Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study (preprint)

BackgroundSocial gradients in COVID-19 exposure, illness severity, and mortality have been observed in multiple international contexts. Whether pre-existing social factors affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood. MethodsWe analysed data on self-perceived recovery following self-reported COVID-19 illness in two United Kingdom community-based cohorts, COVID Symptom Study Biobank (CSSB) (N = 2548) and TwinsUK (N = 1334). Composite variables quantifying socio-demographic advantage and disadvantage prior to the COVID-19 pandemic were generated from sex, ethnic group, education, local area deprivation and employment status. Associations between self-perceived recovery and composite variables were tested with multivariable logistic regression models weighted for inverse probability of study participation, adjusting for potential confounding by age, region and pre- pandemic health factors, and potential mediation by COVID-19 illness characteristics and adverse experiences during the pandemic. Further analyses tested associations between recovery and individual socio-demographic variables reflecting status prior to and during the COVID-19 pandemic. FindingsSocio-demographic gradients in recovery were observed, with unadjusted recovery rate varying between 50% and 80% in CSSB and 70% and 90% in TwinsUK based on composite socio-demographic variables. Likelihood of recovery was lower for individuals with more indicators of pre-pandemic social disadvantage in both cohorts (CSSB: odds ratio, OR = 0.74, 95% confidence interval, CI: 0.62-0.88, TwinsUK: OR = 0.79, 95% CI: 0.64-0.98 per disadvantage) and higher with more social advantages (CSSB: OR = 1.26, 95% CI: 1.08-1.47, TwinsUK: OR = 1.36, 95% CI: 1.09-1.70 per advantage). Associations were neither explained by differences in COVID-19 illness severity or timing, nor adverse social experiences during the pandemic, which were themselves inversely associated with recovery. InterpretationStrong social inequalities in the likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with multiple indicators of social disadvantage. Work is needed to identify modifiable biopsychosocial factors to enable interventions that address inequalities. FundingChronic Disease Research Foundation, National Institute for Health and Care Research, Medical Research Council, Wellcome LEAP, Wellcome Trust, Engineering & Physical Sciences Research Council, Biotechnology and Biological Sciences Research Council, Versus Arthritis, European Commission, Zoe Ltd. Plain language summaryAcross the world acute COVID-19 illness has affected the most disadvantaged in society the most. However, we have not looked in detail whether peoples social circumstances affect their recovery from COVID-19. In our study, we asked people from two UK-based health studies if they still had symptoms after having COVID-19. We looked at how advantaged or disadvantaged they were at the start of the pandemic, based on information about their sex, ethnic group, education level, local area, and employment. In both studies, people who were more disadvantaged were more likely to still have symptoms long after having COVID-19. In contrast, more advantaged people were more likely to have fully recovered. We also saw that people who had negative experiences during the pandemic such as losing their job, being unable to afford their bills or not being able to access health & social care services were less likely to recover. More work is needed to understand how and why recovery was so different for people with different circumstances. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSTo search for previous reports on associations between recovery from COVID-19 and socio-demographic factors, we screened abstracts identified from the PubMed search query on December 21, 2023: "((COVID-19) AND ((recovery) OR (convalescence) OR (" ongoing symptoms")) AND ((socioeconomic) OR (sociodemographic) OR (social) OR (gradient))) AND LitCLONGCOVID[filter]", where LitCLONGCOVID is a filter for articles relating to long COVID (https://pubmed.ncbi.nlm.nih.gov/help/#covid19-article-filters), which returned 210 results published between July, 2020 and December, 2023. A small number (N = 11) of studies contained direct measures of recovery from COVID-19 in terms of presence/absence of ongoing symptoms relating to COVID-19 illness, either as perceived by the individual or inferred from current symptom reports. Of these, most focused on associations with COVID-19 illness factors such as severity and symptomatology, and prior health indicators. Socio-demographics were mostly used for sample description and adjustments in models rather than as exposures of interest. Of the few studies (N = 8) that tested associations with socio-demographic variables, the range of socio-demographics tested was limited and/or follow-up time typically restricted to 6-12 months since symptom onset. In these studies, associations with recovery were reported for age (N = 4), sex (N = 7), race/ethnicity (N = 2), local area deprivation (N = 1), and education level (N = 1). Associations between long-term symptoms and education or income have been reported in single separate studies. Monthly bulletins up to March 2023 from the UK Coronavirus Infection Survey highlighted prevalence of individuals reporting current effects on daily activities due to long COVID was associated with age, sex, race/ethnicity, local area deprivation and economic activity. No studies were identified that tested for associations of multiple socio-demographics in combination with the likelihood of recovery following COVID-19. Added value of this studyThis is the first study to testing the effects of multiple socio-demographics on self-perceived recovery in combination. Measures that attempt to quantify social advantage and disadvantage were generated from multiple known social determinants of health. We tested a wider range of socio-demographic factors than previous studies, including UK geographic region, educational qualification level, employment status and income. Our study has a longer follow-up time than previous comparable reports, with most participants assessed more than one year after infection onset. Detailed data on health before the coronavirus pandemic and COVID-19 illness allowed models to be adjusted extensively and mediation effects to be tested. Implications of all the available evidenceThe likelihood of full recovery following COVID-19 appears to follow a social gradient, higher for individuals with multiple indicators of social advantages and fewer disadvantages, and lower for those with multiple social disadvantages and fewer advantages prior to the coronavirus pandemic. This reflects and reaffirms the established cycle of social inequalities in health, between individuals status within social hierarchies and ill-health. More work is needed to understand the pathways through which this inequality operates so that interventions can be made.

Intentions to be Vaccinated Against COVID-19: The Role of Prosociality and Conspiracy Beliefs across 20 Countries.

Understanding the determinants of COVID-19 vaccine uptake is important to inform policy decisions and plan vaccination campaigns. The aims of this research were to: (1) explore the individual- and country-level determinants of intentions to be vaccinated against SARS-CoV-2, and (2) examine worldwide variation in vaccination intentions. This cross-sectional online survey was conducted during the first wave of the pandemic, involving 6697 respondents across 20 countries. Results showed that 72.9% of participants reported positive intentions to be vaccinated against COVID-19, whereas 16.8% were undecided, and 10.3% reported they would not be vaccinated. At the individual level, prosociality was a significant positive predictor of vaccination intentions, whereas generic beliefs in conspiracy theories and religiosity were negative predictors. Country-level determinants, including cultural dimensions of individualism/collectivism and power distance, were not significant predictors of vaccination intentions. Altogether, this study identifies individual-level predictors that are common across multiple countries, provides further evidence on the importance of combating conspiracy theories, involving religious institutions in vaccination campaigns, and stimulating prosocial motives to encourage vaccine uptake.

Muscle volume, functionality and metabolic resilience during recovery following severe COVID-19

Introduction: Following hospitalisation with SARS-Cov2 infection a large proportion of individuals report fatigue as a persisting symptom. Here, we performed a detailed study of the muscle for insight into underlying mechanisms. Method(s): Adults were recruited at 5-7 months following hospital discharge for severe SARS-Cov2 infection (n=21), along with control volunteers (n=10) of a similar age, gender, ethnicity and body mass. Perceived fatigue was estimated using the fatigue severity scale. The short physical performance battery test determined habitual functionality, alongside isometric quadriceps strength normalised for appendicular mass and isokinetic force loss during 20 knee extensions (Cybex Norm dynamometer). Leg muscle volume, and phosphocreatine (PCr) resynthesis during recovery from ischemic plantar flexion exercise (an index of muscle metabolic resilience) were quantified using MRI and 31P MRS. Student t-test was used to detect differences between groups and all data are mean (SD). Result(s): Patients (P) reported greater perception of fatigue and demonstrated worse habitual functionality compared to controls (C). However, leg volume [P: 2,578 (303) cm3/m2 vs C: 2,384 (289) cm3/m2, p=0.1], strength [P: 21.8 (4.1) Nm/kg vs C: 21.1 (4.5) Nm/kg, p=0.7], force loss [P: 25% (6) vs C: 21% (10), p=0.1] and PCr recovery kinetics (Qmax) [P: 25.8 (11.3) vs C: 22.8 (8.7), p=0.5] were not different. Conclusion(s): Despite greater perception of fatigue and lower habitual functionality, patients recovering from severe COVID-19 infection did not have altered muscle volume, strength, fatiguability or metabolic resilience compared to controls.

Pandemic boredom: Little evidence that lockdown-related boredom affects risky public health behaviors across 116 countries.

Some public officials have expressed concern that policies mandating collective public health behaviors (e.g., national/regional "lockdown") may result in behavioral fatigue that ultimately renders such policies ineffective. Boredom, specifically, has been singled out as one potential risk factor for noncompliance. We examined whether there was empirical evidence to support this concern during the COVID-19 pandemic in a large cross-national sample of 63,336 community respondents from 116 countries. Although boredom was higher in countries with more COVID-19 cases and in countries that instituted more stringent lockdowns, such boredom did not predict longitudinal within-person decreases in social distancing behavior (or vice versa; n = 8,031) in early spring and summer of 2020. Overall, we found little evidence that changes in boredom predict individual public health behaviors (handwashing, staying home, self-quarantining, and avoiding crowds) over time, or that such behaviors had any reliable longitudinal effects on boredom itself. In summary, contrary to concerns, we found little evidence that boredom posed a public health risk during lockdown and quarantine. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Gender and Racial/Ethnic Disparities in Undergraduate and Graduate Students' Mental Health and Treatment Use Amid the COVID-19 Pandemic.

The COVID-19 pandemic has negatively impacted numerous people?s mental health and created new barriers to services. To address the unknown effects of the pandemic on accessibility and equality issues in mental health care, this study aimed to investigate gender and racial/ethnic disparities in mental health and treatment use in undergraduate and graduate students amid the COVID-19 pandemic. The study was conducted based on a largescale online survey (N = 1,415) administered during the weeks following a pandemic-related university-wide campus closure in March 2020. We focused on the gender and racial disparities in current internalizing symptomatology and treatment use. Our results showed that in the initial period of the pandemic, students identified as cis women (p < .001), non-binary/genderqueer (p < .001), or Hispanic/Latinx (p = .002) reported higher internalizing problem severity (aggregated from depression, generalized anxiety, intolerance of uncertainty, and COVID-19-related stress symptoms) compared to their privileged counterparts. Additionally, Asian (p < .001) and multiracial students (p = .002) reported less treatment use than White students while controlling for internalizing problem severity. Further, internalizing problem severity was associated with increased treatment use only in cisgender, non-Hispanic/Latinx White students (pcis man = 0.040, pcis woman < 0.001). However, this relationship was negative in cis-gender Asian students (pcis man = 0.025, pcis woman = 0.016) and nonsignificant in other marginalized demographic groups. The findings revealed unique mental health challenges faced by different demographic groups and served as a call that specific actions to enhance mental health equity, such as continued mental health support for students with marginalized gender identities, additional COVID-related mental and practical support for Hispanic/Latinx students and promotion of mental health awareness, access, and trust in non-White, especially Asian, students are desperately needed.

Coding-Complete Genome Sequences of 40 SARS-CoV-2 Omicron XBB, XBB.1, and XBB.2 Sublineage Strains in Bangladesh.

Here, we report the coding-complete genome sequences of 40 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains of the newly emerged recombinant Omicron variants XBB, XBB.1, and XBB.2. The strains were isolated from nasopharyngeal swab samples that had been collected from symptomatic patients in Bangladesh between September and October 2022 and were sequenced using an Oxford Nanopore Technologies (ONT) system.

Relations between higher- and lower-order alcohol and cannabis expectancies and simultaneous use frequency among undergraduate dual users

Simultaneous alcohol and cannabis (i.e. marijuana;[SAM]) use is prevalent among college students. There is limited research on expectancy effects for SAM use, which are known correlates of use frequency and mediators of treatment outcomes. We examined the unique associations of both positive and negative alcohol and cannabis expectancies with frequency of SAM use among college students. Participants were 1012 college students (70.9% female, 51.8% white, Mage = 19.63) from seven US universities who reported past-month alcohol and cannabis use (77.2% of the sample reported SAM use). Students completed measures of past-month typical weekly alcohol and cannabis frequency and quantity, alcohol and cannabis expectancies, and SAM frequency through an online self-reported survey. A negative binomial regression revealed that higher-order positive, but not negative, alcohol and cannabis expectancies were significant predictors of SAM frequency above and beyond frequency of alcohol and cannabis use, biological sex, and whether the survey was completed pre- or post-COVID-19 campus closures. Specifically, higher frequency SAM use was associated with weaker positive alcohol and stronger positive cannabis expectancies. A second negative binomial regression including lower-order expectancies found that SAM frequency was associated with weaker social and cognitive and behavioral impairment alcohol expectancies and stronger sexual and social facilitation cannabis and liquid courage alcohol expectancies, specifically. Results highlight the importance of comprehensively examining both higher- and lower-order alcohol and cannabis expectancies when examining SAM frequency, and provide avenues of targeted intervention to reduce SAM use among dual users.

Tendency to Share Positive Emotions Buffers Loneliness-Related Negativity in the Context of Shared Adversity.

Loneliness is associated with adverse outcomes, and the COVID-19 pandemic threatened to increase loneliness. How loneliness-related outcomes unfold, though, varies across individuals. Individuals' sense of social connectedness and engagement with others to regulate emotional experiences (interpersonal emotion regulation; IER) may modulate loneliness-related outcomes. Individuals failing to maintain social connectedness and/or regulate emotions may be at heightened risk. We assessed how loneliness, social connectedness, and IER related to valence bias, a tendency to categorize ambiguity as more positive or negative. Loneliness was associated with a more negative valence bias among individuals reporting above average social connectedness but who shared positive emotion less often (z=-3.19, p=.001). These findings suggest that sharing positive emotional experiences may buffer loneliness-related outcomes during shared adverse experiences.

Nonutility of procalcitonin for diagnosing bacterial pneumonia in patients with severe COVID-19.

Background: Patients hospitalized with COVID-19 are at significant risk for superimposed bacterial pneumonia. However, diagnosing superinfection is challenging due to its clinical resemblance to severe COVID-19. We therefore evaluated whether the immune biomarker, procalcitonin, could facilitate the diagnosis of bacterial superinfection. Methods: We retrospectively identified 185 patients hospitalized with severe COVID-19 who underwent lower respiratory culture; 85 had evidence of bacterial superinfection. Receiver operating characteristic curve and area under the curve (AUC) analyses were performed to assess the utility of procalcitonin for diagnosing superinfection. Results: This approach demonstrated that procalcitonin measured at the time of culture was incapable of distinguishing patients with bacterial infection (AUC, 0.52). The AUC not affected by exposure to antibiotics, treatment with immunomodulatory agents, or timing of procalcitonin measurement. Conclusion: Static measurement of procalcitonin does not aid in the diagnosis of superinfection in severe COVID-19.

Worse survival in patients with right ventricular dysfunction and COVID-19-associated acute respiratory distress requiring extracorporeal membrane oxygenation: A multicenter study from the ORACLE Group.

OBJECTIVE: We sought to determine the impact of right ventricular dysfunction on the outcomes of mechanically ventilated patients with COVID-19 requiring veno-venous extracorporeal membrane oxygenation. METHODS: Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with veno-venous extracorporeal membrane oxygenation during the first wave of the pandemic (March to August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics, and survival were compared. RESULTS: The cohort included 424 mechanically ventilated patients with COVID-19, 126 of whom were cannulated for veno-venous extracorporeal membrane oxygenation. Right ventricular dysfunction was observed in 38.1% of patients who received extracorporeal membrane oxygenation and 27.4% of patients who did not receive extracorporeal membrane oxygenation with an echocardiogram. Biventricular dysfunction was observed in 5.5% of patients who received extracorporeal membrane oxygenation. Baseline patient characteristics were similar in both the extracorporeal membrane oxygenation and non-extracorporeal membrane oxygenation cohorts stratified by the presence of right ventricular dysfunction. In the extracorporeal membrane oxygenation cohort, right ventricular dysfunction was associated with increased inotrope use (66.7% vs 24.4%, P < .001), bleeding complications (77.1% vs 53.8%, P = .015), and worse survival independent of left ventricular dysfunction (39.6% vs 64.1%, P = .012). There was no significant difference in days ventilated before extracorporeal membrane oxygenation, length of hospital stay, hours on extracorporeal membrane oxygenation, duration of mechanical ventilation, vasopressor use, inhaled pulmonary vasodilator use, infectious complications, clotting complications, or stroke. The cohort without extracorporeal membrane oxygenation cohort demonstrated no statistically significant differences in in-hospital outcomes. CONCLUSIONS: The presence of right ventricular dysfunction in patients with COVID-19-related acute respiratory distress syndrome supported with veno-venous extracorporeal membrane oxygenation was associated with increased in-hospital mortality. Additional studies are required to determine if mitigating right ventricular dysfunction in patients requiring veno-venous extracorporeal membrane oxygenation improves mortality.

Genome Sequences of 23 SARS-CoV-2 Omicron-Lineage Strains from Bangladesh.

We announce the coding-complete genome sequences of 23 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron strains obtained from Bangladeshi individuals. The Oxford Nanopore Technologies sequencing platform was utilized to generate the genomic data, deploying ARTIC Network-based amplicon sequencing.

Use of Asynchronous Interprofessional e-Consults in Cancer Patients During the COVID-19 Pandemic: Current and Future Role.

The COVID-19 pandemic created a unique challenge to health care systems, requiring rapid implementation of telemedicine services to provide continued care to patients while preserving personal protective equipment and decreasing the risk of disease transmission. Herein, we describe how our institution, an urban cancer center, utilized provider-to-provider telemedicine consultations (interprofessional e-consults) to provide subspecialty access to care to vulnerable patients in the epicenter of a global pandemic.

Practice Patterns of Pediatric Ophthalmologists During the COVID-19 Pandemic.

PURPOSE: To report the use of protective personal equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A 12-question multiple-choice survey was posted on a discussion board used by members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Respondents provided information about their experience, PPE use, office equipment, and approach to care during the COVID-19 pandemic. RESULTS: One hundred twenty-eight pediatric ophthalmologists completed the survey. Eighty-seven (68.0%) identified as in private practice, whereas 41 (32.0%) identified as in an academic setting. Sixty-nine pediatric ophthalmologists (53.9%) reported routinely using N95 respirators, 72 (56.3%) reported wearing medical scrubs, 41 (32.0%) reported using disposable gloves, 33 (25.7%) reported wearing goggles, and 12 (9.4%) reported using face shields during office examinations. One hundred twenty-one pediatric ophthalmologists (94.5%) reported having slit lamps with plastic shields and 52 (40.6%) reported having phoropters with plastic shields. Ninety-nine (77.3%) responded that they would see a patient older than 2 years who refused to wear a mask for a nonemergency visit. CONCLUSIONS: Practice patterns of pediatric ophthalmologists have varied during the COVID-19 pandemic. [J Pediatr Ophthalmol Strabismus. 2022;59(3):145-150.].

Cardiac Surgery Outcomes During the COVID-19 Pandemic Worsened Across All Socioeconomic Statuses.

BACKGROUND: Increasing socioeconomic distress has been associated with worse cardiac surgery outcomes. The extent to which the pandemic affected cardiac surgical access and outcomes remains unknown. We sought to examine the relationship between the COVID-19 pandemic and outcomes after cardiac surgery by socioeconomic status. METHODS: All patients undergoing a Society of Thoracic Surgeons (STS) index operation in a regional collaborative, the Virginia Cardiac Services Quality Initiative (2011-2022), were analyzed. Patients were stratified by timing of surgery before vs during the COVID-19 pandemic (March 13, 2020). Hierarchic logistic regression assessed the relationship between the pandemic and operative mortality, major morbidity, and cost, adjusting for the Distressed Communities Index (DCI), STS predicted risk of mortality, intraoperative characteristics, and hospital random effect. RESULTS: A total of 37,769 patients across 17 centers were included. Of these, 7269 patients (19.7%) underwent surgery during the pandemic. On average, patients during the pandemic were less socioeconomically distressed (DCI 37.4 vs DCI 41.9; P < .001) and had a lower STS predicted risk of mortality (2.16% vs 2.53%, P < .001). After risk adjustment, the pandemic was significantly associated with increased mortality (odds ratio 1.398; 95% CI, 1.179-1.657; P < .001), cost (+$4823, P < .001), and STS failure to rescue (odds ratio 1.37; 95% CI, 1.10-1.70; P = .005). The negative impact of the pandemic on mortality and cost was similar regardless of DCI. CONCLUSIONS: Across all socioeconomic statuses, the pandemic is associated with higher cost and greater risk-adjusted mortality, perhaps related to a resource-constrained health care system. More patients during the pandemic were from less distressed communities, raising concern for access to care in distressed communities.

COVID-19 and multiple sclerosis: a thematic analysis of the unique experiences of people with multiple sclerosis during the COVID-19 pandemic

Introduction: The impact of the COVID-19 pandemic on people living with multiple sclerosis (MS) is expected to be significant. Whilst quantitative research in this area has been undertaken, there is a paucity of qualitative research;this study will therefore provide valuable insights into individual experiences and perceptions of people with MS (PwMS) in the United Kingdom (UK) during this unique period. Objective(s): The ongoing global health crisis leaves us all in a state of uncertainty that requires constant adaptation to the new 'normal' we are living in, and it is important that the challenges faced by the MS community are recognised and addressed as part of this learning process. We explore self-reported data gathered during the pandemic to reach conclusions regarding the impact of the crisis on PwMS. Aim(s): To enhance understanding of the experiences of PwMs during the COVID-19 pandemic and identifying potential areas where further support could be beneficial. Method(s): Between March 3 and October 29, 2020, 1,685 free-text comments regarding the unique experiences of PwMS were collected online by the UK MS Register (UKMSR). Thematic analysis of 1,000 randomly selected responses made by 682 individuals was used to investigate the perceived impact of COVID-19 on the participants, following a constructivist approach. Result(s): Five main themes were identified in the data: connectedness, attitudes towards change, mental health, stigma, and information and advice. Results of the thematic analysis were varied, with significant numbers reporting positive experiences of the pandemic. Conclusion(s): Individual levels of connectedness and attitude towards change significantly influence how PwMS experience life during the COVID-19 outbreak. The data showed the impact of COVID-19 on mental health to be mixed among PwMS. The pandemic hashighlighted that some PwMS remain fearful of being stigmatised in the workplace because of their condition.

Enhancing information extraction from patient reported outcomes: the impact of COVID-19 on people with multiple sclerosis during the UK pandemic

Introduction: Online registries enable home-based, cost-effective and long-term follow up. The benefits were highlighted during the pandemic where lockdowns limited engagement with health professionals. The UK MS Register has been collecting patient reported outcomes (PROs) over 11 years. PROs consist of a number of questions summed to form a total, however, each question has a scale and addresses a particular problem. Objectives/Aims: We investigated the responses to individual questions of the Multiple Sclerosis Impact Scale (MSIS-29) and the Hospital Anxiety and Depression Scale (HADS) through a series of lockdowns throughout the evolving crisis. Method(s): We studied 5 timepoints (March 2019, September 2019, March 2020, September 2020, March 2021) spanning the pandemic. ~1000 patients completed all timepoints. We studied how the responses to each questionnaire item changed, evaluating the %patients who reported an increased, decreased or stable rating of each item over each 6-months window (e.g. March-September 2019). We then quantified the change in %patients across windows. Significance was evaluated using permutation testing. Result(s): >50% patients stayed stable across all questionnaire items over a period of 6 months and the remaining patients either got better or worse. This fluctuating behaviour is not unexpected in MS. The change in %patients reporting an increased, decreased and stable item rating over 6-months periods did not change significantly for most items. Notably, the items where a significant change was observed, could be directly related to Covid-19 given the nature of the question. These included "feeling stuck at home", "having to cut down time spent on work" and "feeling limited in your social and leisure activities" for MSIS-29 and "feeling frightened something awful is about to happen", "being able to see the funny side of things" and "losing interest in your personal appearance" for HADS. Conclusion(s): PROs capture disease specific elements, including MS patients variability and fluctuating symptoms, but are also sensitive to external factors such as the social context. When considering the questionnaires' total scores this information can be lost. Detailed item-level analyses can help disentangle the causes behind observed trends and the relations between disease-related and external factors (e.g. covid in this specific case) adding to the relevance of PROs in monitoring disease long-term.

DYNAMO Covid-19 Dynamic assessment of multi organ level dysfunction in patients recovering from Covid-19: insulin resistance and metabolic flexibility

P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.

Cost of the Otolaryngology Residency Application Process: Comparison With Other Specialties and Equity Implications.

Objective: This study aims to assess trends in applicant-reported costs of the otolaryngology residency application process between 2019 and 2021 and evaluate the impact of application costs on number of interview offers. Study Design: Cross-sectional study. Setting: US allopathic and osteopathic medical schools. Methods: Survey data from applicants were obtained from the Texas STAR database (Seeking Transparency in Application to Residency) for the years 2019 to 2021. Outcomes included total cost, interview cost, other costs, application fees, and number of interview offers. Simple and multivariable linear regression was used to identify novel predictors of cost and assess the correlation between cost and interview offers. Results: Among 363 otolaryngology applicants, there was a 74% reduction in total costs and a 97% reduction in interview costs in the 2021 cycle vs the 2020 cycle. Significant predictors of total cost among otolaryngology applicants included the number of away rotations (P < .01), the number of research experiences (P = .04), and couples matching (P < .01). During the 2019 and 2020 application cycles, there was a significant association between applicant-reported total spending and number of otolaryngology interview offers (P < .01), which was not present during the 2021 cycle (P = .35). Conclusion: Number of otolaryngology interview offers appears to be directly correlated with applicant-reported total costs regardless of number of applications or interviews attended, which may be a source of inequality in the application process. There was a drastic reduction in total costs, interview costs, and other costs during the COVID-19 pandemic, which was likely driven by virtual interviewing and the absence of away rotations.

Individual differences in appraisals of emotional ambiguity: Biological, psychological, and social predictors

Uncertainty is ubiquitous in life, and its impacts are seen in decision-making across diverse contexts (e.g., financial, health, and interpersonal/social). As a result, individual differences in response to emotional ambiguity, a special type of uncertainty, can have far-reaching impacts. A growing literature has explored these individual differences in valence bias, or the tendency to appraise ambiguous social signals as more positive or negative. Although these appraisals are generally characterized by an initial negativity, many individuals arrive at positive appraisals through regulatory processes. Chronic negativity appears to be linked to an increased risk of mood and anxiety symptoms and has spurred research assessing predictors of valence bias at the biological, psychological, and social levels, that support the overriding of initial negativity. Here, biological predictors are probed via resting-state functional connectivity, in particular among emotion regulation (i.e., amygdala and PFC) and task performance (i.e., cingulo-opercular) brain networks, which are leveraged to predict individual differences in valence bias with machine learning algorithms. Next, psychological predictors are explored in the context of a Mindfulness-Based Stress Reduction intervention - showing a malleability of the trait-like valence bias. Then, the broad-scale uncertainty stemming from the COVID-19 pandemic and its impacts on valence bias over the period of approximately 15 months is characterized, showing a generalized increase in negativity at the start of the pandemic but individual differences in this change after the pandemic's onset. Findings from each of these three levels of analysis are then discussed in the context of understanding sources of variability in individual differences in valence bias and improving physical and mental well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved)