Twenty-two couples belonged to the experimental group (received the intervention) and 22 to the control group (received no intervention). The intervention program consisted of seven two-hour sessions over a month, in groups of four to five couples. The variables studied were sociodemographic characteristics, emotional intelligence (TMMS-24), emotional inter-regulation with the partner (SIERC), attachment (ECR-S) and satisfaction with the relationship (RAS). The proposed design was quasi-experimental, with two randomized groups  and longitudinal data from two occasions. SPSS version 24.0 was used to perform analysis of variance (MANOVA and MANCOVA), multiple hierarchical regression and reliable change index. PROCESS was also used for moderation analyses. The results indicate that the program is effective in increasing emotional self-regulation and emotion regulation with the partner, as well as reducing couples’ avoidance of intimacy. Age, relationship duration and previous relationship satisfaction moderate the effectiveness of the program. The importance of continuing this research line to address well-being of young populations is discussed.Our aim was to assess the effectiveness of EMOVERE, a psychoeducational and experiential program to increase emotion regulation in couples. Forty-four young couples ( A couple relationship can be defined as a relatively stable sentimental bond between two people who share emotional and intellectual intimacy, establish a commitment by planning shared projects and define a joint identity as a couple, making it visible to others . In westOne way to improve the quality of relationships is to acquire personal skills, such as emotional competences . EmotionWithin the emotional competences, emotional self-regulation and inter-regulation seem to have an especially strong influence on couple relationships’ well-being and stability . EmotionPrevious studies with dyads suggest that a person’s emotion regulation not only influences one’s own well-being and health, but also indirectly influences their partner’s . In addiIn order to help couples to maintain healthy, mutually satisfying and stable relationships, relationship education programs have been developed. Relationship education programs are psychoeducational interventions designed to prevent future relationship problems by developing relationship skills and disseminating knowledge about life as a couple . EducatiThe first relationship education program was developed, called The Couple Communication Program, which demonstrated moderate to large effects on relationship satisfaction at the end of the program and follow-up . FollowiRelationship education programs have been shown to be effective in improving the quality of relationships and reducing partner distress ,32,33. TFollowing an extensive review of the most current literature, a number of relationship education programs developed in recent years have been found to have effective outcomes for couples’ well-being ,33,37,43Therefore, emotional education of the couple from youth is a social need that has to be covered through the implementation of validated and effective interventions . NeverthTo promote the effectiveness of interventions, as well as a careful methodology, it is imperative to base them on sound theoretical frameworks ,51. The The vulnerability–stress–adaptation model of relationship functioning  proposesOn the other hand, the emotion regulation model based on emotional processing  suggestsThe objective of the present work was to develop and assess the effectiveness of the program EMOVERE. We propose three hypotheses: (1) the intervention will be effective in developing emotional competences  in partners; (2) the program will also reduce avoidance of intimacy and attachment anxiety associated with insecure attachment styles; and (3) the demographic variables (gender and age) as well as the relationship variables (relationship duration and relationship satisfaction) will moderate the effectiveness of the intervention.The sample was collected through Internet promotions, and through posters and brochures in universities. As we can see in the sample chart , 416 peoHalf of the couples who met the criteria (29 couples) were randomly assigned to the experimental group, and the other half (29 couples) to the control group. Randomization was performed by a simple coin flip carried out by a person who was blind to the different conditions. The couples in the control group were registered on a waiting list to receive the program later. A brief pre-interview was conducted with the participants of the experimental group before starting the program, to confirm that they met the established criteria and know their expectations. Finally, 7 couples were excluded from the experimental group  and the control group of 22 couples . None of the participating couples had dependent children. Regarding the sexual orientation of the participants in both groups, 77 (87.5%) were heterosexuals, 5 (5.7%) were homosexuals 5 (5.7%) were bisexuals and 1 (1.1%) was of another orientation. Of the participants, 27.3% lived with their partner, with a length of cohabitation ranging from 2 months to 10 years . Consequently, the experimental group was formed of 22 couples  was useAdult attachment. The Experiences in Intimate Relationships questionnaire   was usedLater, the reliable change index (RCI) was calculated, which evaluates the reliable change by means of the variation of the standard error (SE) of the measurement that considers the two evaluations that have been carried out. Reliable change refers to the extent to which the change shown by an individual is outside the range that could be attributed to the variability inherent in measurement . Chi-squFinally, moderation analyses were carried out using the S . The depEMOVERE program is a weekly, seven-session intervention lasting 14 h. The main objective of EMOVERE is to increase the intrapersonal and interpersonal emotional competences of young couples. The program is developed in groups of 8–10 young couples and has theoretical and practical interactive activities in individual, couple and group formats. Psychoeducation in emotional competences is transversal to the entire program, and the experiential work of the participants is also encouraged. Two psychologists implemented the intervention after receiving specific training. At the end of each session, facilitators offer participants materials and different proposals focused on generalizing what they have learned to their everyday lives. The aim and activities developed in each session are detailed in In the EMOVERE program, we work with the three factors that the vulnerability–stress–adaptation model  includesAs mentioned above, the emotion regulation model based on emotional processing  was adapp = 0.831), age , sexual orientation  and relationship duration .There appear to be no statistically significant differences in T1 between participants from the experimental and control group in terms of gender . Thus, it could be stated that both groups are homogeneous before the application of the intervention in their levels of emotional intelligence, emotional inter-regulation with their partner and attachment security  indicate that there are no previous differences between the control group and the experimental group in any of the variables before the intervention . As for intrapersonal emotional intelligence, participants in the experimental group presented higher levels of emotional repair . Regarding the interpersonal emotional competences, participants in the experimental group presented higher levels of emotional expression to the partner , understanding of the partner’s emotions  and regulation of the partner’s emotions . Regarding the subjective perception of the partner’s emotional inter-regulation competences, the participants in the experimental group affirmed that their partners showed greater emotional understanding . Likewise, participants in the experimental group showed lower levels of avoidance of intimacy than those in the control group . The size of the effect of the differences was low–moderate, ranging from d = 0.10 to d = 0.39. The mean of effect size in T2 considering those variables with significant effects  was moderate (d = 0.24).The results of the multivariate covariance analysis (MANCOVA) indicate that there are statistically significant differences between the control group and the experimental group after the intervention , the expression of emotions to the partner , the understanding of emotions of the partner  and the regulation of emotions with the partner . They also increased the perception that the partner can understand one’s own emotions . Finally, participants in the intervention decreased their avoidance of intimacy .The results indicated that belonging to the experimental group influenced the change from T1 to T2 in certain variables compared to the control group. Specifically, the participants of the experimental group increased the intrapersonal emotional repair , emotional expression of the actor  and emotional management of the actor , as well as understanding of the partner  and management of the partner .Regarding the emotional inter-regulation of the actor (who responded to the questionnaire), in the experimental group, five people (11.4%) improved in expression, six (13.6%) in understanding and seven (15.9%) in management, while in the control group, no person improved in expression and management, and one person (2.3%) in understanding. Regarding the emotional inter-regulation of the partner (the perception the actor has about their partner), in the experimental group, six people (13.6%) claimed their partners improved in expression, 10 people (22.7%) in understanding and nine (20.5%) in management, while in the control group, real change occurred in two people (4.5%) in expression and one (2.3%) in management, and none of them improved in understanding. The percentage of people who showed a reliable change was significantly higher in the experimental group than in the control group in the following variables: avoidance of intimacy ) and relationship satisfaction in improving repair in the experimental group ). Likewise, an interaction effect of the duration of the relationship in the change of avoidance is also observed ).Moderation analyses were performed , showingThe quality of a sentimental relationship has a strong influence on health and well-being ,19. TherThe results obtained suggest that our program is effective in improving intrapersonal and interpersonal emotion regulation with a partner. We can say that the first proposed hypothesis is fulfilled, although not completely. The program manages to effectively increase the capacity to regulate one’s emotions. This means that participants increased their ability to influence the intensity of their emotions and the way they are experienced. In addition, they increased their ability to adequately express emotions to their partner, attend and understand their partner’s emotions, as well as validate and soothe their partner’s emotions. Additionally, after completing the program, participants reported that they perceived their partners as having greater ability to understand them emotionally, which is likely to increase the perception of satisfaction . Thus, aPrevious studies suggest that people with insecure attachment, both anxious and avoidant, have greater difficulties in understanding and regulating their own and their partners’ emotional states than people with a secure attachment style . The secRegarding the size of the average effect of the results in our study, we can say that it is in line with previous studies. The meta-analysis by Simpson, Leonhard and Hawkins  found siThe third hypothesis suggested that demographic characteristics as well as the initial levels of relationship satisfaction could moderate the effectiveness of the intervention, which is confirmed by the results. Age and relationship satisfaction appear to be moderating participants’ learning of emotional self-regulation. Participants who learn to self-regulate their emotions most easily are the younger ones and those most satisfied with their relationships. This could be because younger people have greater plasticity for learning . LikewisConsidering the criticism that previous prevention programs for couples have received, the EMOVERE program takes up and implements the various suggestions for improvement that have been proposed . One of However, the limitations of the study cannot be ignored. One of the main limitations is the small sample size, which should be expanded in future research, as well as diversified . Thus, we can see that our results can be generalized to a young Spanish population with different characteristics.Another of the main limitations of our study is the absence of a medium- or long-term follow-up assessment since we only have a post-short-term measure. Therefore, we cannot bring clarity to the contradiction of results existing in the previous literature on the doubtful medium- and long-term effects of relationship education programs . It woulOn the other hand, it is also remarkable that this is non-blinded research, since the psychologist who carried out the program sessions knew the objective of the research, which could have influenced the results by experimenter effects, such as generating social desirability in the participants. For future applications of the program, it would be of interest that it be applied by different trained psychologists who are not involved in the research itself.Finally, we can observe that the effect sizes in our research are small to moderate. This is a frequent result in psychoeducation programs, as it is often difficult to observe large changes in psychological variables . TherefoDespite the limitations, we believe that the program has interesting practical implications for other researchers, educators and psychologists. The EMOVERE program could be applied in the university context, as an activity outside the academic curriculum to reinforce the well-being of university youth. It could also be useful to be applied in high schools, extending the study of its outcome to the adolescent population. Clinical psychologists in the private sphere could make use of the program to prevent the development of couple problems and promote health. In general, other organizations and associations in both the public and private sectors interested in positive youth development could use our research to work with young populations. To carry out these proposals, the authors are available for other researchers and professionals who want to request the complete program to continue with the assessment of its effectiveness in diverse and more extensive samples.To sum up, this work aims to awaken the interest of psychologists and researchers in the emotional education of young couples . EffectiIn conclusion, we can highlight the main results obtained after the application of our EMOVERE program for emotional education in young couples. Regarding intrapersonal emotional competences, the results suggest that our program effectively increases emotional self-regulation. Within interpersonal emotional competences, the program seems to improve emotional expression to the partner, as well as the partner’s understanding and management of the partner’s emotions. Additionally, participating in the program increases the perception of the partner’s emotional understanding. Finally, it seems to reduce couples’ avoidance of intimacy. Age, relationship duration and relationship satisfaction moderate the effectiveness of the program. These findings could be of interest to complement existing literature on emotional education and effective intervention for couples.


