Social connectedness for socially withdrawn and vulnerable young people's well-being: A qualitative study

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems for vulnerable young people

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. Following the 'social cure' theory, this study aimed to investigate the association, and potential mechanisms, of group membership continuity and reducing mental ill-health amongst vulnerable young people. Method(s): Cross-sectional survey data from a sample of 105 young people aged 16-35, collected approximately 1 year after the global COVID-19 outbreak (January-July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences), and the mediation of these associations by hope and social connectedness (in-person and online). Results and Conclusion(s): Prior multiple group memberships were associated with the preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as a means to potentially help prevent exacerbated symptoms and promote recovery of mental health problems, particularly during significant life events.

Hope and social connectedness as intervention targets in youth mental health

The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic Quantitative findings (N = 105) will be shared to demonstrated how belonging to multiple social groups can promote better mental health through the provision of hopefulness and social connectedness. Qualitative findings (N = 16) will be shared to elucidate how young people with complex emerging mental health problems experienced social connectedness during the ongoing social restrictions, and how they perceive social connection to be associated with their well-being Results also indicate young people's social preferences and the complex role of in-person versus online connection and interaction. A brief summary will be given regarding a linked trial (TOGETHER), evaluating the feasibility of delivering a social connectedness-focused intervention for young people with emerging complex mental health problems across clinical and community services in the UK.

Young people with complex emerging mental health problems: Packages of care and peri-pandemic experiences

The PRODIGY trial found that for young people with complex emerging mental health problems in the UK (N = 270), Social Recovery Therapy did not confer additional benefits above and beyond treatment as usual. Treatment as usual in the trial was, however, surprisingly comprehensive. A study was conducted to evaluate the provision of 'packages' of standard youth mental health care, and the association of provision with trial outcomes. In a subsequent study individuals who participated in the PRODIGY trial (N = 13) were interviewed about their experiences during the COVID-19 pandemic. The restrictions imposed by the COVID-19 pandemic have had significant and wide-ranging impacts on young people due to social isolation, disruption to education and employment opportunities, and young people with pre-existing mental health difficulties were considered to have been disproportionality affected. The results of this study indicated a reciprocal relationship between participants' mental health and their response to the pandemic. Participants told stories of both how the pandemic exacerbated their difficulties, but equally told stories of how their long-standing experiences of managing adversity supported them to cope during pandemic-related social restrictions.

Predictors of COVID-19 anxiety in UK university students

The current research aimed to evaluate UK student mental health during the first 4 months of the COVID-19 pandemic. Specifically, we were interested in exploring factors that contribute to students' anxiety levels about COVID-19. Demographics, mental health symptomatology and well-being-related variables were tested as predictors of COVID-19 anxiety. A cross-sectional online survey was completed by 1,164 UK university students (71.8% females). Measures included self-reported data on stress, social phobia, anxiety, depression, psychotic-like experiences, hopefulness, group membership, social identity, belonging, loneliness, COVID-19 related variables and demographics. The majority of participants were between 18 and 24 years old (92.2%), White British (57.9%) and in the first or second year of their course study (63.12%). A series of multiple linear regressions revealed that being female, experiencing more stress and anxiety, and greater worry about COVID-19 and its effects on social relationships were significant in explaining students' pandemic-related anxiety. Students' level of pandemic-related anxiety was independent of ethnicity, socioeconomic background and pre-existing mental health problems. Worrying about the future was the most common pandemic-related stressor, but it was not a significant predictor of COVID-19 anxiety. Our findings are in line with previous findings that females and students experiencing more stress have been disproportionately affected by the COVID-19 pandemic. Our findings could inform the delivery of targeted stress-management interventions that might prove beneficial for student wellbeing.

The Paradox of Green Growth: Challenges and Opportunities in Decarbonizing the Lithium-Ion Supply Chain

Global decarbonization is a megatrend destined to impact multiple sectors of the economy. The commodity sector in particular looks set to benefit, given the acute need for raw materials to feed the energy transition. This global transition will take decades and while an "all of the above” energy policy will be necessary, the lithium-ion battery promises to play a central role in the decarbonization of the transportation and grid scale energy storage sectors. With lithium-ion battery costs falling steadily since the early 1990s, many believe that the technology promises to become even more ubiquitous, helping to electrify the global economy. Recent exogenous shocks such as the US-China trade war, COVID-19, and the Russian invasion of Ukraine have underlined the fragility of global energy supply chains and the need for a resilient global energy infrastructure. While solutions to the exogenous shocks seem straightforward, there is an increasingly evident paradox. To achieve significant decarbonization and electrification goals, more, not fewer, battery raw materials will be required and the energy used to produce these materials will almost certainly originate from fossil fuels, possibly slowing the decline of the carbon intensity of industry. Innovation along the supply chain is the only realistic way to achieve large-scale decarbonization. This will require R&D, necessitating a coordinated response between the public and private sector as supply chains evolve. This chapter looks at the geopolitical, economic, technological, and legislative challenges and opportunities that green growth presents in the lithium-ion battery ecosystem as the industry embarks on a rapid growth phase. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

