Low risk of postoperative ulnar nerve affection in surgically treated distal humeral fractures when the nerve is released in situ

BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.

Discussion on Using Classroom Teaching in Satisfying Students’Emotional Needs and Stimulating Their Interest in Learning

The English Curriculum Standards particularly emphasize that“we should pay attention to the emotions of each student,cultivate their interest in learning English,help them build a sense of achievement and self-confidence in learning,and enable them to develop comprehensive language-using capabilities,improve humanistic qualities,enhance practical skills,and cultivate a spirit of innovation in the learning process.”The foreign language learning process is an information-processing process in which both subjective and objective factors play a great influence.Subjective factors are factors related to the quality of the informant himself,such as cognitive factors,affective factors,and age influence,among which the influence and role of affective factors on foreign language information cannot be ignored.In the teaching process,it is required that teachers use the knowledge of pedagogical psychology for the in-depth understanding of the students and their psychological and emotional needs,and attempt to satisfy them,so that they can have positive emotions and feelings.

Functional dissection of parabrachial substrates in processing nociceptive information

Painful stimuli elicit first-line reflexive defensive reactions and,in many cases,also evoke second-line recuperative behaviors,the latter of which reflects the sensing of tissue damage and the alleviation of suffering.The lateral parabrachial nucleus(lPBN),composed of external-(elPBN),dorsal-(dlPBN),and central/superior-subnuclei(jointly referred to as slPBN),receives sensory inputs from spinal projection neurons and plays important roles in processing affective information from external threats and body integrity disruption.However,the organizational rules of lPBN neurons that provoke diverse behaviors in response to different painful stimuli from cutaneous and deep tissues remain unclear.In this study,we used region-specific neuronal depletion or silencing approaches combined with a battery of behavioral assays to show that slPBN neurons expressing substance P receptor(NK1R)(lPBNNK1R)are crucial for driving pain-associated self-care behaviors evoked by sustained noxious thermal and mechanical stimuli applied to skin or bone/muscle,while elPBN neurons are dispensable for driving such reactions.Notably,lPBNNK1R neurons are specifically required for forming sustained somatic pain-induced negative teaching signals and aversive memory but are not necessary for fear-learning or escape behaviors elicited by external threats.Lastly,both lPBNNK1R and elPBN neurons contribute to chemical irritant-induced nocifensive reactions.Our results reveal the functional organization of parabrachial substrates that drive distinct behavioral outcomes in response to sustained pain versus external danger under physiological conditions.

Development in oxide metallurgy for improving the weldability of high -strength low-alloy steel-Combined deoxidizers and microalloying elements

The mechanisms of oxide metallurgy include inducing the formation of intragranular acicular ferrite(IAF)using micron-sized inclusions and restricting the growth of prior austenite grains(PAGs)by nanosized particles during welding.The chaotically oriented IAF and refined PAGs inhibit crack initiation and propagation in the steel,resulting in high impact toughness.This work summarizes the com-bined effect of deoxidizers and alloying elements,with the aim to provide a new perspective for the research and practice related to im-proving the impact toughness of the heat affected zone(HAZ)during the high heat input welding.Ti complex deoxidation with other strong deoxidants,such as Mg,Ca,Zr,and rare earth metals(REMs),can improve the toughness of the heat-affected zone(HAZ)by re-fining PAGs or increasing IAF contents.However,it is difficult to identify the specific phase responsible for IAF nucleation because ef-fective inclusions formed by complex deoxidation are usually multiphase.Increasing alloying elements,such as C,Si,Al,Nb,or Cr,con-tents can impair HAZ toughness.A high C content typically increases the number of coarse carbides and decreases the potency of IAF formation.Si,Cr,or Al addition leads to the formation of undesirable microstructures.Nb reduces the high-temperature stability of the precipitates.Mo,V,and B can enhance HAZ toughness.Mo-containing precipitates present good thermal stability.VN or V(C,N)is ef-fective in promoting IAF nucleation due to its good coherent crystallographic relationship with ferrite.The formation of the B-depleted zone around the inclusion promotes IAF formation.The interactions between alloying elements are complex,and the effect of adding dif-ferent alloying elements remains to be evaluated.In the future,the interactions between various alloying elements and their effects on ox-ide metallurgy,as well as the calculation of the nucleation effects of effective inclusions using first principles calculations will become the focus of oxide metallurgy.

Impaired implicit emotion regulation in patients with panic disorder:An event-related potential study on affect labeling

BACKGROUND Panic disorder(PD)involves emotion dysregulation,but its underlying mechanisms remain poorly understood.Previous research suggests that implicit emotion regulation may play a central role in PD-related emotion dysregulation and symptom maintenance.However,there is a lack of studies exploring the neural mechanisms of implicit emotion regulation in PD using neurophysiological indicators.AIM To study the neural mechanisms of implicit emotion regulation in PD with eventrelated potentials(ERP).METHODS A total of 25 PD patients and 20 healthy controls(HC)underwent clinical evaluations.The study utilized a case-control design with random sampling,selecting participants for the case group from March to December 2018.Participants performed an affect labeling task,using affect labeling as the experimental condition and gender labeling as the control condition.ERP and behavioral data were recorded to compare the late positive potential(LPP)within and between the groups.RESULTS Both PD and HC groups showed longer reaction times and decreased accuracy under the affect labeling.In the HC group,late LPP amplitudes exhibited a dynamic pattern of initial increase followed by decrease.Importantly,a significant group×condition interaction effect was observed.Simple effect analysis revealed a reduction in the differences of late LPP amplitudes between the affect labeling and gender labeling conditions in the PD group compared to the HC group.Furthermore,among PD patients under the affect labeling,the late LPP was negatively correlated with disease severity,symptom frequency,and intensity.CONCLUSION PD patients demonstrate abnormalities in implicit emotion regulation,hampering their ability to mobilize cognitive resources for downregulating negative emotions.The late LPP amplitude in response to affect labeling may serve as a potentially valuable clinical indicator of PD severity.

Effects of Drilling in Mastoid Cavity over Hearing in the Contralateral Ear

In advanced otological surgeries, powered instruments form an indispensable part. The risk of deterioration to hearing in the operated ear is a commonly discussed issue, however, there remains a possibility of affecting the hearing in the contralateral ear due to transcranial vibration. So in this study we aimed to assess the possibility of the non-operated ear being affected by the noise generated during ear surgeries and whether it is temporary or permanent in nature. Methodology: This study included 63 patients diagnosed with unilateral disease who underwent mastoid surgery. Preoperatively all the patients were subjected to Pure tone audiometry (PTA), Transient evoked otoacoustic emission (TEOAE) and Distortion product otoacoustic emission (DPOAE). Patients were operated using both cutting and diamond burrs of ranging from sizes 1 - 6 mm. Total drilling time was recorded. Results: Post-operative hearing evaluation was done at 1 week, 4 weeks and 12 weeks. The sound emitted by various burrs was recorded by Sound Level Meter. Out of the total 58 patients that followed up, 46 showed change in at least one of the hearing parameters. Patients showing changes had a higher drilling time as compared to those with no changes. Of these, the changes associated with the total drilling time and with cutting burr time were found to be significant. The hearing changes seen on PTA, TEOAE and DPOAE were transient in nature with only one patient having a persistent decreased high frequency threshold at the end of 12 weeks. It was also found that cutting burrs produce more sound as compared to diamond burrs and a larger size burr of a type produces more sound than a smaller one of its type. Conclusion: The drilling of mastoid bone during ear surgeries can transiently impair the hearing in the contralateral ear which is of great significance in patients with only one hearing ear.

Applying SMART Goal Intervention Leads to Greater Goal Attainment, Need Satisfaction and Positive Affect

Previous research suggests that planning interventions lead to increased goal attainment, while other researchsuggests that goal attainment leads to increased well-being. This research integrates these two sets of researchfindings by investigating the effectiveness of one goal planning intervention, the SMART goal program, on goalattainment, and thus need satisfaction and well-being, in university students. An experimental design across aone-week period was employed to test whether participants in the experimental group, who received the SMARTgoal instructions, better obtained their goal in comparison to control group participants who did not receive thosespecific instructions. Findings indicated that the SMART goal program led to greater rated goal attainment andneed satisfaction, but not greater subjective well-being (SWB). Nevertheless, one component of SWB, positiveaffect, was greater in the Experimental group. Type of individually chosen self-concordant goal content hadno impact on whether participants attained their goal.

Urological Affections after Laparoscopic Hernia Repair in Long-Term Follow up

Objectives: Chronic pain is a severe complication of mesh-based inguinal hernia repair. Pain upon ejaculation, testicular touch sensitivity and dysuria are apparent. Regarding the large amount of patients undergoing laparoscopic hernia repair, the problem seems quite evident. In this prospective, clinical, randomized, double-blind study we intended to investigate the biocompatibility of three different meshes and their influence on urological affections after operative procedure. Methods: 180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m2), double-filament PP mesh (Prolene, 10 9 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m2) of PP mesh (Serapren, 10 9 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 9 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate), urological affections and life quality (SF-36 Health Survey). The follow-up period was 60 months. Results: Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th post-interventional week the differences diminished. Conclusions: Independent which kind of mesh was implanted still 5% of patients suffered from urological affections 60 month later.

Correlation between Depth of Myometrial Invasion and Degree of Lymph Node Affection in Cases of Endometrial Cancer

Introduction: Endometrial cancer is the fourth most frequent cancer in females. Many factors can affect prognosis of this type of cancer, these mainly are the degree of myometrial invasion by the tumour, pelvic and paraaortic lymph node spread as well as the tumour histological type (endometrioid vs non-endometrioid type). transvaginal ultrasound (TVS) is a highly accurate and easy method for preoperative evaluation of myometrial invasion. Aim of the Work: The aim of this work is to assess if there is relation between the depth of myometrial invasion by the tumor and the rate of lymph node involvement in cases of endometrial cancer. Results: It was found that there was a significant relation between lymph node affection and the depth of myometrial invasion, all the positive lymph node affections cases had myomterial invasion > 50.0%. Conclusion: The incidence of pelvic lymph node affection is very high in cases where the myometrium is deeply infiltrated with the tumor. Assessment of myometrial invasion preoperatively by TVU and microscopically by pathological examination of the myometrium after hysterectomy provides an accurate estimation of the rate of pelvic lymph node affection and hence necessitates lymphadenectomy procedures in cases where myometrium is deeply infiltrated by the tumor and omitted in cases where it is tumor free.

The Life Course of a Long-Lasting Affection Medium:A Fieldwork Based on the Communication Practice of the Rural Loudspeakers in North China

The loudspeakers played a crucial role in rural community during the COVID-19 pandemic,and had returned to the public with the help of short video platforms.However,with the continued popularity of digital media,is the revival of the loudspeakers which belong to traditional media just a flash in the pan?What the historic process of return has the loudspeakers undergone?Based on these questions,the paper applies Bourdieu’s sense of practice theory,focuses on“habit”throughout,adopts the research methods of online ethnography and fieldwork,and conducts participant observation and targeted in-depth interviews in a village in North China for about nine months.The study found that:(1)There is the lag of habit in the state’s handling of social relations in villages.Based on rational habit,village cadres used the loudspeakers to manifest their physical presence and restructure their authority;the villagers,operating under perceptual habit,rationalized the presence of the loudspeakers through using the key words such as elders,nostalgia,and homesickness;(2)the loudspeakers was maintained under the habit of village cadres and ordinary villagers,and the outbreak of the epidemic made the loudspeakers as an habit truly“appearing”;(3)the young village cadres,on the other hand,acquired this habit through imitation,transposed the loudspeakers into the short video platform,and carried out different forms of experimentation and innovation,thus surpassing the previous forms of loudspeakers practice.The return of the loudspeakers is the result of the game of different habits.As a long-lasting affection medium,the loudspeakers,on the one hand,has become an important media scene and memory field indispensable to rural community,and on the other hand,the people living on this land have a deep attachment to the loudspeakers,which is indirectly transformed into the bearer of homesickness.This brings new inspiration for us to rethink the relationship between the traditional media and the new media,the iteration of cadres and the change of rural community.

