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Introduction: Myasthenia gravis (MG) is a rare, debilitating, chronic disorder caused by the production of pathogenic immunoglobulin G autoantibodies against the neuromuscular junction. A lack of real-world studies in rare diseases reflects a relatively limited understanding of the significant unmet needs and burden of disease for patients. We aimed to provide comprehensive real-world insights into the management and burden of MG from treating physicians in the United States (US)., Methods: Data were collected using the Adelphi Real World MG Disease Specific Programme™, a point-in-time survey of physicians and their patients with MG, in the US between March and July 2020. Physician-reported clinical data, including demographics, comorbidities, symptoms, disease history, treatments, and healthcare resource utilization, were collected., Results: In total, 456 patient record forms were completed by 78 physicians based in the US. At time of survey completion, patient mean age was 54.5 years. Mean time from symptom onset to diagnosis was 9.0 months (n = 357). Ocular symptoms were reported in 71.7% of patients. General fatigue affected 47.1% of patients and over half of those reported the severity as moderate or severe (59.5%, n = 128). Acetylcholinesterase inhibitors and/or steroids were the most frequently prescribed first-line treatment type among patients receiving treatment at time of survey completion and with moderate-to-severe symptoms (77.9%, n = 159/204). High-dose steroids (n = 14) and intravenous immunoglobulin (n = 13) were the most prescribed acute treatments among those receiving an acute treatment at time of survey completion (n = 36), with symptom exacerbations or myasthenic crises being the most common reasons for acute treatment. On average, 2.5 healthcare professionals were involved in patient management and 5.0 consultations were made per patient over the last 12 months., Conclusions: Our findings indicated that, despite treatment, there is a proportion of patients with MG in the US who had a significant need for improved disease management., (© 2022. The Author(s).)

The study of processes that enrich positive relationships has been an under-researched area within positive psychology practice. The way an individual responds during couple conflicts (accommodation response) and toward the disclosure of good news of a partner (capitalization response) has been linked to relationship quality. Although the accommodation and capitalization communication processes are part and parcel of our everyday lives, the two processes have been examined separately and dominated by the Western perspectives in past research. Prior work has suggested that Western and Asian cultures differ in expressing and perceiving beneficial communication behaviors. Yet, it is still unclear which accommodation and capitalization responses matter the most from an Asian lens. To date, there is no research examining these interconnected variables simultaneously in Asia, specifically in Malaysia. In this study, two forms of communication processes, namely, (1) accommodation and (2) capitalization, were explored concurrently to disentangle the unique associations and influence on relationship satisfaction. This study also sought to understand the moderating effects of culture in terms of interdependent self-construal on the link between these two communication processes and relationship satisfaction. Responses of 139 Malaysians in dating relationships between the age of 18 and 30 years ( M age = 23.15) were collected through online surveys. An active and constructive reaction was captured as the most favorable response through both the capitalization and accommodation processes. Prominently, an active-constructive capitalization response bore the strongest influence on relationship satisfaction above and beyond other responses. A passive and constructive response was revealed only fruitful for disclosures of positive news and not during conflicts. Conversely, in the destructive paradigm, passive-destructive responses were the most detrimental factor in relationships compared to other destructive responses. The results also uncovered that interdependent self-construal did not moderate the two forms of communication processes. However, the findings discovered unexpected individual and cultural variations. This pioneering study is a noteworthy addition to the positive psychology literature from an Asian standpoint. It highlights the significance of not only protecting relationships through better conflict management but also enriching relationships by capitalizing on the positive aspects across the lives of the couple, ultimately providing a greater holistic insight into cultivating flourishing lives., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 De Netto, Quek and Golden.)

Background: The COVID-19 pandemic lockdowns have adversely impacted children on the autism spectrum and their families, especially in Malaysia where this population is often marginalized. The current quantitative research aimed to investigate the impact of the Malaysian COVID-19 lockdown on the behavior and psychological distress of children formally diagnosed with an autism spectrum condition (ASC) as well as the psychological distress and well-being of their parents, in comparison with a typically developing (TD) control group. Methods: The children's ages ranged between 5 and 17 years. The sample included 72 ASC parent-child dyads and 62 TD parent-child dyads. The primary caregiver completed an online survey including the following: demographic and diagnostic information; ASC symptoms; children's inattention, hyperactivity/impulsivity, perceived stress, depression, and anxiety; parents' perceived stress, depression, anxiety, and well-being based on their experience pre- and mid-lockdown (March 18th to June 9th 2020) in Malaysia. Results: Among the ASC group, no significant pre- and mid-lockdown change was found in ASC symptoms ( p > 0.05). There were no significant gender differences (boys/girls) in all the child scales. The 2 [diagnosis (ASC, TD)] × 2 [lockdown (pre-lockdown, mid-lockdown)] mixed-model ANOVAs revealed main effects of lockdown on children's attention, hyperactivity/impulsivity, anxiety, and parents' perceived stress, depression, and psychological well-being ( p < 0.005). There was a main effect of diagnosis in all child and parent variables, except parents' perceived stress ( p >0.005). However, there was no significant interaction effect between diagnosis and lockdown ( p >0.005). All child behavior (inattention and hyperactivity/impulsivity) and child psychological distress (anxiety, depression, and perceived stress) were significantly correlated in both the ASC and TD groups ( p < 0.005). On the other hand, only some of the parent variables were significantly correlated with child variables ( p < 0.0045) in the ASC group while none of the parent variables were significantly correlated with the child variables ( p > 0.005) in the TD group. Conclusion: The results provide preliminary evidence indicating negative effects of the Malaysian lockdown on both children on the autism spectrum and TD children, as well as their parents. These quantitative results will be triangulated with the qualitative interview data to provide a holistic understanding of the impact of the pandemic, informing translational policy and practice recommendations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Fong, Cornish, Kirk, Ilias, Shaikh and Golden.)

Background: Progressive supranuclear palsy (PSP) is a neurodegenerative disorder with symptoms including vertical gaze palsy, frequent falls, abnormal gait, and cognitive/language/behavioral changes, making diagnosis and treatment challenging., Methods: Descriptive analysis was undertaken of cross-sectional, real-world data for patients with PSP provided by neurologists in France, Germany, Italy, Spain, UK, and USA., Results: Data on 892 PSP patients were obtained from patient records. Common initial symptoms included difficulty walking/maintaining gait, confusion/disorientation, loss of balance/falling, and rigidity. These symptoms and vertical gaze palsy commonly aided diagnosis. At data collection, dysphagia and blepharospasm were also very common. Mean times from symptom-onset to consulting a healthcare professional and PSP diagnosis were 5.2 and 15.0 months, respectively. General practitioners or movement disorder specialists were most commonly consulted initially; 98% of patients were diagnosed with PSP by a movement disorder specialist or general neurologist. Alternative diagnoses, including Parkinson's disease (67%) and dementia (10%), were considered for 41% of patients prior to PSP diagnosis. Non-wheelchair walking aids and wheelchairs were used by 60% and 23% of patients, respectively, with mean times from symptom-onset to use being 20.8 and 39.5 months, respectively. Symptomatic medication, most often levodopa and antidepressants, was prescribed for 87% of patients., Conclusion: This study provided information on disease course and treatment for a large number of PSP patients from various countries. PSP carries a considerable clinical burden. Diagnosis is often delayed. Consulting a movement disorder specialist might expediate diagnosis. Currently, only symptomatic treatments are available with a poor satisfaction, and there is an urgent need for disease-modifying agents., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Little is known about the coping and resilience experiences of parents of children with autism spectrum disorder (ASD) in the Malaysian cultural context. This study utilized a qualitative methodological approach adopting constructive grounded theory. The study sought to address the lack of research to date exploring the risk and protective experiences that contribute to parental stress and resilience for parents of primary school age children with ASD in the Malaysian setting. Twenty-two parents of children with ASD (13 mothers and 9 fathers) participated in semi-structured interviews. A strength of the study was the inclusion of both mother and father participant perspectives. The interviews lasted 50-80 min (mean: 67.5 min). The 22 parents had a total of 16 children (12 males; 4 females) formally diagnosed with ASD. Child age ranged between 5 and 12 years (mean age: 8.44). Overall, analysis of the 22 interviews revealed four prominent themes - "initial reaction to child's ASD symptoms and diagnosis," "family life affected by a child with ASD," "awareness about ASD in Malaysia," and "coping strategies, wellbeing, and becoming resilient. " The first three themes revolved around stress and adversity , and, the adaptability and acceptance of the parents. These processes illustrated the risks experienced by the parents of children with ASD in Malaysia. The last theme especially highlighted the strengths and determination of the parents and illustrated the protective experiences and processes that helped parents to develop and enhance resilience. Overall, the findings revealed that resilience develops synergistically and dynamically from both risk and protective experiences across different levels - individual, family, community, society and government. The findings motivated the development of our theoretical model of resilience that can help health and education professionals tailor assessment and interventions for parents of children with ASD in the Malaysian context. Clinical, policy, and research suggestions were discussed.

Past research on healthy lifestyle behaviours has been primarily conducted within Western or Judeo-Christian contexts, while non-Western or Muslim contexts remain under-represented. This study examined predictors of healthy lifestyle behaviours (religiosity, goal-setting, impulse control, and subjective well-being) in Malaysian Muslims and explored the mechanisms underlying the relationship between religiosity and healthy lifestyle behaviours. Self-report survey responses from 183 healthy adults (M age  = 28.63 years, 18-50 years) were analysed using regression and multiple mediation analyses. The results indicated that subjective well-being emerged as the strongest predictor, followed by goal-setting. Furthermore, subjective well-being and goal-setting mediated the religiosity-healthy lifestyle behaviour relationship. The findings provide guidance for future health-promoting interventions.

Background: A great deal of research has been carried out on the assessment of the eudaimonic perspective of psychological well-being and the hedonic perspective of subjective well-being. The Flourishing Scale (FS) has been extensively used in research and practice, as it assesses the fundamental aspects of social psychological functioning. Nevertheless, the psychometric properties of Urdu versions of eudaimonic measures, such as the FS, have not yet been ascertained. The translation and validation of the FS in the Urdu language was not available, and hence this study was planned with the aim to validate the Urdu version of the FS. Methods: We assessed the psychometric properties of the FS in a sample of adults aged 18 years and above in Pakistan ( N = 130) using exploratory factor analysis based on principal component analysis with varimax rotation and confirmatory factor analysis. Results: The exploratory factor analysis confirmed the unidimensional nature of the 8-item FS. We assessed that the Urdu version of the FS showed a high internal consistency reliability (α = 0.914) with a significant intraclass correlation coefficient (ICC), p < 0.001). In our study, the Kaiser-Mayer-Olkin value was 0.915 with a chi-square test value (χ 2 ) of 637.687, and Bartlett's test of sphericity was significant ( df = 28, p < 0.001). The intraclass correlation coefficients (ICCs) at test-retest for all domains were statistically significant ( p < 0.001) and showed excellent agreement for all the items. The revised confirmatory factor analysis revealed a good-fit model, but with item 8-"People respect me"-removed due to its lower factor loading. Conclusions: The findings suggest that the FS is a psychometrically sound instrument for assessing social psychological functioning among adults in Pakistan. Therefore, the validated Urdu version of the FS may be used in future studies of well-being in clinical psychology and positive psychology.

