preVIEW: COVID-19

Corpus overview

Overview

MeSH Disease

Stress Disorders, Traumatic (57)

COVID-19 (56)

Depressive Disorder (38)

Anxiety Disorders (33)

Stress Disorders, Post-Traumatic (26)


HGNC Genes

steroid sulfatase (1)

peptidyl arginine deiminase 1 (1)

membrane associated ring-CH-type finger 9 (1)

membrane associated ring-CH-type finger 8 (1)

lipolysis stimulated lipoprotein receptor (1)


SARS-CoV-2 proteins

There are no SARS-CoV-2 protein terms in the subcorpus


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    Refining long-COVID by a prospective multimodal evaluation of patients with long-term symptoms related to SARS-CoV-2 infection MESHD

    Authors: Marc SCHERLINGER; Renaud Felten; Floriane Gallais; Charlotte Nazon; Emmanuel Chatelus; Luc Pijnenburg; Amaury Mengin; Adrien Gras; Pierre Vidailhet; Rachel Arnould-Michel; Sabrina Bibi-triki; Raphael Carapito; Seiamak Bahram; sophie trouillet-assant; Magali Perret; Alexandre Belot; Laurent Arnaud; Jacques-Eric Gottenberg; Samira Fafi-Kremer; Jean Sibilia

    doi:10.1101/2021.04.08.21255167 Date: 2021-04-13 Source: medRxiv

    Background: COVID-19 MESHD long-haulers or long-COVID represent 10% of COVID-19 MESHD patients and remain understudied. Methods: In this prospective study, we recruited 30 consecutive patients seeking medical help for persistent symptoms (> 30 days) attributed to COVID-19 MESHD. All reported a viral illness compatible with COVID-19 MESHD. The patients underwent a multi-modal evaluation including clinical, psychological, virological, specific immunological assays and were followed longitudinally. Results The median age was 40 [interquartile range: 35-54] and 18 (60%) were female. After a median time of 152 [102-164] days after symptom onset, fever MESHD, cough MESHD and dyspnea MESHD were less frequently reported as compared with the initial presentation, but paresthesia and burning pain MESHD emerged in 18 (60%) and 13 (43%) patients, respectively. The clinical examination was unremarkable in all patients although the median fatigue MESHD and pain MESHD visual analogic scales were 7 [5-8] and 5 [2-6], respectively. Extensive biological studies were unremarkable, as were multiplex cytokine and ultra-sensitive interferon-a2 measurements. At this time, nasopharyngeal swab and stool RT-PCR were negative for all tested patients. Using SARS-CoV-2 serology and IFN-{gamma HGNC} ELISPOT, we found evidence of a previous SARS-CoV-2 infection MESHD in 50% (15/30) of patients, with objective evidence of lack or waning of immune response in two. Finally, psychiatric MESHD evaluation showed that 11 (36.7%), 13 (43.3%) and 9 (30%) patients had a positive screening for anxiety MESHD, depression MESHD and post- traumatic stress disorder MESHD, respectively. Conclusions Half of patients seeking medical help for long-COVID lack SARS-CoV-2 immunity. The presence of SARS-CoV-2 immunity did not cluster clinically or biologically long haulers, who reported severe fatigue MESHD, altered quality of life, and exhibited psychological distress.

    Prevalence and associated factors with mental health outcomes among interns and residents physicians during COVID-19 MESHD epidemic in Panama: a cross-sectional study

    Authors: Edward A. Espinosa-Guerra; Edgar R. Rodriguez-Barria; Christl A. Donnelly; Jean Paul Carrera