Texture development of mesophase in reservoir pyrobitumen and the temperature-pressure converting of the gas reservoir in the Chuanzhong Uplift, Southwestern China

The Neoproterozoic-Lower Paleozoic dolostone gas reservoirs in the Chuanzhong Uplift in Southwestern China contain the mesophase pyrobitumen (pyrobitumen with mesophase). The mesophase in the pyrobitumen is mostly composed of a mixture of condensed macromolecule polycyclic aromatic hydrocarbons (PAH), and has been mostly converted to various grain, flow, and domain textures. The volcanic activity nearby the Chuanzhong Uplift may have generated very hot (over 300 °C) hydrothermal fluid, with migration of the fluid into the dolostone reservoir transforming the hydrocarbons in the reservoir into an anisotropic carbon by-product, which formed under high temperature and pressure conditions;over 300 °C and 200 MPa according to fluid inclusion analysis. The high temperature-pressure in reservoir was caused by sudden devolatilization of the hydrocarbons due to hydrothermal heating, which formed the unusual texture of the mesophase. The elliptical mesophase grains (EG), the honeycomb structure of pyrobitumen, and the occurrence of polarized classes of mesophase in single pyrobitumen deposits are all unusual textures. This study investigates the texture development of this pressure-affected pyrobitumen. Observation and study of the mesophase suggest that the class of mesophase in pyrobitumen is determined by temperature, while pressure (assessed from associated fluid inclusions) significantly affected the texture. Analysis of the texture of the pyrobitumen in conjunction with previous thermometry results from methane inclusions suggests that the high class mesophase of the pyrobitumen could be applied as a temperature indicator for geological conditions. Furthermore, the unusual textures of the pyrobitumen including elliptical mesophase grains (EG), the honeycomb structure of pyrobitumen, and the occurrence of polarized classes of mesophase in single pyrobitumen could reflect the abnormal high formation pressure.

Crushing Mechanism of Spherical Tungsten Alloy Fragments Penetrate Thick Steel Plate Target

Against protection requirements for high-speed fragments on the ground weapons,we carried out the research work of crushing mechanism at different impact speeds ofφ8.7 mm spherical tungsten alloy,the penetration to 603 armor steel was completed by 20 mm ballistic gun,and the ANSYS/LS-DYNA software was used to complete the numerical calculation of the penetration.We find that there are different crushing mechanisms of spherical tungsten alloy with different speeds and low speed,the crushing mechanism of fragment is mainly controlled by overall plastic deformation,shearing stripping,and squeezing at a high pressure and a high speed.The crushing mechanism will have a spallation phenomenon in addition to the crushing mechanism under high pressure.

Validation of the Chinese Version of the Affective Exercise Experiences Questionnaire (AFFEXX-C)

Despite the well-established benefits of regular physical activity(PA)on health,a large proportion of the world population does not achieve the recommended level of regular PA.Although affective experiences toward PA may play a key role to foster a sustained engagement in PA,they have been largely overlooked and crudely measured in the existing studies.To address this shortcoming,the Affective Exercise Experiences(AFFEXX)questionnaire has been developed to measure such experiences.Specifically,this questionnaire was developped to assess the following three domains:antecedent appraisals(e.g.,liking vs.disliking exercise in groups),core affective exercise experiences(i.e.,pleasure vs.displeasure,energy vs.tiredness,and calmness vs.tension),and exercise motivation(i.e.,attraction vs.antipathy toward exercise).The current study aimed to validate a Chinese version of the AFFEXX questionnaire(AFFEXX-C).In study 1,722 Chinese college students provided data for analyses of factorial,convergent,discriminant,criterion validity,and test-retest reliability of the AFFEXX-C.In addition,1,300 college students were recruited in study 2 to further validate its structural model.Results showed that the AFFEXX-C demonstrates a goodfit and reliability.Additionally,results further supported the hypothesized model based on previous research:antecedent appraisals predicted core affective exercise experiences,which in turn predicted attraction-antipathy toward physical exercise.The AFFEXX-C was found to be a reliable and valid measure of affective exercise experiences in a population of Chinese college students.

