Youth suicide risk and mental health post-COVID: An Australian perspective

Aims: Suicide is a leading cause of death for young people, and rates in Australia are increasing. The Australian city of Melbourne faced the toughest COVID-19 pandemic lockdown restrictions worldwide, which had a major impact on youth mental health. This study aimed to provide a snapshot into the mental health and suicide-related thoughts and behaviours of Australian Adolescents from Melbourne post the lockdowns. Method(s): Participants were 932 young people (Age M = 15.5, 53% female) recruited from high schools in Melbourne, Australia as part of a larger RCT. Participants completed measures of suicidal ideation (SIDAS) and behaviour (recent attempts and current plans), and depressive symptoms (PHQ-9). Result(s): Preliminary results indicate that 28% of participants experienced some level of suicidal ideation with 7% reporting severe suicidal ideation. Suicide attempts in the sample in the last 12 months (13%) and current plans (3%) were less common but still prevalent. In terms of depressive symptoms, the breakdown in the sample was 5% severe, 8% moderately severe, 18% moderate, 25% mild and 43% none to minimal with 1% not reporting. Data related to particular risk factors (e.g., years since the pandemic, gender, school etc.) along with implications for practice and policy will be presented at the conference. Conclusion(s): This study sheds light on the mental health and suiciderelated thoughts and behaviours of school-attending young people following COVID-19-related lockdowns in Australia. The high levels of suicidality and poor mental health in the cohort point to a need for targeted interventions and support for this group.

Anticipated Long-Term Neurobehavioral Outcomes Following COVID-19

First identified in December 2021, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-the virus causing COVID-19, is responsible for significant morbidity and mortality rates. Given the worldwide impact of COVID-19, there is much interest in the anticipated long-term effects for those with history of SARS-CoV-2 infection. While initially presumed as a respiratory infection, there is now evidence of a broader array of pathophysiological mechanisms which result in a wide spectrum of reported acute and chronic symptoms in patients with confirmed COVID-19. These include including memory and other neurocognitive changes as well as psychiatric and behavioral symptoms. These nonspecific, but often debilitating, sequalaeare complex and difficult to disentangle from more common causes of neurobehavioral change. The goal of this chapter is to discuss anticipated chronic neurocognitive and psychiatric outcomes of COVID-19 survivors based on emerging peer-reviewed literature, data from prior pandemics, and outcome studies from well-characterized, clinically similar syndromes. This unpacking of long-term complications from COVID-19 will seek to set expectations and provide guidance for clinicians who will undoubtably encounter increased volumes of patients with residual post-COVID-19 neurobehavioral changes. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The Importance of General Surgery Residency Program's Online Presence Varies Among Applicant Groups.

INTRODUCTION: The COVID-19 pandemic necessitated an exclusively virtual 2021 residency application cycle. We hypothesized that residency programs' online presence would have increased utility and influence for applicants. METHODS: Substantial surgery residency website modifications were undertaken in the summer of 2020. Page views were gathered by our institution's information technology office for comparison across years and programs. An anonymous, voluntary, online survey was sent to all interviewed applicants for our 2021 general surgery program match. Five-point Likert-scale questions evaluated applicants' perspective on the online experience. RESULTS: Our residency website received 10,650 page views in 2019 and 12,688 in 2020 (P = 0.14). Page views increased with a greater margin compared to a different specialty residency program's (P < 0.01). From 108 interviewees, 75 completed the survey (69.4%). Respondents indicated our website was satisfactory or very satisfactory compared to other programs (83.9%), and none found it unsatisfactory. Applicants overall stated our institution's online presence impacted their decision to interview (51.6%). Programs' online presence impacted the decision to interview for nonWhite applicants (68%) but significantly less for white applicants (31%, P < 0.03). We observed a trend that those with fewer than this cohort's median interviews (17 or less) put more weight on online presence (65%), compared to those with 18 or greater interviews (35%). CONCLUSIONS: Applicants utilized program websites more during the 2021 virtual application cycle; our data show most applicants depend on institutions' websites to supplement their decision-making; however, there are subgroup differences in the influence online presence has on applicant decisions. Efforts to enhance residency webpages and online resources for candidates may positively influence prospective surgical trainees, and especially those underrepresented in medicine, to decide to interview.

mHealth and social mediation: Mobile support among stigmatized people living with HIV and substance use disorder

The social mediation role of mobile technology is typified by mHealth apps designed to connect individuals to others and support substance use disorder (SUD) recovery. In this study, we examined the use and utility of one such app designed to support people living with HIV (PLWH) and SUD. Drawing on Ling's emphasis on reciprocity and micro-coordination in mobile telephony as a social mediation technology, we gathered digital trace data from app logs to construct two metrics, initiation (i.e. whether a particular feature is engaged on a given day) and intensity (i.e. degree of involvement in the activity when engaged on that day), at three levels of communication—networked (one-to-many), dyadic (one-to-one), and intraindividual (self-to-self). We consider these affordances alongside use of information resources, games and relaxation links, a meeting and events calendar, and support tools to address use urges. We found few differences in patterns of use by race, sex, and age, though African Americans were less likely to engage in intraindividual expression, whereas women and older users were more likely to make use of this affordance. The initiation and intensity of network and dyadic reception, as well as the intensity of network expression, predicts recovery outcomes as measured on a weekly "check-in” survey, suggesting the utility of mobile log data for digital phenotyping in mHealth. By implementing this app during the COVID-19 pandemic, the study also found the disruption caused by national lockdown was negatively related to the app use. © The Author(s) 2023.

Switching from intravenous to subcutaneous infliximab: Clinical and patient experience outcomes

Background: Intravenous (IV) infliximab (IFX) monotherapy is associated with significant loss of response. Therapeutic drug monitoring shows an association with low serum trough drug levels and development of anti-IFX antibodies. Combination therapy with immunomodulators is not always possible, and IFX dose escalation leads to higher drug costs and time pressure on infusion units. Both approaches have raised heightened patient safety concerns due to the Covid-19 pandemic. Subcutaneous (SC) IFX pharmacokinetics lead to improved drug trough levels, which could lead to better clinical outcomes. Method(s): The NHS Greater Glasgow and Clyde biologics database was used to identify selected patients currently treated with IV IFX for IBD for suitability for SC switch. Patients were contacted to allow informed choice to opt in or out of switch. Baseline clinical data was collected, and patients were reviewed at week 8 and week 24 for assessment of clinical disease activity scores, IFX trough levels/anti-drug antibody levels, and faecal calprotectin. Patient experience outcomes were assessed using a quality of life questionnaire (CUCQ-8). Result(s): 31 patients consented to switch;F:M = 17:14. The majority of patients (16) had Crohn's disease, with 13 with UC and 2 IBDU. Mean duration of disease was 9.1 years and duration of prior IV therapy was 3.3 years. 28 patients were reviewed at week 8 and 24 at week 24. At week 24, 71% of patients were in clinical remission (Harvey-Bradshaw index score <5 or partial Mayo score <2), 96% had CRP <5 mg/Land 87% had FCP <250mug/g. 21% of patients had subtherapeutic IFX trough levels at baseline, all had increased by week 8 and there were no subtherapeutic levels measured by week 24. One patient had detectable antibodies at week 24, compared with 9 patients at baseline. Three patients required oral steroid therapy during the 24-week follow up period. There were no hospital admissions, significant infections or adverse reactions within the cohort. 15 patients submitted CUCQ-8 scores, of these 7 patients' scores had worsened at week 8 but by week 24 13/15 were stable or improved compared to baseline. Conclusion(s): Switching from IV to SC infliximab is welcomed by most patients. The efficacy, tolerability, increased drug level and safety which has previously been demonstrated is reproduced in our cohort. This study is the first to explore patient experience outcomes. The finding of initial worsening of the CUCQ-8 score, but overall improvement by week 24 opens further opportunity for engaging patient involvement in switch programmes.

