The Role of ACEs and Discrimination on Mental Health: A Longitudinal Analysis Among College Students

Both adverse childhood experiences (ACEs) and perceived discrimination have been found to impact mental health in adults, but less is understood about the ways they interact to affect anxiety and depression symptoms. In the spring and summer of 2020, there were large societal changes stemming from the COVID-19 pandemic and social and racial justice movements in the United States. The current study aimed to characterize the interactive associations of ACE history and perceived discrimination with mental health in a sample of college students assessed prior to the pandemic in the fall of 2019 and then again in the fall of 2020. Results showed that in 2019, greater discrimination and more ACEs were associated with greater anxiety/depression symptoms. In 2020, a negative interactive effect of ACE history and discrimination on mental health was found, such that for individuals with low ACEs, greater discrimination was associated with significantly greater anxiety/depression symptoms. We also found that increases in perceived discrimination from 2019 to 2020 were significantly positively associated with increases in anxiety/depression symptoms over that same time period. The findings highlight the significant impacts that both ACEs history and perceived discrimination have on mental health and suggest that experiences of discrimination should be thought of as a critical, dynamic factor impacting college students' mental health. [ FROM AUTHOR] Copyright of Journal of Aggression, Maltreatment & Trauma is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Clinical and Correlative Study of Elotuzumab, Carfilzomib, Lenalidomide, and Dexamethasone (Elo-KRd) for Lenalidomide Refractory Multiple Myeloma in First Relapse.

INTRODUCTION: Treatment of patients with multiple myeloma (MM) in first relapse remains a challenge. This phase II study combined elotuzumab (Elo) with carfilzomib, lenalidomide, and dexamethasone (KRd) for treatment of MM in first relapse with the aim of improving efficacy. METHODS: Enrolled patients received Elo-KRd induction for 4 cycles, and Elo-lenalidomide maintenance until progression. The primary endpoint was VGPR or better (≥VGPR) postinduction. Secondary endpoints were MRD by flow cytometry, OS, PFS, and safety. Correlatives included characterization of the impact of Elo-KRd on NK and T cell subsets via flow cytometry. Target accrual of 40 patients was not met due to COVID-19 pandemic. RESULTS: Of 15 patients enrolled, 10 (67%) had high-risk features (del17p, t[4;14], t[14;16], 1q gain/amplification, plasma cell leukemia, extramedullary MM, or functional high risk), 12 (80%) were lenalidomide-refractory, and 5 (33.3%) bortezomib-refractory. Postinduction ≥VGPR was 7/15 (46.7%) and MRD-negative (10-5) rate 20%. Overall response during study was 80%, including ≥VGPR as best response of 53.3%. At median follow-up of 28.2 (range, 3.8 to 44.2) months, the median PFS was 11.5 months (95% CI 1.9, 18), and median OS not reached (95% CI 10.1, NA). No new safety concerns were reported. Elo-KRd treatment did not augment NK cell distribution or activity in blood or bone marrow. Effector CD4+ and CD8+ T cells significantly decreased postinduction, with concomitant acquisition of T central memory phenotype, particularly at a high rate in ≥VGPR group. CONCLUSION: A short course of Elo-KRd induction followed by Elo-lenalidomide maintenance demonstrated activity in predominantly lenalidomide-refractory and / or high-risk MM. The results with this well-tolerated combination are comparable to other contemporary approved triplet combinations.

A view of probation and mental health after the pandemic

2020 has seen the world we know change beyond recognition. The COVID-19 pandemic has meant we are now further away from one another, working differently or prevented from working altogether, we are less able to physically connect, and we have lost loved ones. These factors present multiple opportunities for adverse effects on mental health, which are magnified within the Criminal Justice System, and specifically probation. Evidence is emerging around detrimental effects for service users from the enforced social isolation, loss of employment or inability to work and increased risk of domestic abuse. The National Probation Service and community rehabilitation companies responded to the pandemic through implementing the Exceptional Delivery Model which sought to sustain core probation services through limited or remote delivery. The mental health challenges of this shift in operations were wide-ranging, with the impact on service users and staff sometimes profound. Drawing on data from several research studies and lived experience of working in a community rehabilitation company, this chapter explores (1) the mental health experiences of those receiving and delivering probation services during the pandemic, (2) the implications of these experiences and (3) how probation practice might need to adapt and change in this post-pandemic world. © 2023 selection and editorial matter, Charlie Brooker and Coral Sirdifeld;individual chapters, the contributors.

Virtual hospital-level care-feasibility, acceptability, safety and impact of a pilot Hospital-In-The-Home model for COVID-19 infection.

Background: Hospital-in-the-Home (HITH) delivers hospital level care to patients in the comfort of their own home. Traditionally HITH involves clinicians travelling to patients' homes. We designed and implemented a virtual model of care leveraging a combination of virtual health modalities for children with COVID-19 in response to rising patient numbers, infection risk and pressures on protective equipment. In contrast to other models for COVID-19 infection in Australia at the time, our HITH service catered only for children who were unwell enough to meet criteria for hospitalisation (ie bed-replacement). Aims: To measure the feasibility, acceptability, safety and impact of a virtual model of care for managing children with COVID-19 infection requiring hospital-level care. Methods: Retrospective study of a new virtual model of care for all children admitted to the Royal Children's HITH service with COVID-19 infection between 7th October 2021 and 28th April 2022. The model consisted of at least daily video consultations, remote oximetry, symptom tracking, portal messaging and 24 h phone and video support. Patients were eligible if they met a certain level of severity (work of breathing, dehydration, lower oxygen saturations) without requiring intravenous fluids, oxygen support or intensive care. Online surveys were distributed to staff and consumers who experienced the model of care. Results: 331 patients were managed through the virtual HITH program with a mean length of stay of 3.5 days. Of these, 331 (100%) engaged in video consultations, 192 (58%) engaged in the patient portal and completed the symptom tracker a total of 634 times and communicated via a total of 783 messages. Consumer satisfaction (n = 31) was high (4.7/5) with the most useful aspect of the model rated as video consultation. Clinician satisfaction (n = 9) was also high with a net promoter score of 8.9. There were no adverse events at home. Eight children (2.4%) represented to hospital, 7 (2.1%) of whom were readmitted. The impact is represented by a total of 1,312 hospital bed-days saved in the seven-month period (2,249 bed-days per year). In addition, 1,480 home visits (travel time/ protective equipment/ infection risk) were avoided. Conclusion: A virtual HITH program for COVID-19 in children is feasible, acceptable and safe and has a substantial impact on bed-days saved and nursing travel time. The implications for management of other acute respiratory viral illnesses that contribute to hospital bed pressure during winter months is immense. Virtual HITH is likely to be a key enabler of a sustainable healthcare system.

In a group, "we're not just a number”: what we learnt from an accidental hybrid health and well-being group programme for First Nations Australians with diabetes

First Nations peoples in Australia are disproportionately affected by diabetes. We report on a qualitative evaluation of a healthy lifestyle group programme at an Aboriginal Community Controlled Health Service. The programme was designed by an Aboriginal Health Worker and took place in a regional community. Yarning interviews of five participants and four facilitators were conducted followed by a collaborative analysis. The group context provided connecting and relationship-building opportunities, allowing participants to feel that they were seen as an individual. The accidental hybrid approach adopted due to the impact of COVID-19 pandemic lockdown supported transition of healthy activities into the home context while still accessing support and motivation from the group. This paper concluded that the unintentional hybrid programme found promising individual and cross-generational health and wellbeing benefits for First Nations families which suggests that intentional hybrid frameworks may show promise in improving First Nations peoples' health and well-being. © The Author(s) 2023.

Empirical Evidence to Support a Nudge Intervention for Increasing Online Engagement in Higher Education

Student engagement is recognised as being a critical factor linked to student success and learning outcomes. The same holds true for online learning and engagement in higher education, where the appetite for this mode of learning has escalated worldwide over several decades, and as a result of COVID-19. At the same time teachers in higher education are increasingly able to access and utilise tools to identify and analyse student online behaviours, such as tracking evidence of engagement and non-engagement. However, even with significant headway being made in fields such as learning analytics, ways in which to make sense of this data, and to utilise data to inform interventions and refine teaching approaches, continue to be areas that would benefit from further insights and exploration. This paper reports on a project that sought to investigate whether low levels of student online engagement could be enhanced through a course specific intervention strategy designed to address student engagement with online materials in a regional university. The intervention used course learning analytics data (CLAD) in combination with the behavioral science concept of nudging as a strategy for increasing student engagement with online content. The study gathered qualitative and quantitative data to explore the impact of nudging on student engagement with 187 students across two disciplines, Education and Regional/Town Planning. The results not only revealed that the use of the nudge intervention was successful in increasing the levels of engagement in online courses but also revealed that the prerequisites for nudging were needed in order to increase success rates. The paper points to the value for the broader awareness, update, and use of learning analytics as well as nudging at a course, program, and institutional level to support student online engagement. © 2023 by the authors.

Antibody Correlates of Protection for COVID-19 Convalescent Plasma Associated with Reduced Outpatient Hospitalizations (preprint)

SARS-CoV-2 antibody levels associated with reduced hospitalization risk remain undefined. Our outpatient COVID-19 convalescent plasma (CCP), placebo-controlled trial observed SARS-CoV-2 antibody levels decreasing 22-fold from matched donor units into post-transfusion seronegative recipients. Unvaccinated recipients were jointly stratified by a) early or late transfusion (< 5 or >5 days from symptom onset) and b) high or low post-transfusion SARS-CoV-2 antibody levels (< or > geometric mean). Early treatment with high post-transfusion antibody levels reduced hospitalization risk-0/102 (0%) compared to all other CCP recipients-17/370 (4.6%; Fisher exact-p-0.03) and to all control plasma recipients-35/461 (7.6%; Fisher exact p-0.001). A similar donor upper/lower half antibody level and early late transfusion stratified analyses indicated significant hospital risk reduction. Pre-transfusion nasal viral loads were similar in CCP and control recipients regardless of hospitalization outcome. Therapeutic CCP should comprise the upper 30% of donor antibody levels to provide effective outpatient use for immunocompromised and immunocompetent outpatients.

Educators' experiences of pivoting online: unearthing key learnings and insights for engaging students online

The impact of the COVID-19 pandemic meant that online teaching in higher education became the default. Educators were, and often now continue to be, required to pivot to online teaching, necessitating them to adapt their teaching delivery, effectively engage students online, and apply existing skills to new and unfamiliar pedagogical contexts. This paper presents a small international case study, investigating the experiences of a diverse group of educators who wanted to learn about engaging students because their higher education institutions were pivoting to online teaching. Following the educators' involvement in professional learning about a particular online engagement framework, the educators used their learning in their planning and online teaching. Data extracted from a deductive coding exercise augmented by qualitative data gleaned from semi-structured interviews was used to explore how the educators enhanced the engagement strategies they implemented in their courses. The findings indicate the types of learning processes used by the educators and how they applied their learning to online teaching. The deductive analysis suggests that the strategies the participants revealed worked well in their online practice correspond with the strategies delineated in the framework.

How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States.

BACKGROUND: Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois. METHODS: Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses. RESULTS: We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care. CONCLUSION: The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.

Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

Understanding Youth Athlete Motivation, Training, and Activity Progression During and After the COVID-19 Sports Interruption.

Background: COVID-19 restrictions created a period of disrupted sports participation for youth athletes. The physical conditioning, sports training habits, and patterns of sports activity resumption upon returning to normal sports activity are currently unknown. Purpose/Hypothesis: This study aimed to determine the extent to which youth athletes maintained their training levels during the early stages of the COVID-19 pandemic and understand the strategies that enhanced motivation and adherence to a training regimen while in isolation. A secondary aim was to analyze how youth athletes returned to activity and identify injuries associated with prolonged sports interruption. Study Design: Observational / Survey Study. Methods: A survey designed to determine activity changes, type of organized instruction, and athlete preferences for training support were distributed by email using snowball sampling methodology to athletes 14-21 years old who were involved in competitive sports when pandemic restrictions were enacted. As sports activities resumed, a follow-up survey was distributed to the same respondents to identify feelings of preparedness, training habits, and injuries. Results: Of the155 subjects (mean age 16.1 ± 2 years, 64.5% female) that completed the initial survey, 98% reported a stoppage of in-person sports participation and 70% decreased their exercise/training volume, with 41% (n=63) reporting > 50% reduction. Most athletes (86%) received instruction from coaches, with written workouts (70%) being most common; however, most athletes (70%) preferred instructor-led, group training sessions. Of the 43 subjects that completed the follow-up survey (34% response rate), there was an increase in athletic exposures compared to mid-pandemic levels, and 25% reported sustaining a sports-related injury shortly after resuming sports activities. Conclusions: Pandemic-related sports restrictions resulted in a significant reduction in youth athlete training and conditioning. Coaches attempted to maintain training via the use of written workouts; however, athletes preferred instructor-led, group training sessions. There was a rapid resumption of sports activities, which may have contributed to the high rate of injuries in this study. Level of Evidence: 3.

Attitudes toward harm reduction and low-threshold healthcare during the COVID-19 pandemic: qualitative interviews with people who use drugs in rural southern Illinois.

BACKGROUND: Chronic health conditions associated with long-term drug use may pose additional risks to people who use drugs (PWUD) when coupled with COVID-19 infection. Despite this, PWUD, especially those living in rural areas, may be less likely to seek out health services. Previous research has highlighted the increased disease burden of COVID-19 among PWUD. Our manuscript supplements this literature by exploring unique attitudes of PWUD living in rural areas toward the pandemic, COVID-19 vaccination, and the role of harm reduction (HR) organizations in raising health awareness among PWUD. METHODS: Semi-structured interviews were conducted with 20 PWUD living in rural southern Illinois. Audio recordings were professionally transcribed. A preliminary codebook was created based on interview domains. Two trained coders conducted iterative coding of the transcripts, and new codes were added through line-by-line coding and thematic grouping. RESULTS: Twenty participants (45% female, mean age of 38) completed interviews between June and November 2021. Participants reported negative impacts of the pandemic on mental health, financial wellbeing, and drug quality. However, the health impacts of COVID-19 were often described as less concerning than its impacts on these other aspects of life. Many expressed doubt in the severity of COVID-19 infection. Among the 16 unvaccinated participants who reported receiving most of their information from the internet or word of mouth, uncertainty about vaccine contents and distrust of healthcare and government institutions engendered wariness of the vaccination. Distrust of healthcare providers was related to past stigmatization and judgement, but did not extend to the local HR organization, which was unanimously endorsed as a positive institution. Among participants who did not access services directly from the HR organization, secondary distribution of HR supplies by other PWUD was a universally cited form of health maintenance. Participants expressed interest in low-threshold healthcare, including COVID-19 vaccination, should it be offered in the local HR organization's office and mobile units. CONCLUSION: COVID-19 and related public health measures have affected this community in numerous ways. Integrating healthcare services into harm reduction infrastructures and mobilizing secondary distributors of supplies may promote greater engagement with vaccination programs and other healthcare services. TRIAL NUMBER: NCT04427202.

Associations of Anxiety during the COVID-19 Pandemic with Patient Characteristics and Behaviors in CKD Patients: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study.

Background: Chronic kidney disease (CKD) is associated with anxiety and depression. Although the coronavirus disease 2019 (COVID-19) pandemic has increased stressors on patients with CKD, assessments of anxiety and its predictors and consequences on behaviors, specifically virus mitigation behaviors, are lacking. Methods: From June to October 2020, we administered a survey to 1873 patients in the Chronic Renal Insufficiency Cohort (CRIC) Study, asking participants about anxiety related to the COVID-19 pandemic. We examined associations between anxiety and participant demographics, clinical indexes, and health literacy and whether anxiety was associated with health-related behaviors and COVID-19 mitigation behaviors. Results: The mean age of the study population was 70 years (SD=9.6 years), 47% were women, 39% were Black non-Hispanic, 14% were Hispanic, and 38% had a history of cardiovascular disease. In adjusted analyses, younger age, being a woman, Hispanic ethnicity, cardiovascular disease, household income <$20,000, and marginal or inadequate health literacy predicted higher anxiety. Higher global COVID-19-related anxiety scores were associated with higher odds of reporting always wearing a mask in public (OR=1.3 [95% CI, 1.14 to 1.48], P<0.001) and of eating less healthy foods (OR=1.29 [95% CI, 1.13 to 1.46], P<0.001), reduced physical activity (OR=1.32 [95% CI, 1.2 to 1.45], P<0.001), and weight gain (OR=1.23 [95% CI, 1.11 to 1.38], P=0.001). Conclusions: Higher anxiety levels related to the COVID-19 pandemic were associated not only with higher self-reported adherence to mask wearing but also with higher weight gain and less adherence to healthy lifestyle behaviors. Interventions are needed to support continuation of healthy lifestyle behaviors in patients with CKD experiencing increased anxiety related to the pandemic.

Immunopeptidome profiling of human coronavirus OC43-infected cells identifies CD4 T cell epitopes specific to seasonal coronaviruses or cross-reactive with SARS-CoV-2 (preprint)

Seasonal "common-cold" human coronaviruses are widely spread throughout the world and are mainly associated with mild upper respiratory tract infections. The emergence of highly pathogenic coronaviruses MERS-CoV, SARS-CoV, and most recently SARS-CoV-2 has prompted increased attention to coronavirus biology and immunopathology, but identification and characterization of the T cell response to seasonal human coronaviruses remain largely uncharacterized. Here we report the repertoire of viral peptides that are naturally processed and presented upon infection of a model cell line with seasonal human coronavirus OC43. We identified MHC-I and MHC-II bound peptides derived from the viral spike, nucleocapsid, hemagglutinin-esterase, 3C-like proteinase, and envelope proteins. Only three MHC-I bound OC43-derived peptides were observed, possibly due to the potent MHC-I downregulation induced by OC43 infection. By contrast, 80 MHC-II bound peptides corresponding to 14 distinct OC43-derived epitopes were identified, including many at very high abundance within the overall MHC-II peptidome. These peptides elicited low-abundance recall T cell responses in most donors tested. In vitro assays confirmed that the peptides were recognized by CD4+ T cells and identified the presenting HLA alleles. T cell responses cross-reactive between OC43, SARS-CoV-2, and the other seasonal coronaviruses were confirmed in samples of peripheral blood and peptide-expanded T cell lines. Among the validated epitopes, S903-917 presented by DPA1*01:03/DPB1*04:01 and S1085-1099 presented by DRB1*15:01 shared substantial homology to other human coronaviruses, including SARS-CoV-2, and were targeted by cross-reactive CD4 T cells. N54-68 and HE128-142 presented by DRB1*15:01 and HE259-273 presented by DPA1*01:03/DPB1*04:01 are immunodominant epitopes with low coronavirus homology that are not cross-reactive with SARS-CoV-2. Overall, the set of naturally processed and presented OC43 epitopes comprise both OC43-specific and human coronavirus cross-reactive epitopes, which can be used to follow T cell cross-reactivity after infection or vaccination and could aid in the selection of epitopes for inclusion in pan-coronavirus vaccines.

Validation Study of a Direct Real-Time PCR Protocol for Detection of Monkeypox Virus.

Monkeypox has recently been described as a public health emergency of international concern by the World Health Organization and a public health emergency by the United States. If the outbreak continues to grow, rapid scalability of laboratory testing will be imperative. During the early days of the coronavirus disease 2019 (COVID-19) pandemic, laboratories improved the scalability of testing by using a direct-to-PCR approach. To improve the scalability of monkeypox testing, a direct real-time PCR protocol for the detection of monkeypox virus was validated. The assay retains the sensitivity and accuracy of the indirect assay while eliminating the need for nucleic acid extraction kits, reducing laboratory technologist time per sample and decreasing exposure to an infectious agent. The direct method will make it easier for laboratories across the world to rapidly develop, validate, and scale testing for monkeypox virus.

Understanding Youth Athlete Motivation, Training and Activity Progression During and After the COVID-19 Sports Interruption

Background: COVID-19 restrictions created a period of disrupted sports participation for youth athletes. The physical conditioning and sports training habits of youth athletes during COVIDrelated sports interruption and upon returning to normal sports activity are currently unknown. The purpose of this study was to determine the extent to which athletes maintained their training levels during the COVID-19 pandemic and understand the strategies that enhanced motivation and adherence to a training regimen while in isolation. A secondary aim was to further understand the manner as to how youth athletes returned to activity and identify any secondary effects of the prolonged sports interruption as they resumed athletic activities. Methods: A two-part survey was designed to determine activity changes, type of organized instruction, and athlete preferences for training support. This was distributed by email using snowball sampling methodology to athletes 14-21 years-old who were involved in competitive sports when pandemic restrictions were enacted. As sports activities resumed, a follow-up survey was distributed to the same respondents to identify feelings of preparedness, training habits, and injuries. This study was reviewed and approved by the Institutional Review Board of the sponsoring organization. Results: Of the 155 subjects (mean age 16.1 ± 2 years, 64.5% female) that completed the initial survey, 98% reported a stoppage of in-person sports participation and 70% decreased their exercise/training volume, with 41% (n=63) reporting > 50% reduction. Most athletes (86%) received instruction from coaches, with written workouts (70%) being most common, however most athletes (70%) preferred instructor-led, group training sessions. Many athletes (73%) reported supplementing team-based training recommendations with independent workouts, primarily jogging (62%), strength training (54%) and sports specific skills (51%). With regards to their feelings of preparedness for returning to normal sports activity, 42% of athletes reported feeling only minimally or somewhat prepared. Of the 43 subjects that completed the follow up survey (34% response rate), 30% reported immediately returning to play for more than one team, and there was a sharp increase in athletic exposures compared to mid-pandemic levels (Figure 1). Despite this increase in structured athletic activity, 63% of the sample reported they still supplemented team-based practices with jogging (51%), sports specific skill work (47%) and strength training (40%) on an individual basis. Interestingly, 25% of athletes reported sustaining a sports-related injury a mean of 79 days after resuming sports activities. Conclusion: Pandemicrelated sports restrictions resulted in a large reduction in youth athlete training and conditioning. Coaches attempted to maintain training via use of written workouts, however athletes preferred instructor-led, group training sessions. There was a rapid resumption of sports activities, which may have contributed to the high rate of injuries seen in this study. Respondents' number of training days per week during remote led instruction and upon return to in-person sports.

Serious Funny Papers: A Contextual Examination into the Making of an Acadomic

In this academic comic (or acadomic) I reflect on impacts to the creative process when reconceptualizing and recontextualizing a comics-based research (CBR) project as an acadomic for an edited book during the Covid-19 pandemic. The lockdowns intensified computer-mediated-communication (CMC) and I am compelled by two years of virtually exclusive engagement with digital technologies to explore the impact unrestrained online activities have on my creative comics practice, on my conceptions of research, and on my experiences as a teacher. Analysis of this process and its impacts is realized through a mixed research methodology that explores the impacts of conceptualizing and making an earlier acadomic, which in turn documents a comics-based research project between university students and a national charity as they successfully collaborate on the creation of a graphic novel. I probe the boundaries of academic writing by visualizing and performing Baudrillard's theoretical violence to critique digital intensification through metaphor, semiotics, and comics. The work for this article was undertaken during the rolling pandemic lockdowns in the UK and around the world from 2020 to 2022. Academic theory and the medium of comics problematize the digital simulacrum as I action a utopian pedagogy that supports balance between traditional and digital techniques. © 2022 Informa UK Limited, trading as Taylor & Francis Group.