How a mRNA COVID-19 Vaccine works inside a Cell: A Virtual Reality Serious Game

Vaccine hesitancy and uptake have been important issues in controlling the current COVID-19 pandemic in many regions around the globe, but the increase in vaccination rates has been slow or even halted in some countries. Therefore, people who have hesitated in getting the vaccine need to be addressed. One driver influencing vaccination uptake is closing the knowledge gap among the public by equipping them with a deeper understanding of how a vaccine works inside our cells to activate the immune system and develop immunity. Viral immunology is highly conceptual and requires an appreciation of molecular biology in the cell. To give individuals an intuitive awareness of the operation of a mRNA-type virus vaccine for COVID-19, we designed and developed a Virtual Reality (VR) based serious game called 'Cell Traveler'. Through this innovative VR serious game, the player can control and interact with a sequence of critical real-life events inside a cell triggered by the injected mRNA COVID-19 vaccine. In this paper, we describe the prototype of the 'Cell Traveler'. We utilize the concepts of serious game to create an experience to encourage students and the public to develop deeper mRNA vaccine knowledge through a memorable and fun experience. © 2022 IEEE.

COVID-19 Clinical Characteristics and Outcomesin Children Aged </=16 Years at theUniversityHospital ofthe WestIndies, Jamaica in 2020-2021

Background: By June 1, 2021, Jamaica recorded 48,639 RT-PCR confirmed SARS-CoV-2 cases and 951 deaths, with a case fatality rate of 2%. Children <18 years comprised 10.3% (4,999) of cases and 0.1% and 0.2% deaths in <10 and 10-18 year age-groups, respectively. Community transmission is ongoing, having been declared September 2020. Methods: Ambispective case series describing clinical characteristics and outcomes of COVID-19 in children aged. Results: Seventy-nine children aged 4 abnormal inflammatory biomarkers (13/72%) including D-dimers, Creactive protein, ESR, ferritin, troponins, lactate dehydrogenase, neutrophils, platelets, lymphocytes, albumen . MISC-positive cases were treated with intravenous immune gammaglobulin (78% vs. 0%;p < 0.01), aspirin (68% vs. 0%;p < 0.01) and steroids (50% vs. 9%;p = 0.003). MISC-positive cases had intensive care admissions (two), non-invasive ventilation (two) and inotropes/vasopressor support (none). Outcomes included readmission for MISC-related neurological complications two(5%), discharged with one month follow-up 39(95%), transferred one(2.4%) and demise from myocardial complications in a child with premorbid end-stage renal disease and haemodialysis one(2.4%). Conclusion: More than half of the children aged.

Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21.

BACKGROUND: Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. METHODS: A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. DISCUSSION: Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. TRIAL REGISTRATION: ClinicialTrials.gov NCT04900961 . Prospectively registered on 25 May 2021.

PREVENTIVE EFFECT OF STATINS AGAINST RESPIRATORY TRACT INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objective: Statins result in lower H5N1 (influenza A) titers on viral exposure and inhibit Ebola virus production and glycoprotein processing. So a similar pattern might be a target for SARS-CoV-2. However, there are data that indicate statins upregulate ACE2 which may have an opposite effect on SARS-CoV-2 infection. To address this question we conducted a systematic review on the efficacy of statins on the risk of respiratory tract infections (RTIs). Design and method: Publications of head-to-head randomized controlled trials (RCTs) of statins were retrieved from MEDLINE, EMBASE, Web of Science, and Cochrane (from 2000-July 2021). We included RCTs with at least 100 participants and with a minimum follow-up of one year. Two authors independently selected the included trials, evaluated the risk of bias, and retrieved the data on RTIs. Meta-analyses were performed to summarise the pooled risk ratios (RRs) of RTIs between treatment arms. Results: The initial literature search identified 568 records. After duplicates were excluded, there were 318 records. Twenty-five RCTs were excluded after a fulltext review of the 29 eligible studies. In the end, four RCTs with a total of 7,912 participants were included in our meta-analysis. As to the effect of statins on RTIs, the point estimate for statins was less than 1, but it did not reach statistical significance in the overall analysis (the pooled RR in the fixed effect model was 0.99 [95% CI: 0.94, 1.04;I2 = 59%;x2 p = 0.66]). Conclusions: The findings of our systematic review and meta-analysis do not support the hypothesis that statins reduce the risk of including RTIs. (Figure Presented).

Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

Right ventricular dysfunction in patients with COVID-19 pneumonitis whose lungs are mechanically ventilated: a multicentre prospective cohort study.

Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3-13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.

Compliance with Stay-at-Home Orders During COVID-19

Are stay-at-home orders effective during a global pandemic? Although stay-at-home orders should help to slow the spread of contagious diseases (like COVID-19) by reducing person-to-person contact outside a household, these orders are only effective if people actually stay at home. This study uses data on the mobility of (anonymized) smartphones within states before and after the enactment of stay-at-home orders to understand the effects of stay-at-home orders on mobility. The dataset contains over ten million observations on the movements of smartphones across all states within the US, which allows for an analysis of compliance with stay-at-home orders without worrying about the potential for self-reporting biases. By using a quasi-experimental method, this study overcomes biases that can come from comparing pre and post policy trends (due to unmeasured differences across states). The results from a difference-in-difference analysis suggest that stay-at-home orders are associated with a 4.6% increase in the percent of smartphones that remained at home during the late spring of 2020 across the US. Although there is a statistically significant difference across states with and without stay-at-home orders, it is important to note that the average percent of smartphones that remained at home was 40% in stay-at-home states compared to 36% in states without stay-at-home orders. The results also show that penalties (jail time and fines) had no significant effect on compliance with stay-at-home orders (considering all states with such orders), while compliance with stay at home orders in Republican controlled states was 5.3% lower than in Democratic controlled states. Further, states with higher population densities had the highest percent of smartphones that remained at home after stay-at-home orders went into effect (at 45%). Overall, the results in this paper suggest that stay-at-home orders had a small but significant impact on mobility, while also suggesting that studies of individual behaviors and choices will be necessary to understand when and why people may be more or less willing to shelter at home during a global pandemic. © 2021 IEEE.

Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

Introduction: Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on nongated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. Purpose:We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification. Methods: We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019- 31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results: 385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months. CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1). Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions: A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events. (Figure Presented).

Fighting Covid: An autonomous indoor cleaning robot (AICR) supported by artificial intelligence and vision for dynamic air disinfection

Due to the sever circumstances in the global pandemic, there has been an immense need for disinfectant robot technology. This pandemic has made people much more aware about the severity of virus transmission in public areas. This prompts society to be much more aware of the need to maintain a clean environment. The purpose of this paper is to present the design principles of an Autonomous Indoor Cleaning Robot (AICR) developed to reduce the spread of COVID-19 in indoor environments such as small shops and office settings. Its main purpose is to proactively disinfect the air and maintain a clean breathing environment by actively targeting populated areas with the use of a vision system, using Visual Simultaneous Localization and Mapping (VSLAM) technology. Currently there are other air disinfection products on the market also making use of a combination of a High-Efficiency Particulate Absorbing (HEPA) air purifier and Ultra Violet (UV) light to kill airborne viruses like the Coronavirus. However, all of these are stationary with lack of intelligence machines that have to be kept or manually wheeled from room to room. The device proposed in the paper is a fully autonomous air purifying device capable of going to certain critical regions of the indoor environment to disinfect the air in that area without any human interaction. The stationary purifiers should be much more powerful covering a larger area which makes them very expensive. In contrast, the developed autonomous air purifier needs much less power consumption compared to static purifiers, with the advantage of intelligently and dynamically learning the status of the room using the information captured from the occupancy, itself, and the environment. © 2021 IEEE

Role of inpatient coronary CT angiography on clinical decision making during COVID- 19 pandemic

