OLDER ADULTS' EXPERIENCE OF AND ATTITUDES TOWARDS USING TECHNOLOGY FOR MENTAL HEALTH SERVICES

Older adults (OAs) are particularly vulnerable to negative mental health effects from isolation and loneliness. During the COVID-19 pandemic many older adults are experiencing greater isolation, and many mental health services have moved to remote access. Knowledge and experience of technology are likely barriers for OAs in accessing these supports. Our research aims to understand OAs' experience of, and attitudes towards, using technology;both quantitative and qualitative methods were employed. It was hypothesised that the older cohort (75+) would be less experienced and comfortable with technology and that greater exposure to technology would be associated with greater comfort with its use. Participants (n = 22) were service users (SUs) of an older adult mental health service in Ireland. Results indicated no differences in exposure to technology or comfort with technology based on age. Increased exposure to technology was associated with greater comfort with use, including for engagement with mental health services (MHS). This research has implications for how remote services are offered to and conducted with older people. © 2022, University of Galway. All rights reserved.

Isolation of SARS-CoV-2-blocking recombinant antibody fragments and characterisation of their binding to variant spike proteins

COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2. From its initial appearance in Wuhan, China in 2019, it developed rapidly into a global pandemic. In addition to vaccines, therapeutic antibodies play an important role in immediately treating susceptible individuals to lessen severity of the disease. In this study, phage display technology was utilised to isolate human scFv antibody fragments that bind the receptor-binding domain (RBD) of SARS-CoV-2 Wuhan-Hu-1 spike protein. Of eight RBD-binding scFvs isolated, two inhibited interaction of RBD with ACE2 protein on VeroE6 cells. Both scFvs also exhibited binding to SARS-CoV-2 Delta variant spike protein but not to Omicron variant spike protein in a Raman spectroscopy immunotest. The study demonstrates the potential of recombinant antibody approaches to rapidly isolate antibody moieties with virus neutralisation potential. Copyright © 2022 Antoine, Mohammadi, McDermott, Walsh, Johnson, Wawrousek and Wall.

A fast, ultrasensitive SERS immunoassay to detect SARS-CoV-2 in saliva.

The COVID-19 pandemic has emphasized the need for accurate, rapid, point-of-care diagnostics to control disease transmission. We have developed a simple, ultrasensitive single-particle surface-enhanced Raman spectroscopy (SERS) immunoassay to detect the SARS-CoV-2 spike protein in saliva. This assay relies on the use of single chain Fv (scFv) recombinant antibody expressed in E. coli to bind the SARS-CoV-2 spike protein. Recombinant scFv labeled with a SERS-active dye in solution is mixed with unlabeled scFv conjugated to gold-coated magnetic nanoparticles and a sample to be tested. In the presence of the SARS-CoV-2 spike protein, immunocomplexes form and concentrate the labeled scFv close to the gold surface of the nanoparticles, causing an increased SERS signal. The assay detects inactivated SARS-CoV-2 virus and spike protein in saliva at concentrations of 1.94 × 103 genomes mL-1 and 4.7 fg mL-1, respectively, making this direct detection antigen test only 2-3 times less sensitive than some qRT-PCR tests. All tested SARS-CoV-2 spike proteins, including those from alpha, beta, gamma, delta, and omicron variants, were detected without recognition of the closely related SARS and MERS spike proteins. This 30 min, no-wash assay requires only mixing, a magnetic separation step, and signal measurements using a hand-held, battery-powered Raman spectrometer, making this assay ideal for ultrasensitive detection of the SARS-CoV-2 virus at the point-of-care.

Lessons Learned from Teaching in Person Cadaveric Anatomy During the COVID19 Pandemic

In March 2020, TTUHSC opened a new 20,000sf Institute of Anatomical Sciences for human gross anatomy. When the COVID-19 pandemic struck and many schools shifted from in person to online teaching, we hypothesized that if safety measures were used, in person cadaveric anatomy could be safely taught without a decrease in student performance. To test this, we reduced onsite attendance to less than 25% of room capacity. Masks were required at all times and students were instructed to social distance. Six students were assigned per cadaver, but only two students dissected at a time. The other four students reviewed and completed dissections and/or reviewed in groups of two at other allotted times. Thus, students dissected only every third lab. Dissection and lab review attendance was mandatory and students were nearly 100% compliant. Teaching assistants recorded dissected prosections reviews, and these videos were uploaded to password protected course files for independent learning. Students were provided iPads in the laboratory and access to three software packages for use on and off site. All students had access to multiple formative quizzes and exams, and three new online practice practical exams were created. To help reduce testing anxiety, a pass/fail system replaced categorical grading. However, all written and practical exams were conducted on site and in person. At TTUHSC, we have developed an exam question database to track historical student performance including a 25-question optional pre-block practice exam used to assess incoming student anatomical aptitude. In 2020, 90% of incoming students (93% in 2019) took the pre-block exam and scored an average of 28% (24% in 2019). In 2020, despite vastly different content delivery approaches (>80% of lectures were on Zoom) and reduced in-person dissection requirements, students modestly outperformed their 2019 counterparts. Overall exam averages were 89% in 2020 compared to 87% in 2019. If a categorical system was in place, 66% of students would have earned Honors or High Pass in 2020 compared to 61% in 2019. Our formative assessments were highly predictive of summative exam performance, and students reported that they reduced exam stress. Furthermore, summative exam averages correlated strongly with NBME performance (p<0.0001, r =0.63). TTUHSC medical students estimated that a majority of their peers at other medical schools did not have any in person dissection in 2020. Our students ranked in person laboratory dissection as the most useful learning activity, 88% reported that our COVID-19 preparations were very good to outstanding, and 97% were satisfied with the quality of their anatomy education. We conclude that 1) When using appropriate precautions, in person cadaveric anatomy can be taught safely during a pandemic;2) cadaveric dissection is essential for mastery of anatomical concepts;and 3) coupling online learning modalities with rigorous formative assessments prevented a modest reduction in cadaveric dissection opportunities from negatively impacting student performance. 2.

Rapid, Point-of-Care scFv-SERS Assay for Femtogram Level Detection of SARS-CoV-2.

Rapid, sensitive, on-site identification of SARS-CoV-2 infections is an important tool in the control and management of COVID-19. We have developed a surface-enhanced Raman scattering (SERS) immunoassay for highly sensitive detection of SARS-CoV-2. Single-chain Fv (scFv) recombinant antibody fragments that bind the SARS-CoV-2 spike protein were isolated by biopanning a human scFv library. ScFvs were conjugated to magnetic nanoparticles and SERS nanotags, followed by immunocomplex formation and detection of the SARS-CoV-2 spike protein with a limit of detection of 257 fg/mL in 30 min in viral transport medium. The assay also detected B.1.1.7 ("alpha"), B.1.351 ("beta"), and B.1.617.2 ("delta") spike proteins, while no cross-reactivity was observed with the common human coronavirus HKU1 spike protein. Inactivated whole SARS-CoV-2 virus was detected at 4.1 × 104 genomes/mL, which was 10-100-fold lower than virus loads typical of infectious individuals. The assay exhibited higher sensitivity for SARS-CoV-2 than commercial lateral flow assays, was compatible with viral transport media and saliva, enabled rapid pivoting to detect new virus variants, and facilitated highly sensitive, point-of-care diagnosis of COVID-19 in clinical and public health settings.

Intensive outpatient treatment of pediatric rumination syndrome in the era of telemedicine

Background: Rumination syndrome is a functional gastrointestinal disorder (FGID) that involves effortless postprandial regurgitation of food followed either by rechewing or expulsion, and can be challenging to both diagnose and treat effectively. Patients with more severe symptoms require intensive management. At our institution, we have had success treating children with severe rumination syndrome using a multidisciplinary intensive outpatient program (IOP) involving multiple treatment sessions daily. Due to the COVID-19 pandemic, we have needed to transition from in-person treatment to telemedicine. The objective of this study is to compare outcomes of patients with rumination syndrome who completed IOP treatment in person versus by telemedicine. Methods: We performed a retrospective review of patients diagnosed with rumination syndrome by Rome IV criteria and participated in IOP treatment from 2018-2020. IOP consists of intensive medical and behavioral treatment provided by a specialized multidisciplinary team. Until March 2020, this program involved 3 in-person treatment sessions with meals per day for up to a week. Similar treatment sessions were performed during telemedicine visits. We compared outcomes of patients who received IOP treatment in person versus by telemedicine. Families/patients were then asked to complete a survey outlining their child's current rumination symptom severity and review of the IOP. Results: We included 34 patients (79% F, median age 15 years, range 7-19 years) with rumination syndrome who completed IOP treatment. Patients had also been diagnosed with anxiety (17/34, 50%), depression (7/34, 21%), gastroesophageal reflux disease (6/34, 18%), constipation (6/34, 18%), functional abdominal pain (5/34, 15%), eating disorder (5/34, 15%), and superior mesenteric artery syndrome (4/34, 12%). At baseline, 9 patients (26%) required tube feeding or parenteral nutrition compared to 2 patients (6%) at follow up. Twenty-six patients (76%) were treated in person and 8 patients (24%) by telemedicine. There were no significant differences in sex, age, likelihood of anxiety or depression, and duration of IOP treatment between in person and telemedicine groups. The median duration of treatment for both groups was 4 days. Symptom severity at baseline and follow up are described in Table 1. For patients treated in person, 76% (19/25) had improvement in symptoms while 16% (4/25) had complete resolution of symptoms. For patients treated by telemedicine, 88% (7/8) had improvement in their symptoms. There were no significant differences between groups in likelihood of improvement. Of the 34 patients who completed the IOP, 23 (68%) completed both surveys. Overall, 78% (18/23) preferred in person therapy while 17% (4/23) did not have a preference. Of the telemedicine patients, 60% (3/5) would have preferred in-person IOP. All 18 of the in-person cohort preferred in-person management. When asked to elaborate, 4 families expressed similar answers including the need for “in-person interaction,” having a “hands-on approach,” and because the psychologist can give “body instructions.” Other reported strengths of in-person treatment included a majority of families believing this would lead to “a stronger connection with the provider” (90%, 19/21), “fewer distractions” (86%, 18/21), and noting “treatment would be more effective in person” (76%, 16/21). In-person challenges included transportation and parking (63%, 12/19) as well as concerns about time commitment (84%, 16/19). The primary strengths of online treatment were that it saves time (72%,13/18) and some parents felt their child was more comfortable at home (39%,7/18). One family described that it was “easier to integrate habits at home” after completing the process online. Online challenges included having more distractions (81%, 13/16) and some parents felt their child was more comfortable talking to someone in person (75%, 12/16). Conclusion: Although multidisciplinary intensive outpatient treatment for children and adolescents with severe rumination syndrome is effective and the likelihood of improvement appears similar when completed in person or by telemedicine, the majority of families prefer in-person therapy.