De Novo Experience of Individuals with Li-Fraumeni Syndrome: Sometimes the people in your family are never going to be the ones who understand best

Background/Objectives: Li-Fraumeni Syndrome (LFS) is a rare hereditary cancer predisposition syndrome characterized by high lifetime risks for multiple primary malignancies. Although most individuals with LFS inherit a pathogenic TP53 variant from a parent, approximately 20% have de novo variants with no suggestive family cancer history. This may result in an LFS experience distinct from individuals with affected relatives. This multi-case study report examines the unique psychosocial experiences of three young adults with de novo TP53 variants. Method(s): The National Cancer Institute's LFS study (NCT01443468) recruited adolescents and young adults (AYAs;aged 15-39 years) with LFS for qualitative interviews. Three participants had a de novo TP53 variant and a personal cancer history. An interprofessional team analyzed interview data using extended case study and narrative methods. Result(s): De novo participants lacked familiarity with LFS to situate a cancer diagnosis, interpret genetic test results, or adjust to chronic cancer risk. Communicating with and receiving support from family was challenged by their lack of common experience. De novo participants experienced socioemotional isolation, which was amplified during the COVID-19 pandemic. To cope, they sought support in online rare disease communities or through mental health providers. Conclusion(s): Individuals with de novo variants may lack familial guides and familiar providers to address disease management and uncertainty. Specialty health and mental health providers may support de novo patients across hereditary cancer syndromes by validating their uncertainties and connecting them with diseasespecific patient advocacy groups that support adjustment to chronic cancer risk.

Implementation and sustainability of public health approaches for mental health and wellbeing in schools

Aims: With increasing prevalence of emotional difficulties in children and young people in England, there is a growing emphasis on prevention programs delivered in school settings. The Education for Wellbeing program is working with around 400 schools in England to evaluate five universal mental health and wellbeing interventions Here, we present an overview of the Education for Wellbeing program and describe patterns across different school settings in barriers and facilitators to sustaining intervention delivery Methods: This study draws on interviews with staff and pupils from eight schools over multiple timepoints, including during the COVID- 19 pandemic. Qualitative methods were used to cluster schools with similar 'journeys' over a three-year period in terms of staff members' experiences of intervention delivery and perceived barriers and facilitators to sustaining delivery Results: The analysis demonstrated patterns in schools' journeys over time, each underpinned by a range of barriers and facilitators to the sustainability of the interventions. Four clusters of schools were identified each representing one overarching pattern: 'Spreading and embedding', 'Trialled and moved on', 'Everything's changed', and 'Built into the curriculum for now' Conclusion(s): The variety in schools' experiences highlights the complexity of both school settings and the process of implementing and sustaining interventions. These findings suggest that the environment and conditions into which a public health intervention is placed may be as, if not more, important than the intervention itself, and provoke important questions regarding future research and intervention development.

The utility of a fidelity measure to monitor early psychosis services across Australia

Aims: This project aims to describe the development, implementation, and adaptation of a fidelity tool to measure service quality in a national network of early psychosis services across Australia-the headspace Early Psychosis program. Method(s): An 80-item Early Psychosis Prevention and Intervention Centre Model Integrity Tool (EMIT) was developed. The tool assesses adherence in six sites across Australia. Ratings were informed by interviews, routine data and site policies. The EMIT has been adapted for use virtually during Covid-19 restrictions on in-person site visits. A review is underway to enhance the tool to capture quality of services. The Revised EPPIC Model Integrity Tool (REMIT) will be utilized to assess fidelity and service quality in 2023. Result(s): All six sites participated in five fidelity assessments since 2017. In the initial visits, average scores were in the 'low' fidelity range. By the fifth fidelity visit, the network average improved to 'superior' fidelity. The EMIT was successfully adapted for use virtually during Covid-19 and sites were able to maintain scores of high to superior fidelity. The results from the use of the redeveloped tool, the REMIT will be presented. Conclusion(s): The Australian Early Psychosis model has been successfully implemented across the headspace Early Psychosis program. Ongoing fidelity assessments are an effective method to improve and maintain fidelity. The review and development of the REMIT reflects the sites state of implementation and ensures services are of high quality. The findings of the initial use of the REMIT tool in fidelity assessments in early 2023.

An EPPIC tale - 30 years of EPPIC and PACE

Background: The Early Psychosis Prevention and Intervention Centre (EPPIC) and the Personal Assessment and Crisis Evaluation (PACE) were established in Melbourne in 1992. The two services focused on the early detection of emerging illnesses and the development of clinical interventions for psychosis in young people. Aim(s): To describe the development and evolution of the EPPIC and PACE teams over the past 30 years. Method(s): Initially a modest service, operating on one site with fewer than 100 new clients each year, the service has expanded to nine subteams across two regional hubs and three satellite clinics. We will describe the components of the services and the changes to service provision over a 30-year period. Result(s): Over the past 30 years, national and international early psychosis services have developed and youth services have broadened their scope. Service models are being developed that reflect a staged model of illness and clinical care to ensure interventions are responsive to young people's needs. We will outline some of the challenges for EPPIC and PACE in delivering evidence-based interventions across a large service with limited clinical resources, as well as through multiple Covid lockdowns. One of the ongoing challenges is to maintain a focus on early intervention of positive symptoms of psychosis amongst increasing diagnostic complexity and associated interventions. Conclusion(s): The EPPIC and PACE clinical model has been successfully replicated in a number of services around Australia and worldwide. Challenges and future directions will be discussed further.

Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences.

INTRODUCTION: Patients with Non-English Language Preferences (NELP) experience challenges navigating the US healthcare system which can lead to disparate outcomes. This study sought to investigate injury patterns and outcomes in hospitalized trauma patients with NELP. METHODS: A retrospective review was performed at a trauma center from January 2019-December 2020. An institutional database of all emergency department video consultations for interpreter services was cross-referenced with the trauma registry and comparisons were made between NELP and English-preferred (EP) speaking patients. RESULTS: During the study, 257 NELP patients were hospitalized after traumatic injury. Twenty-two percent had work related injuries compared to only 3.0% in the EP cohort (p < 0.001). When propensity score matched, there were no significant differences in ICU and hospital length of stay or mortality between NELP and EP patients. DISCUSSION: Trauma patients are linguistically diverse and understanding their injury patterns and outcomes is crucial for guiding culturally and linguistically appropriate injury prevention.

Distinct clinical phenotypes of critically ill COVID-19 patients: a cohort observational study

Introduction: COVID-19 presents a complex pathophysiology and evidence collected points towards an intricated interaction of viraldependent and individual immunological mechanisms. The identification of phenotypes, through clinical and biological markers, may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness severity. Method(s): Multicenter prospective cohort study performed in 5 hospitals of Portugal and Brazil, during one year, between 2020-2021. All adult patients with an Intensive Care Unit admission with SARS-CoV-2 pneumonia were eligible. COVID-19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. A two-step hierarchical cluster analysis was made using several class-defining variables. Result(s): 814 patients were included. The cluster analysis revealed a three-class model, allowing for the definition of three distinct COVID- 19 phenotypes: 244 patients in phenotype A, 163 patients in phenotype B, and 407 patients in phenotype C. Patients included in the phenotype C were significantly older, with higher baseline inflammatory biomarkers profile, and significantly higher requirement of organ support and mortality rate (Table 1 ( P062)). Phenotypes A and B demonstrated some overlapping clinical characteristics but different outcomes. Phenotype B patients presented a lower mortality rate, with consistently lower C-reactive protein, but higher procalcitonin and interleukin-6 serum levels, describing an immunological profile significantly different from phenotype A (Table 1). Conclusion(s): Severe COVID-19 patients exhibit three different clinical phenotypes with distinct profiles and outcomes. Their identification could have an impact in patients' care, justifying different therapy responses and inconsistencies identified across different randomized control trials results.

Practitioner Perspectives on COVID-19's Impact on Computer Science Education Among High Schools Serving Students from Lower and Higher Income Families

Research Problem. Computer science (CS) education researchers conducting studies that target high school students have likely seen their studies impacted by COVID-19. Interpreting research findings impacted by COVID-19 presents unique challenges that will require a deeper understanding as to how the pandemic has affected underserved and underrepresented students studying or unable to study computing. Research Question. Our research question for this study was: In what ways has the high school computer science educational ecosystem for students been impacted by COVID-19, particularly when comparing schools based on relative socioeconomic status of a majority of students? Methodology. We used an exploratory sequential mixed methods study to understand the types of impacts high school CS educators have seen in their practice over the past year using the CAPE theoretical dissaggregation framework to measure schools' Capacity to offer CS, student Access to CS education, student Participation in CS, and Experiences of students taking CS. Data Collection Procedure. We developed an instrument to collect qualitative data from open-ended questions, then collected data from CS high school educators (n = 21) and coded them across CAPE. We used the codes to create a quantitative instrument. We collected data from a wider set of CS high school educators (n = 185), analyzed the data, and considered how these findings shape research conducted over the last year. Findings. Overall, practitioner perspectives revealed that capacity for CS Funding, Policy & Curriculum in both types of schools grew during the pandemic, while the capacity to offer physical and human resources decreased. While access to extracurricular activities decreased, there was still a significant increase in the number of CS courses offered. Fewer girls took CS courses and attendance decreased. Student learning and engagement in CS courses were significantly impacted, while other noncognitive factors like interest in CS and relevance of technology saw increases. Practitioner perspectives also indicated that schools serving students from lower-income families had (1) a greater decrease in the number of students who received information about CS/CTE pathways;(2) a greater decrease in the number of girls enrolled in CS classes;(3) a greater decrease in the number of students receiving college credit for dual-credit CS courses;(4) a greater decrease in student attendance;and (5) a greater decrease in the number of students interested in taking additional CS courses. On the flip-side, schools serving students from higher income families had significantly higher increases in the number of students interested in taking additional CS courses.

Let's Regroup: Engaging Cancer-Bereaved Youth in Group Programming Following COVID-19

Background/Purpose: Inova Life with Cancer (LWC) is a communityoriented program providing outpatient education and support to families affected by cancer. During the pandemic, psychosocial providers trialed several service models, such as virtual monthly groups and in-person 5-week series, yet experienced low attendance and/or retention rates. To address these challenges, the LWC Grief Circle Program was developed as a one-time peer-based workshop to (1) re-engage youth bereaved by cancer (2) more effectively allocate facilitators' time and resources;and (3) flexibly tailor programming to identified community needs. Method(s): Grief Circles rotated age groups and were held quarterly to allow time to screen families and plan workshops. A rolling interest list identified potential participants and determined the next targeted age range. Eligible participants included children and adolescents who had lost a family member to cancer within the last four years. Referral sources included hospital-based providers, schools, community partners, and individual inquiries. Result(s): Four Grief Circle workshops have occurred since February 2022: two for ages 7-11 (in-person), one for tweens (virtual), and one for teens (in-person). Programming was evaluated by each workshop's referral numbers, attendance rates, and parent feedback. While referrals for each group were consistent, attendance fluctuated due to several barriers (e.g., child illnesses, caregiver forgetfulness). Facilitators adapted accordingly, rescheduling when necessary and updating processes. Benefits were reported, such as participants staying connected after workshop completion. Additional workshops are planned for early 2023 and will be incorporated into results. Conclusions and Implications: After the height of the pandemic, an age-based, one-time workshop model for bereavement support of children and adolescents allowed for improved allocation of facilitator's time and resources. While creative solutions to attendance barriers are still needed, the LWC Grief Circle program provides a potential framework for revitalizing community engagement in cancer-related bereavement support and demonstrates how providers can respond flexibly to changing community needs.

UNEXPECTED FINANCIAL CRISES: Family Communication, Financial Planning, Ethnic/Racial Financial Practices, and Transformative Financial Security

The global COVID-19 pandemic has changed everything. Job loss, personal and public health concerns/fears, isolation, and financial stressors have placed everyone on edge. In this chapter, the authors take up the issue of culture as it relates to thinking about money and managing it. As Caucasian writers, we acknowledge our middle class, educated, and White values and lift them up to the reader. We know that we are very specific in our cultural scope. Whatever the class and cultural histories that a person experiences, commonalities exist that all families face in talking about and planning for their financial security. The introduction of the financial planning concepts and the family communication approaches to begin and maintain the conversations can be varied and adapted to the diverse cultural needs. Given this, the authors complete a review of literature to describe a snapshot of the general financial planning traditions and practices of US African-American, Asian, Hispanic/Latino, Native American, and Caucasian cultures. Commonalities and differences among the various cultures can illuminate the varying taboos as well as the cultural thinking to discuss money and its use. We conclude with a list of questions for future research and/or suggested strategies for how family communication can be used to discuss finances, take action, and minimize the financial and economic insecurities during a global health and economic crisis. © 2023 selection and editorial matter, Rhunette C. Diggs and Thomas C. Socha;individual chapters, the contributors.

Practitioner Perspectives on COVID-19's Impact on Computer Science Education Among High Schools Serving Students from Lower and Higher Income Families

Research Problem. Computer science (CS) education researchers conducting studies that target high school students have likely seen their studies impacted by COVID-19. Interpreting research findings impacted by COVID-19 presents unique challenges that will require a deeper understanding as to how the pandemic has affected underserved and underrepresented students studying or unable to study computing.Research Question. Our research question for this study was: In what ways has the high school computer science educational ecosystem for students been impacted by COVID-19, particularly when comparing schools based on relative socioeconomic status of a majority of students?Methodology. We used an exploratory sequential mixed methods study to understand the types of impacts high school CS educators have seen in their practice over the past year using the CAPE theoretical dissaggregation framework to measure schools' Capacity to offer CS, student Access to CS education, student Participation in CS, and Experiences of students taking CS.Data Collection Procedure. We developed an instrument to collect qualitative data from open-ended questions, then collected data from CS high school educators (n = 21) and coded them across CAPE. We used the codes to create a quantitative instrument. We collected data from a wider set of CS high school educators (n = 185), analyzed the data, and considered how these findings shape research conducted over the last year.Findings. Overall, practitioner perspectives revealed that capacity for CS Funding, Policy & Curriculum in both types of schools grew during the pandemic, while the capacity to offer physical and human resources decreased. While access to extracurricular activities decreased, there was still a significant increase in the number of CS courses offered. Fewer girls took CS courses and attendance decreased. Student learning and engagement in CS courses were significantly impacted, while other noncognitive factors like interest in CS and relevance of technology saw increases.Practitioner perspectives also indicated that schools serving students from lower-income families had (1) a greater decrease in the number of students who received information about CS/CTE pathways;(2) a greater decrease in the number of girls enrolled in CS classes;(3) a greater decrease in the number of students receiving college credit for dual-credit CS courses;(4) a greater decrease in student attendance;and (5) a greater decrease in the number of students interested in taking additional CS courses. On the flip-side, schools serving students from higher income families had significantly higher increases in the number of students interested in taking additional CS courses. © 2022 Association for Computing Machinery.

Dipeptidyl Peptidase-1 Inhibition in Patients Hospitalized with COVID-19: a Multicentre Randomized Double-Blind Placebo Controlled Trial

Background: Neutrophil serine proteases (NSPs) are involved in the pathogenesis of COVID19 and are increased in severe and fatal infection. We investigated whether treatment with Brensocatib, an inhibitor of dipeptidyl peptidase-1, an enzyme responsible for the activation of NSPs, would improve outcomes in hospitalized patients with COVID19. Method(s): In a randomized, double-blind, placebo-controlled trial, 406 hospitalized patients with COVID19 with at least one risk factor for severe disease were randomized 1:1 to once-daily Brensocatib 25mg (n=192) or placebo (n=214) for 28 days. Primary outcome was the 7-point World Health Organisation Clinical Status scale at day 29. Secondary outcomes included time to clinical improvement, national early warning score, new oxygen and ventilation use, neutrophil elastase activity in blood and mortality. Finding(s): Brensocatib treatment was associated with worse clinical status at day 29 (adjusted odds ratio 0 72, 95%CI 0 57-0 92) compared to placebo. The adjusted hazard ratio (aHR) for time to clinical improvement was 0 87 (95%CI 0 76-1 00) and time to hospital discharge was 0 98 (95%CI 0 84-1 13). During the 28-day follow-up period, 23 (11%) and 29 (15%) patients died in the placebo and Brensocatib treated groups respectively). Oxygen and new ventilation use were greater in the Brensocatib treated patients. Neutrophil elastase activity in blood was significantly reduced in the Brensocatib group from baseline to day 29. Prespecified subgroup analyses of the primary outcome supported the primary results.

Teachers' work in the context of COVID-19

This chapter considers teachers' work in the context of COVID-19. Drawing from a longitudinal study of US teachers' work during the pandemic, and situated in related research within and across national contexts, it focuses attention on three areas: teachers' working conditions, the pedagogical work of teaching, and the relational work of education. Findings indicate the pandemic intensified work, disrupted pedagogical and relational norms, and interrupted—at least temporarily—technocratic control of teachers' work. Implications for the future and sustainability of the teacher workforce are considered. © 2023 Elsevier Ltd. All rights reserved.

PACE-A: An international phase 3 randomised controlled trial (RCT) comparing stereotactic body radiotherapy (SBRT) to surgery for localised prostate cancer (LPCa)-Primary endpoint analysis

Background: People presenting with early-stage LPCa have several treatment options. There is therapeutic equipoise with lack of randomised evidence for superiority of radiotherapy or surgery. PACE-A aimed to determine if there is improved quality of life (QoL) following SBRT compared to surgery. Method(s): PACE (NCT01584258) is a phase 3 open-label multiple-cohort RCT. In PACE-A, people with LPCa, T1-T2, Gleason<=3+4, PSA<=20ng/mL & suitable for surgery were randomised (1:1) to SBRT or surgery. SBRT dose was 36.25Gy/5 fractions in 1-2 weeks;surgery was laparoscopic or robotically assisted prostatectomy. Androgen deprivation was not permitted. Co-primary endpoints were patient reported outcomes (PROs) of Expanded Prostate Index Composite (EPIC-26) questionnaire number of absorbent pads per day & EPIC bowel subdomain score at 2 years. Target sample size was 234 participants (pts) to detect 9% difference in urinary incontinence (80% power, 5% 2-sided alpha) & 5-point difference in mean bowel subdomain score (90% power, 5% 2-sided alpha) with higher EPIC score (range 0-100) indicating better QoL. Secondary endpoints included clinician reported toxicity and additional PROs (1% significance level). Analysis is by treatment received. Result(s): From Aug 2012 to Feb 2022, 123 men from 10 UK centres were randomised. The IDMC advised stopping recruitment after a 2-year gap in during COVID. Pts had median age 66years (IQR: 61, 69), median PSA 8ng/ml (6, 11) with 52% tumours >=T2b and 79% Gleason 3+4;93% pts were of white race. 58/63 pts received SBRT as allocated (2 received surgery, 2 unknown, 1 withdrawn);48/60 received surgery as allocated (1 received SBRT, 3 received CRT, 2 unknown, 6 withdrawn). 8 laparoscopic and 42 robotic assisted operations were performed. Median follow-up is 50 months (IQR 41, 74). At 2 years, fewer SBRT pts reported use of urinary pads: 2/43 (4.5%) vs 15/32 (46.9%), p<0.001. SBRT pts had significantly worse bowel subdomain score (mean (SD) 88.4 (12.7) vs 97.3 (5.5), p<0.001). 7/45 (15.6%) SBRT and 0/31 (0%) surgery pts reported moderate/big problem with bowel symptoms (p=0.04). SBRT pts reported less EPIC sexual subdomain score (58.0 (31.9) vs 29.3 (20.5), p<0.001);there was no evidence of a difference in urinary subdomain score (85.5 (19.8) vs 80.5 (20.8), p=0.29). At 2 years, CTCAE genitourinary grade 2 or higher(G2+) toxicity was seen in 5/54 (9.3%) SBRT vs 4/42 (9.5%) surgery pts (p=0.97);there was no G2+ gastrointestinal (GI) events seen in either group. Conclusion(s): PACE-A contributes the first randomised data to the comparison of SBRT with surgery in LPCa providing PRO data relevant to informed decision making. Compared to surgery, pts receiving SBRT had better urinary continence & sexual bother score;clinician reported GI toxicity was low but SBRT pts reported more bowel bother at 2 years.

Longitudinal Lung Function Assessment of Patients Hospitalized With COVID-19 Using 1H and 129Xe Lung MRI.

BACKGROUND: Microvascular abnormalities and impaired gas transfer have been observed in patients with COVID-19. The progression of pulmonary changes in these patients remains unclear. RESEARCH QUESTION: Do patients hospitalized with COVID-19 without evidence of architectural distortion on structural imaging exhibit longitudinal improvements in lung function measured by using 1H and 129Xe MRI between 6 and 52 weeks following hospitalization? STUDY DESIGN AND METHODS: Patients who were hospitalized with COVID-19 pneumonia underwent a pulmonary 1H and 129Xe MRI protocol at 6, 12, 25, and 51 weeks following hospital admission in a prospective cohort study between November 2020 and February 2022. The imaging protocol was as follows: 1H ultra-short echo time, contrast-enhanced lung perfusion, 129Xe ventilation, 129Xe diffusion-weighted, and 129Xe spectroscopic imaging of gas exchange. RESULTS: Nine patients were recruited (age 57 ± 14 [median ± interquartile range] years; six of nine patients were male). Patients underwent MRI at 6 (n = 9), 12 (n = 9), 25 (n = 6), and 51 (n = 8) weeks following hospital admission. Patients with signs of interstitial lung damage were excluded. At 6 weeks, patients exhibited impaired 129Xe gas transfer (RBC to membrane fraction), but lung microstructure was not increased (apparent diffusion coefficient and mean acinar airway dimensions). Minor ventilation abnormalities present in four patients were largely resolved in the 6- to 25-week period. At 12 weeks, all patients with lung perfusion data (n = 6) showed an increase in both pulmonary blood volume and flow compared with 6 weeks, although this was not statistically significant. At 12 weeks, significant improvements in 129Xe gas transfer were observed compared with 6-week examinations; however, 129Xe gas transfer remained abnormally low at weeks 12, 25, and 51. INTERPRETATION: 129Xe gas transfer was impaired up to 1 year following hospitalization in patients who were hospitalized with COVID-19 pneumonia, without evidence of architectural distortion on structural imaging, whereas lung ventilation was normal at 52 weeks.

Longitudinal 129xe and 1h Lung Mri Assessment of Lung Structure, Ventilation, Perfusion, and Gas Transfer Following Hospitalization with Covid-19

The long-term effects of coronavirus disease 2019 (COVID- 19) pneumonia on the lungs and pulmonary circulation require further characterization. We assessed progression of pathophysiological pulmonary changes during 1 year of follow-up of patients who had been hospitalized because of COVID-19. After discharge, recruited patients had up to four MRI examinations at a median of 6 (n=9), 12 (n=9), 25 (n=7) and 52 (n=3) weeks. Lung MRI examinations included: ultra-short echo time (UTE), dynamic contrastenhanced (DCE) lung perfusion, 129Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Nine patients (age 56 +/-9 years;six male) were recruited. Ventilation defect percentage and whole lung coefficient of variation of lung ventilation decreased significantly at 25 weeks (visit 3) compared with visit 1 at 6 weeks (p=0.010 and p=0.048). The UTE imaging indicated no evidence of lung scarring, and DW-MRI indicated normal lung microstructure across all visits. Dissolved phase xenon imaging showed that RBC:TP increased significantly at visits 2 and 3 compared with visit 1 (p=0.048). Median RBC:TP was abnormally low at all visits compared with reference age- and sex-matched data. An individual's RBC:TP was associated significantly and positively with an increase in their pulmonary blood volume (p=0.026). For patients with 52-week data available, one showed a continued improvement in RBC:TP;however, two of the patients maintained a low RBC:TP. In patients recovering from COVID-19, xenon gas transfer improves alongside pulmonary blood volume. Further work is needed to establish the proportion of post-COVID-19 patients who have longer-term impairment in xenon transfer and to correlate changes in lung MRI parameters with symptoms, lung function tests and other imaging modalities. Persistent impairment of xenon transfer might represent a physiological mechanism underlying ongoing symptoms in some patients and might indicate damage to the pulmonary microcirculation.

What Have They Been Thinking? Home Buyer Behavior in Hot and Cold Markets: A Ten-Year Retrospect

This is an update of a paper that we published with Karl E. Case in Brookings Papers on Economic Activity in 2012. The paper analyzes data from our annual questionnaire survey of US home buyers to understand their expectations for future home price changes. We again see a period of rapid price increase as we did in our surveys a decade ago. We find that home buyers were generally well informed, and their short-run expectations were conserva-tive, typically underreacting to the year-to-year changes in actual home prices. Housing bubbles can be seen in their long-term (annualized ten-year) home price expectations. The long boom that preceded the 2007–2009 crisis was associated with changing public understanding of speculative bubbles. During the early years of this decade-long rebound, both short-and long-term expectations were out of line with actual changes in prices. Since 2013, long-term expectations have converged with short-term expectations and actual price changes in most locations, and all three series have moved in synch. With the onset of COVID-19, in 2021 actual and anticipated appreciation diverged once again. This time, however, short-term expectations surged above long-term expectations but remained far below actual appreciation rates. Buyers presumed a coming slowdown in the market that has yet to materialize. © 2022 The Brookings Institution.

SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination.

BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript.

Introduction to the Second Special Issue: Acute, Intensive, and Residential Services

This second special issue of Evidence Based Practice in Child and Adolescent Mental Health will focus on Acute, Intensive, and Residential Services (AIRS) for youth. Despite recent increases in AIRS research, there remains a shortage of applying, evaluating, and developing evidence-based treatments (EBTs) in these settings. In addition, since the publication of our first special issue, the American Academy of Pediatrics (AAP), Children's Hospital Alliance (CHA), and American Academy of Child and Adolescent Psychiatry (AACAP) have issued a joint statement declaring the state of youth mental illness to be a national crisis, worsened by the COVID-19 pandemic (American Academy of Pediatrics, Children's Hospital Association, & American Academy of Child and Adolescent Psychiatrists [AAP, CHA, & AACAP], 2021). The introduction to the special issue will highlight work being done in AIRS settings for youth around the country. Copyright © 2022 Society of Clinical Child & Adolescent Psychology.

The need for early intervention for psychosis to persist throughout the COVID-19 pandemic and beyond

In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.

HIGH-FLOW NASAL CANULA AND INHALED EPOPROSTENOL RESPONSE IN COVID-19

SESSION TITLE: Medications and Pulmonary Rehabilitation in COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The use of inhaled epoprostenol (iEPO) has demonstrated improvement in outcomes for patients with pulmonary hypertension and right heart failure. iEPO has been used as a rescue therapy for acute respiratory distress syndrome (ARDS) and has been shown to improve oxygenation, reduce shunting, and decrease pulmonary artery pressures. However, pulmonary vasodilators do not improve mortality in patients with ARDS. Furthermore, there is currently little data on the efficacy of iEPO via high flow nasal cannula (HFNC) for ARDS patients. Here, we describe our experience with iEPO in our patients with COVID-19-related ARDS on HFNC in a Northern California county hospital. METHODS: From March 2020 to December 2021, 74 patients with COVID-19 infection and related ARDS were placed on HFNC and received iEPO, at a public tertiary care center. A positive response to iEPO was defined as an increase P/F ratio of 10%, increase in PaO2 of 20%, decrease in FiO2, or reduced flow rate within 24 hours of initiation of iEPO. Non-parametric statistics were used to compare groups. RESULTS: 21 women and 53 men with COVID ARDS ranging from 30-86 years of age (mean age 60.1 ± 13.9) received iEPO while on HFNC. The mean hospital length of stay was 36.3 ± 43 days. All patients received steroids and 83.8% received antibiotics. 55.4% of all patients in the study (n=41) progressed to mechanical ventilation and 58.1% (n=43) survived to discharge, mean age 57 ± 14 years. 20.3% (n=15) of patients showed a response to iEPO. Patients who responded to iEPO were significantly less likely to progress to mechanical ventilation (13% vs 66%, p=0.0003) and more likely to survive to discharge (93% vs 49%, p=0.0021). CONCLUSIONS: Among patients with COVID ARDS on HFNC, patients who respond to iEPO are less likely to progress to mechanical ventilation and more likely to survive to discharge. Our study is limited by small sample size and lack of randomization. Use of iEPO in the right subset COVID ARDS on HFNC may improve outcomes. CLINICAL IMPLICATIONS: Patients on HFNC selected for initiation of iEPO had a poor overall prognosis, with 41.9% not surviving to discharge and 55.4% requiring mechanical ventilation. iEPO response correlates with not requiring mechanical ventilation and with increased likelihood of survival to discharge. DISCLOSURES: No relevant relationships by Heng Duong No relevant relationships by Craig Ivie No relevant relationships by Neharika Khurana No relevant relationships by Connie Park No relevant relationships by Natasha Puri No relevant relationships by Adam Thompson No relevant relationships by John Wehner