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological tests have been suggested as an additional diagnostic tool in highly suspected cases with a negative molecular test and determination of seroprevalence in population. We compared the diagnostic performance of eight commercial serological assays for IgA, IgM, and IgG antibodies to the SARS-CoV-2 virus.The comparison study was performed on a total of 76 serum samples: 30 SARS-CoV-2 polymerase chain reaction (PCR)-negative and 46 SARS-CoV-2 PCR-positive patients with asymptomatic to severe disease and symptoms duration from 3-30 days. The study included: three rapid lateral flow immunochromatographic assays (LFIC), two enzyme-linked immunosorbent assays (ELISA), and three chemiluminescence immunoassays (CLIA).Agreement between IgM assays were minimal to moderate (kappa 0.26 to 0.63) and for IgG moderate to excellent (kappa 0.72 to 0.92). Sensitivities improved with > 10 days of symptoms and were: 30% to 89% for IgM; 89% to 100% for IgG; 96% for IgA; 100% for IgA/IgM combination; 96% for total antibodies. Overall specificities were: 90% to 100% for IgM; 85% to 100% for IgG; 90% for IgA; 70% for IgA/IgM combination; 100% for total antibodies. Diagnostic accuracy for IgG ELISA and CIA assays were excellent (AUC ≥ 0.90), without significant difference. IgA showed significantly better diagnostic accuracy than IgM (P < 0.001).There is high variability between IgM assays independently of the assay format, while IgG assays showed moderate to perfect agreement. The appropriate time for testing is crucial for the proper immunity investigation. Coronaviridae family caused the 2019 global pandemic of the infectious disease marked with severe acute respiratory distress syndrome (A newly identified virus belonging to the β-subgroup of the via receptor-binding domain (RBD), while the S2 subunit contains elements essential for fusion of the virus  is a lipid bilayer where membrane glycoproteins (M) and spike proteins (S) are anchored. The interior of the particle contains nucleocapsid (N) proteins bound to the RNA molecule  on respiratory tract specimens . Unfortunately, the sensitivity of this method is highly dependent on preanalytical and analytical variables such as the type of the specimen (upper or lower respiratory tract), sampling technique, the timing of the sampling, or conditions during transportation of the sample, and false-negative results can be attributed to all of these  and chemiluminescence immunoassays (CLIA) . The sera were stored at - 80 °C until analysis. Repetitive thawing was avoided. The clinical presentation among the patients in the positive group was different (from asymptomatic to very severe) as well as the duration of the symptoms (from 3 to 30 days). Eleven persons (11/46) were asymptomatic, 27 out of 46 had symptoms lasting longer than 10 days and 8 out of 46 had symptoms lasting shorter than 10 days. For one patient, data on the duration of symptoms were not completely clear in the sense that could be classified with certainty as less than or more than 10 days. For 10 out of 11 asymptomatic persons, the blood sampling was performed one day after the RT-PCR confirmed infection. SARS-CoV-2 PCR-negative patients (N = 30) included the patients referred for RT-PCR SARS-CoV-2 testing before hospitalization in Sestre Milosrdnice University Hospital Centre due to different indications and did not have symptoms associated with COVID-19 nor evidence of the previous SARS-CoV-2 infection.The Ethical Board of the Sestre Milosrdnice University Hospital Centre approved the study.in-vitro diagnostics certificate (CE-IVD). Detailed assay specifications are given in Eight different serological tests for IgA, IgM, or IgG antibodies to SARS CoV-2 virus detection were compared. Three of them were rapid lateral flow immunochromatographic assays (LFIC): Biozek COVID-19 IgG/IgM Rapid cassette , Encode COVID-19 IgG/IgM Rapid test device , and Lumiquick rapid test IgM/IgG . Two of them were ELISA tests: Euroimmun IgA/IgG Anti-SARS-CoV-2 , and ELISA Vircell IgM+IgA/IgG . Three fully automated assays were: the CLIA MAGLUMI 2019-nCoV IgG/IgM on Snibe Maglumi 800 analyser , chemiluminescent microparticle immunoassay (CMIA) Abbott SARS-CoV-2 IgG on Abbott Architect i2000SR analyser  and electrochemiluminescence immunoassay (ECLIA) Roche Elecsys Anti-SARS-CoV-2 total antibody assay on Cobas e601 analyser . All assays have an Eight borderline positive results obtained with Vircell IgM+IgA/IgG ELISA assay were excluded from statistical analysis since we were not able to repeat the test according to the manufacturer’s suggestion. Lateral flow immunochromatographic tests were performed by 4 operators and the result was always interpreted by the same operator who performed the test. In the case of a faint band, the result was defined by the consensus between two observers to minimize the visual error effect.Ribonucleic acid was extracted from clinical specimens  with the viral RNA mini kit  following the original manufacturer protocol.et al.  were calculated. Kappa statistic was calculated to investigate agreement in positive/negative categorization between tests. Interpretation of Cohen’s kappa coefficient is as follows: 0.0–0.20 no agreement; 0.21–0.39 minimal agreement; 0.40–0.59 weak agreement; 0.60–0.79 moderate agreement; 0.80–0.90 strong agreement; > 0.90 almost perfect agreement  ≥ 0.90 for all methods . Also, tROC analysis for the methods measuring individual or combined markers of acute phase infection (IgA and IgM) revealed excellent diagnostic accuracy for IgA alone and a combination of IgA + IgM, while for IgM alone it was at the level of good accuracy . In lineTo check if there is any added value of combined measurement of the markers of the acute and late phase of infection we included the Elecsys Anti-SARS-CoV-2 method in the pairwise comparison of ROC curves for IgG methods and did not observe any significant difference in the AUCs both for the whole RT-PCR-positive group  as well as for the group with > 10 days of symptoms duration .Application of ROC analysis provided cut-offs improved diagnostic accuracy for assays: a) MAGLUMI 2019-nCoV IgM enabled detection of 7 more RT-PCR-positive patients irrespective of symptoms duration and 5 in the group with > 10 days of symptoms duration, without diminishing the specificity of the test; b) Euroimmun Anti-SARS-CoV-2 ELISA IgG change in cut-off nullifies the number of false positives to the detriment of the one false-negative case, irrespective of symptoms duration; c) Vircell COVID-19 IgG nullifies false positives without the change of sensitivity in the group with > 10 days of symptoms duration.We aimed to compare diagnostic efficacy for detection of SARS-CoV-2 antibodies of eight commercially available serological assays of different formats. Our results confirmed the general poor utility of serological tests if performed in a period less than 10 days from the onset of the symptoms. The high variability between results of IgM assays was obtained, while the results for IgG showed good agreement and high diagnostic accuracy, especially after 10 days of symptoms onset. Low sensitivity of IgM isotype for one of the tested rapid devices pointed out the necessity for verification of the test before the use in patient care.et al. also obtained a very low sensitivity of 19% (95%CI 12–28) for Biozek IgM for the post-symptom period of 7–28 days  and endemic coronaviruses 229E, NL63, and OC43  , Euroimmun IgA (90%) and IgG (93%) and especially low for Vircell (IgM + IgA 70% and IgG 85%). Manufacturer declaration regarding the crossreactivity study is given for both ELISA as well as for chemiluminescent assays but not for LFIC assays. For Euroimmun IgA and IgG assays, crossreactivity was examined for other coronaviruses, and pronounced crossreactivity was declared only with SARS-CoV-1. However, Charlton Diagnostic accuracy of the ELISA and chemiluminescence IgG assays did not significantly differ, including the Elecsys Anti-SARS-CoV-2 total antibodies assay which indicates the low added value of combined measurement of Ig isotypes in comparison to IgG, only. However, the number of RT-PCR-positive cases with symptoms duration less than 10 days included in our study is too small to assert this firmly.It is worth noting that among 10 of our asymptomatic individuals sampled 1 day after RT-PCR confirmation, none was negative with all tests, and surprisingly, most of them were positive for both IgA/M and IgG with more than at least two tests of different formats.Obtained sensitivities and specificities for five out of eight accompassed assays are similar to those declared by the manufacturers, taking into account the slight differences in the time from the onset of symptoms used for testing. Significant discrepancies were obtained for IgM isotype in two LFIC assays (Biozek and Lumiquick) and Maglumi CLIA assay. However, the time from symptoms onset used by these manufacturers for evaluation of sensitivities and specificities is unknown and can have a huge impact on comparability with our results.Comparison of IgG serological assays in our study confirmed a low level of variability between different assays (including rapid tests), despite the differences in employed antigenic targets . On the contrary, variability between results of the IgM assays was high with only one acceptable agreement (between two rapid tests) according to the rule that kappa coefficient < 0.60 indicates inadequate agreement between methods to be equally employed in clinical laboratory practice . The majority of studies presented sensitivities and specificities of different SARS-CoV-2 serological assays while our study additionally evaluates the agreement of the results between tested assays.Although this is not the first study that compares several different serological SARS-CoV-2 assay methods, to the best of our knowledge, Lumiquick IgG/IgM and Biozek IgG/IgM as rapid assays and Vircell IgM+IgA/IgG as an ELISA method were not previously compared to other assays included in this study.The low number of participants, especially those with a duration of the symptoms less than 10 days is the limitation of the study. Additionally, to determine the specificity of the SARS-CoV-2 serological assay, the use of prepandemic samples would be the most correct approach.In conclusion, our study confirmed that the selection of the appropriate time-frame for testing is crucial for the proper investigation of immunity, which can be very challenging among asymptomatic persons. There is high variability between IgM SARS CoV-2 serological assays independently of the assay format. On the contrary, IgG assays showed moderate to perfect agreement. We observed a higher diagnostic accuracy of IgA in comparison to IgM SARS CoV-2 serological assays.


