Mental health of Japanese firefighters administering emergency medical treatments during COVID-19

This is the first study investigating the determinants of mental health among Japanese firefighters with the COVID-19 outbreak. Firefighters who respond to emergency calls and administer emergency medical treatment face numerous serious threats to their mental health because of the spread of COVID-19. These threats range from significant infection risks to changes in daily operations. We conducted an online questionnaire survey with Japanese firefighters (n = 2,748, valid responses = 2,204) who also served as ambulance workers during the second COVID-19 wave in August 2020. The questionnaires inquired about personal and occupational demographics, occupational stress resulting from COVID-19, social support, germ aversion using a subscale of tire Perceived Vulnerability to Disease (PVD) scale, and the General Health Questionnaire (GHQ-12). The results indicated that the burdens of infection prevention, anxiety about infection and furloughs, interpersonal conflicts related to COVID-19, reduced social support, and germ aversion were associated with deterioration of mental health. Measures for maintaining the mental health of firefighters are discussed based on these results. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Japanese society and psychology during the COVID-19 pandemic: Study based on a survey in late March 2020

The purpose of this study was to investigate the cognitions, behaviors, attitudes, and living conditions of Japanese people during the severe novel coronavirus pandemic that reached the country in January 2020 and to publish the data related to the study. Using experiential data gathered from 612 Japanese nationals in late March 2020, we conducted an exploratory analysis of the associations between the variables measured in order to capture an authentic portrait of a society grappling with an infectious disease. We found that infection preventive behaviors and exclusionary attitudes toward foreigners were associated with individual differences in the cognitive responses specific to infectious diseases and pathogen avoidance. In variables directly related to the pandemic, there were some differences by gender, but not by generation or area of residence. This study provides practical, essential in formation that could give academic researchers, policymakers, and social support agencies valuable insights into the social pathologies specific to infectious diseases, managing public health, and improving lives. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19 and insomnia: Sleep in times of pandemic

COVID-19 disease caused by a new type of coronavirus has been an integral part of everyday reality for almost two years. Its presence and connection with psychiatric diseases is the subject of intensive and extensive research. A very common problem described in the literature is sleep disorders connected to the coronavirus infection. Sleep is an essential process needed to integrate all the functions of the CNS and is essential for physical and mental health. Studies demonstrate a number of negative effects of sleep deprivation and sleep disorders. Those known include hypoprosexia, hypoenergy, increased irritability, and increased anxiety. Among the lesser known but particularly important for COVID-19 disease are changes in the immune response, including the response to active immunization in the form of vaccination. Previous meetings with coronavirus family show that they significantly interfere with sleep management and cause sleep disorders in a high percentage of patients who have recovered from the infection. Recent studies of the new coronavirus SaRSCoV2 provide insight into a dual mechanism of sleep disorders. In the first case, the pandemic itself, as a significant historical event, increases the level of stress and anxiety in the population. Individuals have to adapt to a lot of new measures, to learn new forms of work and social interaction. This can lead to the development of insomnia and other sleep disorders in disposed individuals. In the second case, SaRS-CoV2 alone, like other coronaviruses (MERS, SARS), appears to interfere with the sleep control axis and in a high percentage of cases (studies report a prevalence of up to 39% of patients) leads to insomnia after overcoming the acute stage of the disease. So far, very limited data are available on the treatment of both forms of sleep disorders caused by the COVID-19 pandemic. Nevertheless, the first clues and possibilities for how to adapt the therapy of sleep disorders in the covid period appear. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Czech) Onemocneni COVID-19 zpusobene novym druhem koronaviru temer dva roky tvori nedilnou soucast kazdodenni reality. Jeho pritomnost a propojeni s psychiatrickymi onemocnenimi je predmetem intenzivniho a extenzivniho vyzkumu. Velmi castym problemem, ktery se v literature popisuje, jsou poruchy spanku. Spanek je esencialni dej potrebny k integraci veskerych funkci CNS a je nezbytny pro fyzicke i psychicke zdravi. Studie demonstruji radu negativnich efektu spankove deprivace a spankovych poruch. Mezi ty zname patri hypoprosexie, hypoenergie, zvysena iritabilita a zvysena mira anxiety. Mezi ty mene zname, ale zvlaste pro onemocneni COVID-19 vyznamne patri zmeny imunitni odpovedi, vcetne odpovedi na aktivni imunizaci ve forme vakcinace. Predchozi setkani se zastupci koronaviru ukazuji, ze vyznamnou merou zasahuji do rizeni spanku a zpusobuji poruchy spanku u vysokeho procenta pacientu, kteri se z infekce zotavili. Soucasne studie o novem koronaviru SaRS-CoV2 prinaseji poznatek o dvojim mechanismu vzniku poruch spanku. V prvnim pripade samotna pandemie jakozto vyznamna dejinna udalost zvysuje miru stresu a anxiety v populaci. Jedinci se museji adaptovat na spoustu novych opatreni, ucit se novym formam pracovni a socialni interakce. To u disponovanych jedincu muze vest k rozvoji nespavosti a dalsich spankovych poruch. V druhem pripade se ukazuje, ze samotny SaRS-CoV2 podobne jako ostatni koronaviry (MERS, SARS) zasahuje do osy rizeni spanku a ve vysokem procentu pripadu (studie uvadeji prevalenci az 39 % pacientu) vede k rozvoji insomnie po prekonani akutniho stadia onemocneni. Stran terapie obou forem poruch spanku vyvolanych pandemii COVID-19 je zatim k dispozici velmi malo relevantnich dat. Presto se objevuji prvni voditka a moznosti, jak adaptovat terapii poruch spanku v dobe kovidove. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Why do people wear a mask? A replication of previous studies and examination of two research questions in a Japanese sample

