What Makes Systemic Discrimination, "Systemic?" Exposing the Amplifiers of Inequity (preprint)

Drawing on work spanning economics, public health, education, sociology, and law, I formalize theoretically what makes systemic discrimination "systemic." Injustices do not occur in isolation, but within a complex system of interdependent factors; and their effects may amplify as a consequence. I develop a taxonomy of these amplification mechanisms, connecting them to well-understood concepts in economics that are precise, testable and policy-oriented. This framework reveals that these amplification mechanisms can either be directly disrupted, or exploited to amplify the effects of equity-focused interventions instead. In other words, it shows how to use the machinery of systemic discrimination against itself. Real-world examples discussed include but are not limited to reparations for slavery and Jim Crow, vouchers or place-based neighborhood interventions, police shootings, affirmative action, and Covid-19.

Persistent immune abnormalities discriminate post-COVID syndrome from convalescence (preprint)

Innate lymphoid cells (ILCs) are key organizers of tissue immune responses and regulate tissue development, repair, and pathology. Persistent clinical sequelae beyond 12 weeks following acute COVID-19 disease, named post-COVID syndrome (PCS), are increasingly recognized in convalescent individuals. ILCs have been associated with the severity of COVID-19 symptoms but their role in the development of PCS remains poorly defined. Here we used multiparametric immune phenotyping, finding expanded circulating ILC precursors (ILCPs) and concurrent decreased group 2 innate lymphoid cells (ILC2s) in PCS patients compared to well-matched convalescent control groups at > 3 months after infection. Patients with PCS showed elevated expression of chemokines and cytokines associated with trafficking of immune cells (CCL19/MIP-3b, FLT3-ligand), endothelial inflammation and repair (CXCL1, EGF, RANTES, IL1RA, PDGF-AA). These results define immunological parameters associated with PCS and might help find biomarkers and disease-relevant therapeutic strategies.

Virtual Assessment of Patients with Dry Eye Disease During the COVID-19 Pandemic: One clinicians experience (preprint)

ObjectivesTo report on 1) the impact of DED on social, mental, and financial well-being, and 2) the use of virtual consultations to assess DED during the COVID-19 pandemic. Design & MethodsAn exploratory retrospective review of 35 charts. Telephone consultations for patients with DED conducted during the first lock-down period in Ontario in 2020 were reviewed. ResultsThe most commonly reported DED symptoms were ocular dryness, visual disturbances, and burning sensation. The most common dry eye management practices were artificial tears, warm compresses, and omega-3 supplements. 20.0% of charts documented worsening of DED symptoms since the onset of the pandemic and 17.1% reported the lockdown had negatively affected their ability to perform DED management practices. 42.8% of patients reported an inability to enjoy their daily activities due to DED symptoms. 52.0% reported feeling either depressed, anxious, or both with 26.9% of patients accepting a referral to a social worker for counselling support. More than a quarter of the charts recorded financial challenges associated with the cost of therapy, and more than a fifth of patients reported that financial challenges were a direct barrier to accessing therapy. ConclusionsPatients living with DED reported that their symptoms negatively affected their daily activities including mental health and financial challenges, that in turn impacted treatment practices. These challenges may have been exacerbated during the COVID-19 pandemic. Telephone consultations may be an effective modality to assess DED symptom severity, the impact of symptoms on daily functioning, and the need for counselling and support. AUTHOR SUMMARYDry Eye Disease occurs when your tears do not provide enough lubrication for your eyes, which can be caused by either decreased tear production, or by poor quality tears. This study reviewed 35 patient charts to examine 1) the impact of Dry Eye Disease on patients well-being, and 2) the use of telephone appointments to assess Dry Eye Disease during the COVID-19 pandemic. Patients reported an inability to enjoy their daily activities due to symptoms of dry eye including burning sensation and blurred vision. Over half of patients reported mental health challenges. Over a quarter of patients reported that financial challenges prevented them from treating their Dry Eye Disease, such as affording eye drops, dietary supplements, and appointments to see their optometrist. These findings highlight that healthcare providers should considering quality of life, mental health, and financial challenges when treating patients with Dry Eye Disease. Through the experience of an ophthalmologist who specializes in Dry Eye Disease, telephone appointments may be an effective way to assess Dry Eye Disease symptoms, the impact of symptoms on daily functioning, and the need for counselling and support.

Post-COVID-19 Perceived Stigma-Discrimination Scale: Psychometric Development and Evaluation (preprint)

The COVID-19 survivors face social stigmatization, even with negative tests. Valid and reliable instruments are required to quantify the stigma-discrimination complex associated with COVID-19 (COVID-19-CED). The study aimed to adapt and evaluate a scale to measure COVID-19-CED in COVID-19 survivors. A validation study was done with 330 COVID-19 survivors between 18 and 89 years. The COVID-19 Perceived Discrimination Scale (C-19-PDS) was used, which was adapted from the Tuberculosis Perceived Discrimination Scale. An exploratory factor analysis (EFA), confirmatory factor analysis (CFA), internal consistency, and differential item functioning (DIF) were performed using the classical theory of tests. EFA showed a one-dimensional solution for the items of C-19-PDS; however, CFA showed poor goodness-of-fit indicators. The 5-item version of the C-19-PDS showed better goodness-of-fit indicators, high internal consistency, and non-gender DIF. In conclusion, the 5-item version of the C-19-PDS is one-dimensional, with high internal consistency, and without gender DIF. This instrument is recommended to evaluate COVID-19-CED in the Colombian population.

Editorial for special issue on neglect rehabilitation.

It is clear already that in current and future years more people will suffer from stroke, whether related to COVID-19 or not, and given its prevalence, many more people's lives will be affected by neglect. Here we hope to have contributed to its possible amelioration with highlights of the latest thinking on neglect diagnosis, prevalence and treatment.

What drives beliefs in COVID-19 conspiracy theories? The role of psychotic-like experiences and confinement-related factors (preprint)

The COVID-19 pandemic is a worldwide threat to public health and the global economy. The climate of fear and uncertainty associated with the pandemic has fostered the emergence of a wide-range of COVID-19 conspiracy theories that has the potential do shape public opinion and hinder the effective dissemination of valid information. Beliefs in conspiracy theories has been associated with maladaptive personality traits such as schizotypy and paranoia, as well as other non-psychotic psychological characteristics (e.g., social isolation, stress). The current study aimed to examine the association between beliefs in COVID-19 conspiracy theories and psychotic-like experiences within the community, while also addressing the role of sociodemographic information, psychological outcomes (e.g., stress, affective states) and other pandemic-related factors (e.g., confinement conditions/behaviors). Our results suggest that psychotic-like experiences are associated with beliefs in COVID-19 conspiracy theories, particularly perceptual abnormalities and persecutory ideation. Moreover, increased health-related concerns and reduced education levels also seem to be liability factors for these conspiracy beliefs. These results add important insights into how the adherence to illogical and erroneous disease-related arguments may be contingent to proneness to psychotic-like experiences. COVID-19 conspiracy theories are yet another major challenge that governments and policy makers must contemplate when defining strategic directions to manage the current and future pandemics.

Persecutory ideation and anomalous perceptual experiences in the context of the COVID-19 outbreak in France: what's left one month later? (preprint)

Aims: Beyond the effects of the coronavirus pandemic on the public's health, the length of lockdown and its possible psychological impacts on populations around the world is heavily debated. However, the consequences of lockdown on psychotic symptoms have not yet been investigated. Methods: An online survey was run from April 13 to May 11, 2020; a total of 728 French subjects from the general population participated. We assessed the perceived impact of the COVID-19 outbreak, length of self-isolation, diagnosis/symptoms/hospitalisation related to the COVID-19 (oneself and family). Paranoid ideations and anomalous perceptual perceptions were assessed via the Paranoia Scale and the Cardiff Anomalous Perceptions Scale. Measures of negative affect, loneliness, sleep difficulties, jumping to conclusion bias, emotion regulation, and perseverative thinking were also included. Results: Final regression model for paranoia indicated that socio-demographic variables, loneliness, cognitive bias, anxiety, repetitive thoughts and hallucinations were associated with paranoia (R2 = 0.43). For hallucinations, clinical variables as well as the quality of sleep, behavioural activation, repetitive thoughts, and paranoia were associated with hallucinations in our sample (R2 = 0.27). Neither length of self-isolation nor the perceived impact of the COVID-19 pandemic were associated with psychotic experiences in the final models. Conclusions: No evidence was found between a significant impact of self-isolation on psychotic symptoms in the general population in France one month after the lockdown. It nevertheless confirms the preeminent role of several factors previously described in the maintenance and development of psychotic symptoms in the context of a pandemic and lockdown measures.