Enclothed Harmony or Enclothed Dissonance? The Effect of Attire on the Authenticity, Power, and Engagement of Remote Workers

Due to the COVID-19 pandemic, a record number of employees began working remotely. These workers have a wide array of attire options, from "work outfits" (which are con-sistent with the content of work) to "home outfits" (which are consistent with remote work settings). Media accounts suggest this shift has created a new outfit: business tops with casual bottoms. Although this "Zoom mullet" outfit has been called "the perfect pandemic work-from-home attire," it is not fully consistent with either the work or the home context. To investigate the psychological consequences of attire on remote work-ers, we conducted two multiday experiments. We randomly assigned remote workers, both within-and between-participants, to wear "work attire," "home attire," or "mixed attire" (work attire on top/home attire on bottom), and measured their authenticity, power, and engagement at work. The experiments produced three key findings. First, Home Attire increased authenticity and engagement. Second, Work Attire did not con-sistently increase power. Finally, the media-hyped Mixed Attire outfit did not produce any psychological or work-related benefits. To understand these effects, we introduce the concepts of "enclothed harmony" and "enclothed dissonance," which capture whether one's attire is symbolically consistent with one's context. The results suggest clothing choices, even for remote workers, are psychologically and organizationally impactful.

A scoping review of health professional oncosexology education and training programs focused on adolescents and young adults (AYA)

Background: AYA with cancer commonly experience sexuality concerns during and post treatment. Evaluation andmanagement of these critical aspects are often neglected by health professionals due to factors such as poor knowledge, confidence and communication, lack of comfort, time and prioritisation of sexuality concerns. It is not known what policy and practice tools are available to bridge this evidence gap. Aim(s): To scope, analyse and map the literature on policy and practice tools, specific to AYA oncosexology education and training programs, for health professionals. Method(s): A scoping review was conducted using the Joanna Briggs Institute methodology. A search strategy was developed using key words initially tested in OVID MEDLINE. The formal search was conducted in July 2022 in Medline, EMCARE, EMBASE and PsychINFO (all on OVID platform) for articles: published after 2012;in English;qualitative, quantitative, mixed method studies, case studies, review articles or grey literature;in patients aged 15-39 years. Articles were excluded if they did not meet these criteria, only examined potential education/training programs or health professionals' knowledge, attitudes or practices, or only focused on patients' perspectives. Retrieved articles were extracted into Covidence and two screening roundswere independently performed by two authors each for the final analysis and evidence synthesis. Result(s): After removing 1140 duplicate records, 1825 records were screened of which 1523 were excluded and 302 full texts assessed for eligibility. The final number of studies included along with other quantitative findings will be reported against the PRISMA-ScR reporting checklist. Results from the basic content analysis to organise qualitative findings into higher level categories will also be presented. Conclusion(s): Evidence gaps, limitations and implications for research will be discussed. We will seek stakeholders' views on whether our findings are locally relevant and how they can inform improvements in health professional oncosexology policy and practice tools.

Controlling Blood Pressure During a Pandemic: The Impact of Telepharmacy for Primary Care Patients.

INTRODUCTION: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. METHODS: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. RESULTS: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344). CONCLUSION: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.

Shared genetic background between SARS-CoV-2 infection and large artery stroke.

