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Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions.
To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness.
Data were collected from individuals aged 18–26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown.
Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78–36.57) and 15.6% (95% CI 15.39–15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease.
Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.
Evaluating the impact of health technology assessment (HTA) is vital to measure its contribution to health and social care decision-making and improving citizen outcomes. Health Technology Wales (HTW) is a HTA body committed to evaluating the impact of our work. Here we present HTW’s impact evaluation approach with a case study for autologous hematopoietic stem cell transplantation (AHSCT) for highly active relapsing remitting multiple sclerosis (RRMS).
Using an outcomes-focused approach based on contribution analysis, HTW has worked with an external evaluation organization to develop a framework to measure the impact of our work. Data on impact was collected from both qualitative and quantitative sources, including social media metrics, surveys, and informal feedback from stakeholders. We engaged with various stakeholders, including clinicians, academics, patient organizations and other HTA bodies.
The technology appraisal and guidance were published in July 2020, recommending AHSCT for routine adoption to treat highly active RRMS. Patient groups welcomed the appraisal findings as an important step forward in recognising the needs of people with RRMS and felt that “people living with MS were listened to throughout the process”. Following publication online, the guidance has had approximately 500 views, and featured on the MS Trust website and in several news articles. The Welsh Health Specialist Services Committee, a commissioning body in Wales, recommended AHSCT for RRMS as a ‘high priority’ for funding in the WHSSC Integrated Commissioning Plan 2021-22.
Since its publication, we have been able to prospectively capture the impact of this guidance through various stakeholders groups and sources. Overall, responses have been positive and the guidance has supported decision makers in Wales. Ongoing evidence capture, including through HTW’s adoption audit processes, will add further understanding to the potential impact of our work.
Health Technology Wales (HTW) is committed to evaluating the impact of our work. In March 2020, HTW directed efforts to support Welsh Government and health and social care providers in response to the COVID-19 pandemic. We adapted the HTW evaluation framework to specifically capture the impact of our additional COVID-19 work. Here we analyze data collected since the framework was implemented.
Both formal and informal feedback was analyzed. Formal feedback was obtained through the HTW Impact Questionnaire, which was developed to support more formalized data capture for all HTW workstreams and to facilitate feedback from all stakeholder groups. It was piloted with a targeted list of individuals and responses were received for COVID-19 work. Informal feedback included feedback received via email or through word of mouth.
HTW COVID-19 products to date include Topic Exploration Reports, rapid evidence summaries and an Evidence Appraisal Report (EAR) on COVID-19 diagnostic tests (molecular and antibody tests). Stakeholders were positive about these outputs, describing them as valuable and informative. Reported impacts included informing policy and decision making, reducing duplication of efforts and helping to target development. The EAR received national and international focus, leading to HTW involvement in the European Network for Health Technology Assessment (EUnetHTA) COVID-19 reviews. Survey participants who gave feedback on COVID-19 activities included two members of Health Technology Assessment organizations, a health board representative and an industry representative; all agreed that HTW's COVID-19 work was useful, that the methods were reliable and robust and that HTW is responsive. All participants also felt that HTW's COVID-19 work had a positive impact in the wider health and social care context.
HTW was able to respond rapidly to the COVID-19 pandemic and adapt current evaluation practices to capture the impact of COVID-19 work. We will continue to evaluate our COVID-19 activities. Future work will involve following up on the developing impact of our COVID-19 work and expanding our methods for data capture, for example conducting stakeholder interviews.
Research indicates that congresswomen are more effective at moving bills through the lawmaking process than their male counterparts. To investigate why, we discuss what legislative entrepreneurship involves and explain why it can serve as the basis for problem-solving and effective lawmaking in the U.S. Congress. We also examine the entrepreneurial work that members of Congress did on behalf of bills that they sponsored from 1973 to 2008. Among other findings, we observe that congresswomen, especially those in the minority party, are more entrepreneurial than their male colleagues. This finding enhances our understanding of why female lawmakers are more effective lawmakers.
