The role of personal identity as a resource for college students during COVID-19.

Objective: We examined the role of personal identity vis-à-vis COVID-related outcomes among college students from seven U.S. campuses during spring/summer 2021. Participants: The present sample consisted of 1,688 students (74.5% female, age range 18-29). The sample was ethnically diverse, and 57.3% were first-generation students. Procedures: Students completed an online survey assessing personal identity synthesis and confusion, COVID-related worries, general internalizing symptoms, positive adaptation, and general well-being. Results: Personal identity synthesis was negatively related to COVID-related worries and general internalizing symptoms, and positively related to positive adaptation, both directly and indirectly through life satisfaction and psychological well-being. Personal identity confusion evidenced an opposing set of direct and indirect associations with outcome variables. Conclusions: Personal identity may potentially be protective against pandemic-related distress among college students, in part through its association with well-being. Reducing identity confusion and promoting identity synthesis are essential among college students during this and future pandemics.

Designing for the Embedding of Employee Voice

Previous research on employee voice has sought to design technological solutions that address the challenges of speaking up in the workplace. However, effectively embedding employee voice systems in organisations requires designers to engage with the social processes, power relations and contextual factors of individual workplaces. We explore this process within a university workplace through a research project responding to a crisis in educational service delivery arising from the COVID-19 pandemic. Within a successful three-month staff-led engagement, we examined the intricacies of embedding employee voice, exploring how the interactions between existing actors impacted the effectiveness of the process. We sought to identify specific actions to promote employee voice and overcome barriers to its successful establishment in organisational decision-making. We highlight design considerations for an effective employee voice system that facilitates embedding employee voice, including assurance, bounded accountability and bias reflexivity. © 2023 ACM.

Neurological sequelae of vaccines.

IMPORTANCE: Vaccines are a safe and efficacious way to prevent a variety of infectious diseases. Over the course of their existence, vaccines have prevented immeasurable morbidity and mortality in humans. Typical symptoms of systemic immune activation are common after vaccines and may include local soreness, myalgias, nausea, and malaise. In the vast majority of cases, the severity of the infectious disease outweighs the risk of mild adverse reactions to vaccines. Rarely, vaccines may be associated with neurological sequela that ranges in severity from headache to transverse myelitis, acute disseminated encephalomyelitis, and Guillain-Barre syndrome (GBS). Often, a causal link cannot be confirmed, and it remains unclear if disease onset is directly related to a recent vaccination. OBSERVATIONS: This review serves to summarize reported neurologic sequelae of commonly used vaccines. It will also serve to discuss potential pathogenesis. It is important to note that many adverse events or reactions to vaccines are self-reported into databases, and causal proof cannot be obtained. CONCLUSIONS AND RELEVANCE: Recognition of reported adverse effects of vaccines plays an important role in public health and education. Early identification of these symptoms can allow for rapid diagnosis and potential treatment. Vaccines are a safe option for prevention of infectious diseases.

Career planning and workforce preparation during economic downturn: perceptions of graduating business students

Purpose: To gather insight into how graduating business students are preparing for the workplace and their future careers and how this has been impacted by COVID-19. Design/methodology/approach: In total, 144 business students at an Australian university who had recently completed an internship and were nearing graduation took part in the study. Group A was surveyed before COVID-19 had emerged and Group B undertook their internships during a COVID-19 lockdown when the related economic downturn had become apparent. The responses were analysed using career construction theory (CCT). Findings: This study concludes that graduating students do not generally place greater emphasis on career planning in times of economic downturn. However, they do devote more effort to job search and networking activities. They also display more career decisiveness and are less willing to seek out information about potential careers or their suitability for them. Their confidence in embarking on a career was not impacted. Research limitations/implications: This enables us to form a more complete picture of how graduating students perceive their work-readiness and the action they feel is important in order to improve their employability. Practical implications: This has implications for career practitioners and employers of graduates as it adds to the knowledge of employability and the decision-making process in times of economic crisis and is particularly important for the tertiary education sector as it seeks to better target initiatives to aid employability in graduates. Originality/value: The results increase the understanding of the impact of COVID-19 on early career development and argue that early-career decision-making is a specific area requiring investigation. © 2023, Emerald Publishing Limited.

A Case Study of Successful Application of the Principles of ME/CFS Care to an Individual with Long COVID.

