Performance and Early Results from the Earth Surface Mineral Dust Source Investigation (EMIT) Imaging Spectroscopy Mission

The Earth Surface Mineral Dust Source Investigation (EMIT) acquires new observations of the Earth from a state-of-the-art, optically fast F/1.8 visible to short wavelength infrared imaging spectrometer with high signal-to-noise ratio and excellent spectroscopic uniformity. EMIT was launched to the International Space Station from Cape Canaveral, Florida, on July 14, 2022 local time. The EMIT instrument is the latest in a series of more than 30 imaging spectrometers and testbeds developed at the Jet Propulsion Laboratory, beginning with the Airborne Imaging Spectrometer that first flew in 1982. EMIT's science objectives use the spectral signatures of minerals observed across the Earth's arid and semi-arid lands containing dust sources to update the soil composition of advanced Earth System Models (ESMs) to better understand and reduce uncertainties in mineral dust aerosol radiative forcing at the local, regional, and global scale, now and in the future. EMIT has begun to collect and deliver high-quality mineral composition determinations for the arid land regions of our planet. Over 1 billion high-quality mineral determinations are expected over the course of the one-year nominal science mission. Currently, detailed knowledge of the composition of the Earth's mineral dust source regions is uncertain and traced to less than 5,000 surface sample mineralogical analyses. The development of the EMIT imaging spectrometer instrumentation was completed successfully, despite the severe impacts of the COVID-19 pandemic. The EMIT Science Data System is complete and running with the full set of algorithms required. These tested algorithms are open source and will be made available to the broader community. These include calibration to measured radiance, atmospheric correction to surface reflectance, mineral composition determination, aggregation to ESM resolution, and ESM runs to address the science objectives. In this paper, the instrument characteristics, ground calibration, in-orbit performance, and early science results are reported. © 2023 IEEE.

Impact of Time-Motion Patient Flow Analysis on the Productivity of an Endoscopy Unit in a Large Safety-Net Health Center

Introduction: The COVID-19 pandemic disrupted health care delivery, particularly for high-volume procedural areas. To improve productivity in the Los Angeles County 1 University of Southern California Medical Center (LAC + USC) Endoscopy Unit, we initiated an iterative rapid cycle quality improvement process to identify inefficiencies and implement changes to our workflow. Method(s): A time-motion analysis of patient flow through the LAC + USC Endoscopy Unit was used to construct a time-tracked flow sheet to track individual patients as they moved through the Unit. Data were collected weekly over 3 9-10 week phases, and intervening plan-do-study-act (PDSA) cycles were conducted to direct interventions for subsequent phases. Following phase 1 (9/1/21 to 11/9/21) we implemented targeted interventions at the start of phase 2 (12/1/21 to 2/1/22) and phase 3 (3/15/22 to 5/31/22). Phase 2 was focused on our anesthesia supported endoscopy room which requires greater resource coordination. Metrics were compared to published benchmarks. Linear regression was used to compare outcome parameters for the lean process flow improvement project. Result(s): Our phase 1 analysis showed operational delays in room turnover time for all procedures and pre-operative assessment and first-case on time start percentage for procedures supported by anesthesia, when compared to published benchmarks (Table 1). In phase 2 we implemented an intervention of combining pre-anesthesia visits with endoscopy teaching visits for patients designated to have anesthesia support. This significantly improved both turnover time and throughput for the anesthesia room (Table 1). In phase 3 we initiated a policy of preparing the first patient of the day in the procedure room which dramatically increased first-case on time start percentage. We further streamlined inter-procedure processes by simultaneously consenting, placingmonitoring equipment and documenting in the time between procedures, leading to a greater than 20% increase in total procedure volume (Table 1). Procedure throughput for the anesthesia supported procedure room increased from 4.5 to 7 to 9 procedures per room per day for phases 1, 2, and 3 respectively (Table 1). EndoscopyUnit staffing remained unchanged throughout the study period. Conclusion(s): Time-motion analysis of patient flow may be used to perform targeted interventions with significant improvements in Endoscopy Unit efficiency. This may be achieved without costly interventions such as hiring additional support staff or faculty. (Table Presented).

Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is an endolumenal, organ-sparing therapy for obesity, with wide global adoption. We aimed to explore the efficacy and safety of ESG with lifestyle modifications compared with lifestyle modifications alone. METHODS: We conducted a randomised clinical trial at nine US centres, enrolling individuals aged 21-65 years with class 1 or class 2 obesity and who agreed to comply with lifelong dietary restrictions. Participants were randomly assigned (1:1·5; with stratified permuted blocks) to ESG with lifestyle modifications (ESG group) or lifestyle modifications alone (control group), with potential retightening or crossover to ESG, respectively, at 52 weeks. Lifestyle modifications included a low-calorie diet and physical activity. Participants in the primary ESG group were followed up for 104 weeks. The primary endpoint at 52 weeks was the percentage of excess weight loss (EWL), with excess weight being that over the ideal weight for a BMI of 25 kg/m2. Secondary endpoints included change in metabolic comorbidities between the groups. We used multiple imputed intention-to-treat analyses with mixed-effects models. Our analyses were done on a per-protocol basis and a modified intention-to-treat basis. The safety population was defined as all participants who underwent ESG (both primary and crossover ESG) up to 52 weeks. FINDINGS: Between Dec 20, 2017, and June 14, 2019, 209 participants were randomly assigned to ESG (n=85) or to control (n=124). At 52 weeks, the primary endpoint of mean percentage of EWL was 49·2% (SD 32·0) for the ESG group and 3·2% (18·6) for the control group (p<0·0001). Mean percentage of total bodyweight loss was 13·6% (8·0) for the ESG group and 0·8% (5·0) for the control group (p<0·0001), and 59 (77%) of 77 participants in the ESG group reached 25% or more of EWL at 52 weeks compared with 13 (12%) of 110 in the control group (p<0·0001). At 52 weeks, 41 (80%) of 51 participants in the ESG group had an improvement in one or more metabolic comorbidities, whereas six (12%) worsened, compared with the control group in which 28 (45%) of 62 participants had similar improvement, whereas 31 (50%) worsened. At 104 weeks, 41 (68%) of 60 participants in the ESG group maintained 25% or more of EWL. ESG-related serious adverse events occurred in three (2%) of 131 participants, without mortality or need for intensive care or surgery. INTERPRETATION: ESG is a safe intervention that resulted in significant weight loss, maintained at 104 weeks, with important improvements in metabolic comorbidities. ESG should be considered as a synergistic weight loss intervention for patients with class 1 or class 2 obesity. This trial is registered with ClinicalTrials.gov, NCT03406975. FUNDING: Apollo Endosurgery, Mayo Clinic.

DYNAMO Covid-19 Dynamic assessment of multi organ level dysfunction in patients recovering from Covid-19: insulin resistance and metabolic flexibility

P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.

Outlaw Bikers and Ancient Warbands Hyper-Masculinity and Cultural Continuity Conclusion

This conclusion summerises the chapters of the book. Through a comparative approach Outlaw Bikers and Ancient Warbands: Hyper-masculinity and Cultural Continuity demonstrates a cultural continuity that is part of human society, identified since prehistory. Warband values and outlaw biker tenets of hyper-masculinity has been defined and measured. Issues of hyper-masculinity and domestic violence have been assessed while also conceptualising the creation of the sacred masculine culture that underpins the values of the outlaw biker. Neoliberalism and socioeconomic inequality have been critiqued to explain why groups such as outlaw bikers exist. This book concludes that outlaw bikers are just one group within modern society that prioritise hyper-masculinity in the formation, socialisation and enforcement of hegemonic masculinity. Outlaw biker clubs are here to stay, and as the socioeconomic gap grows, there needs to be serious consideration as to what role they will play in their communities and in the post-COVID-19 environment.

Future Trends

Given the cultural continuity and persistence of hyper-masculine groups such as outlaw bikers, what is the future likely to hold within the context of contemporary warband societies? With an arguably widening gaps of inequality, increased social tension and an ongoing COVID-19 epidemic, how will young men and women respond? This chapter explores the future for outlaw biker clubs through the concept of the outlaw biker/ community contract, and socioeconomic inequality. It will explore the trends of internationalisation and posit the increased trajectory of the American-styled bikers and Australian clubs impacting the major groups in Europe and post-Soviet Eastern Europe, Aotearoa New Zealand, and Asia. This chapter will discuss territoriality and the violence that often follows such moves of internationalisation and assess the implications for conflict. Lastly, there will be some discussion on the outlaw biker/military nexus where clubs are actively recruiting combat veterans and current serving military personnel.

