Biomarker-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection: statistical analysis plan for the BATCH trial and PRECISE sub-study.

INTRODUCTION: The BATCH trial is a multi-centre randomised controlled trial to compare procalcitonin-guided management of severe bacterial infection in children with current management. PRECISE is a mechanistic sub-study embedded into the BATCH trial. This paper describes the statistical analysis plan for the BATCH trial and PRECISE sub-study. METHODS: The BATCH trial will assess the effectiveness of an additional procalcitonin test in children (aged 72 h to 18 years) hospitalised with suspected or confirmed bacterial infection to guide antimicrobial prescribing decisions. Participants will be enrolled in the trial from randomisation until day 28 follow-up. The co-primary outcomes are duration of intravenous antibiotic use and a composite safety outcome. Target sample size is 1942 patients, based on detecting a 1-day reduction in intravenous antibiotic use (90% power, two-sided) and on a non-inferiority margin of 5% risk difference in the composite safety outcome (90% power, one-sided), while allowing for up to 10% loss to follow-up. RESULTS: Baseline characteristics will be summarised overall, by trial arm, and by whether patients were recruited before or after the pause in recruitment due to the COVID-19 pandemic. In the primary analysis, duration of intravenous antibiotic use will be tested for superiority using Cox regression, and the composite safety outcome will be tested for non-inferiority using logistic regression. The intervention will be judged successful if it reduces the duration of intravenous antibiotic use without compromising safety. Secondary analyses will include sensitivity analyses, pre-specified subgroup analyses, and analysis of secondary outcomes. Two sub-studies, including PRECISE, involve additional pre-specified subgroup analyses. All analyses will be adjusted for the balancing factors used in the randomisation, namely centre and patient age. CONCLUSION: We describe the statistical analysis plan for the BATCH trial and PRECISE sub-study, including definitions of clinical outcomes, reporting guidelines, statistical principles, and analysis methods. The trial uses a design with co-primary superiority and non-inferiority endpoints. The analysis plan has been written prior to the completion of follow-up. TRIAL REGISTRATION: BATCH: ISRCTN11369832, registered 20 September 2017, doi.org/10.1186/ISRCTN11369832. PRECISE: ISRCTN14945050, registered 17 December 2020, doi.org/10.1186/ISRCTN14945050.

The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults.

LAY ABSTRACT: Autistic people may be at higher risk of suicidal behavior than people in the general population. Suicidal behavior may include thinking about suicide or attempting to end one's own life by suicide. It is important to identify autistic people who may be thinking about suicide. People who are at risk of suicidal behavior can be identified by asking questions about whether they have been thinking about suicide. A specially designed questionnaire, or screening instrument, can help someone ask the best questions to find out if someone has been thinking about suicide. This information can help to identify supports to be put in place to prevent suicidal behavior, such as a suicide attempt. However, autistic people may interpret questions differently than non-autistic people. It is important to use screening tools that have been designed with, and for autistic people. In this study, we examined the Suicidal Ideation Attributes Scale (SIDAS). The SIDAS is an existing tool that was developed to screen for suicidal thinking in the general population. We modified SIDAS for use with autistic adults. We involved autistic people in the process of modifying SIDAS. We called the modified instrument the SIDAS-M. The results of our study showed SIDAS-M may be useful for screening for suicidal thinking in autistic adults who do not have an intellectual disability.

Live experience of people with diabetes mellitus on self-management during COVID-19 in remote area of Indonesia

I n tro d u c tio n: People with Diabetes Mellitus (DM) are vulnerable to COVID-19. Therefore, it's important to maintain good self-management (diet, exercise, medicine, and health care visitations) during pandemics. Unfortunately, during the COVID-19 pandemic, it's difficult for them to maintain adequate self-management. Therefore, this study aimed to explore the self-management of people with DM during the pandemic, especially in a remote area of Indonesia. M ethods: This study is qualitative and uses the phenomenology method. The data was obtained from 10 people with Diabetes Mellitus using face-to-face interviews. Data collected was analyzed thematic using Atlas.ti software and statements from participants were presented verbatim to illustrate the themes realized. Results: Participants'experience in self-management during COVID-19 was categorized into three themes and ten sub-themes. The three themes emerged from the study: psychological distress of being vulnerable to COVID-19, preferring traditional over medical treatment,andprejudgmenttowardhealthcareworkers and facilities. Conclusion: Rural residents with DM experience psychological distress, leading to poor self-management and stigma toward healthcare workers and facilities. Therefore, it is important to do comprehension care consisting of self-management, psychologicalcare,andeducationonthestigmaaround COVID-19 for people with DM. © 2022 Academia Nacional de Medicina. All rights reserved.