Although the integration of social determinants of health (SDH) screening and referral programs in clinical settings has rapidly grown, the voice and experience of participants within SDH programs has not been well understood in program evaluations. To qualitatively evaluate a comprehensive SDH screening and referral program based in an academic primary care setting, we conducted a qualitative analysis of a semi-structured, focus group interview of 7 caregivers. We performed inductive coding representing emerging ideas from each transcript using focus group transcripts from families who participated in the SDH screening and referral program. A thematic model was created describing caregivers’ experiences with respect to screening, intake, and referral phases of the program. Caregivers reported satisfaction with structural and process-related components of screening, intake, and referral. They expressed a preference for trained patient navigators over physicians for screening and intake for they were perceived to have time to prioritize caregivers’ social needs. Caregivers reported disappointment with legal services screening, intake, and referral, citing lack of timely contact from the legal resource team and prematurity of provided legal resources. Overall, caregivers recommend the program, citing that the program provided social support, an environment where expression is encouraged, motivation to address their own health needs, and a convenient location. Overall, caregivers would recommend the program because they feel socially supported. The use of trained patient navigators appears to be instrumental to the successful implementation of the program in clinics, for navigators can provide caregivers with the appropriate time and personal attention they need to complete the survey and discuss their needs. Streamlining the referral process for evaluation of health-harming needs by the medical legal partnership was highlighted as an area for improvement. A number of studies have documented the contribution of unmet social needs –3, incluSocial determinants of health (SDH) screening and referral programs have been implemented in pediatric clinical settings over the last decade –19. HoweTo understand the perceptions and experiences of program participants, this study provides qualitative analysis of participant feedback on the Social Health Alliance to Promote Equity (SHAPE) comprehensive SDH screening and referral program based in the Division of General Pediatrics primary care practice of Cohen Children’s Medical Center at Northwell Health. The program screens families for unmet social needs in the pediatric clinical setting and refers families to community-based resources and partner organizations, as well as a medical-legal partnership. Given the dearth of information on caregiver perceptions and experience on SDH screening and referral programs, this paper aims to leverage existing feedback from a focus group with families participating in the SHAPE Program in order to provide insight into this population’s attitudes and beliefs on these programs and guidance for areas of improvement.Northwell Health’s Cohen’s Children Medical Center-General Pediatrics (CCMC-GP) Practice implemented the SHAPE Screening Program [previously referred to as the Family Needs Screening Program] . SDH scrTo qualitatively evaluate the SHAPE program, the SHAPE Program Director (OTU) hosted a patient forum for families of patients who participated in the SDH screening and referral program. Preparations for the forum included assistance from Public Agenda, a group that has facilitated multiple forums for the United Hospital Fund . Public At the time of the family recruitment, there were 927 patients screened, 590 patients screened positive for at least one social need, and 190 had accepted assistance from patient navigators. There were 25 families that, regardless of whether or not they had completed the 12-week referral program, utilized referrals from the Northwell Medical Legal Partnership, Child Center of New York Single Stop program or the Interfaith Nutrition Network. Of the 10 families that were invited, 6 families attended—6 mothers and 1 father. Participants mainly spoke English at home (5 out of 6 participants), were from a racial/ethnic minority group , had varied educational attainment , and were born outside of the United States (3 out of 6 were born outside of the United States).The forum time and duration were selected based on the convenience of families. Dinner was provided and two patient navigators assisted with on-site childcare. The forum was moderated by the SHAPE Program Director, Program Coordinator and patient navigators. Moderators used a guide with open ended questions and probes related to the screening program. Participants were queried about factors that influenced child health, perceptions of the screening program, and the quality of the referral process. The discussion was digitally recorded and stored on an internal server to ensure security and later transcribed. Transcripts were checked against the original recordings for accuracy. At the close of the forum, each family received a $75 Amazon gift card for their participation.To optimize credibility, transferability, and dependability of results, we utilized researcher triangulation, peer debriefing, and documented the trail of decisions made during the analysis and rationale. A thematic analysis approach was utilized as the primary methodological orientation . The focOverall, 13 sub-themes were categorized under the 3 main themes of structure, process and outcome .Overall, caregivers are satisfied with the SDH screening tool; specifically, with regard to location of survey administration (exam room/waiting room), length of screening survey (1-page), and survey questions."…everything she asked me, I felt it was pretty decent…like it wasn't nothing that I didn't have to share with her, that I felt was too confidential…”Caregivers reported satisfaction with the trained patient navigators administering the screening survey. When offered the option to receive surveys from their physician or a trained navigator, caregivers expressed a preference for the trained navigator. This preference appeared to be mediated by a perception that navigators have time to appropriately attend to caregiver concerns.“The navigators because they are trained. The doctors are here to do their job mainly so it's kind of hard to pour your heart to a doctor when they have a bunch of patients who probably want to do the same thing…so it's better that way.” “The patient navigator was good at making it feel not routine…”Caregivers reported being comfortable with the structural components of intake, with regard to questions and mode of communication (via phone). When probed for improvements to the intake process, caregivers suggested providing additional modes of communication (e.g. email)."It is effective over the phone" " I don't know if there is an email option"Caregivers prefer to receive the screening survey while waiting for the physician visit, noting that this makes good use of waiting time.“…it was something for me to do while I waited for the doctor”When probed for improvements to the intake process, caregivers recommended that navigators align the intake phone call with caregiver’s schedules to yield more consistent responses.“It’s all about schedules. Everybody has different lives. We need someone available at 9 a.m., some people are going to want 9 p.m… It just depends on their lives and their work schedule.”On average, referrals ranged between hours to 1 week after the intake phone call and caregivers generally appear satisfied with this timing. In fact, parents were impressed by speed of referrals and relevance of referrals  to their circumstance.:“Actually, wasn't that long…3–4 hours and then I got a phone call.” “A week.”Generally, caregivers expressed satisfaction with the referrals they received to resources such as food pantries and employment assistance programs."they know everything about me, like the navigator explained everything to them and they were like we know this part and we would want to help you. It was really impressive.”“…I like the calls I got from the two young ladies who called me. I liked that call about the job search and stuff like that. That was nice.”Some caregivers revealed that their physicians received the results of their screening survey during the visit and they expressed that they appreciated when the doctor is informed about the results of the screening.“Actually, my doctor came in right after her [patient navigator] … and she was like okay…well I am going to see what is going on, to help you”Caregivers expressed disappointment with timing, speed, and relevance of legal referrals, citing that follow-up times were longer than anticipated and that some legal referrals were premature for the patient's circumstance.For the part with the lawyer. I didn't get the follow-ups like I thought I was going to get, no calls or emails from the lawyer that I thought I was going to get…” “The lawyer was really no help to me because it wasn't like a resource I could use at the moment right now to help with my situation.” “ Well, yeah, like a better resource besides a lawyer… but at the moment because I don't have a court date, it is not useful at now.”“Parents reported feeling supported when someone on the health care team takes the time to ask about, listen to, and understand the difficulties they’re having.it feels good to know that someone else is thinking about you as a parent. Because you as a parent, you gotta be there for your kids, can't be depressed or down especially when you have to take care of your kids. So, it is important that somebody else is able to see besides people who are with you every day.”“In fact, caregivers actually expect such support from their health team.You expect someone there to take care of us. Even the doctors come in, ask questions, how are you feeling, give us a stress form, how things going on, are you depressed and mostly what happened to me, my kids, they helped me out…”“Interestingly, caregivers reported that SDH screening motivates them to discuss, prioritize, and care for their own health.“…I just feel like every single time it tells me something because it still reminds yourself that you have to take this as seriously as you take any other health issue.”When asked to identify social issues that could influence the heath of their children, caregivers identified two types of factors. Here, we use the phrase “direct determinants” to describe factors that the child experiences, while “indirect determinants” describe factors that the caregiver experiences . PediatrCaregivers overwhelmingly responded that that they would recommend the screening program. Reasons for recommending the program included: providing help to parents, providing a safe space where expression is encouraged and prioritized, the convenience of locating the program where caregivers already visit.