Research priorities for the COVID-19 pandemic and beyond: A call to action for psychological science

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that has caused the coronavirus disease 2019 (COVID-19) pandemic represents the greatest international biopsychosocial emergency the world has faced for a century, and psychological science has an integral role to offer in helping societies recover. The aim of this paper is to set out the shorter- and longer-term priorities for research in psychological science that will (a) frame the breadth and scope of potential contributions from across the discipline; (b) enable researchers to focus their resources on gaps in knowledge; and (c) help funders and policymakers make informed decisions about future research priorities in order to best meet the needs of societies as they emerge from the acute phase of the pandemic. The research priorities were informed by an expert panel convened by the British Psychological Society that reflects the breadth of the discipline; a wider advisory panel with international input; and a survey of 539 psychological scientists conducted early in May 2020. The most pressing need is to research the negative biopsychosocial impacts of the COVID-19 pandemic to facilitate immediate and longer-term recovery, not only in relation to mental health, but also in relation to behaviour change and adherence, work, education, children and families, physical health and the brain, and social cohesion and connectedness. We call on psychological scientists to work collaboratively with other scientists and stakeholders, establish consortia, and develop innovative research methods while maintaining high-quality, open, and rigorous research standards.

Challenges in implementing and assessing outcomes of school start time change in the UK: experience of the Oxford Teensleep study

OBJECTIVE

Later school start times for adolescents have been implemented in the US and associated benefits found, although no randomised controlled trials (RCT) have been undertaken. The objective of this study was to evaluate the impact of two school interventions in the UK, a delayed start time and a sleep education programme, on students' academic performance, sleep outcomes and health-related quality of life.

METHODS

The study had an RCT design to enable an investigation into the differential effects of two interventions or a combination of both: schools were to delay their start time to 10:00am and/or provide a classroom-based sleep education programme. The recruitment target was 100 state (non-fee-paying) secondary schools. Participants were to be students in Year 10/11 (14-16-year-olds).

RESULTS

Despite much media coverage, only two schools volunteered to take part in the RCT. The main challenges faced in recruitment fell under three categories: research design, school, and project-specific issues. The delayed start time and prospect of randomisation to this intervention were the overwhelming reasons cited for not taking part. Facilitators and barriers to research were identified. Recommendations include carrying out a feasibility study prior to a main trial, allowing adequate time for recruitment, involving stakeholders throughout the decision-making process, incorporating independent (fee-paying) schools in recruitment, focusing on students not taking important examinations or involving an older year group with greater independence.

CONCLUSION

The Teensleep study provides supporting evidence that evaluating the effects of a change in school start times through an RCT is unfeasible in the UK.

Gendered accounts of managing diabetes in same-sex relationships: A discursive analysis of partner support

The gendered dimensions of partner support in relationships where one partner has a chronic condition has been a recurring focus within the literature on gender and health. Such literature however typically focuses exclusively on heterosexual couples while same-sex relationships are rendered invisible, leading to the discourse around partner support being heteronormative. This article examines gendered dimensions within accounts of lesbian, gay and bisexual people with diabetes using a discursive psychological approach. The analysis identifies how participants drew upon a range of interpretative repertoires, including: (1) notions that women are more caring than men; (2) that men can take control in an emergency; (3) that gay men are caring; (4) that grown men can take care of themselves; and (5) that gay men are more independent than heterosexual men. It is argued that rather than simply dismissing heteronormative repertoires of gender and health, non-heterosexuals draw upon them in ways that display ideological tensions.

Poststroke Trajectories: The Process of Recovery Over the Longer Term Following Stroke

We adopted a grounded theory approach to explore the process of recovery experienced by stroke survivors over the longer term who were living in the community in the United Kingdom, and the interacting factors that are understood to have shaped their recovery trajectories. We used a combination of qualitative methods. From the accounts of 22 purposively sampled stroke survivors, four different recovery trajectories were evident: (a) meaningful recovery, (b) cycles of recovery and decline, (c) ongoing disruption, (d) gradual, ongoing decline. Building on the concept of the illness trajectory, our findings demonstrate how multiple, interacting factors shape the process and meaning of recovery over time. Such factors included conception of recovery and meanings given to the changing self, the meanings and consequences of health and illness experiences across the life course, loss, sense of agency, and enacting relationships. Awareness of the process of recovery will help professionals better support stroke survivors.