Wearing masks is an easy and effective way to prevent infection by COVID-19. In Japan, two studies investigated the reasons why people wear a mask;however, the results were inconsistent. Therefore, the present study reexamined the association between mask wearing and the reasons given for doing so, focusing on the differences in and problems of item wording. The results of both studies were found to be almost reproducible, and there were few issues regarding item wording. Furthermore, the results revealed that people wear a mask to prevent them selves and others from infection and to conform to others wearing a mask. We suggest that inconsistencies in the results were due to differences in item wording, and discuss how future research should be conducted. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Determinants of hand-washing behavior during the infectious phase of COVID-19

Hand washing is one of the most effective measures to reduce the risk of transmitting infectious diseases. However, motivation for regular hand washing during the infectious phase of the SARS-CoV-2 infection remains unclear. We examined four possible reasons for practicing regular hand washing-two involved the perceived effectiveness of this practice in reducing the risk of infection, and the other two involved other motivations. The results of our nationwide survey revealed that people conformed to other people's practice of washing hands and felt relief from their anxiety when washing their hands. The perceived effectiveness of personal risk reduction, however, showed little effect on the behavior, while motivations such as conformity and relief from anxiety successfully explained a large proportion of hand-washing behavior. Our findings suggest that policymakers responsible for public health should consider social motivations when implementing public strategies to combat the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Flattening the curve

We quantify attening the curve under the assumption of a soft quarantine in the spread of a contagious viral disease in a society. In particular, the maximum daily infection rate is expected to drop by twice the percentage drop in the virus reproduction number. The same percentage drop is expected for the maximum daily hospitalization or fatality rate. A formula for the expected maximum daily fatality rate is given. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Why is right-wing media consumption associated with lower compliance with COVID-19 measures?