    doi:10.1101/2021.03.26.21254435 Date: 2021-03-28 Source: medRxiv

    Background. A new coronavirus SARS-CoV-2 was associated with a newly identified respiratory syndrome MESHD, COVID-19 MESHD in Wuhan, China, in early December 2019. SARS-CoV-2 rapidly spread across the globe resulting in 117 million cases and 2.59 million deaths by March 2021. Rapidly increased numbers of COVID-19 MESHD cases overwhelmed public health systems across the world, imposing increased working hours and workloads for health care workers. Here, we have evaluated the prevalence of health outcomes and associated factors of interns and resident physicians in Panama. Methods. A cross-sectional study was undertaken during July 23, 2020, to August 13, 2020, to evaluate the prevalence of health outcomes and associated factors in interns and residents across Panama. Snowball sampling was used to recruit participants. Then an electronic questionnaire with scales to evaluate anxiety disorders MESHD (GAD-7), depression MESHD (PHQ-9) and post- traumatic stress MESHD (IES-R) was evaluated. In addition, socio-demographic variables, clinical history of mental disorders MESHD and COVID-19 MESHD exposure were evaluated. Independent analyses for each mental health outcome were undertaken using a logistic regression analysis. Results. A total of 517/1205 (42.9%) interns and residents were nationwide recruited. Of these 274 (53.0%) were interns and 243 (47.0%) residents. The overall prevalence of depression symptoms MESHD was 25.3%, 13.7% anxiety MESHD and 12.2% post- traumatic stress MESHD. At least, 9.3% participants reported having suicidal ideation. The most parsimonious model showed females had a higher prevalence of mental health disorders, in all results and the married participants were more likely to present depression MESHD (OR, 1.73; 95% CI, 1.03-2.91; P = 0.039) or at least one alteration to mental health (OR, 1.66; 95% CI, 1.03-2.68; P = 0.039). Resident physicians in surgical specialties were less likely to have post- traumatic stress MESHD (OR, 0.20; 95% CI, 0.06-0.63; P = 0.006) or at least one mental health disturbance (OR, 0.46; 95% CI, 0.26-0.83; P = 0.010). A history of psychological trauma MESHD and psychiatric MESHD pathology were risk factors for most of the disorders investigated. Conclusions. A high prevalence of mental health disorders was found, showing the need to mitigate this emotional burden among healthcare workers in the current context of the COVID-19 pandemic MESHD.

    Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection MESHD/ COVID-19 MESHD

    Authors: Michael J. Peluso; J. Daniel Kelly; Scott Lu; Sarah A. Goldberg; Michelle C. Davidson; Sujata Mathur; Matthew S. Durstenfeld; Matthew A. Spinelli; Rebecca Hoh; Viva Tai; Emily A. Fehrman; Leonel Torres; Yanel Hernandez; Meghann C. Williams; Mireya I. Arreguin; Jennifer A. Bautista; Lynn H. Ngo; Monika Deswal; Sadie E. Munter; Enrique O. Martinez; Khamal A. Anglin; Mariela D. Romero; Jacqueline Tavs; Paulina R. Rugart; Jessica Y. Chen; Hannah M. Sans; Victoria W. Murray; Payton K. Ellis; Kevin C. Donohue; Jonathan A. Massachi; Jacob O. Weiss; Irum Mehdi; Jesus Pineda-Ramirez; Alex F. Tang; Megan Wegner; Melissa Assenzio; Yan Yuan; Melissa Krone; Rachel L. Rutishauser; Isabel Rodriguez-Barraquer; Bryan Greenhouse; John A. Sauceda; Monica Gandhi; Priscilla Hsue; Timothy J. Henrich; Steven G Deeks; Jeffrey N. Martin

