scholarly journals Global connectivity of the frontoparietal cognitive control network is related to depression symptoms in the general population

2017 ◽  
Author(s):  
Douglas H. Schultz ◽  
Takuya Ito ◽  
Levi I. Solomyak ◽  
Richard H. Chen ◽  
Ravi D. Mill ◽  
...  
Keyword(s):  
Mental Health ◽  
Cognitive Control ◽  
Large Scale ◽  
Brain Network ◽  
Depression Symptoms ◽  
Control Network ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Cognitive Control Network ◽  
The Brain

ABSTRACTWe all vary in our mental health, even among people not meeting diagnostic criteria for mental illness. Understanding this individual variability may reveal factors driving the risk for mental illness, as well as factors driving sub-clinical problems that still adversely affect quality of life. To better understand the large-scale brain network mechanisms underlying this variability we examined the relationship between mental health symptoms and resting-state functional connectivity patterns in cognitive control systems. One such system is the frontoparietal cognitive control network (FPN). Changes in FPN connectivity may impact mental health by disrupting the ability to regulate symptoms in a goal-directed manner. Here we test the hypothesis that FPN dysconnectivity relates to mental health symptoms even among individuals who do not meet formal diagnostic criteria but may exhibit meaningful symptom variation. We found that depression symptoms severity negatively correlated with between-network global connectivity (BGC) of the FPN. This suggests that decreased connectivity between the FPN and the rest of the brain is related to increased depression symptoms in the general population. These findings complement previous clinical studies to support the hypothesis that global FPN connectivity contributes to the regulation of mental health symptoms across both health and disease.AUTHOR SUMMARYUnderstanding how large-scale network interactions in the brain contribute to (or serve a protective role against) mental health symptoms is an important step toward developing more effective mental health treatments. Here we test the hypothesis that cognitive control networks play an important role in mental health by being highly connected to other brain networks and able to serve as a feedback mechanism capable of regulating symptoms in a goal-directed manner. We found that the more well-connected the frontoparietal cognitive control network was to other networks in the brain the less depression symptoms were reported by participants. These results contribute to our understanding of how brain network interactions are related to mental health symptoms, even in individuals who have not been diagnosed with a disorder.

scholarly journals Global connectivity of the fronto-parietal cognitive control network is related to depression symptoms in the general population

2019 ◽  
Vol 3 (1) ◽  
pp. 107-123 ◽  
Author(s):  
Douglas H. Schultz ◽  
Takuya Ito ◽  
Levi I. Solomyak ◽  
Richard H. Chen ◽  
Ravi D. Mill ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
General Population ◽  
Cognitive Control ◽  
Diagnostic Criteria ◽  
Depression Symptoms ◽  
Control Network ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Cognitive Control Network

We all vary in our mental health, even among people not meeting diagnostic criteria for mental illness. Understanding this individual variability may reveal factors driving the risk for mental illness, as well as factors driving subclinical problems that still adversely affect quality of life. To better understand the large-scale brain network mechanisms underlying this variability, we examined the relationship between mental health symptoms and resting-state functional connectivity patterns in cognitive control systems. One such system is the fronto-parietal cognitive control network (FPN). Changes in FPN connectivity may impact mental health by disrupting the ability to regulate symptoms in a goal-directed manner. Here we test the hypothesis that FPN dysconnectivity relates to mental health symptoms even among individuals who do not meet formal diagnostic criteria but may exhibit meaningful symptom variation. We found that depression symptoms severity negatively correlated with between-network global connectivity (BGC) of the FPN. This suggests that decreased connectivity between the FPN and the rest of the brain is related to increased depression symptoms in the general population. These findings complement previous clinical studies to support the hypothesis that global FPN connectivity contributes to the regulation of mental health symptoms across both health and disease.

Abstract P248: Assessing for Bi-Directional Relationships between Body Mass Index and Mental Health Symptoms in Girls

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Kathleen M McTigue ◽  
Elan Cohen ◽  
Alison Hipwell ◽  
Charity Moore ◽  
Rolf Loeber ◽  
...  
Keyword(s):  
Mental Health ◽  
Adolescent Girls ◽  
Mixed Models ◽  
Mental Health Problems ◽  
Positive Association ◽  
Depression Score ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Oppositional Defiant

Introduction Obesity and mental health problems are increasing in youth; both are often under-treated. The interplay between mental health and body weight development in adolescent girls is not well understood. Hypothesis Bi-directional associations will be established between mental health symptoms (depression and conduct symptoms) and BMI in urban pre-adolescent girls. Methods We examined data from participants in an accelerated longitudinal cohort study of largely disadvantaged urban girls from a single US city (n=2,451; 53% African American). Data were collected annually over 6 years, starting in 2003 when girls were age 8-11. Depression and conduct symptoms (oppositional defiant disorder and conduct disorder symptoms combined) were collected via the validated Child Symptom Inventory (CSI-4) and height and weight were measured. Transitional models assessed for bi-directional associations between mental health symptoms and BMI. Random-effects mixed models identified within-subject and between-subject effects in models examining whether mental health symptoms predicted BMI. All models were adjusted for race, age, and receipt of public assistance, and when applicable, included interaction terms. Results Transitional models showed that prior depression symptoms (β=0.27; p<0.001) predicted an increase in BMI while prior conduct symptoms (β=0.04; p=0.05) showed a small and borderline significant effect on BMI. An increase in prior BMI predicted an increase in depression symptoms (β=0.074, p<0.001) but not conduct symptoms (β=0.028, p=0.125). Mixed models revealed significant between-girl and within-girl effects (β = 0.38 and 0.038, respectively, both with p<0.001) for depression symptoms predicting BMI. Conduct symptoms showed a significant between-girl effect (β=0.51; p=0.045) but a non-significant within-girl effect (β=0.011; p=0.080) when used to predict BMI. Conclusions We identified a clear bi-directional relationship between depression symptoms and BMI in under-privileged girls, and mixed models confirmed that a change in depression score is associated with increased BMI. While an increase in conduct symptoms shows a weak positive association with BMI, the association was not bi-directional. The potential for BMI and depression to each reinforce the other may represent a mechanism for the development of high-risk weight patterns in girls. Early identification of those at risk may facilitate preventive measures for both weight and mental health outcomes.

Parent and child mental health trajectories April 2020 to May 2021: Strict lockdown versus no lockdown in Australia

2021 ◽  
pp. 000486742110653
Author(s):  
Elizabeth M Westrupp ◽  
Christopher J Greenwood ◽  
Matthew Fuller-Tyszkiewicz ◽  
Craig A Olsson ◽  
Emma Sciberras ◽  
...  
Keyword(s):  
Mental Health ◽  
Child Mental Health ◽  
Community Sample ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Related Factors ◽  
Health Symptoms ◽  
Health Trajectories ◽  
Second Wave ◽  
Parent Child

Objective: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world’s first long and strict lockdowns over July–October 2020, while the rest of Australia experienced ‘COVID-normal’ with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. Methods: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children’s Anxiety Scale). Results: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [β] = 0.09–0.46), parent/child diagnoses (β = 0.07–0.21), couple conflict (β = 0.07–0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12–0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers ( https://lingtax.shinyapps.io/CPAS_trend/ ). Conclusion: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.

scholarly journals Fathers’ Childhood Experiences, Adult Mental Health Problems and Perceptions of Interactions With Their 36 Month-Old Children

2018 ◽  
Vol 8 (2) ◽  
pp. 41
Author(s):  
Roni Mermelshtine ◽  
Jacqueline Barnes
Keyword(s):  
Mental Health ◽  
Paternal Care ◽  
Mental Health Problems ◽  
Community Sample ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Childhood Experiences ◽  
Health Symptoms ◽  
Parenting Support ◽  
Paternal Mental Health