Making the good better: developing a streamlined competency set for ICU Physiotherapists within an Academic Health Science Centre

Introduction: One team, multiple sites is a principle supporting our Academic Health Sciences Centre (AHSC) partnership vision for academic and clinical excellence. COVID-19 has highlighted the need for co-ordinated crossorganisational working within ICU. There is currently no nationally agreed competency framework for ICU Physiotherapists. Having a streamlined set of competencies across the AHSC would be beneficial for safety, quality of care, training efficiency, workforce development, workforce mobility and further embed collaborative cross-site relationships. Objective: To develop streamlined competencies for ICU Physiotherapists working within an AHSC. Methods: Physiotherapy ICU leads from each site in the AHSC were identified via stakeholder mapping. This work stream was facilitated by a dedicated project lead, using a Plan-Do-Study-Act (PDSA) cycle. Organisational and national competencies1-3 relevant to ICU Physiotherapists were collated. Benchmarking and mapping were completed to identify commonalities and deficits. Initial meetings were conducted weekly via virtual forums to ensure benchmarking and mapping procedures were validated by all members. Two face-to-face meetings were employed to discuss the ideal competency set based on expert clinical opinion alongside the results from benchmarking and mapping. A whiteboard collaboration platform provided by Miro4 enabled all members to contribute whilst negotiations were facilitated by the project lead. Consensus on decisions pertaining to the streamlined document required all members to be in agreement. The method for achieving this centred on open discussion and regular communication. Results: The work stream utilised eighteen organisational competency documents and three national documents.1-3 The final competency set was formulated using common themes which allowed for incorporation of specific competencies from each site. Agreement on each theme and specific competencies were easily reached due to the extent of commonality between existing organisational documents. Rather than using bands to denote progression through competencies the work stream agreed on use of the terms Foundation, Specialist, Advanced and Expert, aligning the document with the Intensive Care Society AHP professional development framework.1 These levels are loosely aligned to the expectations for staff in bands 5-8, though allows staff to develop skills through the levels with no ceiling effect based on paygrade. The group comprehensively devised the foundation level set of competencies and approved a sign-off procedure using elements from organisational documents, including self-reported confidence measures and senior supervised assessment of competence. Conclusion: Using quality improvement methodology, the work stream was able to rapidly produce a comprehensive streamlined competency set for foundation level Physiotherapists in ICU across the AHSC. Next steps include gaining workforce feedback as part of a further PDSA cycle to refine the document prior to implementation. Continued collaboration by the work-stream will enable additional competency levels to be built from the foundation set. Education and training aligned to the document is essential for its success. Development of this will extend and reinforce the cross-organisational working and collaboration which is now embedded within the teams. The methodology to date demonstrates a proof of concept which can be utilised with other AHP groups in ICU, other settings or wider regional areas.

Time taken to wake post sedation hold and the impact on functional performance at intensive care unit (ICU) discharge: Do COVID rehabilitation phenotypes exist?

Introduction: The COVID-19 pandemic caused a sudden and unprecedented surge in ICU admissions for severe acute respiratory failure. Whilst there is a wealth of knowledge surrounding risk factors for developing critical care myopathy and effects of prolonged ICU stay on functional outcomes,1,2 little was known about the pathophysiology, treatment or physical outcomes of patients admitted to ICU with COVID-19. In our organisation, patients recovering from the acute phase of COVID-19 demonstrated a range of presentations impacting rehabilitation whist in ICU. Objective: To explore whether time taken to wake post sedation hold impacts on functional outcomes of patients surviving ICU admission for COVID-19. Methods: A retrospective review of patients admitted to ICU with a primary diagnosis of COVID-19 between March-April 2020 was conducted at a large London NHS Foundation Trust. Electronic clinical notes were reviewed and the following data extracted: age, ethnicity, sex, BMI, pre-admission clinical frailty score, duration of sedation, days taken to wake from sedation, duration of mechanical ventilation (MV), ICU length of stay (LOS) and hospital LOS. Functional outcomes were defined using the Intensive Care Unit Mobility Score (ICUMS). Data were analysed using descriptive statistics, reported as absolute numbers, percentages (%) and median (range). Results: 203 patients were identified, 137 were excluded as 58 died, 3 were incidental findings of COVID-19, 67 had missing data due to paper notes or transfers in/out of the Trust and 9 were duplicate records. Sixty-six patients were included in the final analysis (Table 1). Patients could be categorised into four rehabilitation groups: 1 = Never requiring sedation and MV, 2 = Woke from sedation (defined as RASS ≥-1) within 72 hours with preserved muscle power (defined as ICUMS ≥5 on ICU discharge), 3 = Woke from sedation within 72 hours but myopathic (defined as ICUMS ≤4 on ICU discharge), 4 = Slow to wake (> 72 hrs). Those slow to wake following sedation hold (group 4) had an increased age, BMI, and higher proportion of nonwhite ethnicity. Neuromuscular blocking agents (NMBA) and steroid use was more prevalent in group 4 compared to the other groups. There was also increased midazolam administration and higher number of total sedative agents received by these patients. Those slow to wake had a lower ICUMS at ICU discharge than those waking with preserved strength or never sedated (3, 6, 9 respectively). Those who were slow to wake were ventilated for longer than the other groups. Time taken to wake from sedation also resulted in longer ICU and hospital LOS. Similar functional outcomes at hospital discharge were noted between all 4 groups (Table 1). Conclusion: Patients slow to wake from sedation following ICU admission for a primary diagnosis of COVID-19 had a longer ICU LOS, reduced functional ability at ICU discharge and a longer hospital LOS. These preliminary observational clinical data support the testable hypothesis that within in the ICU, COVID rehabilitation phenotypes may exist which warrants further investigation.

Exploring the evolving picture of physical outcomes for patients admitted to ICU with COVID-19: A single centre observational study from a London teaching Trust

Introduction: Prolonged Intensive Care Unit (ICU) admission is frequently accompanied by ICU acquired weakness, impaired mobility and reduced health related quality of life.1,2,3 The COVID-19 pandemic caused a sudden and unprecedented surge in ICU admissions for severe acute respiratory failure in the UK in two distinct waves between March-April 2020 and Jan-Feb 2021. Whilst knowledge surrounding medical management of COVID-19 evolved throughout the pandemic, the impact of this on physical recovery and outcomes is less clear. Objective: To explore the impact of ICU admission on physical function in COVID-19 survivors across two distinct UK waves. Methods: A retrospective clinical review of patients admitted to ICU with a primary diagnosis of COVID-19 between March-April 2020 and January-February 2021 was conducted at a large London NHS Foundation Trust. Electronic clinical notes were reviewed, and the following data extracted: age, ethnicity, sex, BMI, duration of sedation, duration of mechanical ventilation, ICU length of stay (LOS) and hospital LOS. Physical impairment was based on the Intensive Care Unit Mobility Score (ICUMS) and defined as significant (≤3), moderate (≤6), mild (≥7) or none (score of 10). Data was analysed using descriptive statistics, reported as absolute numbers, percentages (%) and median (range). Comparisons were made between data sets from each wave to examine whether greater understanding surrounding the management of COVID-19 translated into improved physical outcomes for those surviving ICU admission. Results: 444 clinical notes were identified, 287 were excluded as 149 died, 14 were incidental findings of COVID-19, 115 had missing data due to paper notes or transfers in/ out of the Trust and 9 were duplicate records. 157 patients were included in the final analysis;66 from wave 1 and 91 from wave 2. Baseline patient demographics were equally matched across both waves (table 1). Wave 1 patients were sedated longer (13(0-39) v's 11(0-83) days), ventilated longer (25(0-277) vs 13(0-175) days) with longer ICU (27(2-67) vs 17(0-189) days) and hospital LOS (49(5-277) vs 32(4-182) days) than those in wave 2 (Table 1). The median ICUMS at ICU discharge was lower for wave 1 than wave 2 (3 (0-10) V's 4 (0-9)). A higher percentage of patients in wave 1 were discharged from ICU with severe physical impairment compared to Wave 2 (52% vs 40%). Moderate physical impairment was the most frequent presentation category at ICU discharge for wave 2 patients (Table 2). At hospital discharge 66% of patients in wave 1 and 76% in wave 2 had ongoing rehab needs, although the majority of these were mild (ICUMS ≥7) in both cohorts. Conclusions: These preliminary data comparisons between the first two waves of the COVID-19 pandemic suggest evolving knowledge and experience of the condition resulted in reduced sedation duration, ventilation days, ICU and hospital LOS. There were also improved physical outcomes for patients at ICU discharge, but long-term rehabilitation needs persisted. Ongoing exploration of the acute and longer-term needs of individuals surviving ICU admission for COVID-19 is required to inform future rehabilitation provision and health care policy.

AN OPERATIONS MANAGEMENT APPROACH TO A CRITICAL ENDOSCOPIC BACKLOG

Background: The COVID-19 pandemic introduced unprecedented disruptions to healthcare delivery, particularly for ambulatory services such as gastrointestinal endoscopy. At the peak of the pandemic in our region between December 2020 to February 2021, ambulatory endoscopy services were suspended at the Los Angeles County + University of Southern California Medical Center (LAC+USC). While endoscopy services resumed in March 2021, the operational challenges introduced by COVID-19 led to a mounting backlog of patients awaiting endoscopic procedures reaching 1,035 by June 2021. As part of our solution to this crisis, we used the principles of operations management to perform a process flow analysis to identify inefficiencies and develop targeted interventions to enhance the operational performance of our endoscopy unit. Methods: A time-motion analysis of patient flow through the LAC+USC Endoscopy Unit was used to construct a comprehensive time-tracked flow sheet to track individual patients as they moved through the unit from check-in to discharge on random dates over a 6-week period (Figure 1). Simultaneously, a qualitative stakeholder survey on perceived operational inefficiencies was distributed to all faculty, staff, and fellows in the endoscopy unit. At the end of 6 weeks, collected data were compared to both published benchmarks and stakeholder survey responses, and inefficiencies identified for intervention. Results: Data were collected for 214 procedures (179 moderate sedation, 35 monitored anesthesia care) in the endoscopy unit. When compared to established benchmarks, we found operational delays in 1) check-in to procedure start time, 2) room turnover time, and 3) first-case on-time start percentage (Table 1). Results from the stakeholder survey aligned with these data. Targeted interventions (Table 1) developed by a multi-disciplinary group of faculty, nursing staff, and trainees from both Gastroenterology and Anesthesiology departments were then implemented, including 1) preparation of the first patient of the day in the procedure room, 2) pre-operative clinic visits for all patients designated to require anesthesia during endoscopy, 3) implementation of a brief-operative note and 4) a time study to encourage first-case on-time start. In combination with maneuvers to streamline the pre-procedure process, this resulted in a reduction of the backlog to 430 by November 2021. Conclusion: Granular analysis of data tracking process flow times through the LAC+USC Endoscopy Unit aligned with stakeholder perceptions regarding operational inefficiencies. The combination of objective and subjective data allowed us to rapidly implement targeted interventions to increase the throughput of the endoscopy unit and address the backlog of endoscopy procedures caused by the COVID-19 pandemic. (Figure Presented) (Table Presented)

Multimodal wearable platform for remote monitoring of breathing patterns, cough events and blood oxygen level

Wearable technologies are essential for telehealth services and for reducing the load on the healthcare systems. The wearables enable individuals to personalize health monitoring out of hospitals and allow physicians to remotely assess the health status of individuals and track the recovery process. Here, we developed a multimodal wearable device to record breathing patterns and cough events with a low noise, wide dynamic range microelectromechanical accelerometer. In addition, the wearable device included a high-sensitivity pulse oximeter and heart rate to record blood oxygen saturation levels. The device recorded cough vibrations, oxygen saturation level and a respiratory profile that can be used for evaluation of the respiratory system. The device was tested on healthy volunteers and a subject with COVID-19 during quarantine. © COPYRIGHT SPIE. Downloading of the is permitted for personal use only.

Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic.

Despite evidence for the effectiveness of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD), many individuals with OCD lack access to needed behavioral health treatment. Although some literature suggests that virtual modes of treatment for OCD are effective, it remains unclear whether intensive programs like partial hospitalization and intensive outpatient programs (PHP and IOPs) can be delivered effectively over telehealth (TH) and within the context of a global pandemic. Limited extant research suggests that clinicians perceive attenuated treatment response during the pandemic. The trajectory and outcomes of two matched samples were compared using linear mixed modeling: a pre-COVID in-person (IP) sample (n = 239) and COVID TH sample (n = 239). Findings suggested that both modalities are effective at treating OCD and depressive symptoms, although the pandemic TH group required an additional 2.6 treatment days. The current study provides evidence that PHP and IOP treatment delivered via TH during the COVID-19 pandemic is approximately as effective as pre-pandemic IP treatment and provides promising findings for the future that individuals with complicated OCD who do not have access to IP treatment can still experience significant improvement in symptoms through TH PHP and IOP treatment during and potentially after the pandemic.

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).

Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults.

The heightened acuity in anxiety and depressive symptoms catalyzed by the COVID-19 pandemic presents an urgent need for effective, feasible alternatives to in-person mental health treatment. While tele-mental healthcare has been investigated for practicability and accessibility, its efficacy as a successful mode for delivering high-quality, high-intensity treatment remains unclear. This study compares the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192). Outcomes are measured with respect to depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report; QIDS-SR) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Q-LES-Q). There were no significant differences in admission score on either assessment comparing in-person and telehealth groups. Patients in the partial hospitalization level of care stayed longer when treatment was remote. Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups. Future research is needed to replicate these findings in other healthcare organizations in other geographical locations and diverse patient populations.

Towards detection of SARS-CoV-2 RNA in human saliva: A paper-based cell-free toehold switch biosensor with a visual bioluminescent output.

The COVID-19 pandemic has illustrated the global demand for rapid, low-cost, widely distributable and point-of-care nucleic acid diagnostic technologies. Such technologies could help disrupt transmission, sustain economies and preserve health and lives during widespread infection. In contrast, conventional nucleic acid diagnostic procedures require trained personnel, complex laboratories, expensive equipment, and protracted processing times. In this work, lyophilized cell-free protein synthesis (CFPS) and toehold switch riboregulators are employed to develop a promising paper-based nucleic acid diagnostic platform activated simply by the addition of saliva. First, to facilitate distribution and deployment, an economical paper support matrix is identified and a mass-producible test cassette designed with integral saliva sample receptacles. Next, CFPS is optimized in the presence of saliva using murine RNase inhibitor. Finally, original toehold switch riboregulators are engineered to express the bioluminescent reporter NanoLuc in response to SARS-CoV-2 RNA sequences present in saliva samples. The biosensor generates a visible signal in as few as seven minutes following administration of 15 µL saliva enriched with high concentrations of SARS-CoV-2 RNA sequences. The estimated cost of this test is less than 0.50 USD, which could make this platform readily accessible to both the developed and developing world. While additional research is needed to decrease the limit of detection, this work represents important progress toward developing a diagnostic technology that is rapid, low-cost, distributable and deployable at the point-of-care by a layperson.

OCD in the time of COVID-19: A global pandemic's impact on mental health patients and their treatment providers.

Individuals with obsessive-compulsive disorder (OCD) have evidenced resilience against large-scale crises, although emerging research on the impact of COVID-19 is mixed. Little is known about the impact of COVID-19 on mental health providers. Items from an instrument evaluating the impact of the September 11, 2001, terrorist attack were adapted to measure the impact of COVID-19 on emotions, cognitions, and behaviors. Using a sample of 65 patients with primary OCD diagnoses and OCD treatment providers in intensive programs for OCD and anxiety, the authors found that COVID-19 evidenced a less significant overall impact on patients than providers. Specifically, providers reported more significant impact on the amount of time spent worrying about COVID-19, taking additional cleaning and sanitization precautions, and time spent socializing with loved ones. Findings support previous literature indicating that individuals with OCD demonstrate resilience to large-scale crises, and offer insights into the specific struggles of providers who treat OCD.

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.