“Yes, because to get the help to the parent and because you can feel like you can express how you feel, how you are being treated somewhere where you attend and the help that you can and cannot get via resources…” “Yes, I'll say I recommend because there are some women who don't want to express what they are feeling or how things are with them so this definitely encouraged like you have someone to explain to and things will be good…”In summary, 3 major themes—structure, process, and outcomes—and 13 subthemes were identified from this study of pediatric caregivers engaged in SHAPE SDH screening and referral program during well-child visits. Overall, caregivers were willing to recommend the SHAPE program, as they perceived that the program offered social support—an important outcome of SHAPE screening and intervention. Additionally, the use of trained patient navigators appeared to be instrumental to the successful implementation of the program in clinics, for navigators could provide patients and caregivers with the appropriate time and personal attention they needed to complete the survey and discuss their needs. Patient navigators also enabled timely coordination of referrals to community-based organizations and follow ups. With this in mind, providers seeking to create successful SDH programs would do well to well to employ trained navigators and integrate them into screening, referral, and follow-up phases of the program.Despite overall satisfaction with the referral program, caregivers were less satisfied with the legal services referral process and outcomes. They cited lack of timely contact from the legal resource team and prematurity of the legal resource provided, which rendered the resource inappropriate. Also of note, was a discrepancy between caregiver expectations of legal referrals and actual referrals. This might be remedied by setting clearer, more accurate expectations of the capabilities of legal services and referral workflow prior to caregiver contact with the legal team.Previous studies on SDH screening studies have already shown that SDH screening and referral programs can lead to increased use of referral resources for pediatric caregivers . This stOne of the notable discussions was caregivers’ linking social determinants of health to their children’s health. At the start of the discussion, participants considered social determinants to be a separate entity from children’s health. When citing factors that could influence child health, parents initially suggested a number of direct determinants, such as exposures to particular illnesses or harm. However, with more discussion, caregivers began linking social determinants, such as financial constraints and social support, to the well-being and health of the child. Specifically, patients were able to understand how a child may internalize the stress that caregivers face when trying to provide with resource constraints. Additionally, patients recognized that a caregiver struggling with meeting socioeconomic needs (e.g. employment lack of childcare) or struggling with physical or mental illness will not have the resources to support dependent children. Once patients were able to link social determinants with health outcomes, it became clearer why the screening program could potentially improve child health outcomes.This study was limited by the homogeneous and a small number of caregivers with respect to the length of time spent in the program. As a result, inferences from this study were limited to the socioeconomic and cultural context of this sample. Although caregivers had received screening, intake, and referrals, none had completed up to 12-weeks of follow up post-screening. Out of convenience and relative difficulty of engaging caregivers who completed the 12-week follow-up period, we included caregivers who were yet to complete all 12 weeks of post-screening follow-up. Inability to capture caregivers outside of the 12-week post-screening window served as a potential limitation to the inferences made by this study. Including caregivers who spent more time with the program could allow researchers to understand the perspectives of and outcomes for caregivers with protracted case resolution timelines, e.g. housing and/or immigration cases requiring legal intervention. Other limitations were patient navigator responses during the forum. Those seeking to replicate the program might wish to extend the post-screening follow up window in order to capture patients with protracted case resolution timelines. Although navigators brought up relevant issues, they could introduce biases and interfere with the collection of usable quotes by caregivers in attendance. Navigator statements at the patient forum, though revelatory, were subsequently excluded from this paper.Overall, the SHAPE SDH screening and referral program offered social support to caregivers. Caregivers reported appreciation of having appropriate time, convenient location and personal attention they needed to complete the survey and discussed their needs. They found patient navigators to be an essential component in the successful delivery of the program. We also identified one major area of improvement—legal service referral process—which tended to include more complex situations, required more transparency and better communication. As the prevalence of SDH screening and referral programs embedded in clinical settings grows, it is of paramount importance to conduct qualitative evaluations of the caregiver/patient experience.


Following publication of the original article , one of The updated funding is given below.This work was supported by Grants to NQ Gong from the National Natural Science Foundation of China (No. 81570678), to NQ Gong from the Clinical Research Physician Program of Tongji Medical College, HUST, to NQ Gong from Major State Basic Research Development Program of China , to CS Ming from the National High-Tech Research and Development Program (Program 863) of the Ministry of Science and Technology of China (2012AA021010), and to ZS Chen from the Translational Grant of Tongji Hospital. JM acknowledges support from grant RO1DK106394.


Interprofessional collaboration is needed to ensure high quality care. Effective programs teaching necessary team-based care skills are under investigation. This study evaluated the Aging in Place program, an interprofessional practice experience (IPE), in preparing pharmacy students for practice with underserved older persons. The Assessment of Interprofessional Team Collaboration Scale (AITCS) and Team Decision Making Questionnaire (TCMQ) were administered to students before and after their experience. The number of disciplines represented, campuses involved, resident sessions, resident interactions, and health screenings performed were documented. Overall, AITCS and TDMQ scores improved after participation in the program. Since the program’s inception, there have been 7 disciplines represented, 2 campuses involved, 125 student participants, 2 housing buildings, 90 resident sessions, and 370 health screenings performed. The Aging in Place program has grown and shown that an IPE program is feasible to better prepare pharmacy students for collaborative care with older residents of affordable housing buildings.


Cell Discovery (2020) 6:4Correction to: 10.1038/s41421-019-0138-2 Published online 28 January 20201, one of the funding was missing in the Acknowledgements part. The corrected Acknowledgements appear below:In the original publication of this articleAcknowledgementsThis study was supported by National Key R&D Program of China (2017YFA0505500), the Strategic Priority Research Program of the Chinese Academy of Sciences (XDB13040700), National Natural Science Foundation of China , and Shanghai Sailing Program (18YF1420700). The authors are grateful to Dr. S. Anderson for English editing of the manuscript.


The assembly of Lac on the surface of PAN/O-MMT/TiO2 nanofibers was confirmed by confocal laser scanning microscope (CLSM). In comparison with free Lac, the immobilized Lac showed better pH, temperature and operational stabilities, reaching highest relative activity at an optimum pH of 3 and optimum temperature of 50 °C. Therefore, the immobilized Lac displayed a higher degradation efficiency of CV at an initial dye concentration of 100 mg/L, an optimum pH of 4.5 and temperature at 60 °C. Under UV illumination, the CV removal efficiency was further improved by ~20%. These results demonstrated that the Lac-immobilized PAN/O-MMT/TiO2 composite nanofibers with a combined effect between the immobilized enzyme and the polymeric support have potential for industrial dye degradation.Removal of a triphenylmethane dye  by a simultaneous enzymatic-photocatalytic-adsorption treatment was investigated in this work. A desirable synergistic effect on dye treatment was achieved by decorating laccase (Lac) onto the surface of TiO Wastewater pollution has been an increasingly serious problem that garners significant attention from society and scientific researchers over the past five decades. Great quantities of wastewater are released from paper, painting, leather, and cosmetics industries, especially the textile industry ,2. It is2) is being combined with Lac due to its desirable photocatalytic capability in the removal of textile dyes. Aura et al. [Trametes versicolor for biodegradation, followed by photocatalytic degradation employing UV/TiO2/RuxSey to treat wastewater from papermaking, resulting in a 92% color removal and 99% chlorophenol degradation after about 96 h. Luisa et al. [2/UV photocatalysis first and then Trametes pubescens, ultimately achieving a degradation rate of 100%. These works show that the sequence of photocatalytic and biocatalytic processes has no influence on the final treatment efficiency. Therefore, it is promising for Lac and TiO2 to work simultaneously, thus further improving the dye degradation efficiency and reducing energy consumption.Laccase  is a multi-copper oxidase that can catalyze the degradation of a wide variety of substrates while avoiding the co-formation of toxic by-products ,14. Howea et al.  proposed2 and immobilized Lac on the degradation of 2,4-dichlorophenol. Compared with free Lac or TiO2/UV, the degradation efficiency of simultaneous photocatalytic-enzymatic treatment was significantly increased, demonstrating a synergy between the TiO2/UV and immobilized Lac. To further improve the overall dye removal capacity, Lac was immobilized on TiO2 particles through covalent bonding methods [2 particles showed low stability, reusability and recyclability. To circumvent this limitation, various attempts were made for the immobilization of Lac and TiO2.Jia et al.  studied  methods ,18,19. H2 immobilization, including cellulose nanofibers [2, electrospun nanofibrous membranes have been proven to have great potential in wastewater treatment, especially with the addition of adsorbent material in the process of electrospinning [A number of scaffolds have been utilized in enzyme and TiOnofibers ,21, ceranofibers , graphennofibers , silica nofibers , magnetinofibers ,26,27 annofibers ,29,30. Aspinning . Electrospinning ,33. Elecspinning ,35, whicspinning . In our spinning .2 sol-gel before the immobilization of laccase (Lac) to prepare a functional composite nanofibrous material, innovatively combining the adsorption abilities of O-MMT and electrospun nanofibrous membrane, enzymatic degradability of laccase as well as photo-catalytic degradability of TiO2  nanofibrous membrane, coated by TiO of TiO2 . In addiMw = 50,000 g/mol) powder was purchased from Shangyu Wu & Yue Economic and Trade Co., Ltd. . Organically modified montmorillonite  was obtained from Zhejiang Fenghong New Material Co., Ltd. . Laccase and 2,2′-Azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS) were supplied by Sigma–Aldrich, China. Crystal violet (CV), N,N-dimethyl formamide (DMF), sodium acetate and acetic acid were all purchased from Sinopharm Chemical Reagent Co., China. All reagents and solvents were used as received.Polyacrylonitrile (PAN)  power supply. The flow rate was set as 0.5 mL/h and the constant distance between needle tip and collector was 15 cm. Finally, it was collected on a roller covered with aluminum foil.2 nanofibers was prepared as follows: first, Ti(OC4H9)4 was added into 6 mol/L HCl dropwise and stirred for 30 min to prepare the TiO2 sol. Then, it was added into deionized water until the ratio of Ti and HCl became 0.83:1. Sequentially, the solution became homogeneous after magnetically stirring for 1 h [2 sol for 12 h. Finally, the as-prepared PAN/O-MMT/TiO2 membrane was dried at 60 °C for 10 min before further use.The PAN/O-MMT/TiO for 1 h . After 52 nanofibers were functionalized after the immobilization of Lac. A 400 mg of PAN/O-MMT/TiO2 nanofibrous membrane was immersed into a 250 mL flask containing 100 mL of 0.3 g/L Lac in sodium acetate solution (pH = 4) and adsorbed by electro-static force between ionized enzyme and cationic TiO2 precursors. After shaking at 25 °C for 3 h, the membrane was thoroughly washed by buffer solution. Later, the Lac-immobilized PAN/O-MMT/TiO2 nanofibrous membrane was stored at 4 °C.Then, the PAN/O-MMT/TiO2 coating, scanning electron microscopy  was performed at an accelerating voltage of 12.5 kV with a magnification of 10 k.To observe the morphology of PAN/O-MMT before and after TiO2 nanofibrous membrane, fluorescein isothiocyanate (FITC)-labeled Lac was applied. After immobilization, the FITC solution was thoroughly washed by buffer solution. Finally, confocal laser scanning microscope  was employed for visualization of Lac at an excitation wavelength of 488 nm.To verify Lac has been successfully immobilized on the PAN/O-MMT/TiOThe activities of both free and immobilized Lac were determined by oxidizing ABTS in sodium acetate buffer solution at 30 °C . Next, 0mK and maxV) were calculated according to Michaelis–Menten equation. Here, mK is the Michaelis constant, representing the concentration of enzyme when the reaction rate reaches half of maxV (the maximum reaction rate).To study the kinetics, ABTS solution (pH = 4) in the range of 0.1–1 mM was oxidized by free and immobilized Lac at 30 °C. The kinetic parameters  at different temperatures ranging from 20–70 °C for 10 min before incubation at 30 °C for 5 min. Then, all the samples were used to react with ABTS for 3 min to test the relative activities of Lac under different conditions.For thermal stability studies, the relative activities of free and immobilized Lac were studied at 20 °C, 30 °C, 40 °C and 50 °C and recorded every 2 h. The operational stability at 30 °C and 50 °C was evaluated by testing the activity of Lac after each repeated utilization (8×). During each interval, the membrane was recovered and sufficiently washed with buffer solution.To determine the amounts  of ABTS mediator (15 mM), 0.1 mL of 0.3 g/L free Lac was employed to degrade 40 mL of 50 mg/L CV solution (pH = 4) at 40 °C for 5 h and concentration was recorded every hour at a wavelength of 590 nm by employing a UV-1200 spectrophotometer. All assays were performed in triplicate. Experimental data were reported as mean ± standard deviation.Different concentrations  of 40 mL CV solution (pH = 4) were degraded by 100 mg of immobilized Lac at 40 °C to study the effect of its initial concentrations on removal efficiency. To investigate the effect of pH on CV degradation, 100 mg of immobilized Lac was used to remove 40 mL of 50 mg/L CV solution in the pH range of 2–6 at 40 °C. The effect of temperature on CV removal efficiency was also studied by employing 100 mg of immobilized Lac to remove 40 mL of 50 mg/L CV solution (pH = 4) at 20–70 °C. The CV removal efficiency of each group was recorded after 5 h.To assess the influence of UV light on laccase activity, free Lac was employed to degrade 40 mL of 50 mg/L CV solution (pH = 4) at 40 °C. To evaluate the CV removal efficiency under UV illumination, immobilized Lac was used to degrade 40 mL of 50 mg/L CV solution (pH = 4) at 40 °C. The CV removal efficiency of each group was recorded at different intervals.2 coating was compared using SEM 22+ generated during hydrolysis, distributed onto the PAN/O-MMT/TiO2 nanofibrous membrane and competed with the H+ in the buffer to prevent the microenvironment around the immobilized Lac being more acidic. Generally, the immobilized Lac demonstrated a higher retention activity over higher pH, broadening the operational pH range.However, the relative activity of immobilized Lac on PAN/O-MMT/TiOIncrease of temperature can speed up the reaction between the enzyme and the substrate to some extent. However, when the temperature becomes too high, the enzyme would be denatured and loss its activity. The thermal stability was evaluated ranging from 20 °C to 50 °C and recorded every 2 h, as shown in At 20 °C, the immobilized Lac maintained around 85% of its initial activity after 8 h, while the free Lac only retained 67% a. At 30 2 nanofibrous membrane at a lower temperature and its great potential in dye degradation and biotechnological applications.Reusability is also essential in the study of enzyme immobilization . Figure Investigation of the optimum concentration of the mediator ABTS was carried out by employing free Lac to degrade 50 mg/L CV solution. The removal efficiency of CV mediated by incremental amount of ABTS was shown in Along with the increased initial CV concentration from 10 mg/L to 150 mg/L, the removal efficiency by free and immobilized Lac fluctuated with a similar trend. When the CV was degraded by free Lac, suspension of insoluble particles was generated when the initial dye concentration was 25 mg/L and they started to agglomerate and precipitate when the concentration was further raised b. For th+ and TiO2+/Ti(OH)22+ in solution competed with dye molecules for adsorption sites on O-MMT so that the removal efficiency of immobilized Lac was relatively lower [The removal efficiency of CV can be also affected by variation of pH and temperature, the results are shown in ly lower . Along wThe effect of temperature (20–70 °C) on CV degradation is shown in 2 onto the support can further improve the degradation efficiency through a synergy of photocatalytic and biological effect.When the dye solution was treated by immobilized Lac, the dye removal efficiency with UV illumination was generally 20% higher than that of the non-illuminated solution over the recorded period, reaching a final dye removal ratio of ~95% b. Theref2 were successfully prepared and further used as a matrix to immobilize laccase. It was confirmed by CLSM that laccase was uniformly immobilized onto PAN/O-MMT/TiO2 nanofibers at a loading of 342 mg per gram of support. After immobilization, the optimum temperature of Lac remained unchanged at 50 °C, while optimum pH of immobilized Lac changed to higher pH. Compared with free Lac, the pH and thermal stability of the immobilized Lac was improved and the reusability was better retained at lower temperature. Therefore, Lac-immobilized PAN/O-MMT/TiO2 nanofibers showed better CV removal capacity, which was hardly influenced by elevated pH and temperature. It reached its highest removal efficiency at an optimal pH of 4.5 and temperature of 60 °C. Under UV illumination, the activity of Lac was hardly affected by UV light. The immobilized Lac combined with photosensitive TiO2 improved CV removal efficiency by 20% and reached a final dye removal ratio of ~95% after 6 h illumination, attributed to the synergistic effects of adsorption, biocatalysis and photocatalysis. These results indicate that the Lac-immobilized PAN/O-MMT/TiO2 nanofibrous membrane demonstrates enormous potential for removing dyes in industrial wastewaters. It also provides a new approach combining adsorption, biocatalysis and photocatalysis for the elimination of pollutants from environment.Electrospun PAN/O-MMT composite nanofibers functionalized by sol-gel coated TiO


The purpose of this study was to examine the effectiveness of an experiential learning program based on Kolb’s theory in increasing dementia supporters’ motivation and activity involvement within the community.In this interventional study, the sample was divided into two groups. The intervention group underwent dementia supporter training and participated in an experiential learning program, which was conducted two weeks after the initial training session. The control group underwent only the dementia supporter training.Kolb’s experiential learning model consists of four stages: concrete experience, reflective observation, conceptualization, and active experimentation. A total of 37 and 44 individuals constituted the intervention and control groups, respectively. The Wilcoxon signed-rank test revealed that there was a significant increase in motivation among the intervention group participants, when compared to the control group participants. Moreover, the activity rate was higher among the intervention group participants.The experiential learning program was effective in increasing motivation levels and activity involvement among the dementia supporters.The experiential learning program for dementia supporters can be used to improve other volunteer and professional programs. Moreover, Kolb’s theory can be used to support individuals with dementia within the community. In Japan, the older adult population is growing very rapidly. The percentage of individuals aged > 65 years was 28.4% in 2019. In other words, one out of four individuals were older than 65 years. The aging rate continues to grow, and one out of three individuals will be older than 65 years in 2036. In 2065, one out of 2.6 individuals will be older than 65 years , <understanding of short- and long-term memory>, and <understanding of daily living of the person with dementia> were extracted, and these categories indicated that the supporters were aware that the person with dementia likely talked of their old days repeatedly. This experiential learning program connected academic knowledge and learning in the field.Third, the dementia supporters presumably found the experience of communicating with individuals with dementia to be pleasant and interesting; this may have increased their motivation levels. Kage  found thIn the interview, shown in [proper understanding of people with dementia] and <pleasant and interesting experience>, there were dementia supporters who had not talked with a person with dementia before the program. They considered the program as a precious experience, and they had a good time talking with person with dementia. Some supporters said the program made them remember their parent who had been diagnosed with dementia and died. The supporters said they spent a peaceful time talking with the person with dementia.Fourth, there was a change in the beliefs of the dementia supporters. Before the experiential learning program, the dementia supporters believed that there were limitations to what individuals with dementia can achieve , and they held negative attitudes toward individuals with dementia. During the intervention, especially the second phase, the supporters realized that individuals with dementia can be outgoing, communicate with others with ease, and independently engage in many activities. Moreover, during the third phase, discussions with the facilitator helped the supporters gain a better understanding of their experiences. Consequently, they realized that individuals with dementia should not be stereotyped.According to the interview results, [proper understanding of people with dementia] and <change from a negative image to a positive one> also support the effect of this program.The preprogram SOC-13J scores of the participants  were slightly higher than those of the average adult (54.0–57.0) . Life exThis study was conducted in only one daycare center, and only one facilitator managed this program. Future studies should implement this program across several daycare centers and recruit many facilitators to test the robustness of the present findings.This program aimed to raise dementia supporters’ motivation and their activity involvement in the community and to examine the effectiveness of the experiential learning program. People in the intervention group increased their motivation and activity involvement compared to the people in the control group. The experiential learning program had significant positive effects on dementia supporters.Kolb’s experiential learning model consists of four stages: concrete experience, reflective observation, conceptualization, and active experimentation. This study was the first practical application of Kolb’s theory to training for dementia supporters. The findings indicated that Kolb’s theory is useful for supporting individuals with dementia and can be used to improve other volunteer and professional programs.S1 Data(XLSX)Click here for additional data file.


