Randomized Trial of A Healthy Weight Intervention for Youth with Mental Illness: The Champion Trial

Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, innovative healthy weight intervention in youth with SED.Hypothesis: The active intervention is more effective than control in decreasing BMI Z-score compared at 12 m. Method(s): We conducted a two-arm randomized trial in 2 outpatient pediatric mental health settings in 112 youth, ages 8-18 yrs. The active intervention group was offered 12m of in-person and virtual individual weight management sessions led by health coaches who provided guidance on improving diet and increasing physical activity, and engaged parents. Result(s): At baseline, mean (SD) age was 13.0 (2.7) yrs with 46% ages 8-12 and 54% 13-18;55% were male, 46% Black, 39% had household income less than $50K/yr and 31% lived in a single-parent household. Primary diagnoses were ADHD (41%), major depression (23%), and anxiety (23%). Mean BMI Z-score (SD) was 2.0(0.4), BMI 30.4 (6.4) kg/m2.Mean(SD) psychotropic medications were 2.1(1.4).At 12m, 111 (99%) had a follow-up weight;42 were collected after the onset of the COVID pandemic). The intervention group compared to the control group had 0.15 decrease in BMI Z-Score (95% CI 0.26 to 0.04), p<0.007) between baseline and 12 m (Figure) and a 1.43 kg/m2 decrease in BMI (95% CI 2.43, 0.42, p<0.006). Estimated net effect on BMI Z-score for intervention vs. control was enhanced during the pandemic but not statistically different from net effects pre-pandemic (p=0.06). Conclusion(s): A weight control intervention designed for children with SED decreased BMI Z-score substantially over 12 months, including during the COVID-19 pandemic. These results provide empirical evidence in support of weight control programs in a population at high risk for early development of CVD risk factors.

Increased shunt and dead space in recovered COVID-19 pneumonitis patients

Introduction/Aim: We previously reported impaired pulmonary gas exchange in acute COVID-19 patients resulting from both increased intrapulmonary shunt (SH) and increased alveolar dead space (AD) 1 . The present study quantifies gas exchange in recovered patients. Method(s): Unvaccinated patients diagnosed with acute COVID-19 infection (March-December 2020) were studied 15 to 403 days post first SARS-CoV-2 positive PCR test. Demographic, anthropometric, acute disease severity and comorbidity data were collected. Breathing room air, steady-state exhaled gas concentrations were measured simultaneously with arterial blood gases. Alveolar CO 2 and O 2 (P A CO 2 and P A O 2 ;mid-exhaled volume) determined;AaPO2, aAPCO2, SH% and AD% calculated. 2 Results: We studied 59 patients (33 males, Age: 52[38-61] years, BMI: 28.8[25.3-33.6] kg/m 2 ;median[IQR]). Co-morbibities included asthma (n = 2), cardiovascular disease (n = 3), hypertension (n = 12), and diabetes (n = 9);14 subjects smoked;44 had experienced mild-moderate COVID-19 (NIH category 1-2), 15 severe-critical disease (NIH category 3-5). PaCO 2 was 39.4[35.6-41.1] mmHg, PaO 2 92.1[87.1-98.2] mmHg;P A CO 2 32.8[28.6-35.3] mmHg, P A O 2 112.9[109.4-117.0] mmHg, AaPO 2 18.8[12.6-26.8] mmHg, aAPCO 2 5.9[4.3-8.0] mmHg, SH 4.3 [2.1-5.9]% and AD 16.6 [12.6-24.4]%. 14% of patients had normal SH (<5%) and AD (<10%);1% abnormal SH and normal AD;36% both abnormal SH and AD;49% normal shunt and abnormal AD. Previous severe-critical disease was a strong independent predictor for increased SH (OR 14.8[2.28-96], [95% CI], p < 0.01), increasing age weakly predicted increased AD (OR 1.18[1.01, 1.37], p < 0.04). Time since infection, BMI and comorbidities were not significant predictors (all p > 0.11). Conclusion(s): Prior COVID-19 was associated with increased intrapulmonary shunt and/or increased alveolar dead space in 86% of this cohort up to ~13 months post infection, with those with more severe acute disease, and older patients, at greater risk. Increased intrapulmonary shunt suggests persistent alveolar damage, while increased alveolar dead space may indicate persistent pulmonary vascular occlusion.

COVID-19 control in the United States: the case for masking.

As of May 2021, the United States remains the world leader with 33 million of 165 million cases worldwide (20%) and 590,000 of 3.4 million deaths worldwide (17%) from COVID-19. Achieving herd immunity by disease spread and vaccination may result in 2 million to 4 million total US deaths. The future perfect of the vaccine should not be the enemy of the present good, which is masking. Masking, especially when combined with social distancing, crowd avoidance, frequent hand and face washing, increased testing capabilities, and contact tracing, is likely to prevent at least as many premature deaths as the widespread utilization of an effective and safe vaccine. Worldwide, masking is the oldest and simplest engineered control to prevent transmission of respiratory pathogens. Masking has been a cornerstone of infection control in hospitals, operating rooms, and clinics for more than a century. Unfortunately, since the epidemic began in the United States, masking has become politicized. All countries, but especially the United States, must adopt masking as an urgent necessity and a component of coordinated public health strategies to combat the COVID-19 pandemic. Any economic advantages of pandemic politics are short-lived and shortsighted in comparison with public health strategies of proven benefit that can prevent needless and mostly avoidable premature deaths from COVID-19. During the worst epidemic in more than 100 years, most Americans (75%) trust their health care providers. As competent and compassionate health care professionals, we recommend that effective strategies, especially masking, and not pandemic politics, should inform all rational clinical and public health decision-making.

Evaluation of variant calling algorithms for wastewater-based epidemiology using mixed populations of SARS-CoV-2 variants in synthetic and wastewater samples.

Wastewater-based epidemiology has been used extensively throughout the COVID-19 (coronavirus disease 19) pandemic to detect and monitor the spread and prevalence of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and its variants. It has proven an excellent, complementary tool to clinical sequencing, supporting the insights gained and helping to make informed public-health decisions. Consequently, many groups globally have developed bioinformatics pipelines to analyse sequencing data from wastewater. Accurate calling of mutations is critical in this process and in the assignment of circulating variants; yet, to date, the performance of variant-calling algorithms in wastewater samples has not been investigated. To address this, we compared the performance of six variant callers (VarScan, iVar, GATK, FreeBayes, LoFreq and BCFtools), used widely in bioinformatics pipelines, on 19 synthetic samples with known ratios of three different SARS-CoV-2 variants of concern (VOCs) (Alpha, Beta and Delta), as well as 13 wastewater samples collected in London between the 15th and 18th December 2021. We used the fundamental parameters of recall (sensitivity) and precision (specificity) to confirm the presence of mutational profiles defining specific variants across the six variant callers. Our results show that BCFtools, FreeBayes and VarScan found the expected variants with higher precision and recall than GATK or iVar, although the latter identified more expected defining mutations than other callers. LoFreq gave the least reliable results due to the high number of false-positive mutations detected, resulting in lower precision. Similar results were obtained for both the synthetic and wastewater samples.

The continuing evolution of a cancer prevention, screening, and survivorship ECHO: A second year of implementation.

INTRODUCTION: An estimated 39,010 Indiana residents were diagnosed with cancer in 2021. To address the cancer burden, Project ECHO (Extension Community Healthcare Outcomes) was launched in 2019 in Indiana to build specialty healthcare capacity among non-specialists. Due to positive outcomes from the pilot year, the Cancer Prevention, Screening, and Survivorship ECHO was implemented for a second year. The purpose of this study was to measure the participation and regional impact of this ECHO. METHODS: ECHO sessions occurred twice monthly from October 2020 to October 2021. Changes were implemented in response to feedback from the pilot year, including making the curriculum more practical for learners and adding accreditation opportunities. Participant information and feedback was extracted from electronic surveys for review. RESULTS: There were 24 ECHO sessions with 213 unique participants, increased from 140 unique participants in the pilot year. An average of 23.5 individuals attended each session, increased from 15.5 individuals per session. Enrolled participants served in a diverse set of roles and represented 247 zip codes, 30 Indiana counties, and 32 states across the United States, each of which increased from the pilot year. DISCUSSION: In this second year, this ECHO expanded to reach more participants with increased attendance and a more diverse distribution of roles within healthcare, which may be attributed to feedback-driven curriculum design. Cancer care is multi-disciplinary, with health educators, nurses, and administrators, each acting within the cancer care continuum. As a result, this ECHO has been adapted to serve an increasingly broad distribution of professionals. CONCLUSION: The second year of the Cancer Prevention, Screening, and Survivorship ECHO displayed increased overall enrollment and participation, greater diversity among participant roles, and a wider reach across Indiana and the United States.

COVID-Impact on Type 2 Diabetes Self-Management during the Pandemic

Introduction: Persons with diabetes and COVID-have higher rates of morbidity and mortality than those without diabetes. Engagement in Diabetes Self-Management Education and Support (DSMES) services may improve diabetes self-management adherence. The purpose of this study was to determine whether COVID-impact and attendance of DSMES services were predictors of diabetes self-management among individuals with T2D during the pandemic. Methods: Participants (N=86) of this cross-sectional survey study were adults with T2D who either had (n=29) or had not (n=57) previously attended at least one DSMES class. The Coronavirus Impact Scale (range 0-24) was used to measure impact of the pandemic on daily life. The Self-Management Profile for Type 2 Diabetes was used to measure overall self-management and subscales for adherence, ease, coping, and importance. Multiple linear regressions were conducted to determine whether COVID-impact and DSMES participation predicted self-management total scores or subscale scores, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis, with separate models for each predictor. Results: Participants were 57±12.3 years;50% female, and 90% non-Hispanic White. DSMES attendance did not significantly predict subscale or overall scores for self-management. Higher COVID-impact predicted worse self-management adherence (F 3.71, p=0.002) , greater self-management ease (F 3.72, p=0.002) , decreased coping (F 4.65, p<0.001) , and worse overall self-management (F 4.93, p<0.001) . Neither COVID-impact nor DSMES attendance predicted self-management importance (p=0.79 and 0.99, respectively) . Conclusions: Findings underscore the negative impact of the COVID-pandemic on diabetes self-management and highlight the need for interventions to improve self-management practices during times of crisis.

Letter from the Editor

The BI was chartered in 1994 by Utah State University's (USU) Board of Trustees and given the mission of improving human-wildlife interactions by reducing humanwildlife conflicts through research, teaching, outreach, and education. The changes in land use that accompany human population growth, the increased global transportation of wildlife and livestock and their products, and increases in both domestic and international travel increase the risk of new dis- ease outbreaks of pandemic scale. Wildlife professionals working at the interface where conflicts arise between people and wild animals have a responsibility in the long-term interest of sustaining society's support for wildlife and its conservation by resolving human-wildlife conflicts so that humans continue to view wildlife as a valued resource.

Cancer prevention, screening, and survivorship ECHO: A pilot experience with an educational telehealth program.

INTRODUCTION: The American Cancer Society, Inc. (ACS) estimates that 37,940 Indiana residents were diagnosed with cancer in 2020, which remains the leading cause of death in the state. Across the cancer continuum, national goals have been established targeting recommended benchmarks for states in prevention, screening, treatment, and survivorship. Indiana consistently falls below most goals for each of these targeted categories. METHODS: To address these disparities, we implemented Project ECHO (Extension for Community Healthcare Outcomes) as a virtual telehealth educational platform targeted at local healthcare providers. ECHO programs utilize a novel tele-mentoring approach to the education of clinicians in a hub/spoke design. Sessions occurred twice monthly from September 2019 to September 2020 and consisted of a traditional didactic lecture and a case-based discussion led by participating providers. RESULTS: During the pilot year there were a total of 22 ECHO sessions with 140 different participants. On average, 15.5 spokes attended each session with increasing participation at the end of the year. Post-session surveys suggested generally favorable perception with 72% of respondents finding the quality "excellent." DISCUSSION: Given the increasing rate of recurrent participation toward the end of the pilot year in conjunction with the favorable survey responses following each session, it was felt that the program was overall successful and warranted continued implementation. CONCLUSION: The Project ECHO platform is a validated telehealth education platform that has the potential to impact cancer care at multiple points along the cancer continuum at the regional level.

Discovery and Genetic Characterization of Novel Paramyxoviruses Related to the Genus Henipavirus in Crocidura Species in the Republic of Korea.

Paramyxoviruses, negative-sense single-stranded RNA viruses, pose a critical threat to human public health. Currently, 78 species, 17 genera, and 4 subfamilies of paramyxoviruses are harbored by multiple natural reservoirs, including rodents, bats, birds, reptiles, and fish. Henipaviruses are critical zoonotic pathogens that cause severe acute respiratory distress and neurological diseases in humans. Using reverse transcription-polymerase chain reaction, 115 Crocidura species individuals were examined for the prevalence of paramyxovirus infections. Paramyxovirus RNA was observed in 26 (22.6%) shrews collected at five trapping sites, Republic of Korea. Herein, we report two genetically distinct novel paramyxoviruses (genus: Henipavirus): Gamak virus (GAKV) and Daeryong virus (DARV) isolated from C. lasiura and C. shantungensis, respectively. Two GAKVs and one DARV were nearly completely sequenced using next-generation sequencing. GAKV and DARV contain six genes (3'-N-P-M-F-G-L-5') with genome sizes of 18,460 nucleotides and 19,471 nucleotides, respectively. The phylogenetic inference demonstrated that GAKV and DARV form independent genetic lineages of Henipavirus in Crocidura species. GAKV-infected human lung epithelial cells elicited the induction of type I/III interferons, interferon-stimulated genes, and proinflammatory cytokines. In conclusion, this study contributes further understandings of the molecular prevalence, genetic characteristics and diversity, and zoonotic potential of novel paramyxoviruses in shrews.

Concerns and Needs of Patients With Head and Neck Cancer in the COVID-19 Era.

OBJECTIVE: To evaluate the concerns and needs of patients and survivors of head and neck cancer (HNC) in the COVID-19 era. STUDY DESIGN: Prospective cross-sectional survey. SETTING: Contact lists of 5 North American HNC advocacy groups. METHODS: A 14-question survey was distributed to the contact lists of 5 HNC advocacy groups evaluating patient and survivor needs and concerns related to their cancer care and COVID-19. RESULTS: There were 171 respondents, with 75% in the posttreatment period. The most common concern was contraction of COVID-19 (49%). More patients in active treatment preferred in-person visits than those in the early (≤5 years) and late (>5) survivorship period (72% vs 61% vs 40%, P < .001). A higher percentage of late survivors preferred virtual visits (38% vs 28%, P = .001). In total, 91 (53.2%) respondents sought emotional support outside of immediate family and friends. This included cancer support groups (36.2%), the medical team (29.7%), and other sources outside of these (34.1%), including faith-based organizations and online communities. A higher proportion of women than men (62% vs 41%, P = .001) were seeking emotional support outside of immediate family and friends. CONCLUSIONS: During the early stages of the COVID-19 pandemic, patients with HNC who were actively undergoing treatment had increased need for support resources and preferred in-person provider visits. Alternatively, a higher percentage of patients >5 years from treatment preferred virtual visits. Emotional support outside of family and friends was sought out by a majority of respondents. Further research is needed to determine what support and educational resources are needed to best aid these various populations.

Urban American Indian Caregiving during COVID-19

This study examined the experience of caregiving during a pandemic by asking five questions about how COVID-19 was impacting twenty American Indian caregivers providing care to a family member who was disabled, elderly, or had a chronic health condition. Interviews were conducted via Zoom. Themes identified were concern about the care recipient contracting COVID-19, increased caregiving intensity, increased Medical care issues, changes to caregiver health and health behaviors, and support received and increased need for support during the pandemic (material and emotional). Responses indicate that tribes and American Indian health organizations should initiate services that can support caregivers during the pandemic or make changes to their caregiver programs.

Experiences and lessons learned from two virtual, hands-on microbiome bioinformatics workshops.

In October of 2020, in response to the Coronavirus Disease 2019 (COVID-19) pandemic, our team hosted our first fully online workshop teaching the QIIME 2 microbiome bioinformatics platform. We had 75 enrolled participants who joined from at least 25 different countries on 6 continents, and we had 22 instructors on 4 continents. In the 5-day workshop, participants worked hands-on with a cloud-based shared compute cluster that we deployed for this course. The event was well received, and participants provided feedback and suggestions in a postworkshop questionnaire. In January of 2021, we followed this workshop with a second fully online workshop, incorporating lessons from the first. Here, we present details on the technology and protocols that we used to run these workshops, focusing on the first workshop and then introducing changes made for the second workshop. We discuss what worked well, what didn't work well, and what we plan to do differently in future workshops.

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020.

Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.

Diagnostic accuracy of rapid antigen tests for COVID-19 compared to the viral genetic test in adults: a systematic review protocol.

OBJECTIVE: The objective of this diagnostic accuracy review is to evaluate the effectiveness of rapid antigen tests versus viral genetic PCR-based tests on COVID-19 diagnostic accuracy in adults 18 years and over. INTRODUCTION: Due to the rapidly changing nature of the COVID-19 pandemic, it is imperative that clinicians have access to the most relevant and effective tools and information required to combat this disease. Testing strategies are being developed continuously and need to be evaluated to ensure their appropriate implementation into clinical practice. INCLUSION CRITERIA: This systematic review will include publications that are in the English language (originally or translated) and any gray literature pertaining to the tests of interest. All races, ages over 18, and geographic locations will be considered. METHODS: MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), Qinsight (Quertle), and WHO COVID-19 database (World Health Organization) will be searched. Scopus, Qinsight, and WHO COVID-19 include gray literature. Studies in English published from November 2019 to the present will be considered. Animal studies and studies including pregnant women will be excluded. Retrieval of full-text studies, data extraction, and assessment of methodological quality will be performed independently by two reviewers. A custom data extraction table will be used. Findings will be graphically represented with two forest plots, one for sensitivity and the other for specificity. The strategy for meta-analysis includes producing a summary receiver operating characteristic curve and estimating the summary sensitivity/specificity for each threshold provided in the articles. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020224250.

How close is too close to wildlife?

In this issue of Human-Wildlife Interactions, our authors provide keen, powerful insights based on global research involving human interactions with amphibians, bears, birds, canids, amphibians, and ungulates. Adult bison can weigh >900 kg and run >50 kph. [...]the U.S. National Park Service has recommended that visitors stay at least 20-25 m away from wild animals like bison and elk (Cervus canadensis) and 90 m away from bears (Ursus spp.) and other carnivores. Not understanding wild animal behavior, coupled with an inability to judge what constitutes a safe distance when using our smartphone to capture our wildlife encounter, can be a recipe for disaster.

The Back Page Humans, wildlife, and our environment: One Health is the common link

At the time this commentary was written (March 18, 2020), 100 countries had confirmed cases of COVID-19, the disease caused by the novel coronavirus. In China, where the outbreak was first reported, 81,000 people have been infected and more than 3,100 have died. Outside of China, 50,000 people have been infected with the virus, and 1,300 have perished. In the United States, there were 6,000 cases reported, 90 deaths, with 53 states and territories reporting cases. Since the coronavirus outbreak was first reported, media reports have traced the cause of the outbreak to horseshoe bats (Rhinolophus spp.;Figure 3). There are literally hundreds of genetically diverse bat-borne coronaviruses in the wild. Most of them are harmless, except for a group responsible for the 2002-2003 severe acute respiratory syndrome (SARS) outbreak. Because of the global distribution of bats, their rich diversity, and the importance of bats as natural reservoirs of coronaviruses, the number of bat coronaviruses with the potential for transmission to humans will likely increase.

Awards and Scholarships

Due to the uncertainty caused by the COVID-19 pandemic, the Berryman Institute (BI) is extending the application deadline for its awards and scholarships to June 1, 2020. The BI is a national organization based in the Department of Wildland Resources at Utah State University. We are dedicated to improving human-wildlife relationships and resolving human- wildlife conflicts through teaching, research, and extension. The BI seeks to recognize individuals or groups who have made notable contributions in the field of human-wildlife conflict management.

Teleassessment with children and adolescents during the coronavirus (COVID-19) pandemic and beyond: Practice and policy implications

Due to physical distancing guidelines, the closure of nonessential businesses, and the closure of public schools, the role of telehealth for the delivery of psychological services for children has never been more debated. However, the transition to teleassessment is more complicated for some types of assessment than others. For instance, the remote administration of achievement and intelligence tests is a relatively recent adaptation of telehealth, and despite recommendations for rapid adoption by some policymakers and publishing companies, caution and careful consideration of individual and contextual variables and the existing research literature, as well as measurement, cultural and linguistic, and legal and ethical issues, is warranted. The decision to use remotely administered achievement and intelligence tests is best made on a case-by-case basis after consideration of these factors. We discuss each of these issues as well as implications for practice and policy, as well as issue provisional guidance for consideration for publishing companies interested in these endeavors moving forward. (PsycInfo Database Record (c) 2020 APA, all rights reserved) Impact Statement Public Significance Statement-The current review describes a number of factors that may reduce the accuracy of standardized tests, like intelligence tests, when they are given remotely. Additionally, it highlights the importance of considering the purpose of assessment, client cultural and linguistic background, as well as ethical and legal decision making, on the use and interpretation of standardized test results. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Ethics and Racial Equity in Social Welfare Policy: Social Work's Response to the COVID-19 Pandemic.

The COVID-19 pandemic has been particularly overwhelming for communities of color in the United States. In addition to the higher levels of underlying health conditions, circumstances related to a history of oppression and unequal access to opportunities and services are apparent. Social service programs will need to be re-developed to accommodate a new reality, both in terms of how people connect with services and how social work professionals provide them. Professional social work organizations' codes of ethics are analyzed, along with the theoretical framework of structural competency. It is an ethical imperative that social welfare policy and practice advance as culturally competent, racial equity, and empowerment-based programs. Child welfare is portrayed as an example where the pandemic could provide an opportunity to learn from the past to construct a more compassionate, competent, and ethical future.