BACKGROUND AND AIMS: Increased risk of stroke, particularly large artery stroke (LAS), has been observed in patients with COVID-19. The biological processes underlying the observed higher risk are still unknown. We explored the association between stroke subtypes and COVID-19 susceptibility to understand whether biological mechanisms specific to SARS-CoV-2 uptake/infection could be leading to excess stroke risk in this population. PATIENTS AND METHODS: We constructed a polygenic risk score (PRS) of COVID-19 susceptibility and tested its association with stroke subtypes using individual- and summary-level genetic data (SiGN, MEGASTROKE). We generated co-expression networks of genes involved in SARS-CoV-2 uptake/infection (ACE2, TMPRSS2, BEST3, ISLR2 and ADAM17) based on existing tissue expression libraries. Gene-based association testing was performed using S-PrediXcan and VEGAS2. Permutation independence tests were performed to assess SARS-CoV-2-related gene enrichment in stroke and its subtypes. RESULTS: Our PRS demonstrated an association between COVID-19 susceptibility and LAS in SiGN (OR = 1.05 per SD increase, 95% CI: (1.00, 1.10), p = 0.04) and MEGASTROKE (ß = 0.510, 95% CI: (0.242, 0.779), FDR-p = 0.0019). The SARS-CoV-2 risk-related ISLR2 co-expression gene network was significantly associated with genetic risk of LAS in aorta, tibial arteries, and multiple brain regions (P < 0.05). CONCLUSION: Presence of genetic correlation and significant pathway enrichment suggest that increases in LAS risk reported in COVID-19 patients may be intrinsic to the viral infection, rather than a more generalized response to severe illness.

Cetylpyridinium chloride (CPC) reduces zebrafish mortality from influenza infection: Super-resolution microscopy reveals CPC interference with multiple protein interactions with phosphatidylinositol 4,5-bisphosphate in immune function.

The COVID-19 pandemic raises significance for a potential influenza therapeutic compound, cetylpyridinium chloride (CPC), which has been extensively used in personal care products as a positively-charged quaternary ammonium antibacterial agent. CPC is currently in clinical trials to assess its effects on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) morbidity. Two published studies have provided mouse and human data indicating that CPC may alleviate influenza infection, and here we show that CPC (0.1 µM, 1 h) reduces zebrafish mortality and viral load following influenza infection. However, CPC mechanisms of action upon viral-host cell interaction are currently unknown. We have utilized super-resolution fluorescence photoactivation localization microscopy to probe the mode of CPC action. Reduction in density of influenza viral protein hemagglutinin (HA) clusters is known to reduce influenza infectivity: here, we show that CPC (at non-cytotoxic doses, 5-10 µM) reduces HA density and number of HA molecules per cluster within the plasma membrane of NIH-3T3 mouse fibroblasts. HA is known to colocalize with the negatively-charged mammalian lipid phosphatidylinositol 4,5-bisphosphate (PIP2); here, we show that nanoscale co-localization of HA with the PIP2-binding Pleckstrin homology (PH) reporter in the plasma membrane is diminished by CPC. CPC also dramatically displaces the PIP2-binding protein myristoylated alanine-rich C-kinase substrate (MARCKS) from the plasma membrane of rat RBL-2H3 mast cells; this disruption of PIP2 is correlated with inhibition of mast cell degranulation. Together, these findings offer a PIP2-focused mechanism underlying CPC disruption of influenza and suggest potential pharmacological use of this drug as an influenza therapeutic to reduce global deaths from viral disease.

Escherichia coli recombinant expression of SARS-CoV-2 protein fragments.

We have developed a method for the inexpensive, high-level expression of antigenic protein fragments of SARS-CoV-2 proteins in Escherichia coli. Our approach uses the thermophilic family 9 carbohydrate-binding module (CBM9) as an N-terminal carrier protein and affinity tag. The CBM9 module was joined to SARS-CoV-2 protein fragments via a flexible proline-threonine linker, which proved to be resistant to E. coli proteases. Two CBM9-spike protein fragment fusion proteins and one CBM9-nucleocapsid fragment fusion protein largely resisted protease degradation, while most of the CBM9 fusion proteins were degraded at some site in the SARS-CoV-2 protein fragment. All of the fusion proteins were highly expressed in E. coli and the CBM9-ID-H1 fusion protein was shown to yield 122 mg/L of purified product. Three purified CBM9-SARS-CoV-2 fusion proteins were tested and found to bind antibodies directed to the appropriate SARS-CoV-2 antigenic regions. The largest intact CBM9 fusion protein, CBM9-ID-H1, incorporates spike protein amino acids 540-588, which is a conserved region overlapping and C-terminal to the receptor binding domain that is widely recognized by human convalescent sera and contains a putative protective epitope.