Exposure to right-wing media has been shown to be related to lower perceived threat from COVID-19, lower compliance with prophylactic measures against it, and higher incidence of infection and death. What features of right-wing media messages may account for these effects? In a preregistered cross-sectional study (N = 554), we tested a model that differentiates perceived consequences of two CDC (Centers for Disease Control and Prevention) recommendations-washing hands and staying home-for basic human values. People who consumed more right-wing media perceived these behaviors as less beneficial for their personal security, for the well-being of close ones, and the well-being of society at large. Perceived consequences of following the CDC recommendations mediated the relationship between media consumption and compliance with recommendations. Implications for public health messaging are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Children, media, and the clarity of crises in 2020

The article briefs about the children safety, media, and the clarity of crises in 2020. 2020 was a YEAR. The main headline was, of course, the COVID-19 pandemic. In the span of days or weeks, hundreds of millions of people around the globe were compelled to rapidly, and radically, alter their daily lives. Wearing masks and maintaining six feet of physical distance from others became routine behaviors. Boundaries between home, work, and school evaporated, as work moved home from the office and children's schoolwork shifted from the classroom to the kitchen table. Caregiving roles of all kinds expanded as social infrastructures shrunk down to the household unit. And social inequalities at all levels were laid bare, from the gendered nature of caring for children, to "essential worker" classifications that disproportionately exposed those workers to risk of COVID-19 infection. The special issue is comprised entirely of commentary-length manuscripts. This format provided their CAM community an opportunity for a peer-reviewed, competitive publication in a format that was more attainable and inclusive during a year of challenges that often felt - and still feels, at the time of this writing - insurmountable on many days. Authors see this special issue as a yearbook for the CAM community of an extraordinary time that will reverberate in their personal and professional lives, and their world, for years to come. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Behavioral risk compensation and the efficacy of nonpharmacological interventions

The COVID-19 pandemic has forced governments around the world into drastic measures without the normal evidence base or analyses of consequences. We present a quantitative model that can be used to rapidly assess the introduction and interaction of nonpharmaceutical infection prevention measures (NPI) both in rapid a priori predictions and in real-world a posteriori evaluations. Two of the most popular NPIs are imposing minimum physical interpersonal distancing and the use of face coverings. The success of both measures is highly dependent on the behavior of the public. However, there is very little published information about the interactions between distance, mask wearing, and the behavioral adaptations that they are likely to generate. We explore the relation between these two fundamental NPIs and the behavioral responses that they may induce, considering both risk compensation and social norms enhancement. At present, we do not have the necessary information to parameterize our model to a sufficient degree to generate quantitative, immediately applicable, advice, but we explore a vast parameter space and illustrate how the consequences of such measures can range from highly beneficial to paradoxically harmful in plausible real situations. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Reflections on intimate partner violence, its psycho-socio-cultural impact amidst COVID-19: Comparing South Africa and the United States

Purpose: The purpose of the study was to provide a comparative analysis on the psychological and socio-cultural impacts of COVID-19 on victims of intimate partner violence (IPV) in South Africa (SA) and the USA. Design/methodology/approach: The authors collected media and scholarly articles that dealt with IPV victims during the early phase of the pandemic. This study focused solely on SA and the USA because of their unique contexts and the fact that the authors are residents of these countries. The authors observed how both presidents dealt with IPV amidst the COVID 19 pandemic, especially when stay-at-home orders were in place. Aspects relating to the psychological and socio-cultural impacts amidst the pandemic were considered. Findings: The authors found that in both countries, many black women from low socio-economic backgrounds experience IPV. Being in isolated spaces with their perpetrators prohibits victims from reporting the abuse. As the world attempts to curb the spread of COVID-19 infections, effective strategies have been suggested for victims and perpetrators. The authors found the approaches of the two governments (until the Biden Administration in 2021) to be starkly different in terms of effective strategies and the neglect and downplaying of the extent of one or both pandemics (i.e. COVID-19 and IPV). Pro-safety, equality, gender and race-conscious embracing approaches to overcome IPV are urgently needed. Originality/value: The paper focused on IPV during the early phase of the COVID-19 pandemic. It provides relevant information about IPV in both countries, especially when stay-at-home orders are in place. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Autism and COVID-19

This article discusses autism and COVID-19. Autistic individuals in congregate and group settings, with co-occurring medical conditions are at higher risk for contracting COVID-19 and poor health outcomes. Wide variations in state vaccine prioritization plans exist, where high-risk disabled populations are not considered high priority. Access to routine medical visits has been disrupted during surges in cases, leading to potential delays in accessing necessary diagnoses, treatments and services. Emergency preparedness plans often overlook the needs of autistic individuals;for example, the use of the frailty scale to ration care, which unfairly disadvantages autistic individuals. Social isolation has negative effects on the well-being of autistic individuals who have lost their routine social interactions and support. The disruption to learning has been particularly concerning for children with special educational needs. The COVID-19 pandemic has highlighted areas that need urgent attention in the community. Autistic individuals, particularly those at high-risk for COVID-19-related hospitalizations and deaths, should be prioritized to receive the COVID19 vaccine. Autistic individuals must be represented in infection control and emergency preparedness planning at multiple levels: for example, within schools, health care settings, residential facilities, etc. Prolonged and unexpected disruptions to health, educational, and behavioral service deliveries during occurrences such as the COVID-19 pandemic must be met with innovative solutions to maximize individual life-course trajectories. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Primary factors that determine the severity of various infections and effective nutraceutical intervention strategies

Current agricultural practices, food processing, and extensive availability of unhealthy "fast foods” impose a broad spectrum of degenerative disorders including bacterial, viral, parasitic, fungal, and yeast infections, all of which became a leading cause of death. An infection is defined as "The invasion and growth of germs in the body.” Several of these germs are opportunistic anaerobic organisms, while their propagation and proliferation potentiate the anaerobic bio-environment alarmingly. An ideal therapeutic objective is to restore a healthier cellular "aerobic” metabolic environment. This chapter will extensively focus on three important infectious disorders (i) COVID-19 infection, (ii) Herpesvirus infection, and (iii) Candida albicans yeast infections. Disease etiology, mechanisms, and pathology will be extensively discussed. Prevention and the potential of therapeutic interventions by structurally diverse nutraceuticals, phytopharmaceuticals, probiotics, and micronutrients will be extensively reviewed. © 2023 Elsevier Inc. All rights reserved.

Infectious disorders: HIV, hepatitis C, and COVID-19 pandemics

This chapter instead focuses on the neuropsychological manifestations and neuropathological underpinnings of three prominent pandemic infectious diseases: human immunodeficiency virus (HIV), hepatitis C virus (HCV), and the novel coronavirus disease of 2019 (COVID-19), given their substantial global prevalence. It shows how these pandemics highlight the complexities of characterizing neurocognition across varying dimensions of clinical disease. Through a predominantly neuropsychological lens, the chapter discusses how variations in disease duration, severity, degree of recovery, and treatment can affect brain health and related outcomes. Toward this end, it discusses how these mechanisms intersect and diverge in HIV and HCV, two historically severe infectious diseases that now have undergone significant advances in treatment. In turn, the chapter draws upon insights gained from researching the neuropsychological complications of these diseases in order to inform the assessment and diagnosis of neurocognitive impairment in the context of COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The social divide of social distancing: Shelter-in-place behavior in Santiago during the Covid-19 pandemic

Voluntary shelter-in-place directives and lockdowns are the main nonpharmaceutical interventions that governments around the globe have used to contain the Covid-19 pandemic. In this paper, we study the impact of such interventions in the capital of a developing country, Santiago, Chile, that exhibits large socioeconomic inequality. A distinctive feature of our study is that we use granular geolocated mobile phone data to construct mobility measures that capture (1) shelter-in-place behavior and (2) trips within the city to destinations with potentially different risk profiles. Using panel data linear regression models, we first show that the impact of social distancing measures and lockdowns on mobility is highly heterogeneous and dependent on socioeconomic levels. More specifically, our estimates indicate that, although zones of high socioeconomic levels can exhibit reductions in mobility of around 50%-90% depending on the specific mobility metric used, these reductions are only 20%-50% for lower income communities. The large reductions in higher income communities are significantly driven by voluntary shelter-in-place behavior. Second, also using panel data methods, we show that our mobility measures are important predictors of infections: roughly, a 10% increase in mobility correlates with a 5% increase in the rate of infection. Our results suggest that mobility is an important factor explaining differences in infection rates between high- and low-incomes areas within the city. Further, they confirm the challenges of reducing mobility in lower income communities, where people generate their income from their daily work. To be effective, shelter-in-place restrictions in municipalities of low socioeconomic levels may need to be complemented by other supporting measures that enable their inhabitants to increase compliance. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Covid-19 crisis in the Netherlands: "Only together we can control Corona"