The Kalasha are a religious, ethnic, and linguistic minority community in Pakistan. They are indigenous people living in remote valleys of the Hindu Kush Mountains in northern Pakistan, neighboring Afghanistan. The Kalasha are pastoral, as well as agricultural people to some extent, although they are increasingly facing pressures from globalization and social change, which may be influencing youth and community development. Their traditional world view dichotomizes and emphasizes on the division of the pure ( Onjeshta ) and the impure ( Pragata ). There remains a scarcity of literature on mental health and resilience of indigenous communities in South Asia and Pakistan generally, and the polytheistic Kalasha community specifically. Thus, the current study was conducted with the aim to explore the cultural protective factors (resilience) of the Kalasha youth (adolescents and emerging adults) and to explore their perceived etiological understandings and preferred interventions for mental health support systems. The theoretical framework of Bronfenbrenner's (1, 2) ecological systems model was used. Interpretative Phenomenological Analysis (IPA) was conducted, considering the advantage of its idiographic approach and the "double hermeneutic" analytic process. This methodology was consistent with the aim to understand and make sense of mental health and resilience from the Kalasha indigenous perspective. A total of 12 in-depth interviews were conducted with adolescents and emerging adults (5 males, 7 females), along with ethnographic observations. The analysis revealed 3 superordinate themes of mental health perceptions and interventions, each with more specific emergent themes: (1) Psychological Resilience/Cultural Protective Factors Buffering Against Mental Health Problems ( Intra-Communal Bonding & Sharing; Kalasha Festivals & Traditions; Purity Concept; Behavioral Practice of Happiness and Cognitive Patterns ); (2) Perceived Causes of Mental Health Issues ( Biological & Psychosocial; Supernatural & Spiritual ; Environmental ); and (3) Preferred Interventions [ Shamanic Treatment; Ta'awiz (Amulets); Communal Sharing & Problem Solving; Medical Treatment; Herbal Methods ]. The overall findings point to the need for developing culturally-sensitive and indigenous measures and therapeutic interventions. The findings highlighted the Kalasha cultural practices which may promote resilience. The findings also call for indigenous sources of knowledge to be considered when collaboratively designing public health programs.

Background: This paper aimed to review the literature on the factors associated with parenting stress and resilience among parents of children with autism spectrum disorder (ASD) in the South East Asia (SEA) region. Methods: An extensive search of articles in multiple online databases (PsycNET, ProQuest, PudMed, EMBASE, CINAHL, Web of Science, and Google Scholar) resulted in 28 papers that met the inclusion criteria (i.e., conducted in the SEA region, specific to ASD only, published in a peer-reviewed journal, full text in English). Studies found were conducted in the following countries: Brunei, n = 1; Indonesia, n = 2; Malaysia, n = 12; Philippines, n = 5; Singapore, n = 5, Thailand, n = 2; and Vietnam, n = 1, but none from Cambodia, East Timor, Laos, and Myanmar were identified. Results: Across the studies, six main factors were found to be associated with parenting stress: social support, severity of autism symptoms, financial difficulty, parents' perception and understanding toward ASD, parents' anxiety and worries about their child's future, and religious beliefs. These six factors could also be categorized as either a source of parenting stress or a coping strategy/resilience mechanism that may attenuate parenting stress. Conclusion: The findings suggest that greater support services in Western countries may underlie the cultural differences observed in the SEA region. Limitations in the current review were identified. The limited number of studies yielded from the search suggests a need for expanded research on ASD and parenting stress, coping, and resilience in the SEA region especially in Cambodia, East Timor, Laos, and Myanmar. The identified stress and resilience factors may serve as sociocultural markers for clinicians, psychologists, and other professionals to consider when supporting parents of children with ASD.