'we are all in this together'-embedding supportive debriefs into a district general hospital's paediatric teaching programme

Background The COVID-19 pandemic required doctors to quickly adapt to new infection-control policies, rota restructuring and pathway changes. There was uncertainty on how the pandemic would affect paediatrics, as well as anxiety of the personal COVID-19 effects, frustration with media reporting and potential isolation with social-distancing measures. Our department recognised that both junior and senior doctors needed a platform to come together to address these feelings and reflect on them, ensuring a supportive team at work during this challenging period. Objectives To implement a supportive debrief session within the paediatric unit's teaching programme to improve team morale and reduce anxiety on the uncertainties of the pandemic. Methods During the first wave of the pandemic (April 2020- August 2020) we ran a weekly 'debrief hour' scheduled within the departmental teaching programme. Co-led by the college tutor, clinical director and trainee representatives, it was open to paediatric junior doctors and consultants. These sessions were held face-to-face and virtually. During the second wave (October 2020-February 2021) these sessions were held fortnightly and were focused on wellbeing. One week prior to each session questionnaires were completed anonymously by junior doctors to collate issues they wished to reflect on. Postdebrief surveys were completed by participants. Results We ran a total of 30 sessions. During the first wave 18 junior doctors and 5 consultants on average attended each debrief. Topics of discussion varied from difficult clinical cases and the emotional challenges of the pandemic to learning about individual approaches to mindfulness. Anecdotally junior doctors appreciated this dedicated time to 'offload' in a safe space. It helped forge bonds and personal connections within the team. Overall doctors were grateful their wellbeing was prioritised by these sessions. We took this initiative forward into the second wave where sessions became fortnightly. Our post-debrief surveys revealed that 96% (N=19) of junior doctors valued this time for team reflection and connection. 92% (N=19) found them useful. 94% (N=19) would like to see these sessions continue after the pandemic. Feedback included junior doctors 'feeling supported', 'paediatrics being the best team' and 'bonding during a worrying time'. From March 2021 these sessions will be led by the department's clinical psychologist. Conclusions • We advocate scheduling a supportive debrief session within departmental teaching programmes, especially in times of uncertainty and potential anxiety (such as global pandemics). This encourages team bonding. • Embedding debrief sessions within the teaching programme sends a clear message to junior doctors that the department prioritises and promotes the wellbeing of doctors, seeing it as an important part of their working lives. • Supportive debrief sessions allow doctors a safe space to 'offload' with their peers in a reflective, relaxed environment, thus helping create a sense of community at work and improving morale. • The department will continue to hold scheduled team debriefs, which will carry on after the pandemic. The Trust recognises the importance of championing wellbeing;moving forward time has been allocated for a clinical psychologist to lead these sessions. • We strongly recommend that budget planning includes provision for trainee wellbeing support services.

Escherichia coli recombinant expression of SARS-CoV-2 protein fragments. (preprint)

We have developed a method for the inexpensive, high-level expression of antigenic protein fragments of SARS-CoV-2 proteins in Escherichia coli. Our approach used the thermophilic carbohydrate binding domain 9 (CBM9) module as an N-terminal carrier protein and affinity tag. The CBM9 module was joined to SARS-CoV-2 protein fragments via a flexible proline-threonine rich linker, which proved to be resistant to E. coli proteases. Two CBM9-spike protein fragment fusion proteins and one CBM9-nucleocapsid fragment fusion protein largely resisted protease degradation, while most of the CBM9-fusion proteins were degraded at some site in the SARS-CoV-2 protein fragment. All fusion proteins were expressed in E. coli at about 0.1 g/L, and could be purified with a single affinity binding step using inexpensive cellulose powder. Three purified CBM9-SARS-CoV-2 fusion proteins were tested and found to bind antibody directed to the appropriate SARS-CoV-2 antigenic region. The largest CBM9 fusion protein incorporates a spike protein self-folding domain, and includes amino acids 540-588 of the spike protein. This conserved region is immediately C-terminal to the receptor binding domain, is widely recognized by human convalescent sera, and contains a putative protective epitope.