Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data.

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

Primary hypertension, anti-hypertensive medications and the risk of severe COVID-19 in UK Biobank

Introduction: Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of antihypertensive medication is related to this risk. Method(s): Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure and medications on the risk of severe COVID-19. Result(s): 17,094 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,774) developed severe COVID-19 and 40% (n = 6,899) were hypertensive. Hypertension was associated with 25% higher odds of severe COVID-19 (OR 1.25;95% CI 1.15, 1.36), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated systolic blood pressure showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129 mmHg (OR 1.51;95% CI 1.15, 1.97), >180+mmHg versus 120-129mmHg (OR 2.10;95% CI 1.21, 3.67)). Systolic blood pressure <120 mmHg was associated with greater odds of severe COVID-19 (OR 1.37;95% CI 1.08, 1.74). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Conclusion(s): Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.

Effects of the COVID-19 lockdown on mental health in a UK student sample.

BACKGROUND: The COVID-19 pandemic and the resulting restrictions placed upon society have had a profound impact on both physical and mental health, particularly for young people. AIMS: The current study assesses the impact of COVID-19 on student mental health. METHOD: Four hundred and thirty four first year Undergraduate students completed a battery of self-report questionnaires (PHQ-P, GAD-7 and SAS-SV) to assess for depression, anxiety and mobile phone addiction respectively with data being collected over a 2 year period. The data from each year was compared (216 and 218 students respectively). RESULTS: A MANOVA revealed that COVID-19 had a significant impact on self-reported levels of depression, anxiety and smartphone addiction-which all significantly increased from the 2020 to the 2021 group. The percentage of students who had a score which warranted a classification of clinical depression increased from 30 to 44%, and for anxiety increased from 22 to 27%-those students who showed a comorbidity across the two rose from 12 to 21%. Smartphone addiction levels rose from 39 to 50%. Correlational analysis showed a significant relationship between Smartphone usage and depression and anxiety. CONCLUSIONS: This research suggests that COVID-19 has had a major impact upon student mental health, and smartphone addiction. The importance of identifying predictive factors of depression and anxiety is emphasised, and suggestions for intervention are discussed.

Teaching During Lockdown: English Teachers' Experiences in the Time of COVID-19

In an attempt to control the spread of COVID-19 in Australia in 2020 state and territory governments mandated the closing of schools for all but vulnerable children and the children of frontline workers in various parts of Australia for various lengths of time. In what follows, five English teachers from across Australia reflect on the everyday experience of teaching during lockdown. Using the framework of 'who' and 'what' stories (Cavarero, 2000), these narratives explore the individual and contextual experience of the everyday work of teaching remotely, while also contributing to the collective story of English teaching during a global pandemic. The narratives raise questions about teachers' identity and development as well as broader questions about subject English. [GRAPHICS]

Refractory Rhombencephalitis Secondary to SARS-CoV-2 Infection: A Case Report

Objective: To describe a case of rhombencephalitis secondary to severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Background: Rhombencephalitis is an inflammation of the brainstem and cerebellum. Etiologies include infectious, inflammatory, and autoimmune causes. Rhombencephalitis has varied presentations but frequently includes encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction. To date, SARS-CoV-2 has been reported as the cause of rhombencephalitis in 4 cases. Design/Methods: Authors searched PubMed and Google Scholar for articles using the keywords: “COVID-19”, SARS-CoV-2', “Rhomboencephalitis”, “Rhombencephalitis”. Results: 30-year-old African American man with poorly controlled type 1 diabetes mellitus presented with dysgeusia, slurred speech, night sweats, left-sided hypoesthesia, paresthesias, ataxic gait, and light-headedness. Exam was notable for, left-sided hypoesthesia of the face and left upper extremity weakness as well as ataxia. MRI brain revealed diffuse pontine edema and central areas of diffusion restriction. COVID-19 nasal PCR and COVID-19 IgG antibodies were positive. Extensive infectious, autoimmune and paraneoplastic workup was unrevealing. Pulse-dose steroids resulted in improvement of edema and patient was discharged with diagnosis of a monophasic infectious rhombencephalitis due to COVID-19. Patient re-presented 8 days following discharge with acute left-sided headache and vomiting. Exam was notable for mild cranial nerve seven palsy and ataxia in all extremities. MRI brain displayed increased edema, mass effect and enhancement throughout the brainstem extending superiorly to include optic tracts and hypothalamus. CSF studies were remarkable for leukocytosis and increased protein. Repeat infectious, autoimmune and paraneoplastic studies again negative. Re-treatment with pulse-dose steroids followed by prolonged taper resulted in clinical and radiographic improvement at 1 month follow-up. Conclusions: The complete picture of neurological sequelae from COVID-19 is developing as the pandemic continues. Our case adds to the literature of SARS-CoV-2 associated rhombencephalitis and highlights the need for close monitoring and slow titration of immunotherapies such as steroids to minimize the potentially devasting effects of rhombencephalitis.

PARENT AND CHILD MENTAL HEALTH TRAJECTORIES APRIL- OCTOBER 2020: STRICT LOCKDOWN VS NO LOCKDOWN IN AUSTRALIA

Background: To control a second wave of COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. Objectives: To (1) investigate trajectories of parent/child MH outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and factors related to COVID-19 associated with MH trajectories. Methods: An online community sample of 2004 Australian parents of a child aged 0-18 years with rapid repeated assessment over 14 time points from April 2020 to May 2021. Measures assessed parent MH (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (4 items from the Brief Spence Children's Anxiety Scale). Findings: MH trajectories shadowed COVID-19 infection rates. Victorians reported a peak in MH symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardised regression coefficient (β) = 0.09- 0.46), parent/child diagnoses (β = 0.07-0.21), couple conflict (β = 0.07-0.18), and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12-0.15)), predicted elevated trajectories. Conclusion: Our findings provide evidence of worse trajectories of parent and child MH symptoms associated with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early in future lockdowns.

RISK AND PROTECTIVE FACTORS ASSOCIATED WITH MENTAL HEALTH DIFFICULTIES FOR CHILDREN WITH ADHD OVER THE COVID-19 PANDEMIC: A LONGITUDINAL STUDY

Background: A growing number of studies have reported both positive and negative outcomes associated with COVID-19 in children with attention-deficit/hyperactivity disorder (ADHD) and their families. However, very few longitudinal studies have examined outcomes over multiple time points over the pandemic. Objectives: To examine COVID-19-related mental health (MH) impacts for children with ADHD and their families over a 12-month period over the pandemic. Methods: The parents of 213 Australian children (5-17 years) with ADHD were recruited in May 2020 when COVID-19 restrictions were in place. Parents completed surveys at repeated time points assessing MH (CoRonavIruS Health Impact Survey [CRISIS] - mood states subscale) and predictors. Latent profile analyses were used to examine the patterns of MH difficulties over the pandemic using the first four waves of data collected from May to August 2020, and the fifth wave of data collected in May-July 2021. Numerous baseline predictors of MH patterns were examined. Findings: Using the first four waves of data, three groups were identified comprising: (1) children with unchanging (36%), (2) increasing resolved (30%) and (3) increasing persistent (34%) MH difficulties. The most robust predictor of increasing persistent MH difficulties was stress related to COVID-19 (e.g. stress associated with restrictions related to COVID-19). Analyses are being updated to include our fifth wave of data collection (May-July 2021) (70% retention rate). Conclusion: A subgroup of children with ADHD appears to be struggling with MH, which is related to the stress associated with COVID-19 restrictions.

Crafting a Virtual Studio: Some Models and Implementations

Studio is an active form of pedagogy that can help train collaborative, reflective engineers. However, traditional studio pedagogy is predicated on a shared physical space-it is not clear how to translate the benefits of the studio to a virtual environment. In this work we contrast and compare four studio classes at Olin College-transitioned to virtual studios in response to the COVID-19 pandemic-in terms of their design, implementation, and student responses. Through a mixed-methods approach we uncover trends in student agency and motivation, technology choices and their ramifications on collaboration, and social aspects of the virtual space. © American Society for Engineering Education, 2021

Drug Repurposing Using Link Prediction on Knowledge Graphs with Applications to Non-volatile Memory

The active global SARS-CoV-2 pandemic caused more than 167 million cases and 3.4 million deaths worldwide. The development of completely new drugs for such a novel disease is a challenging, time intensive process and despite researchers around the world working on this task, no effective treatments have been developed yet. This emphasizes the importance of drug repurposing, where treatments are found among existing drugs that are meant for different diseases. A common approach to this is based on knowledge graphs, that condense relationships between entities like drugs, diseases and genes. Graph neural networks (GNNs) can then be used for the task at hand by predicting links in such knowledge graphs. Expanding on state-of-the-art GNN research, Doshi et al. recently developed the Dr-COVID model. We further extend their work using additional output interpretation strategies. The best aggregation strategy derives a top-100 ranking of candidate drugs, 32 of which currently being in COVID-19-related clinical trials. Moreover, we present an alternative application for the model, the generation of additional candidates based on a given pre-selection of drug candidates using collaborative filtering. In addition, we improved the implementation of the Dr-COVID model by significantly shortening the inference and pre-processing time by exploiting data-parallelism. As drug repurposing is a task that requires high computation and memory resources, we further accelerate the post-processing phase using a new emerging hardware—we propose a new approach to leverage the use of high-capacity Non-Volatile Memory for aggregate drug ranking. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

"Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol.

BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Treatment changes in prostate cancer patients on active treatment during the COVID-19 pandemic in a community cancer center in New York City

Background: The surge of the SARS coronavirus-2 (COVID-19) pandemic posed great challenges in the oncology community for optimal management of cancer patients. We sought to analyze the treatment changes experienced by the prostate cancer patients in March, April and May 2020 and to compare these treatment decisions to the published guidelines. Methods: We focused on patients currently receiving androgen deprivation therapy (ADT) with leuprolide acetate, and/or oral anti-androgen agents (Androgen receptor axis targeted agent, ARAT), or chemotherapy. Electronic medical records were reviewed, and the oncologists and nurse practitioners were interviewed to understand the decision-making process. Results: Seventy-five patients were included, median age 72 years old (range 47- 95). All were taking ADT, and 21 were also taking ARAT, and 3 were also receiving chemotherapy. The incidence and indications for their ADT treatments and schedule changes are shown in the table below. Twenty-seven patients (36%) experienced delays in their ADT treatment, and the percentage of treatment change was similar in categories of metastatic hormone sensitive prostate cancer (mHSPC), metastatic castration resistant cancer (mCRPC), biochemical recurrence as well as stage IVA post surgery. Four patients were receiving neoadjuvant ADT planned prior to definitive radiation, and none had schedule change. One patient with mHSPC and 2 patients with mCRPC continued chemotherapy as planned. One patient declined recommended chemotherapy for mCRPC. Two patients were given q 3 months dose of ADT instead of q 1m, while all the rest were already receiving q3 months dosing. Among the 27 patients who had schedule change, 12 (44.4%) patients had a discussion with their providers first, and 15 patients (55.6%) did not keep their treatment appointment. Conclusions: About one third of patients changed ADT injection schedule with a similar percentage in patients with mHSPC, or mCRPC or Biochemical recurrence, or IVA after surgery. Every 3 months dosing of ADT recommended by NCCN significantly decreases exposure to COVID -19, delaying or skipping treatment was still encountered due to health concern or travel limitations. On the other hand, all patients receiving neoadjuvant ADT, or chemotherapy stayed on schedule. Although NCCN guideline recommended delaying myelosuppressive therapy, palliative chemotherapy for symptomatic, refractory patients may still be a priority.

Telementoring education and mentorship for newborn providersin Kenya, Pakistan, and Tanzania

Background Many countries, including Kenya, Pakistan, and Tanzania, have integrated the Every NewbornAction Plan guidelines into their national health strategies. Within this framework, UNICEF, in partnership with the American Academy of Pediatrics (AAP), and the three countries above, launched a novel collaborativetelementoring project with the primary aim to investigate the feasibility and utility of internationaltelementoring to improve newborn care practices. The objectives were to: 1) collect data regarding baselinenewborn care at participating sites, 2) construct a newborn telementoring curriculum based on the speciceducational needs of each site, and 3) create an adaptable and interactive forum for remote educationavailable for scale-up within each country, with the global goal of increasing individual knowledge of newborncare practices and establishing connections for ongoing educational sharing between countries. MethodsParticipating facilities (Kenya-2, Tanzania-2, Pakistan-12) were identied by UNICEF. Initial site visits wereconducted in September/October 2019 and included collection of baseline data, classication of available resources, and observations of deliveries and general care practices. The telementoring curriculum was constructed based on in-depth discussion with frontline staff and facility leadership during these visits. ResultsA 12-session telementoring curriculum was created for the East African (EA) hospitals based on theiroverlapping educational needs while a unique curriculum was created for Pakistan [Table 1]. The sessions arerun via Zoom teleconferencing software and include a case presentation by participants, a facultypresentation, and a discussion. Where possible, demonstrations and practice with newborn simulatorscomplement discussion. To create a toolkit for later use, each session is recorded for later viewing andcomplemented with links to additional resources and a shared online spreadsheet where participants canpost discussion questions. To date, six sessions have been conducted in EA and seven in Pakistan, andsessions will continue through July 2020. Several lessons have been learned, including the importance of incorporating simulation and technical aspects related to improving communication during the live sessions.Further, as the COVID-19 pandemic occurred in the midst of the project, a panel discussion aboutmanagement of COVID-19 particular to each geographic area was organized, an example of the agility of thistype of educational method. Conclusion This novel telementoring program provides longitudinal education tofrontline newborn staff at sixteen facilities in three countries. Employing techniques to increase interactivityinclude video conferencing, case discussions, skills-based activities, and the use of online question boardsallow participants to maximize their learning experience. Next steps include completion of the curriculum bysummer 2020 and further evaluation, including knowledge assessment and focus group discussions. Ifsuccessful, this project has potential for scale-up in countries with elevated newborn mortality rates, particularly during times when physical distancing is the norm.

Long-term Overall Survival Outcomes in Patients with Early Stage, Peripherally Located, Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiotherapy in a Non-academic Cancer Centre.

AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.