    doi:10.1101/2021.03.11.21252311 Date: 2021-03-13 Source: medRxiv

    BACKGROUND: As the coronavirus disease 2019 MESHD ( COVID-19 MESHD) pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome-coronavirus-2 MESHD (SARS-CoV-2), attention has turned to characterizing post-acute sequelae of SARS-CoV-2 infection MESHD (PASC). METHODS: From April 21 to December 31, 2020, we assembled a cohort of consecutive volunteers who a) had documented history of SARS-CoV-2 RNA-positivity; b) were [≥] 2 weeks past onset of COVID-19 MESHD symptoms or, if asymptomatic, first test for SARS-CoV-2; and c) were able to travel to our site in San Francisco. Participants learned about the study by being identified on medical center-based registries and being notified or by responding to advertisements. At 4-month intervals, we asked participants about physical symptoms that were new or worse compared to the period prior to COVID-19 MESHD, mental health symptoms and quality of life. We described 4 time periods: 1) acute illness (0-3 weeks), 2) early recovery (3-10 weeks), 3) late recovery 1 (12-20 weeks), and 4) late recovery 2 (28-36 weeks). Blood and oral specimens were collected at each visit. RESULTS: We have, to date, enrolled 179 adults. During acute SARS-CoV-2 infection MESHD, 10 had been asymptomatic, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. In the acute phase, the most common symptoms were fatigue MESHD, fever MESHD, myalgia MESHD, cough MESHD and anosmia/dysgeusia MESHD. During the post-acute phase, fatigue MESHD, shortness of breath MESHD, concentration problems, headaches MESHD, trouble sleeping and anosmia/dysgeusia MESHD were the most commonly reported symptoms, but a variety of others were endorsed by at least some participants. Some experienced symptoms of depression MESHD, anxiety MESHD, and post- traumatic stress MESHD, as well as difficulties with ambulation and performance of usual activities. The median visual analogue scale value rating of general health was lower at 4 and 8 months (80, interquartile range [IQR]: 70-90; and 80, IQR 75-90) compared to prior to COVID-19 MESHD (85; IQR 75-90). Biospecimens were collected at nearly 600 participant-visits. CONCLUSION: Among a cohort of participants enrolled in the post-acute phase of SARS-CoV-2 infection MESHD, we found many with persistent physical symptoms through 8 months following onset of COVID-19 MESHD with an impact on self-rated overall health. The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis. Similar evaluations in a population-representative sample will be needed to estimate the population-level prevalence of PASC.

    Post- Traumatic Stress Disorder MESHD ( PTSD MESHD) and Depression MESHD in Iranian Adolescents with and Without Hearing Loss MESHD ( HL MESHD) in Previous and During the Outbreak of the COVID-19 MESHD

    Authors: Saeed Ariapooran; Mehdi Khezeli; Ahadi Batool

    doi:10.21203/rs.3.rs-252257/v1 Date: 2021-02-17 Source: ResearchSquare

    Background: Due to the unavailability of information and resources about COVID-19 MESHD in people with Hearing Loss ( HL MESHD), especially deaf people, the psychological problems, such as PTSD MESHD and depression MESHD are probably raised in people with hearing loss MESHD ( HL MESHD) during the outbreak of COVID-19 MESHD. This study was conducted to compare post- traumatic stress disorder MESHD ( PTSD MESHD) and depression MESHD in Iranian adolescents with and without HL MESHD in previous and during the outbreak of COVID-19 MESHD. Methods: The statistical sample was 112 adolescents half (56) of whom was with HL MESHD, while another half (56) was without HL MESHD. The two groups were also homogenized in terms of age, gender, and education. Data were gathered using the Child PTSD Symptom Scale for DSM-5 (CPSS-5) and Children's Depression MESHD Inventory Short version (CDI: S). The data obtained were analyzed using two-way MANOVA. Results: Results showed that 46.43% and 41.04% of with- HL MESHD adolescents during the outbreak of COVID-19 MESHD, and 17.87% and 25.00% of them in previous the outbreak of COVID-19 MESHD had symptoms of PTSD MESHD and depression MESHD, respectively. Results indicated that the mean score difference between PTSD MESHD and depression MESHD during and in previous the outbreak of COVID-19 MESHD [(during)-(previous)] was higher in adolescents with HL MESHD than the control group. conclusion: We concluded that psychological and medical interventions must be beneficial to decrease symptoms of  PTSD MESHD and depression MESHD in adolescents (especially in deaf and hard-of-hearing adolescents) during the outbreak of COVID-19 MESHD.

    Resilience and Its Relationship With Occupational Stress MESHD and Professional Quality of Life Among Nurses in COVID-19 MESHD Isolation Wards

    Authors: Ali Mostafazadeh; Somayyeh Ghorbani-Sani; Najmadin Seyed-Mohammadi; Kazhal Ghader-jola; Zeinab Habibpour

    doi:10.21203/rs.3.rs-240339/v1 Date: 2021-02-13 Source: ResearchSquare

    Background: Nurses’ direct and continuous contact with patients afflicted by coronavirus disease 2019 MESHD ( COVID-19 MESHD) causes them stress due to fear over affliction and reduces their professional quality of life (PQOL). Resilience has potential protective effects against different stressors. This study aimed to assess resilience and its relationship with occupational stress MESHD ( OS MESHD) and PQOL among nurses in COVID-19 MESHD isolation wards.Methods: This descriptive-analytical study was conducted in 2020. Participants were nurses in the COVID-19 MESHD isolation wards of healthcare centers affiliated to Khoy University of Medical Sciences, Khoy, Iran. In total, 158 eligible nurses were recruited through a census. Data were collected using a researcher-made demographic questionnaire, the short version of the Connor-Davidson Resilience Scale, the Nursing Stress Scale, and the PQOL Scale. Data analysis was performed using the SPSS software (v. 16.) and through the independent-sample t test, one-way analysis of variance, Pearson’s correlation analysis, and linear regression analysis.Results: The total mean scores of resilience and OS MESHD were 26.19±6.2 (in the possible range of 0–40) and 73.3±14.5 (in the possible range of 34–136), respectively. The mean scores of the compassion satisfaction, job burnout, and secondary traumatic stress MESHD dimensions of PQOL were respectively 38.02±8.16, 30.84±5.45, and 27.66±6.13, (all in the possible range of 10–50). Most participants experienced moderate OS MESHD (57.9%). The mean scores of participants’ resilience and OS MESHD had no significant relationship with their demographic characteristics (P > 0.05). Resilience had significant negative relationship with OS MESHD (r = –0.376, P < 0.001) and significant positive relationship with the compassion satisfaction dimension of PQOL (r = 0.373; P < 0.001). Resilience was also a significant predictor of OS MESHD and the compassion satisfaction dimension of PQOL (P < 0.001).Conclusion: Nurses’ OS MESHD can be reduced through resilience-promoting strategies such as development of their social support network, improvement of their optimism, and provision of resilient role models and quality resilience-related education.

    From Recession to Depression MESHD? Prevalence and Correlates of Depression MESHD, Anxiety, Traumatic Stress MESHD and Burnout in Healthcare Workers During the COVID-19 Pandemic MESHD in Greece: A Multi-Center, Cross-Sectional Study

    Authors: Sofia Pappa; Nikolaos Athanasiou; Nikolaos Sakkas; Stavros Patrinos; Elpitha Sakka; Zafeiria Barmparessou; Stamatoula Tsikrika; Andreas Adraktas; Athanasia Pataka; Ilias Migdalis; Sofia Gida; Paraskevi Katsaounou

    id:10.20944/preprints202102.0194.v1 Date: 2021-02-08 Source: Preprints.org

    COVID-19 pandemic MESHD has the potential to adversely affect the mental health of healthcare workers (HCWs). The public healthcare system in Greece was already facing serious challenges at the outset of the outbreak following years of austerity and an escalating refugee crisis. The multi-center, cross-sectional study aims to assess the levels and associated risk factors of anxiety MESHD, depression MESHD, traumatic stress MESHD and burnout of frontline staff in Greece. A total of 464 HCWs in six reference hospitals completed a self-administered questionnaire comprising of sociodemographic and work-related information and psychometric scales. The proportion of HCWs with symptoms of moderate/severe depression MESHD, anxiety MESHD and traumatic stress MESHD were 30%, 25% and 33% respectively. Burnout levels were particularly high with 65% of respondents scoring moderate/severe in Emotional Exhaustion, 92% severe in Depersonalization and 51% low/moderate in Personal Accomplishment. Predictive factors of adverse psychological outcomes included fear, perceived stress, risk of infection, lack of protective equipment and low social support. The psychological burden associated with Covid-19 MESHD in healthcare professionals in Greece is considerable with more than half experiencing at least mild mental health difficulties. Findings signal the need for immediate organizational and individually tailored interventions to enhance resilience and support wellbeing under pandemic conditions.

    RECHARGE – A Brief Psychological Intervention to Build Resilience in Health Care Workers During the COVID-19 Pandemic MESHD: Study Protocol for a Randomized Controlled Trial

    Authors: Naser Morina; Sonja Weilenmann; Katie S Dawson; Jutta Ernst; Zelim Zanitti; Roland von Känel; Matthis Schick; Tobias R Spiller; Richard A Bryant

    doi:10.21203/rs.3.rs-212942/v1 Date: 2021-02-06 Source: ResearchSquare

    Background: Health care workers (HCWs) typically face high work demands, which can be exacerbated during crises such as the COVID-19 pandemic MESHD. These demands may result in high psychological distress and reduced work performance. Although there are psychological interventions to reduce stress in HCWs under normal working circumstances, no intervention have been specifically developed to addresses stress in the context of public health crises such as the current COVID-19 pandemic MESHD. This study aims to evaluate the effectiveness of RECHARGE, a psychological intervention specifically developed for HCWs to reduce distress in HCWs. It is based on a brief crisis intervention of the World Health Organization that teaches basic stress management skills from cognitive behavioural therapy. Methods: A randomized controlled trial (RCT) will be carried out among 160 physicians, nurses, and other HCWs working in hospitals in Switzerland during COVID-19 MESHD, who are at least moderately distressed. HCWs will be randomised to RECHARGE (n=80) or active treatment as usual (ATAU) (n=80). Pre-intervention (week 1, T1), post-intervention (week 4, T2) and 2-month follow-up (week 12, T3) assessments include psychological distress as primary outcome, and indicators of mental ill-being (worries, anxiety MESHD, depression MESHD, burnout, traumatic stress MESHD, distress due to perceived ethical dilemma) and work performance as secondary outcomes. These outcomes will be compared between HCWs in the RECHARGE and ATAU groups. Discussion: RECHARGE is an evidence-informed brief, flexible, easily scalable, fully online psychological program that allows delivery in pandemic conditions, including social isolation. Therefore, this program can serve as a much-needed template for an intervention to reduce stress and enhance work performance in HCWs during the COVID-19 pandemic MESHD. If proven effective, RECHARGE may not only be used to reduce elevated stress in HCWs in Switzerland, but also globally. Key words: COVID-19 MESHD, randomised controlled trial, protocol, health care workers; psychological treatment; distress, crisis intervention; pandemic; resilience;

    The psychosocial MESHD impact of the COVID-19 pandemic MESHD on 4,378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic.

    Authors: Danielle Lamb; Sam Gnanapragasam; Neil Greenberg; Rupa Bhundia; Ewan Carr; Matthew Hotopf; Reza Razavi; Rosalind Raine; Sean Cross; Amy Dewar; Mary Docherty; Sarah Dorrington; Stephani Hatch; Charlotte Wilson-Jones; Daniel Leightley; Ira Madan; Sally Marlow; Isabel McMullen; Anne Marie Rafferty; Martin Parsons; Catherine Polling; Danai Serfioti; Helen Gaunt; Peter Aitken; Joanna Morris-Bone; Chloe Simela; Veronica French; Rachel Harris; Sharon A.M. Stevelink; Simon Wessely

    doi:10.1101/2021.01.21.20240887 Date: 2021-01-22 Source: medRxiv

    Objectives This study reports preliminary findings on the prevalence of, and factors associated with, mental health and wellbeing outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic MESHD in the UK. Methods Preliminary cross-sectional data were analysed from a cohort study (n=4,378). Clinical and non-clinical staff of three London-based NHS Trusts (UK), including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders MESHD ( CMDs MESHD), measured by the General Health Questionnaire (GHQ-12). Secondary outcomes are probable anxiety MESHD (GAD-7), depression MESHD (PHQ-9), Post- Traumatic Stress Disorder MESHD ( PTSD MESHD) (PCL-6), suicidal ideation (CIS-R), and alcohol use (AUDIT). Moral injury is measured using the Moray Injury Event Scale (MIES). Results Analyses showed substantial levels of CMDs (58.9%, 95%CI 58.1 to 60.8), and of PTSD MESHD (30.2%, 95%CI 28.1 to 32.5) with lower levels of depression MESHD (27.3%, 95%CI 25.3 to 29.4), anxiety MESHD (23.2%, 95%CI 21.3 to 25.3), and alcohol misuse (10.5%, 95%CI, 9.2 to 11.9). Women, younger staff, and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of CMDs, anxiety MESHD, depression MESHD, PTSD symptoms MESHD, and alcohol misuse. Conclusions Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal MESHD data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

    Teaching Anxiety MESHD, Stress and Resilience during the COVID-19 Pandemic MESHD: Evaluating the Vulnerability of Academic Professionals in Mexico through the Adapted COVID-19 MESHD Stress Scales

    Authors: Juan Luis Delgado-Gallegos; Gerardo R. Padilla-Rivas; Erika Zuñiga-Violante; Gener Avilez-Rodriguez; Daniel Arrellanos Soto; Hector Franco-Villareal; María de los Angeles Cosio-León; Gerardo Salvador Romo-Cardenas; Jose Francisco Islas

    id:10.20944/preprints202101.0406.v1 Date: 2021-01-20 Source: Preprints.org

    To mitigate the COVID-19 MESHD infection, many world governments endorsed the cessation of non-essential activities, such as the school attendance. Thereby, forcing the evolution of the teaching model to the virtual classroom. In the present work we show the application of a modified version of the adapted COVID-19 MESHD stress scales (ACSS) which also included teaching anxiety MESHD and preparedness, and resilience for academic professionals in Mexico, during the unprecedented transformation of the education system undergone in the COVID-19 MESHD quarantine. Most of the studied variables: gender, age, academic degree, household occupants, having a disease, teaching level, teaching mode, work hours, resilience, teaching anxiety MESHD and preparedness, and fear of being an asymptomatic patient (FOBAP), showed significant statistical correlation between each other (p<0.050) and to the 6 areas of the ACSS (danger, contamination, social economical, xenophobia, traumatic stress MESHD and compulsive checking). Our results further showed that the perceived stress and anxiety MESHD, fell into the category of absent to mild with only the danger section of the ACSS falling into the moderate category. Finally, resilience generated throughout the quarantine, seems to be a predictor of the adaptation the academic professional has undergone to cope with stress.

    Depression MESHD, Post- traumatic Stress MESHD, Anxiety MESHD, and Fear of COVID-19 MESHD in the General Population and Health-Care Workers: Prevalence, Relationship, and Explicative Model in Peru

    Authors: David Villarreal-Zegarra; Anthony Copez-Lonzoy; Ana Lucia Vilela-Estrada:; Jeff Huarcaya-Victoria

    doi:10.21203/rs.3.rs-151028/v1 Date: 2021-01-19 Source: ResearchSquare

    Background: This study has two aims. First, determine the fit of the fear model to COVID-19 MESHD, anxiety MESHD, and post- traumatic stress MESHD in the general population and health-care workers. Second, determine which model best explains the relationship between depression MESHD and the triad of fear, anxiety MESHD, and post- traumatic stress MESHD in both groups. Method: A cross-sectional study was conducted using self-reported questionnaires for anxiety MESHD, fear of COVID-19 MESHD, depression MESHD, and post- traumatic stress MESHD. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural regression model.Results: A high overall prevalence of depressive symptoms MESHD (16%), anxiety MESHD (11.7%), and post- traumatic stress MESHD (14.9%) were identified. A higher prevalence of depressive, anxious MESHD, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19 MESHD, anxiety MESHD, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms MESHD in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI=0.94; TLI=0.94; RMSEA=0.06; SRMR=0.06). Limitations: The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. Conclusions: Our study proposes and tests one model that explains more than 70% of depressive symptoms MESHD. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms MESHD. Keywords: Depression MESHD, post- traumatic stress MESHD, anxiety MESHD, fear of COVID-19 MESHD, Peru

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