Menopause and midlife are stages in a woman’s life that can be marked by debilitating symptoms and increasing risks for cancer, cardiovascular, metabolic, and bone health issues. Walking represents a simple, low cost, and widely accessible activity with proven health benefits, though its therapeutic effect on alleviating menopause symptoms is not well characterized. Women are generally not opposed to exercise programs; however, increasing or maintaining exercise levels remains a challenge. We undertook a qualitative descriptive study to explore features of a walking program that would be conductive to menopausal women’s participation, as well as to inform the development of such a program.We conducted focus groups with women recruited from two menopause clinics and who suffered from moderate to severe menopause symptoms. The focus groups were audio recorded and transcribed. Women were prompted to talk about their menopause experience and exercise practice and how they would envision a walking exercise program that would keep them engaged. Qualitative content analysis was used to analyze the data and to identify characteristics of a walking exercise program.Twenty women participated in 5 focus groups. Women were very interested in trying walking as a means of staying healthy and possibly reducing menopause symptoms. Four major characteristics emerged as important for a walking program: (a) sensitivity to health realities of menopausal women, (b) inclusivity of various needs/levels of physical ability, (c) attentiveness to the need for mutual social support, (d) flexibility in planning of locations and scheduling.A restricted social network platform with features catering to women in menopause was suggested as suitable to initiate and sustain an adequate walking program.The findings of this study will be essential in designing a program that would be attractive for women to start and maintain a walking habit. The program would assist in elucidating whether walking is a useful and valuable alternative therapy for menopausal symptoms and, ultimately, might help women staying fit in midlife and postmenopausal. Menopause is a natural stage in a woman’s life, characterized by the cessation of menstruation and the end of the reproductive years. Hormonal changes during the menopause transition period are often accompanied by physical and psychological symptoms that can impact women’s quality of life (QOL) . During Walking represents a widely accessible, low cost approach to exercise with proven health benefits , 5. WalkResearch indicates that women are not averse to regular exercise, especially those seeking ways to avoid the perceived increased health risk of hormonal therapy , 11. NevDesigning a walking program that is attractive and engaging for women in menopause transition or postmenopausal can be challenging. A variety of components must be considered, including walking group dynamics, program frequency, time, location, and environmental and climate challenges. A city’s layout and general walkability can be an important factor in inspiring or deterring people from walking , 18.The Mature Women’s Health Research group at the University of Alberta aims to investigate whether a walking exercise program can improve QOL in women with moderate to severe menopause symptoms who are seeking help at Edmonton’s menopause clinics. Before exploring the characteristics of an effective walking exercise program for women, we carried out a scoping review of relevant literature and undertook an exploratory environmental scan of existing Edmonton walking programs.Our scoping review confirmed that participating in regular walking programs can have beneficial effects on menopause symptoms and risk factors arising around the age of menopause transition. Our review was unable to establish minimum session length and walking intensity, but we did find that exercise persistence and adherence were important to experience benefit .Our environmental scan of local walking resources identified a variety of groups and organizations that engage in regular, year-round walking exercise, but none was specifically designed for women in the age of menopause transition .Focus group studies have been successfully employed to gain insight into individual experiences and perceptions of exercise programs and to provide information for the development of programs accordingly , 22. UsiWe used a qualitative descriptive design which enables researchers to investigate, describe and summarize a phenomenon in everyday terms . Focus gWomen eligible to join the focus groups were those in menopause transition or postmenopausal, who attended one of the two Edmonton Menopause clinics, and were physically able to walk without assistance. Focus groups were formed using a purposeful sampling approach that identifies information-rich participants . We wereTwo focus group moderators were present. One, with training in moderating focus groups, and no prior relationship with the clinical or research team members, facilitated the discussions. The other was a research team member, who took notes on non-verbal data. A semi-structured discussion interview guide was used including open-ended questions on (i) attitudes towards exercise and walking, (ii) exercise barriers, (iii) exercise promotors, and (iv) perceptions about an ideal walking program. The focus groups were audio recorded and transcribed verbatim. In the process of transcription, all identifying information was replaced by codes, such as P1, FG1 . Focus group notes that included non-verbal data, were taken to support the analysis.Qualitative content analysis, typically used in qualitative descriptive studies, was the approach used to analyze the focus group data . QualitaThe focus groups were analyzed iteratively and simultaneously with data collection. Analytical attention was primarily on the interaction between the participants and the inter-group dynamics . At the Twenty women participated in five focus groups held during December 2017 to February 2018 in two health care locations in Edmonton. Groups ranged in size from two to six women.couch potatoes”).Characteristics of the participants are presented in Table All participants suffered from severe, often multiple, symptoms of menopause that had significantly impacted their QOL over an extended period of time. Insomnia, night sweats/hot flashes and fatigue were the most prevalent symptoms discussed. In addition, lack of sex drive and vaginal dryness, memory loss, depression, and lack of motivation were described as troubling symptoms. Participants stated that the severity of the symptoms and their impact on the QOL were undermined by their primary care physicians. Most participants also reported feeling socially isolated, without connection to women with similar menopause problems.In this context, participants discussed the features of a walking program that would be suitable for women in menopause. Four distinct characteristics emerged: (A) sensitivity to health related realities of women in menopause; (B) inclusivity of various expectations and levels of readiness (fitness) among participating women; (C) attentiveness to the need for social support, and (D) flexibility in planning locations and scheduling of the program.Tired women will not walk”  and “You’re too tired to do it” .The current health status and ability to be physically active varied among participating women. Participants who reported being able to exercise, described a positive impact on their wellbeing, such as improved sleep and better mental stability. Others, who were more active in the past, but developed co-morbidities or injuries, felt regret that they had to reduce the intensity and/or type of exercise. Participants who reported currently being less active, highlighted symptoms of fatigue and lack of energy as the de-motivating factor to exercise, stating “open to any level” . Still, many worried that the incapacitating nature of their menopause symptoms described by one participant as “struggling to get out of bed in the morning”  as well as other health issues would be a potential barrier to joining a walking program. Therefore, the participants suggested that the walking program should be sensitive to different health realities among menopausal women, such as fatigue, “the worry about injury”  , and possible overheating/hot flushes while walking.I get so hot and then I get really irritated when you get that hot and you're irritated and when you can only take off so much clothes, right” .“ Walking was perceived by the participants across all five focus groups as a type of exercise that could be easy, accessible, relaxing, less risky for the body, and ““…but I’m thinking for people who have not been active, the worry about injury and just having somebody who can maybe coach them through that a little bit and what to expect or how to stretch out or what to watch for because even though we talk about walking and it seems like a simple thing, I wonder if it’s possible to have walking injuries” .Several suggestions were put forward to overcome these challenges such as indoor walking as a safer winter solution, cooling aids to manage overheating and hot flashes and basic coaching to prevent injury.In addition, as some of the participants stated, the program should incorporate a right kind of encouragement to keep women motivated, included, and overcoming their concerns.[…] something that keeps us in check as to what the purpose of the walk is” .In the context of these health realities, the focus groups further discussed the program’s goals and expectations. While there was a range of opinions how specific the goals of the walking program should be, the participants believed that the sense of clear expectations and purpose should be transparent, “something to achieve, you know, to look forward to”  to ensure that the program will “make a difference” .“I also think being out and getting out giving you a sense of accomplishment that you know that I'm you know I'm doing this for me and I'm committed to it and I'm actually getting it done. I want some real rewards…” .Some participants stressed the need for disciplined commitment to the program’s schedule, emphasizing the importance of predetermined health outcomes, “As somebody who like I said is just starting to be a functioning human being again […] the expectations [should not be] too great […]so that they can start out small but grow as it can like expand as they feel like they can take on more” .“I like to be able to keep track of my steps, that’s my own personal goal so I think if people had individual goals that’s great too” .