SARS-CoV-2 positivity (OR: 0·90, 95% CI: 0·72-1·13, P= 0·36) in schools. Fever, cough, dyspnea, ageusia, anosmia, rhinitis, sore throat, headache, myalgia, asthenia, and diarrhoea were all associated with the detection of SARS-CoV-2 antibodies (based on two studies). Overall, study quality was judged to be poor with risk of performance and attrition bias, limiting the confidence in the results. In conclusion, there is limited high-quality evidence available to quantify the extent of SARS-CoV-2 transmission in schools or to compare it to community transmission. Emerging evidence suggests lower IAR and SARS-CoV-2 positivity rate in students compared to school staff. Future prospective and adequately controlled cohort studies are necessary to confirm this finding.Registration: PROSPERO (register number: CRD42020192839)Funding Statement: ET is supported by a Cancer Research UK Career Development Fellowship (C31250/A22804). AK is supported by a Wellcome Trust Clinical PhD Programme Fellowship with grant reference: 203919/Z/16/Z. UNCOVER group is supported by Wellcome Trust's Institutional Strategic Support Fund (ISSF3) and by DDI.Declaration of Interests: The authors declare no competing interests.

Danilo Perestrello and the psychosomatic medicine movement in Brazil: from theory to institutional acceptance

In the 1950s, the psychosomatic medicine movement emerged in Brazil, led by psychiatrist and psychoanalyst Danilo Perestrello. This article analyzes the strategies developed to configure this proposal and establish this field of study. From the beginning, this movement was characterized by a plan to reformulate medicine based on psychoanalytic theory and obtain favorable reception in institutions. During his career, Perestrello published articles and books with the intention of establishing a new way of thinking among physicians and worked at strategic institutions. His withdrawal from professional work due to a serious illness in 1976 was a factor contributing to the fragmentation of the psychosomatic movement in Brazil.