Perceptions of poor care in the family of origin can relate to adverse mental health and poor adaptation for mothers but there is less evidence about fathers. This study investigated the relevance of fathers’ recollections of their own parents (Generation 1) for their (Generation 2) current mental health symptoms and for interactions with their 3-year-old children (Generations 2/3), in a community sample of 482 British fathers. Recollections of G1 maternal and paternal behaviour were associated in uncontrolled correlations with G2 paternal mental health, but taking family social class and maternal (G2) mental health into account they did not significantly predict G2 fathers’ mental health symptoms at 36 months postpartum, though a trend remained for G1 paternal care. Significant predictors were paternal depression symptoms in the first year postpartum and G2 mothers’ current mental health. Predictors of more dysfunctional father-child (G2/G3) interactions at 36 months postpartum were working class status, recall of more G1 maternal controlling behaviour and more concurrent paternal mental health symptoms; predictors of less G2/G3 dysfunction were G2 paternal use of more positive discipline. Potential implications of the results for parenting support and advice are discussed, recognising that intergenerational transmission of parent-child relationships is likely for fathers.

scholarly journals Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253891
Author(s):  
Kun Guo ◽  
Xiaoye Zhang ◽  
Simin Bai ◽  
Halimatus Sakdiah Minhat ◽  
Ahmad Iqmer Nashriq Mohd Nazan ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Undergraduate Students ◽  
Shaanxi Province ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Depression Anxiety Stress Scale ◽  
Cross Sectional ◽  
Health Symptoms ◽  
Stress Symptoms

Following the 2019 coronavirus disease (COVID-19) outbreak in China, undergraduate students may experience psychological changes. During emergency circumstances, social support is an important factor influencing the mental health condition among undergraduate students in Shaanxi province. This study aims to find the factors associated with mental health symptoms of depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. A cross-sectional study was conducted from Feb 23 to Mar 7, 2020. A total of 1278 undergraduate students from the universities located in Shaanxi province participated in this study. The mental health symptoms were measured by 12-item Perceived Social Support Scale (PSSS) and Depression Anxiety Stress Scale (DASS-21) instruments. This survey showed that females receive more social support compared to males (t = -5.046, P<0.001); males have higher-level depression symptoms (t = 5.624, P<0.001); males have higher-level anxiety symptoms (t = 6.332, P<0.001), males have higher-level stress symptoms (t = 5.58, P<0.001). This study also found participants who have low social support was negatively correlated with mental health symptoms. In Conclusion, Males and low social support were associated with having the higher level of depression, anxiety, and stress symptoms among undergraduate students in Shaanxi province during the COVID-19 pandemic in China. Therefore, it is suggested that people should supply more social support for undergraduate students in Shaanxi province during COVID-19 pandemic.

scholarly journals Personal, social and relational predictors of UK postgraduate researcher mental health problems

BJPsych Open ◽  
2021 ◽  
Vol 7 (6) ◽  
Author(s):  
Clio Berry ◽  
Jeremy E. Niven ◽  
Cassie M. Hazell
Keyword(s):  
Mental Health ◽  
Large Scale ◽  
Social Connectedness ◽  
Online Survey ◽  
Mental Health Problems ◽  
Health Problems ◽  
Supervisory Relationship ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
The Uk

Background Emerging evidence demonstrates that postgraduate researchers have high rates of mental health problems. These problems are distressing, affect PhD studies, and have longer-term potential effects beyond the duration of the PhD. Yet large-scale studies of multiple risk and protective factors are rare. Aims We aimed to test the predictive validity of a comprehensive set of potential determinants of mental health symptoms (depression, anxiety and suicidality) among postgraduate researchers in the UK, including personal, study-related, and supervision characteristics. Method We used regression models applied to data obtained from a national online survey of UK postgraduate researchers (Understanding DOCtoral researcher mental health; U-DOC, 2018–2019) to test predictors of mental health symptoms. Results These models show that postgraduate researchers' mental health symptoms are predicted by demographic, occupational, psychological, social and supervisory relationship factors. Greater perfectionism, more impostor thoughts and reduced supervisory communion most strongly and consistently predict mental health symptoms. Conclusions Institutions training postgraduate researchers should focus interventions intended to improve depression, anxiety, suicidality, on self-beliefs and social connectedness. Moreover, supervisors should be provided with training that improves the degree of agency, and especially communion, in the relationships they form with postgraduate researchers.

scholarly journals The new frontline: exploring the links between moral distress, moral resilience and mental health in healthcare workers during the COVID-19 pandemic

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Edward G. Spilg ◽  
Cynda Hylton Rushton ◽  
Jennifer L. Phillips ◽  
Tetyana Kendzerska ◽  
Mysa Saad ◽  
...  
Keyword(s):  
Mental Health ◽  
Healthcare Workers ◽  
Online Survey ◽  
Moral Distress ◽  
Protective Measure ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Moral Resilience

Abstract Background Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. Methods A total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed. Findings Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5, p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1, p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p < .001); compared to those with higher moral resilience, the subgroup with the lowest moral resilience had a steeper cross-sectional worsening in moral distress as the frequency of potentially morally distressing events increased. Moral resilience also correlated with lower stress, anxiety, and depression symptoms (r > .27, p < .001). Factors independently associated with stronger moral resilience included: being male, older age, no mental disorder diagnosis, sleeping more, and higher support from employers and colleagues (B [0.02, |-0.26|]. Interpretation Elevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.

scholarly journals Disrupted dynamic functional network connectivity among cognitive control networks in the progression of Alzheimer’s disease

2021 ◽  
Author(s):  
Mohammad S. E. Sendi ◽  
Elaheh Zendehrouh ◽  
Zening Fu ◽  
Jingyu Liu ◽  
Yuhui Du ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Functional Connectivity ◽  
Cognitive Control ◽  
Disease Progression ◽  
Brain Network ◽  
Middle Frontal Gyrus ◽  
Functional Network ◽  
Control Network ◽  
Cognitive Control Network

AbstractBackgroundAlzheimer’s disease (AD) is the most common age-related dementia that promotes a decline in memory, thinking, and social skills. The initial stages of dementia can be associated with mild symptoms, and symptom progression to a more severe state is heterogeneous across patients. Recent work has demonstrated the potential for functional network mapping to assist in the prediction of symptomatic progression. However, this work has primarily used static functional connectivity (sFC) from rs-fMRI. Recently, dynamic functional connectivity (dFC) has been recognized as a powerful advance in functional connectivity methodology to differentiate brain network dynamics between healthy and diseased populations.MethodsGroup independent component analysis was applied to extract 17 components within the cognitive control network (CCN) from 1385 individuals across varying stages of AD symptomology. We estimated dFC among 17 components within the CCN, followed by clustering the dFCs into 3 recurring brain states and then estimated a hidden Markov model and the occupancy rate for each subject. Finally, we investigated the link between CCN dFC connectivity features with AD progression.ResultsProgression of AD symptoms were associated with increases in connectivity within the middle frontal gyrus. Also, the AD with mild and severer symptoms showed less connectivity within the inferior parietal lobule and between this region with the rest of CCN. Finally, comparing with mild dementia, we found that the normal brain spends significantly more time in a state with lower within middle frontal gyrus connectivity and higher connectivity between the hippocampus and the rest of CCN, highlighting the importance of assessing the dynamics of brain connectivity in this disease.ConclusionOur results suggest that AD progress not only alters the CCN connectivity strength but also changes the temporal properties in this brain network. This suggests the temporal and spatial pattern of CCN as a biomarker that differentiates different stages of AD.Impact StatementBy assuming that functional connectivity is static over time, many of previous studies have ignored the brain dynamic in Alzheimer’s disease progression. Here, a longitudinal resting-state functional magnetic resonance imaging data are used to explore the temporal changes of functional connectivity in the cognitive control network in Alzheimer’s disease progression. The result of this study would increase our understanding about the underlying mechanisms of Alzheimer’s Disease and help in finding future treatment of this neurological disorder.

Parent and child mental health trajectories April-October 2020: Strict lockdown versus no lockdown in Australia

2021 ◽  
Author(s):  
Elizabeth Westrupp ◽  
Christopher Greenwood ◽  
Matthew Fuller-Tyszkiewicz ◽  
Tomer S Berkowitz ◽  
George Joseph Youssef ◽  
...  
Keyword(s):  
Mental Health ◽  
Child Mental Health ◽  
Community Sample ◽  
Depression Symptoms ◽  
Mental Health Symptoms ◽  
Related Factors ◽  
Health Symptoms ◽  
Health Trajectories ◽  
Second Wave ◽  
Parent Child

Objective: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world’s first long and strict lockdowns over July-October 2020, while the rest of Australia experienced ‘COVID-normal’ with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes; and (2) identify baseline demographic, individual, and COVID-19-related factors associated with mental health trajectories. Method: Online community sample of 1,877 Australian parents with rapid repeated assessment over 10 time-points over April-October, 2020. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21); child depression symptoms (13-item Short Mood and Feelings Questionnaire); and child anxiety symptoms (four-items from Brief Spence Children’s Anxiety Scale).Results: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a large peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [β]=·09-·39), parent/child diagnoses (β=·11-·22), couple conflict (β=·09-·19), and COVID-19 stressors, such as worry/concern about COVID-19, illness, and loss of job (β=·07-·22), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers (https://lingtax.shinyapps.io/CPAS_trend/).Conclusion: Our findings provide evidence of worse trajectories of parent and child mental health symptoms associated with strict, sustained, COVID-19 lockdown in Victoria, compared to non-locked states in the rest of Australia. We identified several baseline factors that may be useful in detecting high risk families who are likely to require additional support early on in future lockdowns.

scholarly journals Mental Health of International Migrant Workers Amidst Large-Scale Dormitory Outbreaks of COVID-19: A Population Survey

2021 ◽  
Author(s):  
Young Ern Saw ◽  
Edina YQ Tan ◽  
P Buvanaswari ◽  
Kinjal Doshi ◽  
Jean CJ Liu
Keyword(s):  
Mental Health ◽  
At Risk ◽  
General Population ◽  
Migrant Workers ◽  
Financial Stability ◽  
Large Scale ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Stress Symptoms ◽  
Health Burden

SummaryBackgroundIn the COVID-19 pandemic, international migrant workers have faced increased vulnerability on account of their status. This study examined the mental health burden of COVID-19 amongst low-waged migrant workers involved in large-scale dormitory outbreaks within Singapore.MethodsBetween 22 June to 11 October 2020, questionnaires were distributed in-person and online to 1011 migrant workers undergoing movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with each DASS-21 subscale.FindingsComplete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore).InterpretationThe risk factors identified underscore how the ongoing pandemic may impact the mental health of migrant workers. At the same time, we observed resilience within the cohort, with no evidence of increased symptomology (relative to the general population).FundingJY Pillay Global Asia GrantResearch in ContextEvidence before this studyWe searched PubMed and Google Scholar for articles published in English between Jan 1, 2020 and Feb 20, 2021 using the following keywords: (“COVID*” OR “coronavirus”) AND (“mental*” OR “psychiatr*”) AND (“labo*r migra*” OR “migrant work” OR “foreign-work” OR “immigrant work” OR “economic migra*” OR “economic immigra*”). Focusing on international migrant workers employed in low-wage manual labour positions, we identified commentaries and interview-based studies describing the stressors faced by workers during the COVID-19 pandemic. However, we found no study documenting mental health symptoms within this group.Added value of this studyTo our knowledge, this is the first mental health survey of low-wage migrant workers during the COVID-19 pandemic. We observed that the mental health burden was highest amongst participants who encountered pandemic-related adversities (complete movement restrictions, testing positive for COVID-19), perceived the situation negatively (being fearful of their health or job, or judging their health to be poorer), or had higher exposure to COVID-19 rumours.Implications of the available evidenceOur findings provide a basis to identify and support at-risk migrant workers during the pandemic. Although we did not observe elevated rates of depression, anxiety, and stress symptoms within the migrant worker cohort, individual workers who experience poor mental health may find it harder to access health-care services (relative to the general population). Correspondingly, targeted support for at-risk migrant workers may serve to reduce mental health inequalities.

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