“A more flexible approach was suggested by others. Some participants believed that establishing high-achieving goals may be attractive to some women, but these could also deter less active and less competitive women. The program therefore should respect women’s different initial fitness, offering different levels of walking intensity and leave room for individual goals.wellness, envisioning a less competitive program that will “improve health”  or contribute to “feeling better” . Openness to and inclusion of women with various expectations and levels of fitness surfaced as consequential characteristics of the walking program.While developing specific goals would be important for some participants, others would be comfortable with a more general purpose of is walking the same steps as I am” , was emphasized across all focus groups.In discussion about the appropriate nature of the program, the importance of the social support to women, described by one participant as connecting with someone who “coffee time” at the end. Such a program would simultaneously provide an opportunity for physical activity and mutual emotional and social support to women who often do not have a place to share their menopause experience. This was discussed for example in FG3:[…] and it’s not necessarily about the walk […] it’s about the socialization. (P3) “Yeah that’s a big part” (P4). “Because that helps, it’s not the exercise that helps, it’s the socialization and realizing that they're not alone” (P3). “[…] I think if the main focus is socialization, just all in the same boat, but we’re going to walk down the block and talk about our menopausal symptoms, […] the walking is the secondary piece” (P2).“The participants envisioned an organized, regularly scheduled walking group that would be fun, with an optional “buddy system” was also broadly discussed across the focus groups in the context of the lack of motivation to be physically active that women often experience. One exchange, which occurred in FG1, suggested that peer encouragement and mutually developed accountability to one another would be an incentive to continued participation:I would need a buddy because I wouldn't want to do it on my own” (P3). “Walking partners are great” (P1). “That’s true too” (P2). “I would need a buddy. I think definitely the, you know like, group or buddy I think it would, like for me that would be great. […]and yeah to be accountable to go, yeah there’s an accountability piece, there’s a social piece, there is just that… Yeah there’s a lot of features to the buddy thing” (P3).“The concept of a ““And if you set it up something like you know on one of the social aspects on Facebook whenever you set a group up and say ok this is the plan for the day, this is where everybody is going, love to see you there, you know and kind of just whoever shows, shows. You know it’s not a hardcore that you have to be there, it’s you know feel free when you feel up to it or when you're having a day or when you just need to talk” .An additional suggestion, made in two focus groups described a virtual community that would use a Facebook and/or a mobile application accessible to all its members. This was described as multipurpose tools that could increase motivation, keep the social network engaged, and keep track of individual achievements.clock our own walking” . In FG2, two participants , proposed a virtual community where participants would exercise on their own, but could connect periodically in person with the rest of the “walkers”:“…they should make a menopause walking app or something so you check in or something like that” . “…if we did something like that and there was an app that could be adapted to be used then you're doing it alone but you're not alone” (P2). “I would want to see how everyone else is doing you know like P1 did 10,000 steps or she walked 10 miles this week. […] so if there’s an app […] and if we’re all willing to provide that information […] to motivate us (P6).While most participants anticipated a face-to-face walking program that provides social group activity, some participants mentioned the possibility for a combination of group and individual activities. In FG4, this was suggested as an additional opportunity to “By developing in- person and virtual community, as well as individual and group activities, the walking program would demonstrate adaptability and flexibility to suit different lifestyles, while simultaneously creating a space for social interaction.The weather and seasonal changes were emphasized as a key aspect of developing a walking program. The severity of winters with low temperatures and icy sidewalks on one hand, and hot summer days on the other, call for flexibility in identifying appropriate locations and venues for walking. All focus groups discussed summertime walking along the many city walking trails, except when the temperature is too high and walking would be more comfortable in air-conditioned spaces.During the winter, walking inside was preferred as a safer option by the majority of participants, for example walking in recreation centers or shopping malls; though some participants felt inside walking was a less attractive option.Well I guess it depends on where the women are all located right? You want to make it feasible, like you want to make it, you know, easily accessible; if somebody has to travel a half an hour plus to get there, it’s best to sort of have it in three to four different areas in the city” (P2). “I totally agree with that […] because if there was a walking group that just met downtown I wouldn’t join it because I live [in the part of the city] that’s a half an hour drive to get there” (P1). “I agree, I wouldn't drive far to go for a walk because I would just go for a walk out of my house” (P5). “I’m a driver so that wouldn't bother me; that would be fine for me” (P2). “It’s just the time I think for myself anyways you know it’s just, it’s making the time” (P4).“Discussions about geographical locations for the walking program provided less consistent suggestions. While some of the participants were willing to drive and meet the group wherever it is located, the majority would prefer the program being closer to home, to save time and avoid unnecessary driving. The following exchange in FG4 exemplifies this point:Possible solutions included providing the program simultaneously in different neighborhoods or parts of the city, or be mobile and move around the city on a weekly basis, with the various time schedule options, such as evening walking (during the week) and mid-days or afternoons (on weekends).There is always the one constant, it’s the menopause group, so that constant there” .As participants discussed a number of factors related to the logistics of the planning , the need for accommodation and flexibility has emerged across all focus groups, to ensure the access and commitment to and feasibility and sustainability of the program. Most important for all women was the commonality of menopause for the walking group; as one woman sums it up: “The information collected in this focus group study are crucial for the development and implementation of a sustainable walking program that could be therapeutic for women suffering from menopause or menopause-related symptoms. Women were eager to participate and discuss a program that would serve their needs. We heard that women with severe symptoms of menopause often feel they experience insufficient social support. Any planned walking program should acknowledge the need for women to share their experiences and the strategies they use to cope with menopause.The women in this study reiterated findings from previous research, suggesting that women are keen to use walking as a form of exercise that is easy, safe and affordable and an accessible way to be physically active , 7. TheyMany of the features highlighted in the focus groups are already addressed by the existing local walking programs, including mutual support, regular and varied walks . HoweverTo achieve the proposed program features, several possibilities exist from face to face contact, telephone scheduling, or – as suggested in two of the focus groups - through Facebook or other social network applications that could be specifically set up. While a study by Daley claims that use of technology to deliver exercise interventions is not popular among menopausal women , a more One interesting and novel solution suggested by focus group participants, was the development of a virtual community-based online app that would be restricted to women who join the walking groups. The app would permit women to choose their own degree of involvement based on their own needs or preferences for communal walking and/or individual walking. The element of social support and accountability would be important. Women would be able to link up with others who lived in the same neighborhoods and a buddy system could become a feature incorporated in the app to address these points.A key consideration in designing a walking program was flexibility in logistics and adaptability to the weather and daylight changes; the latter being a major concern in a Northern city such as Edmonton. Attention to elements of the environment such as natural surroundings and neighborhood walkability and convenience have been shown to increase physical activity levels . An app Our research group has focused further efforts to create a walking program for women in menopause, by collaborating with computing scientists to develop an online application that will satisfy the preferences identified during the focus groups. To be consistent with our main focus of creating a therapeutic program for menopause symptoms, the application will include links to proper menopause resources and self-assessment tools. A research component of the application will allow menopause researchers to enroll and follow-up with consented women via surveys and questionnaires. A prototypic application has been developed and is currently being tested.The lack of diversity among participants is the most noticeable limitation of this study. The women, recruited from either of the two Edmonton Menopause clinics, typically suffer from moderate to severe menopause symptoms in addition to a variety of other health problems . Even thResearch has shown that interventions to promote walking are successful in increasing walking as a physical activity . A strenWhile originally intended to inform the development of a program in Edmonton, Alberta, it is likely that these factors would also provide a useful starting point for others designing similar programs.The findings of our study have highlighted characteristics that menopausal and postmenopausal women find important for a walking program. The results will assist in our goal of designing a program in the Edmonton area that would provide year-round walking opportunities and would be engaging and inspiring to menopausal and postmenopausal women to start and maintain a walking habit. The program would assist in elucidating whether walking is a useful and valuable alternative therapy for menopausal symptoms. This program ultimately has the potential for being widely available in a range of climates and physical locations, and of generating a meaningful and sustainable impact on health outcomes for women in menopause transition and postmenopausal in encouraging healthy behavior and preventive physical activity.


