The Relationship Between Social Media Use and Beliefs in Conspiracy Theories and Misinformation.

Numerous studies find associations between social media use and beliefs in conspiracy theories and misinformation. While such findings are often interpreted as evidence that social media causally promotes conspiracy beliefs, we theorize that this relationship is conditional on other individual-level predispositions. Across two studies, we examine the relationship between beliefs in conspiracy theories and media use, finding that individuals who get their news from social media and use social media frequently express more beliefs in some types of conspiracy theories and misinformation. However, we also find that these relationships are conditional on conspiracy thinking--the predisposition to interpret salient events as products of conspiracies--such that social media use becomes more strongly associated with conspiracy beliefs as conspiracy thinking intensifies. This pattern, which we observe across many beliefs from two studies, clarifies the relationship between social media use and beliefs in dubious ideas. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11109-021-09734-6.

Deployment of whole genome next-generation sequencing of SARS-CoV-2 in a military maritime setting.

BACKGROUND: SARS-CoV-2 can spread rapidly on maritime platforms. Several outbreaks of SARS-CoV-2 have been reported on warships at sea, where transmission is facilitated by living and working in close quarters. Core components of infection control measures such as social distancing, patient isolation and quarantine of exposed persons are extremely difficult to implement. Whole genome sequencing (WGS) of SARS-CoV-2 has facilitated epidemiological investigations of outbreaks, impacting on outbreak management in real time by identifying transmission patterns, clusters of infection and guiding control measures. We suggest such a capability could mitigate against the impact of SARS-CoV-2 in maritime settings. METHODS: We set out to establish SARS-CoV-2 WGS using miniaturised nanopore sequencing technology aboard the Royal Fleet Auxiliary ARGUS while at sea. Objectives included designing a simplified protocol requiring minimal reagents and processing steps, the use of miniaturised equipment compatible for use in limited space, and a streamlined and standalone data analysis capability to allow rapid in situ data acquisition and interpretation. RESULTS: Eleven clinical samples with blinded SARS-CoV-2 status were tested at sea. Following viral RNA extraction and ARTIC sequencing library preparation, reverse transcription and ARTIC PCR-tiling were performed. Samples were subsequently barcoded and sequenced using the Oxford Nanopore MinION Mk1B. An offline version of the MinKNOW software was used followed by CLC Genomics Workbench for downstream analysis for variant identification and phylogenetic tree construction. All samples were correctly classified, and relatedness identified. CONCLUSIONS: It is feasible to establish a small footprint sequencing capability to conduct SARS-CoV-2 WGS in a military maritime environment at sea with limited access to reach-back support. This proof-of-concept study has highlighted the potential of deploying such technology in the future to military environments, both maritime and land-based, to provide meaningful clinical data to aid outbreak investigations.

Second SARS-CoV-2 Booster Vaccination Significantly Reduces Haemodialysis Patients' Susceptibility to Infection With Omicron Variant

Background: Patients requiring haemodialysis (HD) have disproportionately poorer outcomes from SARS-CoV-2 infection and vaccines afford an opportunity to improve this. However, the efficacy of booster doses on infection with emerging variants remains unclear in this population. Method(s): We report the real-world impact of SARS-CoV-2 booster vaccinations in an ethnically diverse urban cohort of 1172 patients receiving in-centre HD who were routinely screened for SARS-CoV-2 infection by weekly nasopharyngeal PCR between 1st December 2021 and 31st March 2022, during dominant UK prevalence of B.1.1.529 variant ("Omicron"). Where possible, genomic sequencing was performed as standard of care. Result(s): At the start of the observation period, 896 (76.5%) had received 3 doses of SARS-CoV-2 vaccine and only 87 (7.4%) were unvaccinated. By end of study 664 (59.5%) had received 4 vaccine doses. 305 patients had PCR positive SARS-CoV-2 infection, with Omicron variant confirmed in all but one of samples successfully tested. Clinical course of infection was mild: around half of patients asymptomatic, only 1 in 20 hospitalised, case fatality 3%. Three or more vaccine doses significantly associated with reduced risk of SARS-CoV-2 PCR positivity compared to unvaccinated status, together with White ethnicity and lower deprivation index (Cox regression p<0.03). However, 2 booster doses further reduced the risk of infection by around a third compared to 1 boost, independent of age, gender and comorbidity. Conclusion(s): A second SARS-CoV-2 booster vaccine further reduces the risk of Omicron infection in haemodialysis patients. As such, a double-boost policy could significantly reduce the burden and associated spread of SARS-CoV-2 infection in this vulnerable population.

Social work practice for COVID-19 in the acute hospital setting: Recommendations for psychosocial assessment

The global coronavirus SARS-CoV2 (COVID-19) pandemic outbreak caused immediate, far-reaching social schisms and created unprecedented challenges for hospital social work services worldwide. Existing hospital disaster plans were inadequately equipped for pandemics and organisational plans needed to quickly adapt to respond to the increased clinical demands and unique logistical considerations triggered by the virus. Literature reviews provided little in the way of precise guidance for practitioners. Hospital social workers responded not only to a new cohort of patients, but also to all patients affected by the societal repercussions of the pandemic and by governments' attempts to mitigate the impacts of the virus. Psychosocial assessments, the bedrock of social work intervention, needed to adapt and evolve to encompass and address the exacerbation of existing social risks in new ways. This article originated from the authors' interest in identifying practice implications for hospital social work during the COVID-19 pandemic. The authors briefly outline the distinct impact of COVID-19 on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They create a forum of international hospital social work centres to develop a consensus approach for addressing these issues in the context of a social work psychosocial assessment. The global COVID-19 pandemic stretched hospital resources across the globe and presented unique challenges to social work services. Disaster response plans were not adequately applicable given their time-limited nature. The broader social repercussions of the pandemic and governments' approaches to mitigating it meant that the cornerstone of social work intervention in hospitals-psychosocial assessments-needed to consider the aggravation of social risks in entirely new ways. The authors briefly outline the impacts of the pandemic and response on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They consult international hospital social work centres and develop an agreed approach for addressing these issues in the context of a social work psychosocial assessment.

SARS-CoV-2 Susceptibility and ACE2 Gene Variations Within Diverse Ethnic Backgrounds.

There is considerable variability in the susceptibility and progression for COVID-19 and it appears to be strongly correlated with age, gender, ethnicity and pre-existing health conditions. However, to our knowledge, cohort studies of COVID-19 in clinically vulnerable groups are lacking. Host genetics has also emerged as a major risk factor for COVID-19, and variation in the ACE2 receptor, which facilitates entry of the SARS-CoV-2 virus into the cell, has become a major focus of attention. Thus, we interrogated an ethnically diverse cohort of National Health Service (NHS) patients in the United Kingdom (United Kingdom) to assess the association between variants in the ACE2 locus and COVID-19 risk. We analysed whole-genome sequencing (WGS) data of 1,837 cases who were tested positive for SARS-CoV-2, and 37,207 controls who were not tested, from the UK's 100,000 Genomes Project (100KGP) for the presence of ACE2 coding variants and extract expression quantitative trait loci (eQTLs). We identified a splice site variant (rs2285666) associated with increased ACE2 expression with an overrepresentation in SARS-CoV-2 positive patients relative to 100KGP controls (p = 0.015), and in hospitalised European patients relative to outpatients in intra-ethnic comparisons (p = 0.029). We also compared the prevalence of 288 eQTLs, of which 23 were enriched in SARS-CoV-2 positive patients. The eQTL rs12006793 had the largest effect size (d = 0.91), which decreases ACE2 expression and is more prevalent in controls, thus potentially reducing the risk of COVID-19. We identified three novel nonsynonymous variants predicted to alter ACE2 function, and showed that three variants (p.K26R, p. H378R, p. Y515N) alter receptor affinity for the viral Spike (S) protein. Variant p. N720D, more prevalent in the European population (p < 0.001), potentially increases viral entry by affecting the ACE2-TMPRSS2 complex. The spectrum of genetic variants in ACE2 may inform risk stratification of COVID-19 patients and could partially explain the differences in disease susceptibility and severity among different ethnic groups.

Sociopolitical and psychological correlates of COVID-19 vaccine hesitancy in the United States during summer 2021.

Vaccine hesitancy and refusal continue to hamper COVID-19 control efforts. Throughout the pandemic, scientists and journalists have attributed lagging COVID-19 vaccination rates to a shifting set of factors including demography, experiences during the height of the pandemic, political views, and beliefs in conspiracy theories and misinformation, among others. However, these factors have rarely been tested comprehensively, in tandem, or alongside other potentially underlying psychological factors, thus limiting our understanding of COVID-19 vaccine hesitancy. This cross-sectional study assesses a diverse set of correlates of COVID-19 vaccine hesitancy identified in previous studies using US survey data (N = 2055) collected in July-August 2021. The survey contained modules designed to assess various sociopolitical domains and anti- and pro-social personality characteristics hypothesized to shape vaccine hesitancy. Using logistic and multinomial regression, we found that the strongest correlate of vaccine hesitancy was belief in misinformation about the COVID-19 vaccines, though we surmise that this common explanation may be endogenous to vaccine hesitancy. Political beliefs explained more variation in vaccine hesitancy-and in particular, vaccine refusal-after belief in COVID-19 vaccine misinformation was excluded from the analysis. Our findings help reconcile numerous disparate findings across the literature with implications for health education and future research.

Expectations Versus Reality: Understanding the Accuracy of Impressions Made During Virtual Interviews of Pediatric Pulmonary Fellowship Programs

Rationale: As a result of the SARS-CoV-2 pandemic, all pediatric pulmonary fellowship programs for the first time conducted virtual interviews in the Fall of 2020. This study aimed to understand applicants' experiences with virtual interviews and whether this format allowed them to gain accurate impressions of their current training program. Methods: A group of pediatric pulmonary fellows and Program Directors designed a REDCap survey. The survey was emailed to all pediatric pulmonary Program Directors for distribution to first-year fellows 6 months into their training. Results: 23/49 (47%) of first-year pediatric pulmonary fellows completed the survey. Because of the virtual interview format, 43% [CI 26-63%] of respondents reported that they applied to more programs and 65% [CI 45-81%] attended more interviews. Applicants with in-person exposure to their future fellowship program (i.e. attended same institution for residency and fellowship or participated in an elective rotation at the fellowship institution) applied to fewer programs (30% CI 11-60% vs. 54% CI 29-77%) and attended fewer interviews (40% CI 17-69% vs. 85% CI 58-96%) than those applicants with virtual-only exposure. 96% of applicants were able to form general impressions about fellowship programs based on their virtual interview. 96% of applicants expressed agreement that their current experience in fellowship matched their virtual interview-derived impression. Further breakdown of applicant ability to form impressions and how those impressions matched current fellowship experience is represented in figure 1. There was congruency between the virtualinterview derived impressions and actual fellowship experience for 19 different factors applicants used to rank programs. Correcting for in-person exposure to their fellowship institution prior to a virtual interview, fewer applicants with in-person exposure experienced a meaningful change in impression 6 months after arrival to their fellowship program (27% vs. 73%). 83% of applicants preferred some form of virtual interview to be included or offered in the future. A tiered interview format (applicants are invited to a virtual interview day followed by an optional in-person second look) was the most popular preference for future interview cycles (48%). Conclusions: Virtual interviews may provide an accurate representation of pediatric pulmonary fellowship programs and should be offered in future application cycles.

Intracranial complications of hypercoagulability and superinfection in the setting of COVID-19: illustrative cases

BACKGROUND Hypercoagulability with thrombosis and associated inflammation has been well-documented in COVID-19, and catastrophic cerebral venous sinus thromboses (CVSTs) have been described. Another COVID-19–related complication is bacterial superinfection, including sinusitis. Here, the authors reported three cases of COVID-19–associated sinusitis, meningitis, and CVST and summarized the literature about septic intracranial thrombotic events as a cause of headache and fever in COVID-19. OBSERVATIONS The authors described three adolescent patients with no pertinent past medical history and no prior COVID-19 vaccinations who presented with subacute headaches, photosensitivity, nausea, and vomiting after testing positive for COVID-19. Imaging showed subdural collections, CVST, cerebral edema, and severe sinus disease. Two patients had decline in mental status and progression of neurological symptoms. In all three, emergency cranial and sinonasal washouts uncovered pus that grew polymicrobial cultures. After receiving broad-spectrum antimicrobials and various additional treatments, including two of three patients receiving anticoagulation, all patients eventually became neurologically intact with varying ongoing sequelae. LESSONS These cases demonstrated similar original presentations among previously healthy adolescents with COVID-19 infections, concurrent sinusitis precipitating CVST, and subdural empyemas. Better recognition and understanding of the multisystem results of severe acute respiratory syndrome coronavirus 2 and the complicated sequelae allows for proper treatment.

COVID-19 Contact Tracing Highlights Disparities: Household Size and Low-English Proficiency.

Although it is known that coronavirus disease 2019 (COVID-19) disproportionately affects racial and ethnic minorities, our study characterizes the connection between COVID-19 susceptibility and both limited English proficiency (LEP) and large household size. We examined demographic and social data for 1130 individuals who tested positive for or were exposed to COVID-19. Analysis revealed that LEP persons were 3.2 times as likely to report difficulty obtaining supplies for quarantine. Individuals in large households were 1.9 times as likely to report difficulty obtaining supplies for quarantine and 2.0 times as likely to report inability to quarantine. This study, therefore, informs interventions targeted to these populations.

Concurrent Identification and Characterization of Protein Structure and Continuous Internal Dynamics with REDCRAFT.

Internal dynamics of proteins can play a critical role in the biological function of some proteins. Several well documented instances have been reported such as MBP, DHFR, hTS, DGCR8, and NSP1 of the SARS-CoV family of viruses. Despite the importance of internal dynamics of proteins, there currently are very few approaches that allow for meaningful separation of internal dynamics from structural aspects using experimental data. Here we present a computational approach named REDCRAFT that allows for concurrent characterization of protein structure and dynamics. Here, we have subjected DHFR (PDB-ID 1RX2), a 159-residue protein, to a fictitious, mixed mode model of internal dynamics. In this simulation, DHFR was segmented into 7 regions where 4 of the fragments were fixed with respect to each other, two regions underwent rigid-body dynamics, and one region experienced uncorrelated and melting event. The two dynamical and rigid-body segments experienced an average orientational modification of 7° and 12° respectively. Observable RDC data for backbone C'-N, N-HN, and C'-HN were generated from 102 uniformly sampled frames that described the molecular trajectory. The structure calculation of DHFR with REDCRAFT by using traditional Ramachandran restraint produced a structure with 29 Å of structural difference measured over the backbone atoms (bb-rmsd) over the entire length of the protein and an average bb-rmsd of more than 4.7 Å over each of the dynamical fragments. The same exercise repeated with context-specific dihedral restraints generated by PDBMine produced a structure with bb-rmsd of 21 Å over the entire length of the protein but with bb-rmsd of less than 3 Å over each of the fragments. Finally, utilization of the Dynamic Profile generated by REDCRAFT allowed for the identification of different dynamical regions of the protein and the recovery of individual fragments with bb-rmsd of less than 1 Å. Following the recovery of the fragments, our assembly procedure of domains (larger segments consisting of multiple fragments with a common dynamical profile) correctly assembled the four fragments that are rigid with respect to each other, categorized the two domains that underwent rigid-body dynamics, and identified one dynamical region for which no conserved structure could be defined. In conclusion, our approach was successful in identifying the dynamical domains, recovery of structure where it is meaningful, and relative assembly of the domains when possible.

Come for Information, Stay for Support: Harnessing the Power of Online Health Communities for Social Connectedness during the COVID-19 Pandemic.

The COVID-19 pandemic created a globally shared stressor that saw a rise in the emphasis on mental and emotional wellbeing. However, historically, these topics were not openly discussed, leaving those struggling without professional support. One powerful tool to bridge the gap and facilitate connectedness during times of isolation is online health communities (OHCs). This study surveyed Health Union OHC members during the pandemic to determine the degree of COVID-19 concern, social isolation, and mental health distress they are facing, as well as to assess where they are receiving information about COVID-19 and what sources of support they desire. The survey was completed in six independent waves between March 2020 and April 2021, and garnered 10,177 total responses. In the United States, OHCs were utilized significantly more during peak lockdown times, and the desire for emotional and/or mental health support increased over time. Open-ended responses demonstrated a strong desire for connection and validation, which are quintessential characteristics of OHCs. Through active moderation utilizing trained moderators, OHCs can provide a powerful, intermediate and safe space where conversations about mental and emotional wellbeing can be normalized and those in need are encouraged to seek additional assistance from healthcare professionals if warranted.

Improving efficacy and sustainability of virtual cardiology clinics

IntroductionSocial distancing measures were introduced in Ireland to address COVID-19 in March 2020. Strategies to continue Cardiology outpatient services needed to balance patient safety with the need for high quality follow-up care. Therefore, virtual consultations (via phone or video call) were implemented as temporary alternatives to in-person clinics.Objectives and MethodologyWe aimed to identify inefficiencies in physical outpatient services at Beaumont Hospital in comparison with virtual consultations. In face-to-face visits, a patient’s average time outside the physician’s examination room was 39 minutes (range 12-110 minutes). Increased delays occurred if investigations were awaited. The average face-to-face consultation lasted 24 minutes. Next, an analysis was performed on 100 consecutive patients’ virtual consultation experiences. Electronic survey responses were collected from stakeholders including patients, physicians, nurses, and clerical staff relating to these virtual visits.Results81% of outpatient consultations were delivered virtually from July to December 2021, with an average duration of 19 minutes. Patient volume was increased (5 additional patients per week per clinic) with a reduced waiting time for routine attendance. Criteria for outpatient re-attendance was regularly reviewed, with discharge facilitated at the second or third visit if clinically indicated. 89% of visits were supported by communications technology (smartphone or internet access) and 94% had access to a private location. 76% of patients reported that they were able to access their appointment without limitations in comparison to in-person consultations, although some reported a decreased personal connection with their physician. Satisfaction scores reflected this positive outlook (90/100 for patients and 75/100 for physicians), although patients reported that they would prefer virtual consultations less than 50% of the time outside the pandemic. Information was collected from patients on what aspects could be improved on the virtual service.Conclusion and ImplicationsVirtual clinics could be increasingly implemented in modern Cardiology. Telemedicine could provide a high-quality service with reduced cost and increased accessibility, particularly for patients in rural areas. In addition, virtual care at scale could allow in-person visits to be prioritised for patients who would truly benefit from their use, while reducing the risk of transmissible infections including COVID-19 and others.

Rapid analysis of local data to inform off-label tocilizumab use early in the COVID-19 pandemic.

The interleukin-6 receptor antagonist tocilizumab became widely used early in the coronavirus disease 2019 (COVID-19) pandemic based on small observational studies that suggested clinical benefit in COVID-19 patients with a hyperinflammatory state. To inform our local treatment algorithms in the absence of randomized clinical trial results, we performed a rapid analysis of the first 11 hospitalized COVID-19 patients treated with tocilizumab at our academic medical center. We report their early clinical outcomes and describe the process by which we assembled a team of diverse trainees and stakeholders to extract, analyze, and disseminate data during a time of clinical uncertainty.

SARS-CoV-2 susceptibility and ACE2 gene variations within diverse ethnic backgrounds (preprint)

BackgroundHost genetics play a major role in COVID-19 susceptibility and severity. Here, we analyse an ethnically diverse cohort of National Health Service (NHS) patients in the United Kingdom (UK) to assess the association between variants in the ACE2 locus and COVID-19 risk. MethodsWe analysed whole-genome sequencing (WGS) data of 6,274 participants who were tested for SARS-CoV-2 from the UKs 100,000 Genomes Project (100KGP) for the presence of ACE2 coding variants and expression quantitative trait loci (eQTLs). FindingsWe identified a splice site variant (rs2285666) associated with increased ACE2 expression with an overrepresentation in SARS-CoV-2 positive patients relative to 100KGP controls (p = .015), and in hospitalised European patients relative to outpatients in intra-ethnic comparisons (p = .029). We also compared the prevalence of 288 eQTLs, of which 23 were enriched in SARS-CoV-2 positive patients. The eQTL rs12006793 had the largest effect size (d = 0.91), which decreases ACE2 expression and is more prevalent in controls, thus potentially reducing risk of COVID-19. We identified three novel nonsynonymous variants predicted to alter ACE2 function, and showed that three variants (p.K26R, p.H378R, p.Y515N) alter receptor affinity for the viral Spike (S) protein. Variants p.K26R and p.N720D are more prevalent in the European population (p < .001), but Y497H is less prevalent compared to East Asians (p = .020). InterpretationOur results demonstrate that the spectrum of genetic variants in ACE2 may inform risk stratification of COVID-19 patients and could partially explain the differences in disease susceptibility and severity among different ethnic groups. FundingThe 100KGP is funded by the National Institute for Health Research and NHS England. Funding was also obtained from Stanford University, Palo Alto.

#Neurosurgery: A Temporal and Content Analysis of Academic Neurosurgery on Twitter.

BACKGROUND: Social media has become ubiquitous in modern medicine. Academic neurosurgery has increased adoption to promote individual and departmental accomplishments, engage with patients, and foster collaboration. We sought to quantitatively evaluate the adoption of one of the most used social media platforms, Twitter, within academic neurosurgery. METHODS: A quantitative and qualitative analysis of Twitter use across 118 academic neurosurgery departments with residency programs in the United States was performed in March 2019 and March 2021. We collated Twitter handles, Doximity residency ranking (a peer-determined ranking system), geographic location, and Twitter demographics (tweets, followers, likes, and tweet content) from before and after the coronavirus disease 2019 (COVID-19) pandemic. Tweet content was characterized by reviewers over a predetermined 6-month period. Linear regression and parametric/nonparametric tests were used for analysis. RESULTS: Departmental accounts grew 3.7 accounts per year between 2009 and 2019 (R2 = 0.96), but 43 accounts (130%) were added between 2019 (n = 33) and 2021 (n = 76). This growth, coinciding with the COVID-19 pandemic, changed the model from linear to exponential growth (R2 = 0.97). The highest-ranking programs based on Doximity were significantly more likely to have an account (P < 0.001) and have more followers (P < 0.0001). Tweet content analysis revealed prioritization of faculty/resident activity (mean 49.9%) throughout the quartiles. CONCLUSIONS: We demonstrate rapid uptake in Twitter use among U.S. academic neurosurgical departments, accelerated by COVID-19. With the impact of COVID-19, it is clear that there will be continued rapid adoption of this platform within neurosurgery, and future studies should explore the outcomes of peer collaboration, patient engagement, and dissemination of medical information.

A qualitative study of online support communities for lung cancer survivors on targeted therapies.

BACKGROUND: Due to recent treatment advances, people who have non-small cell lung cancer with oncogenic alterations are an important new group of cancer survivors. Little is known about lung cancer online support communities. This research was guided by two primary questions: (1) How do these lung cancer survivors engage in online support communities? and (2) What are the psychological, social, and physical impacts of such engagement? METHODS: Qualitative in-depth interviews were conducted with patients with advanced lung cancer (N = 40) to learn about their experiences with the illness. We used qualitative thematic analysis, inductive and deductive, as outlined by Carspecken. We adapted the framework for studying online communities developed by Zhang and colleagues to examine engagement with and impacts of involvement in online lung cancer support communities. RESULTS: Participants described engaging in the online community through (1) initializing communication through asking questions or sharing resources, (2) responding to others comments or inquiries, or (3) simply observing/reading others posts. Participation had physical, psychological, or social impacts, with benefits (e.g., empowerment) and risks (e.g., feelings of jealousy or misinformation) in each domain. Participants used various strategies to mitigate negative impacts, such as distancing oneself as needed. CONCLUSIONS: Online lung cancer support communities provide support, camaraderie, and specialized health information. However, there are also risks of online engagement, such as social comparison or accessing misinformation. Understanding the utility of online support communities for lung cancer survivors on targeted therapies and further addressing their risks are urgent tasks, especially in the post-COVID era.