Ecosystem changes revealed by land cover in the three-river headwaters region of Qinghai,China(1990–2015)

The Three-River Headwaters Region(TRHR) of Qinghai Province, in the Tibetan Plateau of China, is the main source of the Yangtze, Yellow, and Lancang rivers, and is very significant to the security of freshwater resources for China and southeastern Asia. It is a critical ecological region of China for its ecological functions, and has been changed or even degraded in recent decades owing to climate change and human pressure. To effectively protect and restore the degraded ecosystems, the Chinese government initiated a series of ecological conservation projects in TRHR. It is essential to quantitatively assess ecosystem changes and their relationship to driving factors for indepth understanding of long-term changes of ecosystems and effects of ecological restoration policies and offer practical insights for ecological restoration. Here, land cover data has been interpreted with the series data of Landsat during 1990–2015. The patterns of different ecosystems and their developing process have been derived from land cover change. The results show that ecosystem types in TRHR include forest, grassland, cropland,wetland, artificial surface and barren land, accounting for 4.51%, 70.80%, 0.15%, 9.47%, 0.16% and 14.90%,respectively. Barren land converted to wetland was the significant ecosystem change from 1990 to 2015. Increases in temperature and precipitation and implementation of ecological rehabilitation helped maintain relatively stable ecosystem patterns. It is necessary to continue ecological projects to improve and/or maintain the ecosystems in TRHR because there is still a risk of land degradation under increasing climate change and human activity.

TC-Net:A Modest&Lightweight Emotion Recognition System Using Temporal Convolution Network

Speech signals play an essential role in communication and provide an efficient way to exchange information between humans and machines.Speech Emotion Recognition(SER)is one of the critical sources for human evaluation,which is applicable in many real-world applications such as healthcare,call centers,robotics,safety,and virtual reality.This work developed a novel TCN-based emotion recognition system using speech signals through a spatial-temporal convolution network to recognize the speaker’s emotional state.The authors designed a Temporal Convolutional Network(TCN)core block to recognize long-term dependencies in speech signals and then feed these temporal cues to a dense network to fuse the spatial features and recognize global information for final classification.The proposed network extracts valid sequential cues automatically from speech signals,which performed better than state-of-the-art(SOTA)and traditional machine learning algorithms.Results of the proposed method show a high recognition rate compared with SOTAmethods.The final unweighted accuracy of 80.84%,and 92.31%,for interactive emotional dyadic motion captures(IEMOCAP)and berlin emotional dataset(EMO-DB),indicate the robustness and efficiency of the designed model.

Multi-Versus Optimization with Deep Reinforcement Learning Enabled Affect Analysis on Arabic Corpus

Sentiment analysis(SA)of the Arabic language becomes important despite scarce annotated corpora and confined sources.Arabic affect Analysis has become an active research zone nowadays.But still,the Arabic language lags behind adequate language sources for enabling the SA tasks.Thus,Arabic still faces challenges in natural language processing(NLP)tasks because of its structure complexities,history,and distinct cultures.It has gained lesser effort than the other languages.This paper developed a Multi-versus Optimization with Deep Reinforcement Learning Enabled Affect Analysis(MVODRL-AA)on Arabic Corpus.The presented MVODRL-AAmodelmajorly concentrates on identifying and classifying effects or emotions that occurred in the Arabic corpus.Firstly,the MVODRL-AA model follows data pre-processing and word embedding.Next,an n-gram model is utilized to generate word embeddings.A deep Q-learning network(DQLN)model is then exploited to identify and classify the effect on the Arabic corpus.At last,the MVO algorithm is used as a hyperparameter tuning approach to adjust the hyperparameters related to the DQLN model,showing the novelty of the work.A series of simulations were carried out to exhibit the promising performance of the MVODRL-AA model.The simulation outcomes illustrate the betterment of the MVODRL-AA method over the other approaches with an accuracy of 99.27%.

A Bifactor Analysis Approach to Construct Validity and Reliability of the Affective Exercise Experience Questionnaire among Chinese College Students

Affective exercise experience as an emerging theoretical concept has great potential to provide a more nuanced understanding of individual factors that influence exercise behavior.However,concerning the Affective Exercise Experiences(AFFEXX)questionnaire,it has not been examined yet whether the structural score of the AFFEXX is a useful index to predict physical activity(refers to any bodily movement produced by skeletal muscles that requires energy expenditure).Furthermore,there is currently a gap in knowledge regarding the psychological mechanisms that can explain the relationship between affective exercise experiences and the level of physical activity(PA).In order to adress these gaps in the literature,we conducted two studies among Chinese collge students that aimed(i)to investigated whether the total score of the three AFFEXX-C constructs(antecedent appraisals,core affective exercise experiences,and attraction-antipathy towards exercise)is a relaible indicator that can be utilized in research and pratical settings and(ii)to evalute the specific psychological mechanisms that can explain the relationship between affective exercise experience and PA.In Study 1,we recruited 801 voluntary Chinese college students for bifactor and correlational analyses.In Study 2,875 Chinese college students were enrolled to verify our findings from Study 1 and to explore the aforementioned mechanism.Results from the bifactor analyses supported our hypothesis that the total scores of the three AFFEXX-C constructs can be used among Chinese college students to establish a link with PA.Additionally,our results suggested that core affective exercise experiences and attraction-antipathy mediated the relationship between antecedent appraisals and the level of moderate-to-vigorous intensity PA.Therefore,measuring affective exercise experiences using the AFFEXX-C,specifically the total scores of each individual construct may be a useful approach to predict future PA levels.

International study of the Complex Stress Reaction Syndrome:Implications for transdiagnostic clinical practice

BACKGROUND The debate regarding diagnostic classification systems in psychiatry(categorial vs dimensional systems)has essential implications for the diagnosis,prevention and treatment of stress reactions.We previously found a unique pattern of stress reaction in a study executed during the coronavirus disease 2019 pandemic using large representative samples in two countries,and termed it the Complex Stress Reaction Syndrome(CSRS).AIM To investigate CSRS,Type A(psychiatric symptoms,spanning anxiety,depression,stress symptoms,and posttraumatic stress disorder(PTSD)),with or without long-coronavirus disease(COVID)residuals(CSRS,Type B,neuropsychiatric symptoms spanning cognitive deficits and fatigue,excluding systemic symptoms).Our two-tailed hypothesis was that CSRS is a condition related to an unrecognized type of stress reaction in daily life in the general population(Type A)or that it is related to the severe acute respiratory syndrome coronavirus 2 infection and its long-COVID residuals(Type B).METHODS 977 individuals in four continents(North America,Europe,Australia and the Middle East)completed the online study questionnaire in six languages using the Qualtrics platform.The study was managed by six teams in six countries that promoted the study on social media.The questionnaire assessed anxiety,depression,stress symptoms and PTSD(CSRS,Type A),cognitive deficits and fatigue(CSRS,Type B).The data were analyzed using Proportion Analyses,Multivariate Analysis of Co-Variance(MANCOVA),linear regression analyses and validated clinical cutoff points.RESULTS The results of the Proportion Analyses showed that the prevalence of 4 symptoms spanning anxiety,depression,stress symptoms,and PTSD was significantly higher than the most prevalent combinations of fewer symptoms across 4 continents,age groups,and gender.This supports the transdiagnostic argument embedded in the CSRS(Type A).The same pattern of results was found in infected/recovered individuals.The prevalence of the 4 psychiatric symptoms combination was significantly greater than that of 5 and 6 symptoms,when adding cognitive deficits and fatigue,respectively.MANCOVA showed a significant three-way interaction(age×gender×continent).Further analyses showed that the sources of this three-way interaction were threefold relating to two sub-populations at-risk:(1)Individuals that self-identified as non-binary gender scored significantly higher on all 4 psychiatric symptoms of the CSRS,Type A at young age groups(<50 years old)in North America compared to(self-identified)women and men located in the 4 continents studied,and to other ages across the adult life span;and(2)This pattern of results(CSRS,Type A)was found also in women at young ages(<40 years old)in North America who scored higher compared to men and women in other continents and other ages.Linear regression analyses confirmed the MANCOVA results.CONCLUSION These results show a combined mental health risk factor related to stress reactivity,suggesting that the CSRS is sensitive to populations at risk and may be applied to future identification of other vulnerable sub-populations.It also supports the transdiagnostic approach for more accurate prevention and treatment.Time will tell if such transdiagnostic syndromes will be part of the discussions on the next revisions of the traditional classification systems or whether the crisis in psychiatry further evolves.