Background: The COVID-19 pandemic has had a profound effect on healthcare delivery. Here we describe the effect of repurposing of a research Computed Tomography scanner on clinical care of cardiology patients in an urban academic medical centre which did not have routine access to CCTA prior to the pandemic. Patients requiring invasive coronary angiography require transfer to a regional cardiac centre (no ICA available on site). Purpose: We investigated the effect of CCTA on i) diagnostic certainty ii) avoidance of clinician defined unnecessary invasive angiography in hospitalised patients. Methods: This was a prospective, longitudinal cohort study involving hospitalized patients admitted to an urban academic medical centre (catchment population 650 000) between March 29 and September 21, 2020. Routinely collected (usual care) data were gathered by clinicians who were members of the usual care medical team and ethics approval or explicit patient consent was not required. High-sensitivity Troponin-I was measured on admission and 3- and 6- hours after if mandated (Abbott Architect TnI assay). A 320-detector scanner (Aquilon ONE, Canon) was used. Intravenous metoprolol was used where required to control the heart rate (target 60 b.p.m.) and sublingual glyceryl trinitrate will be given to all patients immediately before the scan acquisition. Results: Forty-three patients underwent inpatient CCTA, mean age: 61 ± 13 years (range 30-88y), 54% female. The presenting complaint was typical chest pain in 28 (65%), atypical chest pain in 10 (23%), and a variety of symptoms in 5 (12%) including palpitations, syncope, breathlessness. Thirty-six (84%) of patients had a detectable TnI above the 99% centile. Median(IQR) peak TnI was 127 (33-635)ng/L. CCTA was carried out on average 1 day post request. CCTA resulted in an improvement in clinician diagnostic certainty (Initial review: 21% yes, 79% probable, post-CCTA review: 84% yes, 16% probable) in providing a diagnosis. 21 (49%) of invasive coronary angiograms were avoided due to CCTA, whilst an inpatient invasive coronary angiogram (ICA) was performed in 4(9%) due to CCTA demonstrating significant disease, and in 2(%) the ICA was changed from out-patient to in-patient. Three ICA tests were requested as OP due to CCTA findings. CCTA did not overestimate disease severity in this cohort. We saved 21 inter hospital transfers for ICA during this time period. Using NHS England cost tariffs, a cost saving of >£36,000 was made for using CCTA instead of ICA in these 21 patients who would have required ICA. Conclusion: Inpatient CCTA resulted in greater clinician diagnostic confidence, avoidance of unnecessary invasive angiograms and a significant cost saving. This also reduced the duration of patient stay, reducing the potential exposure of patients to COVID-19. (Table Presented).

Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging

Introduction Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2. Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed. The Society of Thoracic Radiology have previously highlighted that incidental coronary calcification should be reported on CT chest scans5. We sought to investigate patients presenting to our centre with an acute coronary syndrome (ACS) event with historical CT imaging demonstrating coronary artery calcification. Methods We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019 - 31/03/2019). The national imaging database in Scotland (PACS) was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported. Demographic information was collected from our electronic patient record (Clinical Portal) including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record. Results 385 patients with first presentation of ACS were identified (figure 1). 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months.CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (figure 2). Patients with CAC frequently had risk factors for IHD (table 2). Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin. Conclusions A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events.

Unusual presentation of splenic artery aneurysm rupture in pregnancy

Objective Ruptured splenic artery aneurysms (SAAs) in pregnancy are a rare but significant cause of maternal and foetal mortality. We describe an unusual presentation of SAA rupture at term with predominantly chest symptoms to encourage clinicians to consider this rare differential diagnosis in the obstetric setting, especially in context of the COVID-19 pandemic. Case report A 36-year-old pregnant female (G1P0) presented at 38 + 4 weeks with lower left-sided chest pain and a history of coryzal symptoms. She was hypotensive and tachycardic with oxygen desaturation at presentation. Chest and abdominal examinations were unremarkable. Intravenous fluids and antibiotics were commenced on the suspicion of septic shock from a chest infection. However, new-onset left shoulder-tip pain and a pathological cardiotocogram prompted an emergency Caesarean section. A female infant (APGARs 2,7) was delivered and admitted to NICU for respiratory distress. Significant haemoperitoneum was noted upon abdominal entry, which was localised to the left upper quadrant. Subsequent exploratory laparotomy revealed a large retroperitoneal haematoma and two SAAs (1.5 cm intact, proximal and 2.5 cm ruptured, distal), which were managed via splenic artery ligation and splenectomy. Total estimated blood loss was 4400 mL, requiring intraoperative transfusions of 5U packed red cells, 4U fresh-frozen plasma and 1U cryoprecipitate. Postoperative CT angiogram identified no additional aneurysms but revealed multiple partially occlusive pulmonary emboli, which were managed in ITU with intravenous heparin and, subsequently, low molecular weight heparin. Both mother and baby were discharged in stable condition on day 10. Discussion SAA commonly presents with abdominal pain but is frequently misdiagnosed, as it can mimic other abdominal and obstetric pathologies. We highlight a unique presentation of ruptured SAA with chest pain, which can resemble severe SARS-Cov-2 infection and complicate diagnosis. Importantly, early diagnosis and intervention are critical to reducing mortality. Aggressive fluid resuscitation, emergency Caesarean section and laparotomy remain the mainstay of treatment for symptomatic ruptured SAAs. Additionally, postpartum patients after surgery are at significant risk of venous thromboembolism due to their intrinsically hypercoagulable state;thus, clinicians should have a low threshold for investigation. Conclusion This case stresses the importance of recognising both the typical and atypical clinical features of ruptured SAAs and considering it as a differential for obstetric patients, especially during the COVID-19 pandemic. A multidisciplinary approach with early involvement of the surgical team is imperative to reduce morbidity and mortality.