Scanning transmission electron microscopy (STEM) allows for imaging, diffraction, and spectroscopy of materials on length scales ranging from microns to atoms. By using a high-speed, direct electron detector, it is now possible to record a full two-dimensional (2D) image of the diffracted electron beam at each probe position, typically a 2D grid of probe positions. These 4D-STEM datasets are rich in information, including signatures of the local structure, orientation, deformation, electromagnetic fields, and other sample-dependent properties. However, extracting this information requires complex analysis pipelines that include data wrangling, calibration, analysis, and visualization, all while maintaining robustness against imaging distortions and artifacts. In this paper, we present py4DSTEM, an analysis toolkit for measuring material properties from 4D-STEM datasets, written in the Python language and released with an open-source license. We describe the algorithmic steps for dataset calibration and various 4D-STEM property measurements in detail and present results from several experimental datasets. We also implement a simple and universal file format appropriate for electron microscopy data in py4DSTEM, which uses the open-source HDF5 standard. We hope this tool will benefit the research community and help improve the standards for data and computational methods in electron microscopy, and we invite the community to contribute to this ongoing project.
Health Technology Wales (HTW) is a relatively new Health Technology Assessment (HTA) agency which focuses on non-medicines. In common with other HTA organizations, it identifies and appraises a range of technologies. However, HTW is also looking beyond the publication of guidance, to assess the adoption of advice and its eventual impact.
HTW commissioned development of an Evaluation Plan from independent experts (Matter of Focus). A literature review was carried out to inform an options appraisal of methods for assessing impact. The selected approach was Contribution Analysis, which estimates the counterfactual through engagement of stakeholders.
Whilst it is too early to report the full impact of HTW's guidance, a number of activities have taken place to prepare for evaluation. The core HTW team developed a series of logic models to describe the anticipated impact, the mechanisms by which it would be achieved, and key assumptions. Stakeholders were consulted for insight from a range of perspectives, and to manage expectations. This was achieved through individual interviews, presentation and discussion at committee meetings, and the sharing of written materials for feedback. This information was collated to populate bespoke software (OutNav). The collection of data relating to processes, outputs and outcomes is already an ongoing routine task of researchers and support staff.
HTW has an opportunity to build impact evaluation into its culture from the beginning. This will facilitate the future reporting of HTW's influence using a well-designed, evidence-based approach. Furthermore, this pioneering work will clearly demonstrate the value of HTA to funders, commissioners, governments, and other decision-making bodies.
In 2013, a task force was developed to discuss the future of the Canadian pediatric neurology workforce. The consensus was that there was no indication to reduce the number of training positions, but that the issue required continued surveillance. The current study provides a 5-year update on Canadian pediatric neurology workforce data.
Names, practice types, number of weekly outpatient clinics, and dates of certification of all physicians currently practicing pediatric neurology in Canada were obtained. International data were used to compute comparisons between countries. National data sets were used to provide information about the number of residency positions available and the number of Canadian graduates per year. Models for future projections were developed based on published projected population data and trends from the past decade.
The number of pediatric neurologists practicing in Canada has increased 165% since 1994. During this period, wait times have not significantly shortened. There are regional discrepancies in access to child neurologists. The Canadian pediatric neurology workforce available to see outpatient consultations is proportionally less than that of USA. After accounting for retirements and emigrations, the number of child neurologists being added to the workforce each year is 4.9. This will result in an expected 10-year increase in Canadian pediatric neurologists from 151 to 200.
Despite an increase in the number of Canadian child neurologists over the last two decades, we do not predict that there will be problems with underemployment over the next decade.
A critical question in invasion biology involves the relative importance of propagule rain and community invasibility. For plant invasions, invasibility is often related to disturbance, but few studies of forest invaders have simultaneously investigated both canopy and ground-level disturbance. We investigated the relative importance of seed rain, canopy disturbance, and soil disturbance in a mature forest in Maryland on the recruitment of four invasive species: wine raspberry (Rubus phoenicolasius Maxim.), Japanese barberry (Berberis thunbergii DC), multiflora rose (Rosa multiflora Thunb.), and Japanese stiltgrass [Microstegium vimineum (Trin.) A. Camus]. Using complete censuses of a 9-ha plot at two points in time (2011–12 and 2014), we mapped new recruits, and related their locations to canopy and soil disturbance, as well as to a seed rain index based on locations of reproducing plants and seed-dispersal kernels.
We found that propagule rain, as measured by the seed rain index, was a significant predictor of recruitment for B. thunbergii, R. phoenicolasius, and M. vimineum. For R. multiflora, seed sources were not located, precluding assessment of propagule rain, but recruitment was linked to canopy disturbance, as was recruitment of M. vimineum. However, because reproduction of R. phoenicolasius and, in some years, of B. thunbergii is higher in treefall gaps, these gaps experience higher propagule rain, with the result that recruitment is indirectly associated with these gaps. Ground-layer disturbance was an important predictor of recruitment only for B. thunbergii. Our findings reveal that the importance of propagule rain is the most consistent driver of recruitment, but canopy or ground-layer disturbance promotes recruitment of some invasive plant species.
The purpose of this project was to systematize the use of pharmacogenetic testing (PGT) among psychiatric prescribers. The use of PGT in clinical practice is inconsistent despite the evidence supporting its efficacy (Burke, Love, Jones, & Fife, 2016). The question to be answered is: In patients with major depressive disorder (MDD), how is PGT currently used in clinical practice compared to use after implementation of practice change interventions?
This study was conducted among 4 psychiatric prescribers in a behavioral health clinic. 3 interventions were utilized to change practice. An educational in-service was delivered to address the PGT knowledge gap. A protocol for identifying patients that may benefit from PGT was developed, indicating PGT was warranted for patients with non-remitting moderate to severe MDD and at least 2 medication failures from 2 different classes. Next, a medication failure documentation template and the PGT report were integrated into the EHR. A baseline survey was administered before the in-service, assessing prescriber PGT perceptions and current parameters and barriers for use. Follow-up surveys were administered 3 months post-implementation. Project processes were measured by assessing the rate of medication failure template usage, as well as thePGT EHR upload rate.
A comparison of baseline and follow-up surveys indicated there was little change in prescriber view of test utility, receptiveness, and likelihood of use. This may be attributed to previous experience with testing and to PGT manufacturer education. View of parameters and barriers for use did change. Key parameter for use changes included patient experience of adverse reaction (increase) and only 2 medication failures from the same class (decrease). Key barrier to use changes included time to results (decrease). 3 PGT were completed during the project. All patients met the protocol criteria for testing. None of these patients had medication failures documented using theEHR template; all of the patients did have documentation using each prescriber’s preferred method. 2 of the 3 tests were uploaded to the EHR. The first test completed was not integrated, likely due to support staff becoming accustomed to the new workflow. 117 historical PGT were also integrated into the EHR.
While 16 to 20% of the population meets the criteria for MDD, available treatments achieve symptom remission only 40% of the time (Singh, 2014). Patients who do not achieve remission experience relapse more quickly and are more likely to develop chronic non-remitting MDD (Gaynes, 2016). While the PGT evidence base is still evolving, its use in clinical practice has the potential to improve depression treatment outcomes. This study highlighted continued barriers to PGT use in a practice setting, while implementing key interventions, including PGT use guidelines and EHR integration, to improve its systematic and appropriate use.
There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.
A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.
Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.
Significance of results:
Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.
The scanning electron microscope provides a platform for subnanometer resolution characterization of material morphology with excellent topographic and chemical contrast dependent on the used detectors. For imaging applications, the predominantly utilized signals are secondary electrons (SEs) and backscattered electrons (BSEs) that are emitted from the sample surface. Recent advances in detector technology beyond the traditional Everhart–Thornley geometry have enabled the simultaneous acquisition and discrimination of SE and BSE signals. This study demonstrates the imaging capabilities of a recently introduced new detector system that consists of the combination of two in-lens (I-L) detectors and one in-column (I-C) detector. Coupled with biasing the sample stage to reduce electron–specimen interaction volumes, this trinity of detector geometry allows simultaneous acquisition of signals to distinguish chemical contrast from topographical changes of the sample, including the identification of surface contamination. The I-C detector provides 4× improved topography, whereas the I-L detector closest to the sample offers excellent simultaneous chemical contrast imaging while not limiting the minimization of working distance to obtain optimal lateral resolution. Imaging capabilities and contrast mechanisms for all three detectors are discussed quantitatively in direct comparison to each other and the conventional Everhart–Thornley detector.
This paper describes a pilot project in which (for the first time, worldwide) psychiatry was taught to undergraduate medical students in Somalia using an evidence-based intervention – the World Health Organization's Mental Health Gap Action Programme Intervention Guide.
Seven taxa including three new species of Mallacoota are reported from the South Pacific locations of Papua New Guinea, New Caledonia and the Kermadec Islands. Mallacoota mizegwaden sp. nov. was collected from Papua New Guinea, and M. lifou sp. nov. and M. xepenehe sp. nov. from New Caledonia including the Loyalty Islands. Additional material of M. nananui Myers, 1985 is identified from New Caledonia, supporting previous records by Ledoyer, 1984. Three species, Mallacoota capricornia Lowry & Hughes, 2009; M. chiltoni Kilgallen & Ahyong, 2011 and M. sirius Hughes, 2011 are reported from the Kermadec Islands. There are now 33 known species of Mallacoota, with 19 species occurring in tropical to subtropical waters.