COVID-19 is an infectious disease caused by a novel coronavirus (SARS-CoV-2). The immunopathogenesis of the infection is currently unknown. Healthcare workers (HCWs) are at highest risk of infection and disease.Aim of the study was to assess the sero-prevalence of SARS-CoV-2 in an Italian cohort of HCWs exposed to COVID-19 patients.A point-of-care lateral flow immunoassay (BioMedomics IgM-IgG Combined Antibody Rapid Test) was adopted to assess the prevalence of IgG and IgM against SARS-CoV-2. It was ethically approved .A total of 202 individuals  were retrospectively recruited in an Italian hospital . The percentage (95% CI) of recruited individuals with IgM and IgG were 14.4% (9.6–19.2%) and 7.4% (3.8–11.0%), respectively. IgM were more frequently found in males (24.3%), and in individuals aged 20–29 (25.9%) and 60–69 (30.4%) years. No relationship was found between exposure to COVID-19 patients and IgM and IgG positivity.The present study did show a low prevalence of SARS-CoV-2 IgM in Italian HCWs. New studies are needed to assess the prevalence of SARS-CoV-2 antibodies in HCWs exposed to COVID-19 patients, as well the role of neutralizing antibodies. The coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) is a newly emerging virus which can spread rapidly. The SARS-CoV-2-related disease 2019 (COVID-19) has been declared a public health emergency by the World Health Organization .Human-to-human transmission via droplets, contaminated hands or surfaces has been described. The incubation time can range from 2 to 14 days. Early diagnosis, and supportive critical care can save lives of infected cases  and inapEven if serological tests are not as effective as PCR during the acute infection, they can detect antibodies for a long period after disease recovery. Knowledge of a previous infection is epidemiologically crucial and is currently an unmet need in the pandemic.One of the aims in forefront COVID-19 hospitals, such as the San Paolo University General Hospital in Milan is to protect hospital staff from being infected.The present study is aimed to evaluate the presence of serum specific antibodies against SARS-CoV-2 by a robust and rapid qualitative test in healthcare workers (HCWs) to explore the possibility of subclinical or asymptomatic infection, and to identify individuals who could have been previously infected.A serological survey was carried out in Milan, Italy, from 2nd April 2020 to 16th April 2020.A total of 5.7 mL of blood samples were collected from 202 apparently healthy workers of San Paolo University General Hospital. Different types of workers were recruited Table . PeripheThe BioMedomics IgM-IgG Combined Antibody Rapid Test , which is a rapid point-of-care lateral flow immunoassays specific for SARS-CoV-2, was adopted for the study. It was validated by the Chinese CDC in the recent past. Its sensitivity and specificity were 88.7 and 90.6%, respectively [BioMedomics Rapid IgM-IgG Combined Antibody Test for COVID-19 (IVD-CE certified), immunochromatography based, was used for the present survey. The test card contains colloidal gold-labeled recombinant directed against and quality control antibody colloidal gold marker, two detection lines (G and M), and one quality control line (C) fixed on a nitrocellulose membrane. M and G are fixed with monoclonal anti-human IgM and IgG antibodies for detecting SARS-CoV-2 IgM and IgG antibodies, respectively. The antibody/antigen complex is captured by the anti-human IgM or IgG antibody forming a red M or G line, respectively. If antibodies are missing in the sample, a negative result is showed.Ten μl of serum is added into the sample port followed by the addition of sample dilution buffer. Hydration and transport of reagents are the basis of the assay: they interact with the specimen across the strip via chromatographic lateral flow Fig. a and b.An ad hoc electronic form was prepared to collect all study variables. Qualitative variables were summarized with absolute and relative (percentage) frequencies. Quantitative variables were described with medians  for their non-parametric distribution. Prevalence data were provided with point and interval  estimates. Stratified analyses were carried out to assess the prevalence of IgG and IgM in several population subgroups.Qualitative variables were compared with chi-squared or Fisher exact test, when appropriate.p-value less than 0.05 was considered statistically significant.A two-tailed All statistical computations were performed with the statistical software Stata version 16 .A total of 202 individuals were retrospectively recruited in the present study Table . The medMedian (IQR) body temperature was 36.2 (35.8–36.5)°C, 9 (4.5%) complained of cough, 9 (4.5%) of sore throat, 8 (4.0%) muscle pain, and 3 (1.5%) of anosmia and dysgeusia, respectively.p-value: 0.003), whereas no differences were found in the rate of IgG positivity   of IgM and IgG positivity was 14.4% 9.6–19.2%) and 7.4% (3.8–11.0%), respectively. The percentage of IgM positivity was statistically higher in males than females  .Similar immunological differences were found in the age classes: IgM prevalence was higher in the groups 60–69 years and 20–29 years  and lower in the group 40–49 years   were involved in COVID-19 patients care, the percentage of IgG and IgM positive cases did not differ in case of history of contact with COVID-19 patients in comparison with non-contacts , whereas IgM prevalence was not significantly higher in individuals with a negative nasopharyngeal swab   and 22 10.9%) subjects, respectively , whereas other professional categories than medical doctors and nurses showed the higher IgM prevalence 26.1%)  in HCWs working in an Italian hospital with a high burden of COVID-19 patients. The presence of IgM in the serum is potentially associated with an acute phase in the majority of the infections; in particular, the indirect diagnosis based on the assessment of an immunological response against a virus was adopted to ascertain a recent interaction between a virus and the human host. However, the antibody kinetics is complex: patients could not show IgM during the acute infection or, sometimes, can show a combination of IgM and IgG [, 14.4% iThe nasopharyngeal swab, carried out in individuals with serum IgM to confirm the acute SARS-CoV-2 infection, highlighted the limitation of the indirect diagnosis: only 7 cases out of 29 (24.1%) were positive. This can complicate the management of individuals with an IgM positivity: should be they considered contagious and, then, quarantined to avoid the occurrence of an infection with their close contacts? Although the virological tests do not have a diagnostic accuracy of 100% , they are the current gold standard for the assessment of the SARS-CoV-2 infection.A high proportion of the individuals recruited in the present sero-survey  stated that they had a contact with COVID-19 patients; however, it was not clearly evaluated the type of contact . Close contact with contagious patients could be considered a condition associated with the occurrence of the acute infection, but the nasopharyngeal swab was only carried out to individuals with a IgM positivity and/or clinical symptoms suggestive of SARS-CoV-2 infection.It was found a statistically significant higher prevalence of serum IgM in males than in females (24.3% VS. 9.1%): this issue could highlight a gender imbalance in the infection rate, which was proved by studies where males are at highest risk of infection and severe disease. The high percentage of females in the present study can indirectly support this hypothesis. However, only sero-epidemiological studies performed in the general population could address the present issue. Its clarification could be relevant from a clinical and public health perspective: males could be considered a vulnerable group to protect in case of future epidemic waves.Another interesting finding is the higher IgM prevalence in individuals in the age groups 20–29 years (25.9%) and 60–69 years (30.4%) in comparison with those aged from 30 to 59 years. This epidemiological imbalance needs to be better evaluated: individuals aged 30–59 years were the majority of the individuals enrolled in the study but the single prevalence of the three age groups was less than 10% in two out of three groups. Adults could be a group biologically more protected or could have been more careful in terms of infection control. However, only ad hoc study designs could solve this important epidemiological question.A low proportion of medical doctors (14%) shows serum IgM; however, it was the professional category with the high prevalence, although the difference with other categories was not statistically significant.The IgG prevalence was very low (7.4%) in the recruited sample; it was lower if compared with the IgM prevalence (14.4%). The assessment of the IgG prevalence stratified by several confounding variables  does not showcase statistically significant findings. Another important factor which could be associated to the infection rate is the adherence to the recommendations on the use of personal protective equipment . They can reduce the contact with droplets and contaminated surfaces. Guidance on the correct procedure for putting on and removing them was provided in the hospital. However, a direct assessment of the adherence was not carried out.The antibody prevalence depends on several epidemiological factors; in particular, the exposure to contagious cases , the phase of the epidemic , immunological status , diagnostic accuracy of the serological test (low sensitivity).However, the scientific community should address another important issue: the qualitative function of the detected antibodies. It is important to understand if the IgM and IgG antibodies can neutralize the virus, avoiding the infection of susceptible cells.The present study has several limitations. Although more than 200 individuals recruited in a hospital might have a significant statistical power to show statistically significant differences , other studies with a great sample size are recommended.The present sero-survey is based on a cross-sectional design and, then, cannot prove the incidence of infection and disease in a cohort of patients; the follow-up could be key to better assess the sero-conversion in individuals exposed to contagious patients.Furthermore, the questionnaire was not tailored to assess the association between independent variables and the occurrence of IgM positivity. The study design and the inclusion of other important confounding variables could help clarify the dynamics of acute infection in some at-risk groups.Differences found in the present study could not be generalized to the general population in which a very low percentage of positive cases was found . MoreoveThe findings of our study are key and can help address the role of the serological testing in a population working in a hospital. The results show a low IgM prevalence in more than 200 individuals. Furthermore, a poor correlation between IgM and virological positivity was found thus suggesting that serological testing may be helpful for the diagnosis of suspected patients with negative RT-PCR results and for the identification of asymptomatic infections, as reported by Long et al. .New studies are needed to better explain the role played by the immunological response in the interaction with the human host and to understand the interpretation of the immunological positivity.


Soot and Wala, are used by researchers to prototype and compare program analyses. These frameworks vary on heap abstraction, modeling library classes, and underlying intermediate program representation (IR). Often, these variations pose a threat to the validity of the results as the implications of comparing the same analysis implementation in different frameworks are still unexplored. Earlier studies have focused on the precision, soundness, and recall of the algorithms implemented in these frameworks; however, little to no work has been done to evaluate the effects of program representation. In this work, we fill this gap and study the impact of program representation on pointer analysis. Unfortunately, existing metrics are insufficient for such a comparison due to their inability to isolate each aspect of the program representation. Therefore, we define two novel metrics that measure these analyses’ precision after isolating the influence of class-hierarchy and intermediate representation. Our results establish that the minor differences in the class hierarchy and IR do not impact program analysis significantly. Besides, they reveal the sources of unsoundness that aid researchers in developing program analysis.Static analysis frameworks, such as