TREM2+ and interstitial-like macrophages orchestrate airway inflammation in SARS-CoV-2 infection in rhesus macaques.

The immunopathological mechanisms driving the development of severe COVID-19 remain poorly defined. Here, we utilize a rhesus macaque model of acute SARS-CoV-2 infection to delineate perturbations in the innate immune system. SARS-CoV-2 initiates a rapid infiltration of plasmacytoid dendritic cells into the lower airway, commensurate with IFNA production, natural killer cell activation, and a significant increase of blood CD14-CD16+ monocytes. To dissect the contribution of lung myeloid subsets to airway inflammation, we generate a longitudinal scRNA-Seq dataset of airway cells, and map these subsets to corresponding populations in the human lung. SARS-CoV-2 infection elicits a rapid recruitment of two macrophage subsets: CD163+MRC1-, and TREM2+ populations that are the predominant source of inflammatory cytokines. Treatment with baricitinib (Olumiant®), a JAK1/2 inhibitor is effective in eliminating the influx of non-alveolar macrophages, with a reduction of inflammatory cytokines. This study delineates the major lung macrophage subsets driving airway inflammation during SARS-CoV-2 infection.

Surface-Functionalized Metal-Organic Frameworks for Binding Coronavirus Proteins.

Since the outbreak of SARS-CoV-2, a multitude of strategies have been explored for the means of protection and shielding against virus particles: filtration equipment (PPE) has been widely used in daily life. In this work, we explore another approach in the form of deactivating coronavirus particles through selective binding onto the surface of metal-organic frameworks (MOFs) to further the fight against the transmission of respiratory viruses. MOFs are attractive materials in this regard, as their rich pore and surface chemistry can easily be modified on demand. The surfaces of three MOFs, UiO-66(Zr), UiO-66-NH2(Zr), and UiO-66-NO2(Zr), have been functionalized with repurposed antiviral agents, namely, folic acid, nystatin, and tenofovir, to enable specific interactions with the external spike protein of the SARS virus. Protein binding studies revealed that this surface modification significantly improved the binding affinity toward glycosylated and non-glycosylated proteins for all three MOFs. Additionally, the pores for the surface-functionalized MOFs can adsorb water, making them suitable for locally dehydrating microbial aerosols. Our findings highlight the immense potential of MOFs in deactivating respiratory coronaviruses to be better equipped to fight future pandemics.

Suicidal ideation among men during COVID-19: Examining the roles of loneliness, thwarted belongingness, and personality impairment.

Suicidal ideation (SI) is a known precursor to suicide among men. While loneliness and thwarted belongingness (TB) have been identified as key factors influencing SI, no study has reported on all three constructs to investigate whether loneliness is associated with SI by way of TB. Furthermore, it is not clear whether personality impairment has a moderating role on this process. The present study examined the impact of loneliness on SI among men and whether TB mediated this relationship. Additionally, the study investigated whether personality impairment (i.e., self-functioning, interpersonal functioning) moderated the relationship between loneliness and TB. Canadian men (N = 434) completed an online survey that included self-report assessments of the study constructs. Conditional process modeling was used to test the indirect effect of loneliness on SI via the mediating effect of TB. Findings indicated a significant association between loneliness and SI that was mediated by TB. Further, impairment in self-functioning moderated the relationship between loneliness and TB, indicating that the relationship was stronger among men with greater difficulties in self-functioning. The findings are important to consider within the COVID-19 context, as they point to the need to reduce the detrimental impacts of loneliness, thereby potentially mitigating male SI.

Suicidal ideation in men during COVID-19: an examination of protective factors.

BACKGROUND: Men account for three-quarters of all suicide deaths in many Western nations including Australia. Whilst extensive research has examined risk factors for suicidal ideation and behaviour in men, protective factors remain underexplored, particularly social support, resilience and coping behaviours. Such factors are important to examine particularly in the context of COVID-19, where enforced isolation (among other negative lifestyle effects) has created widespread risk for the development of suicidal ideation. This mixed-methods study aimed to examine associations of various protective factors with suicidal ideation in men, using data from an online survey conducted during the COVID-19 pandemic. In addition, we aimed to qualitatively investigate men's self-reported protective strategies when experiencing suicidal thoughts and behaviour. METHODS: A convenience sample of 700 men (age M = 50.3 years; SD = 15.2 years) responded to an online survey including quantitative measures of suicidal ideation, planning and attempt, alongside employment and relationship status, coping, social support, resilience, and a qualitative free-text item gauging men's self-reported protective strategies. Multinomial logistic regression was applied to compare odds of sub-categories of suicide risk (ideation; planning) according to protective factors. Qualitative responses were analysed via thematic analysis. RESULTS: Men in a relationship, and those lower in emotion-focused and avoidant coping reported lower odds of suicidal ideation. Maintaining employment throughout the pandemic was protective against suicidal ideation and planning; as was greater perceived social support from friends. Greater self-reported resilience was protective against suicidal ideation and planning. Qualitative analyses led to the development of two themes: coping and connecting, reflecting men's intra- and interpersonal management strategies; and sustaining selflessness, where men's imaginings of the collateral damage of their suicidal behaviour was protective against action on suicidal thoughts or plans. CONCLUSIONS: Findings of this study speak to the nuanced roles of interpersonal connections, resilience and coping behaviours in protecting against suicidal ideation and planning in men. In addition, qualitative insights further cement men's identification with familial protector and/or provider roles as protective against suicidal action.

Social support buffers young men's resilient coping to psychological distress.

AIM: Social support and resilient coping can aid mental health. The aim of this study was to examine age effects of social support on men's resilient coping for psychological distress. METHODS: The sample consisted of 434 help-seeking Canadian men who completed standardized measures. Regression analyses tested a moderated moderation model, controlling for COVID-19 pandemic impact. RESULTS: Greater resilient coping was associated with lower psychological distress and this relationship was moderated by social support. Higher levels of social support had a significant positive effect on men's resilient coping for psychological distress. Findings indicated that younger men (18-24 years) were most positively buffered by social support. CONCLUSIONS: Social support appears to be particularly important for young men's coping response to psychological distress. This is an important finding in the context of the COVID-19 pandemic, where social support networks have been challenged. Community-based and clinical programs and initiatives that proactively target young men's development of social connections and robust supportive networks, while bolstering their individual resilient coping skills, are likely to provide protections from psychological distress.

Early Clinical Interventions Dictate Favorable Outcomes: A Case of Lemierre Syndrome

INTRODUCTION: Lemierre's syndrome (LS) is characterized by fever, sore throat, neck swelling and tenderness, and septic thrombophlebitis of the jugular vein. It remains a fatal disease as serious complications commonly arise. DESCRIPTION: 20-year-old male patient with not known past medical history endorsed 1 week of sore throat, emesis, loose stools, weight loss as well as dyspnea associated with bilateral, non-pleuritic chest pain, night sweats, myalgias and subjective fever sensation. Patient was initially hypoxic, hypotensive, tachycardic, tachypneic and febrile, with scleral icterus, lymphadenopathy of neck and jaw bilaterally, enlarged tonsils, and diffuse abdominal tenderness. Laboratory results showed leukocytosis with neutrophile predominance, anemia, thrombocytopenia, elevated inflammatory markers. There was also pre-renal acute kidney injury, elevated alkaline phosphatase and hyperbilirubinemia. SARS-CoV-2 tests were negative. Initial computerized tomography (CT) of the chest showed extensive peripheral ground-glass nodules and rounded consolidations, with lower lobe predominance. Admission to medical ICU was warranted. Initial blood cultures showed no identification of speciation;Ceftriaxone was started with satisfactory response. However, patient developed worsening shortness of breath, orthopnea, rightsided neck pain and erythema. Repeat imaging showed new airspace opacities in both lungs with cavitation consistent with septic emboli, and thrombophlebitis of right jugular vein with no abscess. At that point, blood cultures grew Fusobacterium necrophorum and metronidazole was started. A four-week course was completed upon discharge with satisfactory response. DISCUSSION: Lemierre's syndrome remains as a rare but potentially fatal entity. Internal jugular vein (IJV) thrombophlebitis occurs through infection of the lateral pharyngeal space. Pulmonary metastases are common. Metronidazole comprises the foundation of the treatment given its tissue penetration and activity against all strains of Fusobacterium spp. Data regarding anticoagulation efficacy is limited. Clinicians should maintain high clinical suspicion, and a multidisciplinary approach with broad collaboration among specialties is imperative to aid early diagnosis and better clinical outcomes.

Comparison between viral vector and mRNA based COVID-19 vaccination in prevalence and severity of regional immune reactions, and 18F-FDG PET/CT features.

Objectives: The coronavirus pandemic caused by SARS-CoV-2 commenced in late 2019, and global wide vaccination appears to be the only reasonable solution to fight this dreadful virus. There are two main types of COVID-19 immunization using viral vector and mRNA-based vaccines. However, the impact of each of type on 18F-FDG PET/CT needs to be accurately assessed. This study aimed to compare the 18F-FDG PET/CT features of these two types of COVID-19 vaccines. Methods: A total of 188 patients referred for 18F-FDG PET/CT with a recent history of either BioNTech/Pfizer or AstraZeneca COVID-19 vaccination, and a control group of 40 patients with no history of any type of recent vaccination, were included in the study. 18F-FDG PET/CT studies of vaccinated patients assessed for injection site uptake and regional nodal and systemic reactions post vaccination. The data were compared to the control group and to the contralateral side for each patient. The findings were compared between patients who received Pfizer and AstraZeneca vaccines. Results: 18F-FDG PET/CT was semiquantitatively positive in 50.5% of the studied population for vaccine-related features. The ipsilateral axillary and infra- and supraclavicular lymph nodes were significantly larger in size and exhibited higher metabolic activity compared to the contralateral lymph nodes after both types of vaccination. The prevalence of regional nodal reactions post Pfizer and AstraZeneca vaccination was 39% and 17.9% on visual, and 61% and 47.6% on semiquantitative assessments, respectively. Patients receiving the Pfizer vaccine exhibited higher metabolic activity in the ipsilateral regional lymph nodes (p<0.05). No significant difference in the intensity of regional nodal reaction post vaccination was noted between the first four weeks. Conclusion: Significant local and regional nodal reactions are observed after both viral vector and mRNA COVID-19 vaccination with a tendency to extend toward the infra- and supraclavicular nodal stations but not to the pulmonary hilum. The greater intensity and extension of the nodal reaction after Pfizer vaccination suggests a higher possibility of false-positive results on 18F-FDG PET/CT studies using mRNA vaccination technology.

SARS-CoV-2 Induces Epithelial-Enteric Neuronal Crosstalk Stimulating VIP Release.

BACKGROUND: Diarrhea is present in up to 30-50% of patients with COVID-19. The mechanism of SARS-CoV-2-induced diarrhea remains unclear. We hypothesized that enterocyte-enteric neuron interactions were important in SARS-CoV-2-induced diarrhea. SARS-CoV-2 induces endoplasmic reticulum (ER) stress in enterocytes causing the release of damage associated molecular patterns (DAMPs). The DAMPs then stimulate the release of enteric neurotransmitters that disrupt gut electrolyte homeostasis. METHODS: Primary mouse enteric neurons (EN) were exposed to a conditioned medium from ACE2-expressing Caco-2 colonic epithelial cells infected with SARS-CoV-2 or treated with tunicamycin (ER stress inducer). Vasoactive intestinal peptides (VIP) expression and secretion by EN were assessed by RT-PCR and ELISA, respectively. Membrane expression of NHE3 was determined by surface biotinylation. RESULTS: SARS-CoV-2 infection led to increased expression of BiP/GRP78, a marker and key regulator for ER stress in Caco-2 cells. Infected cells secreted the DAMP protein, heat shock protein 70 (HSP70), into the culture media, as revealed by proteomic and Western analyses. The expression of VIP mRNA in EN was up-regulated after treatment with a conditioned medium of SARS-CoV-2-infected Caco-2 cells. CD91, a receptor for HSP70, is abundantly expressed in the cultured mouse EN. Tunicamycin, an inducer of ER stress, also induced the release of HSP70 and Xbp1s, mimicking SARS-CoV-2 infection. Co-treatment of Caco-2 with tunicamycin (apical) and VIP (basolateral) induced a synergistic decrease in membrane expression of Na+/H+ exchanger (NHE3), an important transporter that mediates intestinal Na+/fluid absorption. CONCLUSIONS: Our findings demonstrate that SARS-CoV-2 enterocyte infection leads to ER stress and the release of DAMPs that up-regulates the expression and release of VIP by EN. VIP in turn inhibits fluid absorption through the downregulation of brush-border membrane expression of NHE3 in enterocytes. These data highlight the role of epithelial-enteric neuronal crosstalk in COVID-19-related diarrhea.

Existential isolation and psychological distress during COVID-19: The role of loneliness and resilient coping in Canadian help-seeking men.

BACKGROUND: The COVID-19 pandemic has had a significant impact on men's lives. Investigating specific constructs and pathways related to men's mental health outcomes may help to more fully understand the short and long-term impact of the pandemic and illuminate opportunities to better promote men's mental health. In this study, we assessed the mediating effect of loneliness on the relationship between existential isolation and psychological distress, and the moderating effect of resilient coping on that relationship. METHODS: This cross-sectional study included a sample of help-seeking Canadian men in the first year of the COVID-19 pandemic (N = 434). Participants completed measures of existential isolation, loneliness, resilient coping, and psychological distress. A moderated mediation analysis was conducted. RESULTS: Over half (54 %) of the participants reported psychological distress in a clinical range. Findings indicated that loneliness was a significant mediator in the association between existential isolation and psychological distress. Furthermore, findings revealed that resilient coping moderated the relationship between loneliness and psychological distress, such that men who were low on resilient coping experienced the greatest effect on psychological distress. LIMITATIONS: The employed mediation analyses were cross-sectional in nature, limiting any firm conclusions regarding causality. CONCLUSIONS: Efforts to reduce psychological distress may be targeted at decreasing men's experiences of existential isolation or improving resilient coping. Consideration should be given to contextual factors related to COVID-19 as well as men's preferences for help-seeking and mental health support.

"I could hang up if the practitioner was a prat": Australian men's feedback on telemental healthcare during COVID-19.

The COVID-19 pandemic restrictions, uncertainties and management inconsistencies have been implicated in men's rising distress levels, which in turn have somewhat normed the uptake of telemental healthcare services (i.e., phone and/or video-conference-based therapy). Given past evidence of poor engagement with telemental health among men, this mixed-methods study examined Australian men's use of, and experiences with telemental health services relative to face-to-face care during the pandemic. A community sample of Australian-based men (N = 387; age M = 47.5 years, SD = 15.0 years) were recruited via Facebook advertising, and completed an online survey comprising quantitative items and open-response qualitative questions with the aim of better understanding men's experiences with telemental healthcare services. In total, 62.3% (n = 241) of participants reported experience with telemental health, and regression analyses revealed those who engaged with telemental health were on average younger, more likely to be gay and university educated. Men who had used telemental health were, on average, more satisfied with their therapy experience than those who had face-to-face therapy. Among those who had telemental healthcare, marginally lower satisfaction was observed among regional/rural based relative to urban men, and those who had to wait longer than 2 months to commence therapy. Qualitative findings highlighted positive aspects of telemental healthcare including comfort with accessing therapy from familiar home environments and the convenience and accessibility of telemental health alongside competing commitments and COVID-19 restrictions. Conversely, drawbacks included technical limitations such as crosstalk impeding therapeutic progress, disconnects and audio-visual lag-times and the 'impersonal' nature of telemental healthcare services. Findings broadly signal COVID-19 induced shifts norming of the use of virtual therapy services, with clear scope for improvement in the delivery of therapeutic practice using digital modalities, especially among help-seeking men.

The Non-take-up of Short-Time Work Benefits during the COVID-19 Pandemic

During the COVID-19 pandemic, short-time work benefits in Germany reached unprecedented heights. At its peak, around one fifth of all regular employees were working short time. Nonetheless, even in sectors that had to cease business operations during the first and second shutdowns, a significant share of – mainly small – enterprises did not apply for short-time work benefits. This article investigates to what extent the non-take-up of short-time work benefits during the first shutdown was involuntary. In addition, light is shed on the causes and consequences of the non-take-up of short-time work benefits for company owners and employees, based on an exploratory mixed-methods study in two sectors dominated by small enterprises, hairdressing salons and dental practices. © 2022 Duncker und Humblot GmbH. All rights reserved.

Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study

Objectives Sleep problems are a transdiagnostic feature of nearly all psychiatric conditions, and a strong risk factor for initial and recurrent episodes. However, people with severe mental ill health (SMI) are often excluded from general population surveys, and as such the extent and associates of poor sleep in this population are less well understood. This study explores sleep health in an SMI sample during the COVID-19 pandemic, using multiple regression to identify risk factors, including daily routine, wellbeing and demographics. Methods An existing cohort of people with an SMI diagnosis were sampled. Participants were invited to complete a self-report survey about their health and the impacts of COVID-19 and associated public health measures. Sleep duration, efficiency, and quality were measured using items from the Pittsburgh Sleep Quality Index (PSQI). Results Two hundred forty-nine adults (aged 21–84 years) completed the survey. Mean sleep duration and efficiency were similar to general population estimates, at 7 h 19 min and 78%, respectively. However, 43% reported “bad” sleep quality that was associated with being younger in age as well as disturbed routine and declined wellbeing. Indeed, 37% reported a disturbed routine during the pandemic. Conclusions High estimates of perceived poor sleep quality in the SMI population align with previous findings. Supporting people with SMI to maintain routine regularity may work to protect sleep quality and wellbeing. Future research should more closely examine sleep health in people with SMI, using accessible and scalable measures of objective and subjective sleep, examining longitudinal trends.

Cobertura vacunal antineumocócica en pacientes mayores de 65 años hospitalizados por la enfermedad de SARS-CoV-2

El neumococo es el principal responsable de neumonía comunitaria y de enfermedad neumocócica invasiva en el adulto. El objetivo del estudio es evaluar el estado de vacunación antineumocócica en los hospitalizados por la enfermedad de SARS-CoV-2 mayores de 65 años previo y posterior al ingreso tras una infección respiratoria grave. Métodos: Se realizó un estudio descriptivo observacional retrospectivo. Se incluyeron los pacientes hospitalizados por enfermedad SARS-CoV-2 mayores de 65 años con pauta de primovacunación completa contra COVID-19 durante el primer trimestre de 2022 en un hospital de tercer nivel. Se analizó la cobertura vacunal antineumocócica en situación pre- y postingreso, sin intervenciones de mejora aplicadas. Resultados: Se analizaron 123 pacientes siendo 56,9% hombres y la media de edad 83,41 años (rango 66-100). Se notificaron 34 fallecimientos durante el ingreso y el primer mes de postingreso. La cobertura vacunal antineumocócica secuencial completa previa al ingreso fue del 23,6%, n = 29 (antineumocócica 13-valente 27,6%, n = 34 y antineumocócica 23-valente 73,2%, n = 90). No se encontró mejora en las pautas de inmunización tras un periodo mínimo de 3 meses posterior al ingreso. Conclusiones: Este estudio muestra tasas bajas de inmunización completa contra neumococo en mayores de 65 años. No se observó un incremento en la cobertura vacunal antineumocócica en este subgrupo, a pesar de haber padecido una infección respiratoria grave. Sería recomendable implementar estrategias vacunales de forma oportunista e individualizada en estos pacientes, a través de una coordinación entre diferentes niveles asistenciales.

The Virtual Palaeosciences (ViPs) project: resources for online learning in or out of a pandemic

The Virtual Palaeosciences (ViPs) project is a collaborative initiative bringing palaeoscientists together to locate, access and share online educational resources (OERs). It began as a response to the 2020 shift to online learning when the COVID-19 pandemic curtailed field and lab work. We outline the development and initial outcomes of the project and consider future directions post-pandemic. Our initial focus was to create a searchable list of OERs (now numbers 600+). The project has also promoted co-operation across institutions and created new collaborations. It became clear that even experienced and teaching-focused educators were anxious about how to incorporate virtual materials and develop alternatives to field and laboratory work and deliver their intended learning outcomes. ViPs aim to become a “hub” for palaeoscience teaching resources. While some face-to-face teaching has returned in Higher Education, the benefits of online elements have become clear to students and educators alike. Therefore, following the pandemic, an increasing shift towards a blended delivery with greater use of OERs in palaeoscience and other disciplines is likely. Longer term, the ViPs project also seeks to increase inclusive, accessible education in the palaeosciences through the digital enhancement of provision, by supporting both users and creators of virtual teaching materials. [ FROM AUTHOR] Copyright of Journal of Geography in Higher Education is the property of Routledge 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.)