Rhetoric and Etiological Beliefs About Sexuality: Reader Responses to Cynthia Nixon's New York Times Interview

In 2012, the U.S. actress Cynthia Nixon was quoted in the New York Times Magazine as having stated that "for me, it [being gay] is a choice. I understand that for many people it's not, but for me it's a choice, and you don't get to define my gayness for me." The interview attracted international media attention and public criticism by lesbian and gay activists. This article suggests a rhetorical approach to understanding etiological beliefs and provides a discursive analysis of 198 online comments by readers of Pink News, a gay news Web site that reported on Nixon's controversial interview. This article explores common arguments used in readers' comments about Nixon and examines the rhetorical construction of sexuality. The analysis examines three themes within the data. First, biological essentialism was treated by many readers as common knowledge; second, readers suggested that only bisexuals have "choice"; and, third, it was suggested by both Nixon's critics and her supporters that counterarguments colluded with homophobia. The article suggests that there is an ideological dilemma whereby both "born-this-way" and "choice" arguments can be understood as colluding with anti-gay prejudice.

Pathological fracture of the coronoid process secondary to medication-related osteonecrosis of the jaw (MRONJ)

•

This case reports the first case to our knowledge of pathological fracture of the coronoid process of the mandible secondary to long term use of alendronic acid.

•

Demonstrates the unpredictable nature of symptoms associated with medication related osteonecrosis and its management within the hospital environment.

•

Demonstrates the rapidly progressing and unpredictable nature of the spread of the necrotic process in medication related osteonecrosis.

•

Clear clinical photographs of the surgical procedure involved in the removal of necrotic bone and curettage of the surgical site in medication related osteonecrosis.

Introduction

Medication-related osteonecrosis of the jaw (MRONJ) is a growing problem within the field of oral and maxillofacial surgery. It is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates, who has not had radiotherapy to the jaw [1]. Since the first report in 2003 that highlighted the potential harm caused by MRONJ, many more patients have been diagnosed with the condition [2]. The growth in recent years is likely due to the more potent drugs delivered intravenously however there is some evidence that oral bisphosphonates given over longer periods of time can have similar effects. Bone exposure may occur spontaneously or most commonly occurs following an invasive dental procedure, as shown in the case below [3].

Presentation of case

This case report demonstrates the unpredictable nature of symptoms associated with medication related osteonecrosis and its management within the hospital environment.

Discussion

This case demonstrastes the unpredictable nature of MRONJ and how the disease can progress to cause significant morbidity. In this case extensive surgery was required to remove the necrotic fragments of bone with no guarnatee that the necrosis will stop spreading.

Conclusion

It seems a matter of great importance that the lasting effects of MRONJ are known to general dental and medical practitioners alike. Nationally recognised evidence based guidelines are lacking and uniformity in the management of MRONJ is required amongst the speciality.

Development and evaluation of tools and an intervention to improve patient- and carer-centred outcomes in Longer-Term Stroke care and exploration of adjustment post stroke: the LoTS care research programme

Background

Evidence-based care pathways are required to support stroke patients and their carers in the longer term.

Aims

The twofold aim of this programme of four interlinking projects was to enhance the care of stroke survivors and their carers in the first year after stroke and gain insights into the process of adjustment.

Methods and results

We updated and further refined a purposely developed system of care (project 1) predicated on a patient-centred structured assessment designed to address areas of importance to patients and carers. The structured assessment is linked to evidence-based treatment algorithms, which we updated using a structured protocol: reviewing available guidelines, Cochrane reviews and randomised trials. A pragmatic cluster randomised controlled trial evaluation of the clinical effectiveness and cost-effectiveness of this system of care was undertaken in 29 community-based UK stroke care co-ordinator services (project 2). In total, 15 services provided the system of care and 14 continued with usual practice. The primary objective was to determine whether the intervention improved patient psychological outcomes (General Health Questionnaire-12) at 6 months; secondary objectives included functional outcomes for patients, outcomes for carers and cost-effectiveness, as measured through self-completed postal questionnaires at 6 and 12 months. A total of 800 patients and 208 carers were recruited; numbers of participants and their baseline characteristics were well balanced between intervention and control services. There was no evidence of statistically significant differences in primary or secondary end points or adverse events between the two groups, nor evidence of cost-effectiveness. Intervention compliance was high, indicating that this is an appropriate approach to implement evidence into clinical practice. A 22-item Longer-term Unmet Needs after Stroke (LUNS) questionnaire was developed and robustly tested (project 3). A pack including the LUNS questionnaire and outcome assessments of mood and social activity was posted to participants 3 or 6 months after stroke to assess acceptability and validity. The LUNS questionnaire was re-sent 1 week after return of the first pack to assess test–retest reliability. In total, 850 patients were recruited and the acceptability, validity and test–retest reliability of the LUNS questionnaire as a screening tool for post-stroke unmet need were confirmed. This tool is now available for clinical use. An in-depth qualitative investigation was undertaken with 22 patients (and carers) at least 1 year after stroke (project 4) to gain further insights into the experience of adjustment. This included initial semistructured interviews, limited observations and solicited diaries with a follow-up interview 3–4 months after the initial interview and highlighted a range of different trajectories for post-stroke recovery.

Conclusions

The programme has been completed as planned, including one of the largest ever stroke rehabilitation trials. This work highlights that successfully addressing the needs of a heterogeneous post-stroke population remains problematic. Future work could explore stratifying patients and targeting services towards patients (and carers) with specific needs, leading to a more specialised bespoke service. The newly developed LUNS questionnaire and the qualitative work will help inform such services.

Trial registration

Current Controlled Trials ISRCTN67932305.

Funding

The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. The Bradford Teaching Hospitals NHS Foundation Trust received additional funding for project 2 in the submitted work from the Stroke Association, reference number TSA 2006/15. The initial development work for the LUNS tool and the Longer-Term Stroke care (LoTS care) trial carried out before the start of the programme grant was funded by the Stroke Association, reference number TSADRC 2006/01.

Sex and Diabetes: A Thematic Analysis of Gay and Bisexual Men’s Accounts

Around 50 per cent of men with diabetes experience erectile dysfunction. Much of the literature focuses on quality of life measures with heterosexual men in monogamous relationships. This study explores gay and bisexual men’s experiences of sex and diabetes. Thirteen interviews were analysed and three themes identified: erectile problems; other ‘physical’ problems; and disclosing diabetes to sexual partners. Findings highlight a range of sexual problems experienced by non-heterosexual men and the significance of the cultural and relational context in which they are situated. The personalized care promised by the UK government should acknowledge the diversity of sexual practices which might be affected by diabetes.

Chronic Illness in Non-heterosexual Contexts: An Online Survey of Experiences

In this article we contribute to the expansion of lesbian, gay, bisexual, transgender and queer (LGBTQ) health psychology beyond the confines of sexual health by examining the experiences of lesbian, gay and bisexual people living with non-HIV related chronic illness. Using a (predominantly) qualitative online survey, the perspectives of 190 LGB people with 52 different chronic illnesses from eight countries were collected. The five most commonly reported physical conditions were arthritis, hypertension, diabetes, asthma and chronic fatigue syndrome. Our analysis focuses on four themes within participants’ written comments: (1) ableism within LGBT communities; (2) isolation from LGBT communities and other LGB people living with chronic illness; (3) heteronormativity within sources of information and support and; (4) homophobia from healthcare professionals. We conclude by suggesting that LGBTQ psychology could usefully draw on critical health psychology principles and frameworks to explore non-heterosexual’s lived experiences of chronic illness, and also that there remains a need for specifically targeted support groups and services for LGB people with chronic illnesses.

Alcohol and radiographs in the accident and emergency department

OBJECTIVE

To investigate the contribution of alcohol ingestion to the radiological workload of an inner city accident and emergency (A&E) department.

METHODS

A prospective survey of patients presenting to A&E who required radiographs was performed over a seven day period. The A&E clinician questioned patients about alcohol intake during the six hours before the onset of the presenting complaint or injury, and made an objective assessment of signs of alcohol ingestion or intoxication. An assessment was made also of the relative contribution of alcohol as a cause of patients' injuries.

RESULTS

A total of 419 patients who had radiography fulfilled the inclusion criteria, and a questionnaire was completed for 351 (84%). Forty (11%) of 351 were found to have ingested alcohol. Thirty five (87%) of 40 patients who had ingested alcohol were radiographed for trauma, as compared with 171 (55%) of the 311 who had not (p<0.001). Alcohol was considered to have been causative of injury in 30% and a contributory factor in an additional 58%. Radiographs of the skull, face and jaw accounted for 18 (33%) of 55 radiographs from trauma patients who had ingested alcohol compared with 20 (9%) of 212 radiographs from those who had not (p<0.001). There was no significant difference in the proportion of abnormal radiographs between these two groups (27% of radiographs from trauma patients who had ingested alcohol compared with 23% of radiographs from those who had not, p>0.2).

CONCLUSION

Patients with alcohol related injuries requiring radiography have a significant impact on the radiological workload of an A&E department, although the prevalence of alcohol ingestion detected in this study was less than expected from previous studies.

The characterization of novel, dual ErbB-2/EGFR, tyrosine kinase inhibitors: potential therapy for cancer

The type I receptor tyrosine kinases constitute a family of transmembrane proteins involved in various aspects of cell growth and survival and have been implicated in the initiation and progression of several types of human malignancies. The best characterized of these proteins are the epidermal growth factor receptor (EGFR) and ErbB-2 (HER-2/neu). We have developed potent quinazoline and pyrido-[3,4-d]-pyrimidine small molecules that are dual inhibitors of ErbB-2 and EGFR. The compounds demonstrate potent in vitro inhibition of the ErbB-2 and EGFR kinase domains with IC(50)s <80 nM. Growth of ErbB-2- and EGFR-expressing tumor cell lines is inhibited at concentrations <0.5 microM. Selectivity for tumor cell growth inhibition versus normal human fibroblast growth inhibition ranges from 10- to >75-fold. Tumor growth in mouse s.c. xenograft models of the BT474 and HN5 cell lines is inhibited in a dose-responsive manner using oral doses of 10 and 30 mg/kg twice per day. In addition, the tested compounds caused a reduction of ErbB-2 and EGFR autophosphorylation in tumor fragments from these xenograft models. These data indicate that these compounds have potential use as therapy in the broad population of cancer patients overexpressing ErbB-2 and/or EGFR.

Indazolylamino quinazolines and pyridopyrimidines as inhibitors of the EGFr and c-erbB-2

Described herein is the design and synthesis of indazolylaminopyridopyrimidines and quinazolines as inhibitors of the class 1 tyrosine kinase receptor family. Data is presented for N(4)-(1-benzyl-1H-indazol-5-yl)-N(6),N(6)-dimethylpyrido[3,4-d]pyrimidine-4,6-diamine 3B. This compound inhibited EGFr and c-erbB-2 enzymes selectively over other kinases. It inhibited the proliferation of a range of tumour cell lines in vitro and the growth of BT474 xenografts in SCID mice.

Sodium channel beta1 and beta2 subunits parallel SNS/PN3 alpha-subunit changes in injured human sensory neurons

Voltage-gated sodium channels consist of a pore-containing alpha-subunit and one or more auxiliary beta-subunits, which may modulate channel function. We previously demonstrated that sodium channel SNS/PN3 alpha-subunits were decreased in human sensory cell bodies after spinal root avulsion injury, and accumulated at injured nerve terminals in pain states. Using specific antibodies for immunohistochemistry, we have now detected sodium channel beta1 and beta2 subunits in sensory cell bodies within control human postmortem sensory ganglia (78% of small/medium (< or = 50 microm) and 68% of large (> or = 50 microm) cells); their changes in cervical sensory ganglia after avulsion injury paralleled those described for SNS/PN3 alpha-subunits. Our results suggest that alpha- and beta-subunits share common regulatory mechanisms, but present distinct targets for novel analgesics.

Isolation and characterisation of a prenylated p-terphenyl metabolite of Aspergillus candidus possessing potent and selective cytotoxic activity; studies on mechanism of action

We describe the discovery and properties of a prenylated p-terphenyl metabolite of the fungus Aspergillus candidus. The compound (1) possesses potent cytotoxic activity against a range of tumour and other hyper-proliferative cell lines. Cell cycle analysis shows that in mouse keratinocyte (BALB/MK) cells treated with 1, the cell cycle is arrested in early S phase, indicative of an antimetabolite effect. Furthermore, cellular cytotoxicity can be reversed by addition of exogenous pyrimidine but not purine nucleosides to the cell culture medium. It is therefore likely that compound 1 selectively inhibits pyrimidine biosynthesis, and it is this property which accounts for its potent cytotoxic properties.