The development and management of the Covid-19 outbreak in the Netherlands is described. The "intelligent lockdown" was aimed at minimizing new infections and limiting the number of deaths, while keeping the economy running as much as possible. Changes in consumer behavior, exit strategy, and lessons learned are considered. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Clinical features of COVID-19 in newborns, infants, and children: A systematic review and meta-analysis

Although it was thought that children were not susceptible to 2019-nCoV in the early days of the COVID-19 infection outbreak, there are currently reports of children and even one-day-old newborns being infected by the virus and hospitalized around the world. Recognizing the symptoms of the infection in children is of great value since a large number of children are asymptomatic or have mild symptoms, which may act as facilitators of the virus transmission. This review aimed to identify and summarize the existing evidence on clinical characteristics of COVID-19 in pediatric patients. A systematic search was conducted in the PubMed, Web of Science, Scopus, Google Scholar, and WHO database for eligible publications. The review proposal was registered with the PROSPERO. The quality assessment was done based on JBI Critical appraisal tools. The random-effects model was used to pool clinical features in the meta-analysis. From the identified 256 potentially relevant studies, 32 articles met the predetermined inclusion and exclusion criteria. Twenty-one studies fulfilled the criteria for this meta-analysis. Fever (58%) and cough (48%) were reported as the most common symptoms of infected children. Disease severity was mild in 51% and moderate in 39% of cases. A total of 63% of cases had respiratory and 25% of children had gastrointestinal symptoms, particularly diarrhea and nausea/vomiting. Approximately 24% of patients were asymptomatic. Results demonstrated that fever and cough were the most common symptoms of COVID-19-infected children and the majority of cases had mild-to-moderate disease severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

COVID-19: What can we learn from shared experiences of social distancing within secure services?

COVID-19 is an infectious disease that has spread across the globe with a social, economic and psychological impact that will undoubtedly change the world in which we live. Those working in mental health services will have experienced major changes in working practices, including navigating the challenges of infection control, whilst caring for some of the most vulnerable members of our society. There have been a number of publications considering many of the practicalities of the COVID-19 challenges in mental health. However, deeper reflections of philosophical issues regarding our own shared experiences have not yet been well covered in the professional press. This commentary describes some experiences of working within a low secure forensic service at the beginning of the COVID-19 pandemic in the UK. It aims to explore some of the key themes arising from this unprecedented situation, proposing areas for reflection and shared learning within the mental health inpatient community. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Promoting older adults' physical activity and social well-being during COVID-19

Staying healthy while following social distancing protocols is of great importance to older adults due to increased risk of serious complications from COVID-19. Mild to moderate physical activity improves immune system responses to viral respiratory infections. Additionally, social engagement has cumulative health protective benefits across the lifespan. At present, active and social recreation opportunities have been drastically reduced or disbanded due to group size limitations, stay-at-home orders, and reductions in services and facilities. As a result, community dwelling older adults are homebound and need alternative exercise and social opportunities to maintain their health during this time. Leisure professionals can promote physical activity and social well-being among older adults by increasing home-based opportunities, including offering additional online leisure services, opportunities for volunteerism, and social interactions. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Evaluating functional roles of CXCL1:CXCL2 signaling in pre-clinical mouse models of neuroinflammation and disease