Persistent fatigue is one of the most common symptoms of post-COVID conditions, also termed long COVID. At the extreme end of the severity spectrum, some individuals with long COVID also meet the criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), raising the possibility that symptom management approaches for ME/CFS may benefit some long COVID patients. We describe the long-term outcomes of a 19-year-old male who developed profound impairment consistent with ME/CFS after a SARS-CoV-2 infection early in the pandemic. We evaluated and treated him using our clinic's approach to ME/CFS. This included a history and physical examination that ascertained joint hypermobility, pathological reflexes, physical therapy maneuvers to look for a range of motion restrictions in the limbs and spine, orthostatic testing, and screening laboratory studies. He was found to have profound postural tachycardia syndrome, several ranges of motion restrictions, and mast cell activation syndrome. He was treated according to our clinic's guidelines for managing ME/CFS, which included manual physical therapy maneuvers and both non-pharmacologic measures and medications directed at postural tachycardia syndrome and mast cell activation. He experienced significant improvement in his symptoms over 30 months. His case emphasizes how the application of the principles of treating ME/CFS has the potential to provide a direction for treating long COVID.

Using Rapid-Cycle Change to Improve COVID-19 Vaccination Strategy in Primary Care.

During the COVID-19 pandemic, misinformation and distrust exacerbated disparities in vaccination rates by race and ethnicity throughout the United States. Primary care, public health systems, and community health centers have shifted their vaccination outreach strategies toward these disparate, unvaccinated populations. To support primary care, we developed the SAVE Sprint model for implementing rapid-cycle change to improve vaccination rates by overcoming community outreach barriers and workforce limitations. Participants were recruited for the 10-week SAVE Sprint program through partnerships with the National Association of Community Health Centers (NACHC) and the Resilient American Communities (RAC) Initiative. The majority of the participants were from community health centers. Data were evaluated during the program through progress reports and surveys, and interviews conducted three months post-intervention were recorded, coded, and analyzed. The SAVE Sprint model of rapid-cycle change exceeded participants' expectations and led to improvements in patient education and vaccination among their vulnerable populations. Participants reported building new skills and identifying strategies for targeting specific populations during a public health emergency. However, participants reported that planning for rapid-pace change and trust-building with community partners prior to a health care crisis is preferable and would make navigating an emergency easier.

A cotwin control study of associations between financial hardship and binge eating phenotypes during COVID-19.

BACKGROUND: COVID-19 was associated with significant financial hardship and increased binge eating (BE). However, it is largely unknown whether financial stressors contributed to BE during the pandemic. We used a longitudinal, cotwin control design that controls for genetic/environmental confounds by comparing twins in the same family to examine whether financial hardship during COVID-19 was associated with BE. METHODS: Female twins (N = 158; Mage  = 22.13) from the Michigan State University Twin Registry rated financial stressors (e.g., inability to afford necessities) daily for 49 consecutive days during COVID-19. We first examined whether financial hardship was associated with BE phenotypes across the full sample. We then examined whether cotwins who differed on financial hardship also differed in BE. RESULTS: Participants who experienced greater mean financial hardship across the study had significantly greater dimensional BE symptoms, and participants who experienced greater financial hardship on a given day reported significantly more emotional eating that day. These results were replicated in cotwin control analyses. Twins who experienced more financial hardship than their cotwin across the study reported greater dimensional BE symptoms than their cotwin, and participants who experienced more financial hardship than their cotwin on a given day reported greater emotional eating that day. Results were identical when restricting analyses to monozygotic twins, suggesting associations were not due to genetic confounds. CONCLUSIONS: Results suggest that BE-related symptoms may be elevated in women who experienced financial hardship during COVID-19 independent of potential genetic/environmental confounds. However, additional research in larger samples is needed. PUBLIC SIGNIFICANCE: Little is known regarding how financial difficulties during the COVID-19 pandemic may have contributed to increased binge eating (BE). We found preliminary evidence that financial hardship during COVID-19 may be associated with greater rates of BE-related symptoms even when comparing twins from the same family. While additional research is needed, results suggest that people who experienced financial hardship during COVID-19 may be at increased risk for BE.

Reshaping the path of mild cognitive impairment by refining exercise prescription: a study protocol of a randomized controlled trial to understand the "what," "for whom," and "how" of exercise to promote cognitive function.

BACKGROUND: Targeted exercise training is a promising strategy for promoting cognitive function and preventing dementia in older age. Despite the utility of exercise as an intervention, variation still exists in exercise-induced cognitive gains and questions remain regarding the type of training (i.e., what), as well as moderators (i.e., for whom) and mechanisms (i.e., how) of benefit. Both aerobic training (AT) and resistance training (RT) enhance cognitive function in older adults without cognitive impairment; however, the vast majority of trials have focused exclusively on AT. Thus, more research is needed on RT, as well as on the combination of AT and RT, in older adults with mild cognitive impairment (MCI), a prodromal stage of dementia. Therefore, we aim to conduct a 6-month, 2 × 2 factorial randomized controlled trial in older adults with MCI to assess the individual effects of AT and RT, and the combined effect of AT and RT on cognitive function and to determine the possible underlying biological mechanisms. METHODS: Two hundred and sixteen community-dwelling adults, aged 65 to 85 years, with MCI from metropolitan Vancouver will be recruited to participate in this study. Randomization will be stratified by biological sex and participants will be randomly allocated to one of the four experimental groups: (1) 4×/week balance and tone (BAT; i.e., active control); (2) combined 2×/week AT + 2×/week RT; (3) 2×/week AT + 2×/week BAT; or (4) 2×/week RT + 2×/week BAT. The primary outcome is cognitive function as measured by the Alzheimer's Disease Assessment Scale-Cognitive-Plus. Secondary outcomes include cognitive function, health-related quality of life, physical function, actigraphy measures, questionnaires, and falls. Outcomes will be measured at baseline, 6 months (i.e., trial completion), and 18 months (i.e., 12-month follow-up). DISCUSSION: Establishing the efficacy of different types and combinations of exercise training to minimize cognitive decline will advance our ability to prescribe exercise as "medicine" to treat MCI and delay the onset and progression of dementia. This trial is extremely timely as cognitive impairment and dementia pose a growing threat to global public health. TRIAL REGISTRATION: ClinicalTrials.gov NCT02737878 . Registered on April 14, 2016.

A Comparative Analysis of Data Quality in Online Zoom Versus Phone Interviews: An Example of Youth With and Without Disabilities

Qualitative researchers are increasingly using online data collection methods, especially during the COVID-19 pandemic. I compared the data quality (i.e., interview duration, average number of themes and sub-themes, and inaudible words) of 34 interviews (29 conducted by Zoom (16 with camera on, 13 camera off) and 5 conducted by phone) drawn from a study focusing on youth's coping experiences during the pandemic. Findings showed that phone interviews had a longer duration compared to Zoom. However, phone interviews had a similar average word count to Zoom interviews (with the camera on). Zoom interviews conducted with the camera off were shorter in duration than interviews with the camera on. The number of themes was similar across the different interview formats but there were fewer sub-themes for Zoom interviews with the camera off. The findings suggest that Zoom interviews conducted with the camera off could affect the data quality. This research also emphasizes the importance of giving participants choice in the format of their interview to allow for optimal sharing of experiences while enhancing the equity, diversity and inclusion of the participants. © The Author(s) 2022.

Children, adolescents, and young adults hospitalized with COVID-19 and diabetes in summer 2021.

INTRODUCTION: More information is needed to understand the clinical epidemiology of children and young adults hospitalized with diabetes and COVID-19. We describe the demographic and clinical characteristics of patients <21 years old hospitalized with COVID-19 and either Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) during peak incidence of SARS-CoV-2 infection with the B.1.617.2 (Delta) variant. METHODS: This is a descriptive sub-analysis of a retrospective chart review of patients aged <21 years hospitalized with COVID-19 in six US children's hospitals during July-August 2021. Patients with COVID-19 and either newly diagnosed or known T1DM or T2DM were described using originally collected data and diabetes-related data specifically collected on these patients. RESULTS: Of the 58 patients hospitalized with COVID-19 and diabetes, 34 had T1DM and 24 had T2DM. Of those with T1DM and T2DM, 26% (9/34) and 33% (8/24), respectively, were newly diagnosed. Among those >12 years old and eligible for COVID-19 vaccination, 93% were unvaccinated (42/45). Among patients with T1DM, 88% had diabetic ketoacidosis (DKA) and 6% had COVID-19 pneumonia; of those with T2DM, 46% had DKA and 58% had COVID-19 pneumonia. Of those with T1DM or T2DM, 59% and 46%, respectively, required ICU admission. CONCLUSION: Our findings highlight the importance of considering diabetes in the evaluation of children and young adults presenting with COVID-19; the challenges of managing young patients who present with both COVID-19 and diabetes, particularly T2DM; and the importance of preventive actions like COVID-19 vaccination to prevent severe illness among those eligible with both COVID-19 and diabetes.

Mental Health Risk Profiles and Related Substance Use During Coronavirus Pandemic Among College Students Who Use Substances.

College students have shown elevated mental distress during the coronavirus disease of 2019 (COVID-19). The extent and persistence of mental distress as COVID-19 restrictions have continued is unclear. This study used latent profile analysis to identify student mental health risk subgroups and to evaluate subgroups in relation with substance use. A four-profile solution was supported with a sample of 930 college students (69.6% female, 58.1% White) from 11 US-based institutions. Students were characterized by slight mental health symptoms, mild mental health symptoms, moderate-to-severe mental health symptoms with mild psychosis/substance use, and severe mental health symptoms. The severe profile comprised more ethnoracial or sexual minorities and students impacted from COVID-19. Whereas the severe profile had more alcohol-related consequences, the slight profile had fewer cannabis-related consequences. COVID-19 has exacerbated college student risks for psychiatric disorders. Students of diverse backgrounds and more impacted by COVID-19 show disproportionately more mental distress and related substance use.

Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19.

OBJECTIVES: To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness. METHODS: We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. RESULTS: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19). CONCLUSIONS: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.

Engagement in Online Learning: Student Attitudes and Behavior During COVID-19

The COVID-19 pandemic resulted in nearly all universities switching courses to online formats. We surveyed the online learning experience of undergraduate students (n = 187) at a large, public research institution in course structure, interpersonal interaction, and academic resources. Data was also collected from course evaluations. Students reported decreases in live lecture engagement and attendance, with 72 percent reporting that low engagement during lectures hurt their online learning experience. A majority of students reported that they struggled with staying connected to their peers and instructors and managing the pace of coursework. Students had positive impressions, however, of their instructional staff. Majorities of students felt more comfortable asking and answering questions in online classes, suggesting that there might be features of learning online to which students are receptive, and which may also benefit in-person classes.

Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS.

Purpose of Review: To discuss emerging understandings of adolescent long COVID or post-COVID-19 conditions, including proposed clinical definitions, common symptoms, epidemiology, overlaps with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and orthostatic intolerance, and preliminary guidance on management. Recent Findings: The recent World Health Organization clinical case definition of post-COVID-19 condition requires a history of probable or confirmed SARS-CoV-2 infection, with symptoms starting within 3 months of the onset of COVID-19. Symptoms must last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms of the post-COVID-19 condition include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction. These symptoms generally have an impact on everyday functioning. The incidence of prolonged symptoms following SARS-CoV-2 infection has proven challenging to define, but it is now clear that those with relatively mild initial infections, without severe initial respiratory disease or end-organ injury, can still develop chronic impairments, with symptoms that overlap with conditions like ME/CFS (profound fatigue, unrefreshing sleep, post-exertional malaise, cognitive dysfunction, and orthostatic intolerance). Summary: We do not yet have a clear understanding of the mechanisms by which individuals develop post-COVID-19 conditions. There may be several distinct types of long COVID that require different treatments. At this point, there is no single pharmacologic agent to effectively treat all symptoms. Because some presentations of post-COVID-19 conditions mimic disorders such as ME/CFS, treatment guidelines for this and related conditions can be helpful for managing post-COVID-19 symptoms. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-022-00261-4.

Employment and Accommodation Needs in Individuals with Traumatic Brain Injury: A Pilot Study

Introduction: Traumatic brain injury (TBI) is a leading cause of disability worldwide. Sex and gender influence employment in TBI. A large facilitator to employment in TBI is having workplace accommodation, however in many cases accommodations are unavailable or may not fit the needs of the individual. Further, it is unknown how the Coronavirus Disease 2019 (COVID-19) pandemic is impacting employment and accommodations for persons with TBI. This study aims to investigate sex and gender-specific workplace accommodations in persons with TBI, while considering the impact of COVID-19 on transitioning to work and on mental health in adults with TBI. Methods: The proposed research is a pilot study with an observational cross-sectional design. Sixty adults with TBI, including men, women and gender diverse people within the age range of 18-65 years inclusive, will be recruited. An online survey will be self-administered through Research Electronic Data Capture. The survey includes questions on demographics (e.g., sex, gender, age, ethnicity, injury severity, mechanism of injury);questions from the Canadian Survey on Disability 2017 on employment status, requirements and unmet needs for workplace accommodations;and questions from Statistics Canada on the impact of COVID-19 on work status. Results: Data collection is in progress. Planned analyses include multinomial logistic and multivariable linear regression analyses to evaluate the relationships between the predictor (i.e., sex, gender) and main outcome variables (i.e., the number and type of accommodations needed, change in employment status and mental health due to COVID-19). Descriptive statistics, between-group comparisons for sex and gender, and sexspecific and gender-specific stratification will be completed to understand emerging trends. Conclusion: Sex and gender influences in TBI can serve to inform rehabilitation professionals, employers and persons with TBI, to enable sex- and gender-sensitive interventions for community participation practices. Findings from this study will contribute to the body of evidence on sex- and gender-specific workplace accommodations, while bridging the knowledge gap of how to improve transition to work in persons with TBI. Results will also further the understanding of the specific needs of men, women and gender-diverse persons with a disability during community participation postdischarge, including during unprecedented times.

Sustained improvement in fellows' echocardiographic completeness through the coronavirus pandemic with a standardised imaging protocol.

First-year cardiology fellows must quickly learn basic competency in echocardiography during fellowship orientation. This educational process was disrupted in 2020 due to the coronavirus pandemic, as our hands-on echocardiography teaching transitioned from practice on paediatric volunteers to simulation-based training. We previously described an improvement in echocardiographic completeness after implementation of a standardised imaging protocol for the performance of acute assessments of ventricular function. Herein, we assessed whether this improvement could be sustained over the two subsequent years, including the fellowship year affected by the pandemic. Echocardiograms performed by first-year paediatric cardiology fellows to assess ventricular function were reviewed for completeness. The frequency with which each requested component was included was measured. A total demographic score (out of 7) and total imaging score (out of 23) were calculated. The pre-protocol years (2015-2017) were compared to the post-protocol years (2018-2020), and the pre-COVID years (2018-2019) were compared to the year affected by COVID (2020). There was a sustained improvement in completeness after protocol implementation with improvement in the demographic score (median increasing from 6 to 7, p < 0.001) and imaging score (median increasing from 13 to 16, p < 0.001). More individual components showed a statistically significant increase in frequency compared to our prior publication. The COVID pandemic resulted in very few differences in completeness. Demographic reporting improved modestly (p = 0.04); the imaging score was unchanged (p = 0.59). The only view obtained less frequently was the apical two-chamber view. A standardised imaging protocol allowed sustained improvements in echocardiographic completeness despite the disruption of fellowship orientation by COVID-19.

Adolescent and Young Adult ME/CFS After Confirmed or Probable COVID-19.

Introduction: Fatigue is a common acute symptom following SARS-CoV-2 infection (COVID-19). The presence of persistent fatigue and impaired daily physical and cognitive function has led to speculation that like SARS-CoV-1 infection, COVID-19 will be followed by myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Methods and Results: We describe three adolescent and young adult patients who had confirmed or probable COVID-19 infections early on during the pandemic and were referred for evaluation to the Chronic Fatigue Clinic at the Johns Hopkins Children's Center. All patients reported orthostatic intolerance symptoms within the first 2 weeks of illness, and 10-min passive standing tests were consistent with postural tachycardia syndrome. After 6 months of illness, all three patients met criteria for ME/CFS. Clinical features of interest included strong histories of allergies in all three patients, two of whom had elevations in plasma histamine. Each demonstrated limitations in symptom-free range of motion of the limbs and spine and two presented with pathological Hoffman reflexes. These comorbid features have been reported in adolescents and young adults with ME/CFS. Conclusion: ME/CFS can be triggered by COVID-19 in adolescents and young adults. Further work is needed to determine the pathogenesis of ME/CFS after COVID-19 and optimal methods of treating these patients. Our preliminary study calls attention to several comorbid features that deserve further attention as potential targets for intervention. These include neuromuscular limitations that could be treated with manual forms of therapy, orthostatic intolerance and POTS for which there are multiple medications and non-pharmacologic therapies, treatable allergic and mast cell phenomena, and neurologic abnormalities that may require specific treatment. Larger studies will need to ascertain the prevalence of these abnormalities.