Using implementation science in youth mental health workforce development: Adapting to the COVID-19 pandemic in Australia

Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.

Private sector involvement in social and affordable housing

Key points Increasingly, a combination of government, not-for-profit, and for-profit organisations are involved in financing, developing and managing specialist, social, and affordable housing. The private sector appetite for such partnerships has never been stronger, reflecting increased corporate governance and shareholder expectations for investments and projects that deliver social and environmental outcomes. Maximising these opportunities to increase new social and affordable housing supply through increased private involvement will require strong policy setting and regulation, efficient procurement processes, and adequate and ongoing ‘gap' subsidy from government, particularly to serve those in highest need. Models should emphasise collaboration and partnership across the public, community, and private sectors, to build capacity throughout the housing industry. This collaboration should be guided by rigorous Australian Government, state and territory government and local government housing strategies. These strategies should identify long term demand for specialist, social, affordable and market housing and articulate clear delivery targets by market segment. These strategies must be underpinned by firm funding commitments and viable delivery mechanisms. Wider benefits associated with private sector participation in social and affordable housing include: the opportunity to support skills and capacity building across the housing industry;improved environmental outcomes in residential housing stock, including social and affordable housing;and local employment and training opportunities. This project investigates the potential for wider private sector involvement to increase the supply of social and affordable housing in Australia. This research draws on the insights of industry leaders and sector experts through a series of Investigative Panels and case studies, as well as a review of the international evidence. This research asks whether and how increased private sector involvement could augment social and affordable housing delivery efforts, increasing housing industry capacity across private not-for-profit and for-profit sectors. In this study we use the term private sector to refer to all non-government and non-public entities. This includes both for-profit and not-for-profit housing providers. For the purposes of the research, the community housing sector is deemed to be part of the private sector. Key findings Reflecting longer term social and economic policy reforms, social and affordable housing is increasingly financed, developed and managed by a combination of government, community-based and market providers. This reflects increasing ‘hybridity' across the housing system, whereby community or not-for-profit housing providers have shifted towards more quasi commercial practices to increase and cross-subsidise their operations (Blessing 2012;Mullins, Milligan et al. 2018). Similarly, some for-profit firms and social enterprises have sought to produce or deliver social or affordable housing, while investors are increasingly valuing Environmental, Social and Governance (ESG) goals and demonstrable corporate social responsibility in business (van Bortel and Gruis 2019). The documented need for 36,000 new social and affordable homes per year to meet the forecast demand to 2036 (Lawson, Pawson et al. 2018) is so great that it is clear this ‘hybridity' of the housing system and cross-sector partnerships are essential;no one sector can address the need alone. In the United Kingdom (UK), private investment in social and affordable housing dwarfs government grant funding by a factor of three to one (Williams, Williamson et al. 2020). Savills UK estimates that the combination of debt finance, government grant, and planning contributions (under s106) is sufficient to fund delivery of around 190,000 new affordable rental dwellings and 60,000 shared ownership dwellings between 2021—26 (UK 2021). In the United States (US), over one million affordable rental units have been financed by private invest rs incentivised by the longstanding low-income housing tax credit scheme, including over 100,000 new dwellings in 2020 alone (US Housing and Urban Development 2021). Existing initiatives in Australia While more modest in scope, Australian governments have also sought to encourage private involvement in affordable rental supply and have entered into a variety of partnerships and joint ventures predominantly at the state level to renew or develop new social and mixed tenure housing. The establishment of the National Housing Finance and Investment Corporation (NHIFIC) Bond Aggregator in 2019 was a major Australian Government initiative to raise low-cost debt finance for community housing providers. In the wake of COVID-19, state and territory governments have committed significant new funding and initiatives to construct additional social and affordable housing units. These include commitments to deliver over 75,000 new social and affordable housing dwellings. Further, community and Aboriginal housing organisations are working with private partners to deliver mixed income projects which cross subsidise social and affordable homes, while also achieving wider benefits of employment, education and community engagement. Despite these initiatives, Australia's well documented shortage of affordable housing will persist without enduring government equity co-investment programs (Lawson, Pawson et al. 2018). These programs are needed to provide the final gap funding so construction of affordable developments by either not-for-profit or for-profit private sectors is financially feasible. Expert perspectives A series of Investigative Panels and interviews with 45 experts across housing, finance, development and policy sectors revealed strong appetite for affordable housing partnerships, reflecting an increasing focus by boards and shareholders on projects that deliver social and environmental outcomes. Private for-profit participants demonstrated a high level of familiarity and investment of time in understanding the sector, forming partnerships with community housing organisations, and indeed tendering for and delivering social and affordable housing. Other key findings included: • Participants emphasised that affordable housing for low-income earners will always require some government subsidy, capital contribution, access to government land and or an inclusionary planning mechanism. Dwellings that house the highest needs clients require the deepest subsidy. • However, when considered across the continuum of housing need, some products (such as those targeting moderate-income earners) require lower levels of government subsidy because they are able to pay more for their housing. Consequently, participants identified significant potential for private investment in affordable housing for key workers. Institutional investors suggested that if the Australian Government and state and territory governments funded social housing in the same way as other infrastructure—by setting targets and providing ongoing subsidies or availability payments—it would unlock a significant capital market of investment to meet long term demand. • Developers broadly recognised the need for mandatory inclusionary zoning (with mandatory requirements seen to create a ‘level playing field' and to enable requirements to be factored into land costs), on the proviso that it is phased in over several years to not financially disadvantage projects on sites already owned, and ideally with incentives such as density bonuses. • Developers and policy leaders see mixed tenure projects, including the redevelopment of public housing estates, as opportunities for increasing social and affordable housing supply through private involvement. • Industry participants see the community housing sector as an essential partner in all mixed tenure projects, though community housing developers noted reluctance to take disproportionate risk on market-rate housing used to cross-subsidise affordable housing. • All participants spoke of delays in government procurement processes and planning approval uncertainties, which increase costs in both risk premiums and holding costs for mixed tenure and affordable housing projects. Further, participants cautioned that ongoing government support to grow the community housing sector will be important if they are to partner effectively in mixed tenure developments at scale. Overall, participants reported that repeated changes in government policies and programs and a lack of continuity across political and bureaucratic leadership undermine opportunities to expand social and affordable housing through private sector involvement. The lack of a stable national program of ‘gap' funding to complete feasibility on social and affordable housing projects holds supply back;finite state and territory programs cannot provide the scale required for large scale institutional investment. They emphasised that certainty is essential for investor confidence, across all regulatory and program settings. Program permanence rather than finite, closed-ended initiatives would encourage participation. Participants across all of the investigative panel meetings and interviews identified wider benefits that may arise from private sector participation in social and affordable housing. These benefits include: the opportunity to support skills and capacity building across the housing industry;improved environmental outcomes in residential housing stock, including social and affordable housing;and local employment and training opportunities. © Australian Housing and Urban Research Institute Limited 2022.

Prepare to adapt: blood supply and transfusion support during the first 2 weeks of the 2019 novel coronavirus (COVID-19) pandemic affecting Washington State.

BACKGROUND: The first coronavirus (COVID-19) case was reported in United States in the state of Washington, approximately 3 months after the outbreak in Wuhan, China. Three weeks later, the US federal government declared the pandemic a national emergency. The number of confirmed COVID-19 positive cases increased rather rapidly and changed routine daily activities of the community. STUDY DESIGN AND METHODS: This brief report describes the response from the hospital, the regional blood center, and the hospital-based transfusion services to the events that took place in the community during the initial phases of the pandemic. RESULTS: In Washington State, the first week of March started with four confirmed cases and ended with 150; by the end of the second week of March there were more than 700 cases of confirmed COVID-19. During the first week, blood donations dropped significantly. Blood units provided from blood centers of nonaffected areas of the country helped keep inventory stable and allow for routine hospital operations. The hospital-based transfusion service began prospective triaging of blood orders to monitor and prioritize blood usage. In the second week, blood donations recovered, and the hospital postponed elective procedures to ensure staff and personal protective equipment were appropriate for the care of critical patients. CONCLUSION: As community activities are disrupted and hospital activities switch from routine operations to pandemic focused and urgent care oriented, the blood supply and usage requires a number of transformations.

Catching CAPA: The Healthcare Impact of COVID-19-Associated Pulmonary Aspergillosis in an Academic Medical Center

Background. COVID-19 associated pulmonary aspergillosis (CAPA) is a known complication of COVID-19 which carries a high mortality rate. While there are proposed diagnostic criteria, CAPA remains likely underdiagnosed. Our objectives are to evaluate markers of disease severity, bacterial coinfections, and outcome measures in order to assess the clinical impact of CAPA in patients admitted with COVID-19. Methods. A retrospective chart review was performed on all adult patients admitted to a single-center, tertiary hospital from March 1, 2020 to May 1, 2022 with a positive COVID-19 PCR and probable or proven CAPA based on ECMM/ ISHAM consensus criteria. Admission data, ICU status, time to CAPA diagnosis, respiratory cultures, and 90-day mortality were identified. Results. 14 patients met criteria for probable CAPA. 10 of 14 patients (71.4%) were immediately admitted to the ICU. By day 14, 13 patients (92.9%) were intubated. The average time from admission to CAPA diagnosis was 31.3 days. 12 patients were diagnosed by BAL galactomannan, while 2 patients were diagnosed by growth on respiratory culture. 12 patients (85.7%) also had bacterial growth on respiratory cultures. The most common pathogen was Staphylococcus aureus, which was seen in 6 patients. All-cause mortality was 42.8%, or 6 of 14 patients, at day 90. In patients with a CAPA diagnosis, the average length of ICU stay was 36.4 days and average total hospital length of stay was 43.6 days, compared to 6.3 and 12.5 days, respectively, for all patients admitted with COVID-19 disease. Conclusion. CAPA is a rare complication of COVID-19 but had substantial negative impacts on affected patients. The late onset of CAPA may be a result from longer hospitalizations and increased healthcare-associated infections. The association of CAPA with bacterial coinfections is consistent with literature on other viral infections such as influenza predisposing to secondary pneumonias. As the majority of cases were diagnosed by galactomannan rather than culture, providers should have a low threshold for testing in patients with protracted hospitalization for COVID-19. This case series emphasizes the poor outcomes associated with CAPA and its burden on already strained hospital resources, highlighting the need for improved disease awareness and further study.

Birmingham and the (International) Business of Live Music in Times of COVID-19

This article discusses the context of, and presents findings from, a project examining the live music sector in Birmingham, UK. This research is set against the backdrop of the broader socio-political impact of the ongoing COVID-19 pandemic, and links it to national and global contexts. We explore the live music ecology of Birmingham and highlight the interdependencies between the various musical and non-musical stakeholders in the context of the pandemic— including the venues where live music takes place—examining how these stakeholders are responding to the crisis as it unfolds. In doing so, this article asks how an urban geographical area tied into national and international mechanisms of culture, commerce and policy can work to sustain its musical ecology in the face of the uncertainty of a post-COVID-19 era, and underlines the interconnectedness of live music ecologies and wider economies. © Equinox Publishing Ltd 2022, Office 415, The Workstation, 15 Paternoster Row, Sheffield S1 2BX

International Society of Blood Transfusion survey of experiences of blood banks and transfusion services during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has impacted blood systems worldwide. Challenges included maintaining blood supplies and initiating the collection and use of COVID-19 convalescent plasma (CCP). Sharing information on the challenges can help improve blood collection and utilization. MATERIALS AND METHODS: A survey questionnaire was distributed to International Society of Blood Transfusion members in 95 countries. We recorded respondents' demographic information, impacts on the blood supply, CCP collection and use, transfusion demands and operational challenges. RESULTS: Eighty-two responses from 42 countries, including 24 low- and middle-income countries, were analysed. Participants worked in national (26.8%) and regional (26.8%) blood establishments and hospital-based (42.7%) institutions. CCP collection and transfusion were reported by 63% and 36.6% of respondents, respectively. Decreases in blood donations occurred in 70.6% of collecting facilities. Despite safety measures and recruitment strategies, donor fear and refusal of institutions to host blood drives were major contributing factors. Almost half of respondents working at transfusion medicine services were from large hospitals with over 10,000 red cell transfusions per year, and 76.8% of those hospitals experienced blood shortages. Practices varied in accepting donors for blood or CCP donations after a history of COVID-19 infection, CCP transfusion, or vaccination. Operational challenges included loss of staff, increased workloads and delays in reagent supplies. Almost half of the institutions modified their disaster plans during the pandemic. CONCLUSION: The challenges faced by blood systems during the COVID-19 pandemic highlight the need for guidance, harmonization, and strengthening of the preparedness and the capacity of blood systems against future infectious threats.

RURAL-COVID-19 Trial: Retrospective Analysis of COVID-19 Coinfections in Hospitalized Urban and Rural Adults

Background. The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (< 72 hrs from admission) and healthcare-associated infection (HAI) rates ( > 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes. Methods. Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria. Predetermined Coinfection Criteria Results. The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents;however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day allcause mortality among both populations. Conclusion. There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital.

Small Towns, Big Cities: Rural and Urban Disparities among Hospitalized Patients with COVID-19

Background. More than half of all hospitals in the U.S. are rural hospitals. Frequently understaffed and resource limited, community hospitals serve a population that tends to be older and have less access to care with increased poverty and medical co-morbidities. There is a lack of data surrounding the impact of COVID-19 among rural minority communities. This study seeks to determine rural and urban disparities among hospitalized individuals with COVID-19. Methods. This is a descriptive, retrospective analysis of the first 155 adult patients admitted to a tertiary hospital with a positive COVID-19 nasopharyngeal PCR test. Augusta University Medical Center serves the surrounding rural and urban counties of the Central Savannah River Area. Rural and urban categories were determined using patient address and county census data. Demographics, comorbidities, admission data and 30-day outcomes were evaluated. Results. Of the patients studied, 62 (40%) were from a rural county and 93 (60%) were from an urban county. No difference was found when comparing the number of comorbidities of rural vs urban individuals;however, African Americans had significantly more comorbidities compared to other races (p-value 0.02). In a three-way comparison, race was not found to be significantly different among admission levels of care. Rural patients were more likely to require an escalation in the level of care within 24 hours of admission (p-value 0.02). Of the patients that were discharged or expired at day 30, there were no differences in total hospital length of stay or ICU length of stay between the rural and urban populations. Conclusion. This study suggests that patients in rural communities may be more critically ill or are at a higher risk of early decompensation at time of hospitalization compared to patients from urban communities. Nevertheless, both populations had similar lengths of stay and outcomes. Considering this data is from an academic medical center with a large referral area and standardized inpatient COVID-19 management, these findings may prompt further investigations into other disparate outcomes.

IDENTIFYING SOURCES OF COVID19 PANDEMIC SUPPLY CHAIN FRAGILITY

Supply chain management is in the industrial engineering management and operations management disciplines. It involves product procurement of raw materials, production, storage, distribution, wholesales, and retail sales. The COVID19 pandemic has the added challenge of healthcare service operations management. This paper is a bibliometric study of the COVID19 supply chain fragility problem. In February 2021, the United States' President called for a review of the pandemic related supply chain for vaccines, personal protective equipment (PPE), medical equipment such as ventilators, and food. This study involves a search for references published between January 1, 2020 and April 30, 2021. It reveals that food was a primary topic among 82 publications rather than vaccines. Also, reasons cited for America's supply chain fragility include America's dependence on products produced in other countries such as China;these countries' own pandemic induced supply chain challenges;and US trade restrictions on such products enacted prior to the COVID19 outbreak. Engineering management strategies were mentioned in 60% of the publications and are summarized in the Conclusions and Implications for Managers are provided. © American Society for Engineering Management, 2021

The transfusion service laboratory in virtual reality.

Due to the global SARS-CoV-2 pandemic, in-person laboratory medicine clerkships were converted to distance learning. The remote clerkship format provided advantages of allowing participation of students from more locations and greater scheduling flexibility but provided new challenges of maintaining learner engagement and providing experiential content of the laboratory environment. Gamification of educational content is one educational modality that has shown effectiveness in a multitude of different contexts to increase learner engagement and retention. Therefore, we created an interactive, educational 360° virtual reality walkthrough tour using off-the-shelf commercially available 360° cameras and software of the Transfusion service and Microbiology Laboratories. The process consists of taking multiple 360° still-images within the space, color-correction, blurring the faces of staff or sensitive information, adding navigation buttons, and other interactive elements. The virtual tours were used for both recruitment and education with further plans to integrate the learning modality into the curriculum. The clerkship is likely to remain as partially or fully as remote learning so such walkthrough tours will continue to remain relevant. This technology can be applied globally to other departments and institutions for education or recruitment.

Crisis as a catalyst for change: COVID-19, spatiality and the UK live music industry

Since the advent of the COVID-19 pandemic, live music spaces - and the practices which produce them as economically viable - have found themselves in crisis. In spite of a UK government announcement on the 25th of July 2020 which allocated £2.25 million to support 150 music venues across the country, the processes of allocation, the conditions under which this emergency funding is allocated, and capacity to secure medium-to-long-term sustainability of the live music industry in the UK, remains unclear. In this paper, we present a Lefebvrian analysis of live music, highlighting the complex ways in which space is produced and consumed within a live music environment. By extending this framing to consider Lefebvre's conceptualisation of dominated and appropriated space, we argue that the economic viability of live music stems from its spatiality, and that ongoing responses to the crisis require greater sensitivity to the spatial practices of music production and consumption. © 2021 International Association for the Study of Popular Music. All Rights Reserved.

Canada's multi-jurisdictional COVID-19 public health response - January to may 2020

In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada's public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada's jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions;closures of borders, schools, and non-essential businesses and services;cancellations of non-essential medical services;and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.

Coping With COVID-19.

OBJECTIVES: The first coronavirus disease 2019 (COVID-19) case in the United States was reported in Washington State. The pandemic caused drastic disruptions to medical institutions, including medical education. The Department of Laboratory Medicine at the University of Washington responded by rapidly implementing substantial changes to medical student clerkships. METHODS: In real time, we converted one ongoing case- and didactic-based course, LabM 685, to remote learning. RESULTS: Fifteen of 17 scheduled sessions proceeded as planned, including two sessions for student presentations. Two didactics were canceled as the functions of the teleconferencing platform were not sufficient to proceed. One grand rounds speaker canceled due to COVID-19 precautions. Elements of an immersive clinical laboratory clerkship, LabM 680, were repurposed to accommodate 40 medical students per class via remote learning, highlighting clinical laboratory activities that continue throughout the outbreak. A new remote clerkship, MedSci 585C, was developed incorporating distance learning and guided small-group sessions. This coincided with parallel efforts to make resident and fellow service work, conferences, and didactics available remotely to comply with social distancing. CONCLUSIONS: The changes in medical education described reflect the dynamic interplay of current events affecting the world of clinical pathology. Throughout this, technology-while with some limitations-has provided the platform for innovative learning.

Laparoscopic and robotic urology surgery during global Pandemic COVID-19

ABSTRACT Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID-19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID-19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID-19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.

Laparoscopic and Robotic Urology Surgery during Global Pandemic COVID19.

Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.

Mindfulness in primary school children as a route to enhanced life satisfaction, positive outlook and effective emotion regulation

BACKGROUND: Mindfulness programmes as a potential avenue of enhancing pupil wellbeing are beginning to show great promise. However, research concerning the effectiveness of mindfulness training for primary aged school children (7-11 years of age) has been neglected. METHODS: Building on methodological limitations of prior research, this study employed an active controlled design to assess the longer term wellbeing and emotion regulation outcomes after a 6 week mindfulness programme (Living Mindfully Programme, UK), for a group of school children aged between 9 and 10. The programme was delivered by class teachers as part of their normal curriculum entitlement. One hundred and eight children took part from across three schools in North East of England. Participants formed a treatment group (n = 64), active control (n = 19) and wait list control (n = 25). Self-report measures of wellbeing, mindfulness and emotion regulation were collected at pre and post training as well as at 3 months follow up. RESULTS: Reliable findings, judged by medium to large effect sizes across both post intervention, follow-up and between both controls, demonstrated enhancement in a number of domains. Immediately after training and follow up, when compared with the wait list control, children who received mindfulness training showed significant improvements in mindfulness (d = .76 and .77), Positive Outlook (d = .55 and .64) and Life Satisfaction (d = .65 and 0.72). Even when compared to an active control, the effects remained although diminished reflecting the positive impact of the active control condition. Furthermore, a significant positive relationship was found between changes in mindfulness and changes in cognitive reappraisal. CONCLUSIONS: Taken together, this study provides preliminary evidence that the Living Mindfully Primary Programme is feasibly delivered by school staff, enjoyed by the children and may significantly improve particular components of wellbeing. Importantly, higher levels of mindfulness as a result of training may be related to effective emotional regulatory and cognitive reappraisal strategies.