Mucosa and taste buds of the human epiglottis

The position of taste buds around the human mouth, pharynx and larynx is outlined in many texts. While their distribution, histological differences and taste sensitivity on the dorsum of the tongue are well described, extralingual taste buds are described in far less detail both in adults (Bannister, 1995) and neonates (Lalonde & Eglitis, 1961). Studies on a variety of grazing mammals (e.g. Bradley et al. 1980 in sheep; Shrestha et al. 1993 in buffalo), omnivores (Andrew & Oliver, 1951 in rat) and carnivores (Palmieri et al. 1983 in cat and dog) have shown abundant taste buds on the laryngeal surface of the epiglottis. Some authors have suggested that these taste buds may be important in initiating reflexes protecting the airway (Bradley et al. 1980) and in this context it is surprising that literature on their distribution on the human epiglottis is not available.

Molecular mechanisms of cell and tissue interactions during early tooth development

BACKGROUND

Morphogenesis and cell differentiation during the development of all organs, including the tooth, are regulated by interactions between cells and tissues. The developing tooth is one of the organs in which the molecular mechanisms of such interactions are starting to be elucidated.

RESULTS

Homotypic cell interactions take place between cells of the same developmental history, and they are a central mechanism in the formation of mesenchymal cell condensates during the bud stage of tooth development. Syndecan-1, a cell surface heparan sulfate proteoglycan, is transiently expressed in the dental mesenchyme and may regulate dental mesenchymal cell condensation. It binds tenascin, a matrix glycoprotein abundant in dental mesenchyme, suggesting involvement of cell-matrix interactions. Syndecan also binds growth factors, and its association with cell proliferation in the dental mesenchyme suggests roles in the regulation of cell number in the condensing cells. Inductive interactions between the epithelial and mesenchymal tissues regulate tooth development at all stages. In the early dental mesenchyme, the expression of several molecules, including syndecan and tenascin, are regulated by the epithelium. There is evidence that growth factors act as diffusible signals mediating these interactions. BMP-2 and BMP-4 (bone morphogenetic proteins), which belong to the TGF beta superfamily, are expressed in the early dental epithelium, and their effects on the dental mesenchyme mimic those of the epithelium. In particular, BMPs induce the expression of the homeobox-containing transcription factors Msx-1 and Msx-2 in the dental mesenchyme.

CONCLUSIONS

Based on current knowledge about the molecular changes accompanying tooth development and the results of experimental studies, we present a model for molecular regulation of early tooth development.

Identification of BMP-4 as a signal mediating secondary induction between epithelial and mesenchymal tissues during early tooth development

Growth factor-mediated signaling has been implicated in the regulation of epithelial-mesenchymal interactions during organogenesis. Bone morphogenetic protein 4 (BMP-4), a member of the transforming growth factor beta superfamily, is expressed in the presumptive dental epithelium at the initiation of tooth development. Subsequently, epithelial signaling leads to mesenchymal induction of BMP-4 expression. To address the role of this factor, BMP-4-releasing agarose beads were added to dental mesenchyme in culture. These beads induced a translucent mesenchymal zone similar to that induced by dental epithelium. Moreover, three transcription factors (Msx-1, Msx-2, and Egr-1) whose expression is governed by epithelial signaling were induced in response to BMP-4. In addition, BMP-4 induced its own mesenchymal expression. These findings support the hypothesis that BMP-4 mediates epithelial-mesenchymal interactions during early tooth development.

The effects of some beta-adrenoreceptor blocking drugs on the uptake and release of noradrenaline by the heart

1. The potencies of some beta-adrenoreceptor blocking drugs in reducing noradrenaline uptake by the isolated heart were compared with their potencies in reducing the release of noradrenaline from the heart by tyramine.2. Of the drugs tested, propranolol, pronethalol and dichloroisoprenaline were the most potent in blocking uptake and release of noradrenaline, although none was at potent as cocaine; MJ 1999 and I.C.I. 50172 were only weakly effective.3. Pronethalol and dichloroisoprenaline each reduced release of noradrenaline by tyramine in the concentration range (10(-7)-10(-6)M) where blockade of responses to tyramine was apparent; with these drugs both reduction of noradrenaline release and beta-receptor blockade contribute to the reduction in responses to tyramine.4. Potency of beta-receptor blocking drugs in reducing noradrenaline uptake is unrelated to potency in blocking beta-receptors; Kö 592 blocks beta-receptors without affecting noradrenaline uptake.