Background: The drowning impact that musculoskeletal injuries (MSI) have on Soldier readiness, deployability, and escalating health care costs is growing. These injuries are associated with approximately 25 million lost duty days each year. The need to curb costs and improve efficacy and efficiency of health care delivery is pressing. This requires the consideration of new paradigms for clinical pathways and health care delivery processes. Soldiers returning from a deployment go through a screening process to ensure any medical, dental, and administrative issues are adequately addressed. This is a great opportunity to influence optimal musculoskeletal (MSK) care, as nonbattle MSI are the most common injury sustained during a combat deployment. These screening processes usually consist of high throughput in short periods, taxing the usual flow of care through the associated medical clinic. Because the highest percentage of medical visits are related to MSK complaints, a dedicated clinic with specialty providers seeing these patients directly may improve the quality and efficiency of care., Methods: This report provides the details related to the implementation of a MSK specialty clinic such as this at Madigan Army Medical Center, for the return of a U.S. Army Reservist Brigade Combat Team of approximately 4,000 Soldiers. It provides a framework for determining patient flow and triaging of patients to expedited appropriate care directly from the screening site. We report on the demographics and types of injuries seen after deployment, and the patient satisfaction associated with those that were seen in this specialty clinic., Findings: Comparison to usual care were outside the scope of this report, however the patient satisfaction with the process was recorded, and was very high for all 284 patients that received care through this expedited care pathway., Discussion: This article provides a framework for an expedited clinical care pathway for patients returning from deployment that have MSI. It provides a platform for future feasibility testing and prospective studies related to the economic impact of this model when compared to usual care., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Background: The manual diagnosis of neurodegenerative disorders such as Alzheimer's disease (AD) and related Dementias has been a challenge. Currently, these disorders are diagnosed using specific clinical diagnostic criteria and neuropsychological examinations. The use of several Machine Learning algorithms to build automated diagnostic models using low-level linguistic features resulting from verbal utterances could aid diagnosis of patients with probable AD from a large population. For this purpose, we developed different Machine Learning models on the DementiaBank language transcript clinical dataset, consisting of 99 patients with probable AD and 99 healthy controls., Results: Our models learned several syntactic, lexical, and n-gram linguistic biomarkers to distinguish the probable AD group from the healthy group. In contrast to the healthy group, we found that the probable AD patients had significantly less usage of syntactic components and significantly higher usage of lexical components in their language. Also, we observed a significant difference in the use of n-grams as the healthy group were able to identify and make sense of more objects in their n-grams than the probable AD group. As such, our best diagnostic model significantly distinguished the probable AD group from the healthy elderly group with a better Area Under the Receiving Operating Characteristics Curve (AUC) using the Support Vector Machines (SVM)., Conclusions: Experimental and statistical evaluations suggest that using ML algorithms for learning linguistic biomarkers from the verbal utterances of elderly individuals could help the clinical diagnosis of probable AD. We emphasise that the best ML model for predicting the disease group combines significant syntactic, lexical and top n-gram features. However, there is a need to train the diagnostic models on larger datasets, which could lead to a better AUC and clinical diagnosis of probable AD.

Objective: To scrutinize a series of pregnant women treated with electroconvulsive therapy (ECT) at a tertiary treatment center and combine these data with a literature review to refine the treatment guidelines for ECT during pregnancy., Methods: A retrospective chart review of mentally ill pregnant patients treated with ECT since the establishment of a formal women's mental health program., Results: A total of 8 pregnant women treated with ECT were identified from January 2012 to August 2014. Information was extracted from the medical records of a total of 30 ECT treatments across this group. Subjects received an average of 3.75 ECT treatments (range, 1-7). All women were diagnosed as having a mood disorder (either unipolar or bipolar), and 5 of the 8 women had suicidal ideation. The treatment team for ECT was consistent across all treatments. Two women experienced significant complications after the initial treatment: 1) an acute episode of complete heart block; and 2) acute onset of mania after ECT. Obstetrical complications included 2 women with preterm delivery-one secondary to premature rupture of membranes. No other complications or adverse outcomes were recorded. The 5 women with suicidal ideation had symptom resolution, and significant symptom improvement was noted in 6 of the 8 women., Conclusions: Electroconvulsive therapy is a safe and effective treatment during pregnancy and of particular benefit in the acute treatment of suicidal ideation.

Perception of the autonomy and relatedness of the self may be influenced by one's experiences and social expectations within a particular cultural setting. The present research examined the role of culture and the Autonomous-Related self-construal in predicting for different aspects of Social Networking Sites (SNS) usage in three Asian countries, especially focusing on those aspects serving interpersonal goals. Participants in this cross-cultural study included 305 university students from Malaysia (n = 105), South Korea (n = 113), and China (n = 87). The study explored specific social and interpersonal behaviors on SNS, such as browsing the contacts' profiles, checking for updates, and improving contact with SNS contacts, as well as the intensity of SNS use, hypothesizing that those with high intensity of use in the Asian context may be doing so to achieve the social goal of maintaining contact and keeping updated with friends. Two scales measuring activities on other users' profiles and contact with friends' profiles were developed and validated. As predicted, some cross-cultural differences were found. Koreans were more likely to use SNS to increase contact but tended to spend less time browsing contacts' profiles than the Malaysians and Chinese. The intensity of SNS use differed between the countries as well, where Malaysians reported higher intensity than Koreans and Chinese. Consistent with study predictions, Koreans were found with the highest Autonomous-Related self-construal scores. The Autonomous-Related self-construal predicted SNS intensity. The findings suggest that cultural contexts, along with the way the self is construed in different cultures, may encourage different types of SNS usage. The authors discuss study implications and suggest future research directions.

Methylation of a membrane-associated protein with an apparent molecular mass of 40,000 daltons has been observed in Bacillus subtilis. The methylation was nutrient dependent and occurred with a doubling time of 4 +/- 1 min. In wild-type strains, the half-life of turnover of the methyl group(s) was 17 +/- 6 min. Several isogenic strains of B. subtilis containing spo0 mutations (spo0A and spo0H) were found to be normal in glutamate-dependent methylation of the protein and turnover of the methyl group(s). In strains containing spo0B and spo0E mutations, the methyl group(s) were incorporated in response to glutamate addition but turnover was not at a normal rate. The half-life of methyl group turnover was extended to 45 +/- 3 min in these strains. In a spo0K mutant and in spoIIJ and spoIIF mutants, the protein was not significantly methylated. The methylation of a 40,000 dalton protein was also found to be dependent on phosphate. This methylation was observed in wild-type and spo0A and spo0H strains with a doubling time of 4 +/- 1 min and a half-life of turnover of the methyl group(s) of 11 +/- 3 min. In strains containing spo0B, spo0E, and spo0F mutations, the phosphate-dependent incorporation of the methyl group(s) was normal (5 +/- 1 min) but the turnover half-life was extended to 46 +/- 8 min. It is not known whether the nitrogen-dependent and phosphate-dependent systems methylated the same protein.(ABSTRACT TRUNCATED AT 250 WORDS)

We report the presence of a single L-asparagine aminohydrolase activity (EC 3.5.1.1) in extracts of Bacillus licheniformis A5. The synthesis of the enzyme was apparently under nitrogen catabolite repression control.

When nitrogen-starved vegetative cells of Bacillus licheniformis A5 were presented with a good nitrogen source in the presence of chloramphenicol and methyl-labeled methionine, a 40-kilodalton (kDa) protein was found to be reversibly methylated, with a half-life of approximately 10 to 15 min. The 40-kDa protein was strongly methylated in response to the addition of ammonia, glutamine, or sodium glutamate nitrogen sources that produce generation times of less than or equal to 90 min) but was very poorly methylated in the absence of a nitrogen source or in the presence of potassium glutamate or histidine (generation times of greater than 150 min). The methylated protein was found to be membrane associated, but the methylation reaction did not appear to be related to chemotaxis, because the spectrum of nutrients that promoted methylation was different from that which prompted a chemotactic response. In addition, the methyl residue on the 40-kDa protein was found to be alkali stable. Approximately 180 to 640 molecules of the methylated protein were found per cell. The characteristics of this methylated protein were consistent with the hypothesis that the reversible methylation of the protein functions in nutrient sensing to regulate growth, cell division, and the initiation of sporulation.