Intracranial infection with the JHM strain of the mouse hepatitis virus (JHMV), a member of the Betacoronavirus family, causes acute encephalomyelitis resulting in immune-mediated demyelination. JHMV infection is an excellent model to study both viral-induced neurologic disease and the immunologic mechanisms contributing to demyelination and is a well-accepted model for the human demyelinating disease multiple sclerosis (MS). Following JHVM infection of the CNS, the innate immune system is rabidly mobilized and secretion of the ELR+ family of chemokines, including CXCL1, which contribute to multiple cell processes including migration, differentiation, and maturation. Using a transgenic mouse in which the neutrophil chemoattractant CXCL1 can be induced to be overexpressed from astrocytes, we previously showed that sustained neutrophil infiltration exacerbates demyelination and clinical severity in the JHMV model. Subsequently, we wanted to replicate these findings in the prototypic experimental autoimmune encephalomyelitis (EAE) model and also to elucidate the mechanisms by which neutrophils are augmenting white matter damage in the JHMV mouse model of demyelination. In the EAE model we found that sustained infiltration of neutrophils into the CNS increased severity of demyelination and worsened clinical score without affecting the infiltration of other immune cell populations. Additionally, blocking neutrophil over accumulation with anti-CXCR2 antibody ameliorated these negative effects. We also found in the JHMV model that sustained neutrophil infiltration exacerbated demyelination through both direct and indirect effects. Neutrophils in the spinal cord were found to have a more mature phenotype associated with increased granularity and proinflammatory protein production and also polarized other infiltrating immune cells to a more inflammatory phenotype.The CXCR2/CXCL1 signaling pathway is also important for proper myelination of the CNS, specifically in the positional migration and proliferation of oligodendrocyte precursor cells (OPCs) in the developing mouse brain. In addition, CXCR2 signaling has been implicated in regulating remyelination in several pre-clinical models of demyelination. In order to determine the role of CXCR2 signaling on OPCs we developed a mouse model in which Cxcr2 was conditionally ablated following tamoxifen treatment in adult mice. We found using the JHMV model that Cxcr2 silencing on OPCs did not affect clinical disease, infiltrating immune cells, or demyelination. It also had no effect on the structural myelin composition of noninfected transgenic mice. However, we did find that Cxr2 ablation resulted in more mature oligodendroglia and more remyelination at later time points following JHMV infection. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Essays on health behaviors in developing countries

This thesis contains three essays on how access to health care and health information affect health behaviors and health beliefs in developing countries. In the first chapter, I study why rural households in Bangladesh keep seeking health advice from untrained informal providers when mobile health services (MHS) are freely available from qualified public healthcare providers and how they can be nudged to adopt the MHS. Using a randomized controlled trial among 2900 rural households from 580 neighborhoods in Bangladesh, this paper studies whether and how the adoption of mobile health services can be improved. I find that information about the service improves households' awareness by more than 30 percentage points but does not affect the adoption in the following two months. Among the participants who were also encouraged to call at one of the MHS phone numbers to see how the service works, 63% attempted during the intervention and 22% of them used the service in the following two months. The adoption of MHS decreases households' health expenditure, mostly driven by the reduction in medicine consumption. This happened because households, who adopted MHS, also made fewer visits to informal providers who usually overprescribe medicine. The second chapter studies how information can affect people's health risk beliefs and health behaviors. The local prevalence of infections and the severity of its consequences are among the key determinants of the adoption of preventive behaviors for an infectious disease. By conducting a survey among more than 2000 adults in Bangladesh, I find that most people either do not know or underestimate the local prevalence of COVID-19 infections and overestimate its fatality rate. In a randomized experiment, I give the treatment group information about the coronavirus case number in their districts and the case fatality rate in Bangladesh and worldwide. Immediately after receiving the information, the treatment group perceives higher infection risk. Nine to fifteen days after the intervention, those who received information underestimate the local prevalence less and, consequently, still perceive higher infection risk than the control group. The treatment group also updates their belief about the fatality rate downward. Potentially due to this countervailing update of risk beliefs, the information does not have any effect on the self-reported preventive behaviors.In the final chapter, I develop a simple model which illustrates why opposition leaders can be very effective for the COVID-19 vaccination awareness campaign. To test this empirically, I also conduct an experiment in Bangladesh where 3,781 individuals in Bangladesh randomly received information about COVID-19 and its vaccines, the vaccination status of ruling and opposition leaders. While all treatments improved confidence on COVID-19 vaccines, the information about the opposition leaders' vaccination status decreased the perceived side effects. The participants from the opposition treatment are 11 percentage points more likely to intend to get vaccinated than the participants of the information treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved)