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Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. Following the 'social cure' theory, this study aimed to investigate the association, and potential mechanisms, of group membership continuity and reducing mental ill-health amongst vulnerable young people. Method(s): Cross-sectional survey data from a sample of 105 young people aged 16-35, collected approximately 1 year after the global COVID-19 outbreak (January-July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences), and the mediation of these associations by hope and social connectedness (in-person and online). Results and Conclusion(s): Prior multiple group memberships were associated with the preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as a means to potentially help prevent exacerbated symptoms and promote recovery of mental health problems, particularly during significant life events.
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The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic Quantitative findings (N = 105) will be shared to demonstrated how belonging to multiple social groups can promote better mental health through the provision of hopefulness and social connectedness. Qualitative findings (N = 16) will be shared to elucidate how young people with complex emerging mental health problems experienced social connectedness during the ongoing social restrictions, and how they perceive social connection to be associated with their well-being Results also indicate young people's social preferences and the complex role of in-person versus online connection and interaction. A brief summary will be given regarding a linked trial (TOGETHER), evaluating the feasibility of delivering a social connectedness-focused intervention for young people with emerging complex mental health problems across clinical and community services in the UK.
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Care homes care for people with complex needs, supporting them to the end of life and are now being seen as the 'de facto' hospice. Reflective debriefing for care home staff has been found to help support staff and provide an educative and communicative function when a resident dies. Pre-COVID-19, one of the authors had been conducting reflective debriefings face-to-face with care home staff but when COVID-19 struck, face-to-face sessions were impossible. An online format was developed with the aim of providing emotional support and practice-based learning in relation to death and dying through reflection. This study assessed the acceptability and feasibility of delivering online supportive conversations and reflective sessions (OSCaRS) on palliative and end of life care to care home staff during the pandemic. A mixed methods study design was undertaken in April to September 2020. Qualitative data comprised of digital recordings of sessions and semi-structured interviews with OSCaRS participants, managers and session facilitators. An online survey was sent to all staff and had a response rate of 12%. Eleven OSCaRS were conducted over ten weeks. Thirty-four staff members attended one or more sessions. Three overarching themes were identified from the data: pressures of working in a pandemic, practicalities of delivering online support and, practice development opportunities. Engaging care home staff in online structured supportive conversations and reflections in relation to death and dying is acceptable, feasible and valuable for providing support with the pressures of working in a pandemic. There is value for OSCaRS to continue as online sessions as they provide care home staff access to practice-based learning and support from professionals and allows specialists based in a range of settings to in-reach into care homes in an efficient way. Future implementation must consider the availability of sufficient devices with cameras to aid participation, timing and frequency of sessions to accommodate staff workflows, the engagement and support of managers and post-session support. © 2022 Lucy Johnston, Jo Hockley, Julie Watson & Susan D. Shenkin. This Open Access article is distributed under the terms of the Creative Commons Attribution Attribution-Non-Commercial No Derivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is unaltered.
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This paper proposes and analyses a stochastic model for the spread of an infectious disease transmitted between clients and care workers in the UK domiciliary (home) care setting. Interactions between clients and care workers are modelled using specially generated networks, with network parameters reflecting realistic patterns of care needs and visit allocation. These networks are then used to simulate a susceptible-exposed-infected-recovered/dead (SEIR/D)-type epidemic dynamics with different numbers of infectious and recovery stages. The results indicate that with the same overall capacity provided by care workers, the minimum peak proportion of infection and the smallest overall size of infection are achieved for the highest proportion of overlap between visit allocation, i.e. when care workers have the highest chances of being allocated a visit to the same client they have visited before. An intuitive explanation of this is that while providing the required care coverage, maximising overlap in visit allocation reduces the possibility of an infectious care worker inadvertently spreading the infection to other clients. The model is generic and can be adapted to any directly transmitted infectious disease, such as, more recently, corona virus disease 2019, provided accurate estimates of disease parameters can be obtained from real data.
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Background: In 2020 cryopreservation of allogeneic donor apheresis products was implemented to overcome the challenges of donor availability and product transport related to the COVID-19 pandemic. Several studies have reported on allo-HCT outcomes with cryopreserved (cryo) grafts with conflicting findings regarding overall survival (OS), engraftment and hematopoietic recovery. Here, we report on the clinical post-HCT outcome in recipients of cryo grafts in our institution. Moreover, we compare the graft composition of cryo and fresh products by assessing the immunophenotype of hematopoietic stem cell (HSC) and lymphocyte subsets. Methods: Data collected from 29 patients who underwent allo-HCT with cryo PBSC (cryo group) from 03-08/2020 were compared to a control cohort of 60 consecutive patients, who received fresh PBSC allo-HCT (fresh group) from 06/2019 to 08/2020. Primary endpoints were OS and graft failure. Secondary endpoints were hematopoietic recovery and GvHD. Flow cytometry was performed on 5 available samples in the cryo group and compared to 4 prospectively collected fresh apheresis samples from allogeneic donors. Results: Conditioning intensity was equally distributed among both groups (cryo-69% RIC vs 31% MAC;fresh-65% RIC vs 35% MAC). Median post-collection (prefreeze) dose of CD34+ cells x106/kg differed in the two groups (7.3 cryo vs 9.2 fresh) with no differences in the dose of CD3+ cells x108/kg. All donor types, except UCB were included in the analysis. The cryo group included more HLA-matched unrelated donors (72.4 vs 41.7%), whereas the fresh group included more HLA-matched sibling (33.3 vs 6.9%) and slightly more haplo/HLAmismatched donors (25.0 vs 20.6%). 4 of 29 patients (13.8%) in the cryo group developed primary graft failure vs 1 of 60 patients (1.7%) in the fresh group (p = 0.03). All 4 cryo patients received HLA-matched unrelated grafts following RIC (3=Flu/Mel, 1=Flu/TBI), whereas the patient in the fresh cohort received a haploidentical graft, following MAC (Bu/Cy). Donor chimerism at 1 month for the RIC allo-HCT is shown in Fig. 1. We observed inferior OS in the cryo RIC group [Fig. 2;HR and 95% CI 4.20 (1.22, 14.4)], and slower recovery of neutrophils (p = 0.006) and platelets (p = 0.058). The incidence of acute GvHD was similar in the two groups. For all patients (n = 89), multivariate analysis performed for OS and graft failure after adjusting for donor type, patient age, gender, CD34 cell dose, and conditioning intensity supported the inferiority of cryo allo-HCT. Finally, flow cytometry analysis revealed significantly lower absolute counts of NK cells (CD3-CD56+) in cryo as compared to fresh apheresis samples (p = 0.0159), with no differences in CD4+ and CD8+ T-, B-(CD19+CD20 +), CD34+ cells and HSC (CD34+CD38-CD90 +CD45RA-). Conclusions: Our data show that the use of cryopreserved grafts following RIC allo-HCT led to inferior OS with increased rate of graft failure. Further studies are needed to determine a potential role of graft composition on cryo vs fresh allo-HCT outcomes.
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Wastewater-based surveillance methods have been implemented in several countries as a tool for monitoring SARS-CoV-2 at a community scale. A variety of methods have been used for concentrating, extracting, and detecting the virus, with no clear consensus on the most effective approach. In this note, we report preliminary findings from a study that is tracking SARS-CoV-2 in wastewater in Halifax, Nova Scotia, with a specific focus on the use of four reverse transcriptase quantitative PCR (RT-qPCR) assays for detecting the virus in wastewater. We were able to detect the virus in wastewater samples during the initial rise of cases in the Halifax region in early November 2020. Levels of the targeted SARS-CoV-2 gene fragments increased and fell in response to reported cases of COVID-19. The CDC N1 and E RT-qPCR assays demonstrated greater relative sensitivity than the CDC N2 and N3 assays for detection of SARS-CoV-2 in raw sewage samples.
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In 2016 Alibaba founder Jack Ma founded eWTP as both a commercial and a digital world trade lobbying platform. COVID-19 provided an important window for eWTP to demonstrate the power of its commercial digital commerce network for both commerce and aid purposes. Relief items, sold and donated, were rapidly distributed from China across Asia, Africa, and Europe. This article explains eWTP in principle and in practice. Evident is that eWTP played an important, targeted, and expansive role during the crisis and has demonstrated a capacity to unlock trade for developing countries and small and medium enterprises. It is, however, too early to tell if this will convert to long-run gains for eWTP itself. This owes to the pandemic having served as a bigger springboard for both the commercial and regulatory agenda that eWTP has been a front-runner of. The net long-run impact for eWTP is hence unclear.
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Introduction COVID-19 Trauma Guidance suggests opportunities for structured,time-limited discussions about challenging experiences should beoffered. It is unknown if such discussions can be effectivelydelivered online by palliative care specialists to support care home(CH) staff in relation to death/dying. Funded by Scotland's ChiefScientist Office COVID-19 “rapid research” fund, online OSCaRS isbeing piloted. Methods Fortnightly OSCaRS delivered to small groups of CH staff via asecure online platform in three local CHs over 10 weeks. Sessionsare digitally recorded. The shortened version of the Chesneycoping self-efficacy questionnaire is completed by all staffpre/post. Additional post-study questions asked of OSCaRSparticipants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews willbe undertaken and related to the staff questionnaire and context of each CH. Results New learning on the feasibility and acceptability of providingOSCaRS to frontline staff. The benefit of OSCaRS to CH staff copingmechanisms, team cohesion and communicaton with relativesduring the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/. Key Conclusions The analysis will inform future practice, and an ImplementationGuide for OSCaRS in CHs will be produced. Key learning on thepotential for online support in relation to death/dying during thepandemic and beyond will contribute to future education, trainingand staff wellbeing resources. It will also inform the role of suchsessions in developing individual coping mechanisms and teamworking alongside communication with relatives duringlockdown.
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Introduction: COVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses.This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward. Methods: 1) Rapid review of care home specific evidence and resources (including published research and social media);2)Online survey of Enabling Research in CareHomes (ENRICH) members across Scotland (n=55);3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support. Results: The rapid review has identified a wide range of resources directed at supporting staff working in care homes;the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. There are many resources available but staff do not access these. The role of the care home manager is key. Key conclusions: This comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.